bluuebunny/crossref_metadata_2025_split huggingface dataset:
TP8.1.7 The utility of a timeline and episode structured breast cancer data system to study outcomes following neoadjuvant chemotherapy for cases stratified by HER2 status
Authors: Rahman Fatima , Copson Ellen , Hales Alan , Rew David 
Published: October 2021

Abstract

Background
Breast neoplasia displays complex patterns of whole-of-life disease progression, which are difficult to study using legacy data systems. Our timeline- and episode-structured breast cancer data set of 20,000 records allows direct visualisation of the entire documentary record of every patient. The embedded data mining module permits research into a wide range of patient cohorts by pathology, treatment and outcome.

Methods
We selected the cohort of patients aged between 15 and 75 with HER-2 –ve and HER-2 +ve breast cancer who were treated with neoadjuvant chemotherapy (NAC), with or without anti-HER2 therapy between 2002 and 2019. We also studied the patterns and time intervals (in months) of disease progression and response to treatment from primary diagnosis, through loco-regional recurrence and distant metastasis to final outcome.

Results
Of 301 women with confirmed early stage breast cancer were treated with NAC over that time, 186 had HER2- and 115 had HER2+ tumours. The patterns and intervals of disease progression, as displayed on the Master Lifetrack, were mapped and measured for every patient. The proportions of patients with Her2+ve tumours receiving trastuzumab and analogues, and the tumour responses to treatment, were audited. The underlying data set was validated by review of the original records.

Conclusions
The whole-of-life timeline structured cancer data system introduces a new direction for clinical data visualisation, record management and user utility in surgical practice. This study validates the model as a tool for the better understanding of treatment effects and longitudinal behaviours in any selected range of cancer phenotypes.
TP8.1.8 Blue flag clinics. A way to achieve a 2 week wait service in the age of plentiful referrals, radiological pressures and pension threat
Authors: Rybinski Blazej , Thomas Peighton , Sulieman Mona , King Polly 
Published: October 2021

Abstract

Introduction
In early 2019 increased referrals to the Breast 2WW Service, limited radiologist capacity and the pension crisis combined to cause the 2 week wait target to fail. A multidisciplinary solution was sought. Using the Nottingham Breast Institute triage criteria and decoupling clinical and radiological assessments, patients were referred along 2 pathways; red and blue flag.

Methods
Patients were clinically assessed by a trained breast surgeon within 2 weeks. Red flag patients underwent standard triple assessment. The aim for blue flag patients was to undergo any necessary imaging within 10 days. In both cohorts selected patients were given a patient satisfaction questionnaire. Data from red flag clinics were obtained from cancer services. Notes were reviewed for blue flag patients.

Results
Data on 858 blue flag patients seen were analysed.
There was no difference between satisfaction scores.

Conclusions
The 2WW target was regained within a month of implementing change. As long as the standard operating procedure is maintained, the triage criteria adopted were successful and reduced pressure on radiology services. Patient safety and satisfaction were maintained.
TP8.1.12 Diagnostic Utility of MRI in the Evaluation of Potential Malignancy in Patients Presented with Nipple Discharge
Authors: Yang Nixon Phua Cher , Butt Muhammad Adeel Javed , Nijjar Parmvir Singh , Phyu Saung , Barkeji Musa 
Published: October 2021

Abstract

Aims
Nipple discharge is a presentation commonly seen at breast clinics. It is conventionally evaluated with physical examination and sonography( or mammography). The aim of this study is to investigate the diagnostic value of magnetic resonance imaging (MRI) as an additional imaging tool in the evaluation of potential malignancy in patients presented with nipple discharge.

Methods
A retrospective evaluation of 85 patients with nipple discharge who underwent breast ultrasound (USS) and MRI between 04/06/2008 and 25/10/2019 was conducted. Clinical notes, radiographic reports and biopsy results were reviewed. Sensitivity, specificity, positive predictive value and negative predictive value of USS and MRI were calculated.

Results
Out of the 85 patients (all female; mean age 45.33 +/- 12.93 years old) with nipple discharge, 11 were found to have biopsy-proven malignancy (invasive ductal carcinoma/ ductal carcinoma in situ; 12.94% risk). USS failed to identify seven malignancies (27.27% sensitivity) while MRI missed three malignancies (72.72% sensitivity). USS falsely identified four malignancies from 74 patients with no malignancy (94.59% specificity) while MRI only falsely identified one case (98.65% specificity). For patients with negative USS results (U1/U2/U3) or negative MRI results (BI-RADS category 1,2 or 3), the negative predictive values of USS is 89.74% while that of MRI is 96.05%. The positive predictive values of USS and MRI are 42.86% and 88.88% respectively.

Conclusion
Compared to USS, MRI has a higher sensitivity, specificity, positive predictive value and predictive value. It will be a valuable addition to the standard nipple discharge evaluation workup to help rule out malignancy.
TP8.2.21 Two Teams, One Patient: Identifying Barriers to Patients’ Flow from Emergency Departments to Surgical Wards
Authors: Morris Lucy , Tarazi Munir , Waugh Christopher , Foster Karl , Shah Jigar , Mansour Moustafa 
Published: October 2021

Abstract

Aims
The transfer of responsibility for patient care across the Emergency Department (ED)/ inpatient interface has always been recognised as a challenging process. Current research focuses on qualitative data and is based occasionally on anecdotal information. The aim of this study was to identify barriers to efficient patient flow with a specific focus on type and quality of referrals and logistics involved.

Methods
Quantitative retrospective data was collected on referrals received by the surgical team from ED (n = 83). The outcome of the referral was recorded. Quality of referrals was assessed on clinical information, examination and investigations performed as well as working diagnoses. Further data was collected on location and time to review referred patients.

Results
Outcome of referral: 14.5% were discharged directly from ED, 16.9% were admitted for &lt;24 hours, 4.8% were referred to another speciality within 24 hours and 63.9% were admitted for &gt; 24 hours. Quality of referral: 18.1% patients were referred without working diagnosis. 31% of patients presenting with upper abdominal pain did not have amylase checked prior to referral and 20% of patients with suspected PR bleeding lacked a PR examination. Logistics: 57% of patients were seen in ED. 15.7% were reviewed within 1 hour (median: 133mins).

Conclusions
Referrals often failed to meet the needs/criteria of the speciality team. Combining the above with high volume of referrals and logistical challenges of working across multiple areas leads to potential delays in timely patients’ review. Intense workloads create stressful environments which eventually breed interpersonal discord.
TP8.2.22 Mind the Gap: Overcoming the disruption of surgical teaching during COVID-19 redeployment
Authors: Habsha Osama Al , Murphy Katherine , Aly Mohamed , Khan Adil , Younis Firas 
Published: October 2021

Abstract

Aims
Due to the pandemic, surgical FY1s in our trust were re-deployed to cover medical patients. In addition to cancellation of surgery-specific teaching, there was less time spent by FY1s with senior surgical colleagues during the normal working day. Our FY1s appeared less confident in managing unwell surgical patients, and there was dissatisfaction for both FY1s and seniors.
This project aimed to identify the particular areas of concern and deliver a tailored teaching session.

Methods
Surgical FY1s and SpRs were surveyed. We received 10 (83%) FY1 responses and 5 (42%) SpR responses. Management of common surgical presentations, routine administrative and clerical tasks were identified as areas of need. A teaching session was delivered via online conferencing software and uploaded to a video sharing website where it could be viewed at a later date. Seven of 12 (58%) surgical FY1s attended live and completed a post-teaching session feedback survey.

Results
Seven (100%) FY1s rated the session ‘very useful’, and a majority found the ‘common surgical presentations’ section of most value. All respondents felt more confident with both clerking surgical patients and administrative tasks following the refresher session.

Conclusions
This project demonstrated the need for additional training sessions to compensate for loss of opportunities due to re-deployment. Utilising remote teaching proved an acceptable alternative to previous in-person options. The tailored refresher session successfully improved confidence in target areas and should be delivered routinely.
TP8.2.23 Surgical education in low resource settings
Authors: Pye Jonathan 
Published: October 2021

Abstract

Aims
To help build medical capacity in low resource settings.

Methods
I researched and worked with two organisations, Médecins Sans Frontières (MSF) and Mercy Ships. I worked with Mercy Ships in collaboration with ASGBI

Results
MSF is a humanitarian organisation. Although MSF works in low resource settings, it is not developmental and therefore education was not part of its brief. I completed 2x 2 month missions with MSF, in Central African Republic and Chad.
Mercy Ships is a developmental organisation. I worked with Mercy Ships, in four countries, to help deliver a total of 10 skills courses and 5 Training the Trainers courses which had been set up in collaboration with ASGBI. The first time was with a UK surgical trainee under this scheme.
French was the working language in each setting.

Conclusions
There is a real and pressing need for basic surgical education in most low resource settings. Teaching with Mercy Ships is a good vehicle for teaching essential surgical skills locally and training local trainers to continue the process. It is also a good opportunity for providing a supervised introduction to working in a low resource setting for those trainees who wish to become involved in humanitarian work.
TP9.2.1Evaluating the incidence, the predictors and the outcomes of patients with negative appendicectomy
Authors: Noureldin Khaled , Elkhouly Mohamed , Shah Heer , HatimAli AliAsgar , Ayantunde Bolu , Ayantunde Abraham 
Published: October 2021

Abstract

Introduction
Negative appendicectomy (NA) is still a major issue following appendicectomy. We evaluated the rate and predictors of negative appendicectomy in a cohort.

Patients and Methods
Data of patients who underwent emergency appendicectomies over a year was collected and analysed. The absence of inflammation and/or other significant pathology in the appendix was considered negative by standard definition. A stricter definition of NA was the absence of inflammatory cells in the appendix. Negative appendicectomy rate (NAR) was calculated using the standard criteria (NAR-SDC) and the strict criteria (NAR-STC).

Results
372 patients were included, 179 males and 193 females with a median age of 27 (5-94) years. Median duration of symptoms and waiting time to surgery were 2 days and 1 day respectively. The mean admission WBC and CRP were 12,600 (3000-38000)/mm3 and 66.9 (1-323) mg/L respectively. Laparoscopic appendicectomy was performed in 93.5% of patients with a conversion rate of 4.6%.
NAR-SDC was 10.2% and NAR-STC was 25.8%. NAR was significantly higher in females than males (39.4% versus 11.1%; p-value 0.0001). Patients with NA were younger (p-value 0.0001), had lower mean total WBC (p-value 0.014) and CRP (p-value 0.0001) on admission. Independent predictors of negative appendicectomy are female gender, duration of symptoms more than 3 days, and lower total WBC.

Conclusion
NA is still a major problem in the management of patients with acute right lower abdominal pain. Our NAR compared favourably with reported rates. Female gender, symptoms duration more than 3 days, lower WBC are independent predictors of NA.
TP9.2.2Evaluating the Outcomes of anal squamous cell carcinoma (ASCC) with curative intent- a 10-year experience
Authors: Ayantunde Abraham , Noureldin Khaled , Hq Hafizul , Edison Daniel , Praveen Bandipalyam 
Published: October 2021

Abstract

Background
Our 10-year experience with radical treatment of patients with ASCC.

Patients and Method
Data of patients with ASCC treated with curative intent were analysed between January 2011 and December 2019. Patients underwent the standard workup, treated and followed up accordingly. The outcome measures were response to radical chemoradiotherapy, recurrent disease, disease-free and overall survival.

Results
117 patients were diagnosed with anal cancer. 26 ASCC patients palliatively treated, adenocarcinoma(11), melanoma(1), Paget disease(1) and carcinoid(1) were excluded. Median age of included patients was 65(38-90) years with a male to female ratio of 1:1.9. Three patients were HIV positive and 52% of the patients had AIN of varying degree of dysplasia. AJCC stages were I(16), II(18), IIIA(19), IIIB(9) and IV(15). 88.3%%(68/77) of the patients had radical chemoradiotherapy while 9 patients with tumours ≤2cm underwent wide local excision. 92.6%(63/68) of the patients treated with radical chemoradiotherapy had complete response while 7.4%(5/77) had partial response. Four patients with incomplete response underwent salvage APER. 13%(10/77) of the patients developed recurrent disease.
Mean survival time was 99.82(95% CI 88.87-110.77) months with 5-year overall survival rate of 78.0%. The mean disease-free survival time was 111.82(95% CI 102.38-121;26) months. 75.3%(58/77) of the patients were alive at the end of the study with an overall mortality rate was 24.7% and disease-specific mortality was 15.6%.

Conclusion
ASCC responds well to radical chemoradiotherapy with favourable outcome but locoregional failure and distant metastases are still issues.
TP9.2.3Laparoscopic Cholecystectomy with Intraoperative Cholangiogram and Antegrade Biliary Stenting in Acute Gall Stone Pancreatitis: A Cohort Study
Authors: Brown Rory , Cowie Jonathan , Saedon Mahmud , Rate Anthony 
Published: October 2021

Abstract

Aims
To demonstrate feasibility and efficacy of laparoscopic cholecystectomy (LC), intraoperative (IOC) and antegrade biliary stenting (ABS) as compared to selective pre-operative biliary investigation and intervention in acute gallstone pancreatitis (AGP).

Methods
A cohort study was performed comparing patients who had IOC+/-ABS during LC versus those who had only LC in the treatment of AGP. 74 consecutive AGP patients were included in this study from January 2016 to October 2018. All patients were included in a prospective database with follow-up for one year.

Results
47 (64.5%) patients underwent IOC during LC (7 required ABS insertion), with a mean age 51 years (SEM: 2.7), 72.3% were female. The median admission bilirubin was 24 (IQR:14-54). The average number of ERCP and MRCP per patient was 0.30 and 0.15 respectively.
27 (36.5%) patients underwent LC with selective pre-operative biliary investigation with a mean age 48 years (SEM: 2.9), 66.7% were female. The median admission bilirubin was 27 (IQR:14-48). The average number of ERCP and MRCP per patient was 0.41 and 0.52 respectively.

Discussion
In our pilot study comparing LC with IOC versus LC with selective pre-operative biliary investigation we demonstrate that, there is marked reduction in biliary investigations required in IOC group. Length of hospital admissions and rate of post-operative complications were comparable. An analytic study with a larger cohort may demonstrate further seniority of IOC.
TP9.2.27A closed loop audit looking at the use of a checklist in surgical ward rounds to improve ward round documentation. Can we improve patient safety?
Authors: Liao Christopher , Sheaff Emma , Wilkins Harry 
Published: October 2021

Abstract

Aims
To assess if surgical ward rounds would improve through the use of a peri-operative ward round checklist in the clinical notes.

Method
We performed a closed loop audit with a different novel ward round checklist in each audit, the second made from improving the first, based on feedback. We looked at checklist utilisation, and the quality of documentation in notes. We compared the quality of documentation in notes with the checklist, to notes without the checklist. The data was then collated and analysed. Standards from the Royal College of Physicians’ “Ward Rounds in Medicine”.

Results
In the first audit, our sample was 68, in the second, our sample was 64. With the use of a checklist (M = 67%, SD = 22%) ward round documentation was significantly better than without the checklist (M = 26%, SD = 10%), t(64)=8.85, p&lt;.00001. Ward documentation was especially improved regarding fluid balance, analgesia, and assessing physiotherapy needs. The second version of the checklist (M = 56%, SD = 28%) was used significantly more than the first checklist (M = 13%, SD = 22%), t(75)=7.59, p&lt;.00001.

Conclusions
With the growing role of clinical notes as legal documents, handover tools, and pillars of care planning, and the move to use electronic patient record systems, improving the quality of documentation is imperative. This study shows that a systematic checklist significantly improves ward round documentation, and so can improve clinical care. We will follow-up this study with a third audit, focusing on patient satisfaction and determining reduction in harm caused to patients with a ward round checklist.
TP10.1.7New Minor Surgical Set as a way to improve surgical efficiency during COVID-19 pandemic
Authors: Eiben Inez , Bahadori Darab Payam , Eiben Paola , Syed Mobinulla 
Published: October 2021

Abstract

Aims
Large number of paediatric plastic surgical procedures were identified in Evelina Hospital during COVID-19 pandemic as not requiring large conventional surgical operative sets that can contain at average 35 instruments. Large sets are more expensive, take longer preparation time due to instrument counting and as a consequence take more total operating time. Furthermore, more instruments need to be unnecessarily purchased, stored and cleaned post procedure.
Simple paediatric plastic surgery procedures including nailbed repair or laceration repair require limited and largely replicating operative instrument set. We have therefore introduced Small Minor Plastic Surgical set (MS) containing only 10 instruments. We audited its effectiveness and introduced a revised version of the set as per feedback, permanently arranged into theatre operative set collection.

Methods
MS set was introduced and used at senior surgeons discursion for paediatric plastic surgical procedures. Feedback was gathered from the surgeon and scrub nurse via specially designed questionnaire at post operation and theatre team debrief. Suggested alterations were implemented and New Minor Surgical (NMS) set was introduced and re-audited using revised questionnaire.

Results
61% of surgeons and 89% of scrub personnel thought MS set contained everything that was needed for the case. Following revision 91% of surgeons and 95% of scrub nurses thought NMS set contained all necessary equipment for the operation.

Conclusions
NMS set introduced into daily surgical practice in Evelina Hospital theatres improved overall staff satisfaction when considering both surgeon and nursing staff. It provided cost- and time-effective operative set now vastly used across surgical specialities.
TP10.1.9End Colostomy Formation: Change in Practice during the Covid-19 Pandemic
Authors: Farrow E Z , Cook T A 
Published: October 2021

Abstract

Aim
Intercollegiate guidance favoured the increased stoma formation during the early phases of the Covid-19 pandemic due to uncertainty around the availability of critical care beds and peri-operative impact of SARS-CoV-2. This study assessed the impact the Covid-19 pandemic and changing guidance had on end colostomy formation.

Methods
Data were reviewed from a prospectively collected database on the number of end colostomies formed over a 10-month period from 1st March to 31st December 2020. Comparison was made with the same period in 2019. Details were confirmed using clinical letters.

Results
There was an overall 11.5% increase in the number of end colostomies formed in the in the same 10-month period in 2020 compared with 2019 (87 vs 78). The increase in end colostomy formation was most marked in the 3-month period of March to May, with 36.8% more end colostomies formed in 2020 than in 2019 (26 vs 19). The number of end colostomies formed in the remaining 7-month period of June to December was similar in the two years (61 vs 59).

Conclusions
There was a change in surgical practice in favour of stoma formation, which peaked in the period of March to May 2020. This coincided with a time of maximum uncertainty surrounding the Covid-19 pandemic and changing intercollegiate guidance. The change in practice has implications for patients longer term and may impact on the service in the post-Covid recovery period with patients requesting reversal procedures.
TP10.2.5Investigating the impact of early COVID-19 policies on Emergency Surgical service at a District General Hospital
Authors: Lunt Adam , Hanger Joseph , Bush Alex , Christopoulos Petros , Munro Alicia , Keatley Ben 
Published: October 2021

Abstract

Aims
On the 23rd March 2020, the UK introduced measures to curb the spread of coronavirus disease 19 (COVID-19). We aimed to investigate the impact of government and Royal College measures on the acute surgical take.

Materials and Methods
Retrospective analysis was performed for patients referred to the acute surgical take between 2nd March 2020 and 5th April 2020. Data were analysed in two groups; ‘pre-COVID measures’ cohort (prior to 23rd March 2020) and ‘post-COVID measures’ cohort (on or after 23rd March 2020). Demographics, Early Warning Score (EWS) at referral, blood results, radiological investigations, antibiotic use, diagnosis, operative and outcome data were compared.

Results
465 patient referrals were included. Mean admissions per day reduced by 39.9% (p = 0.01) in the post-COVID measures’ cohort compared with the pre-COVID measures cohort. Disease severity increased, with white cell count (WCC) increasing by 14% (p = 0.02) and C-reactive protein (CRP) by 34% (p = 0.04). Laparoscopic procedures decreased by 86.4% (p &lt; 0.01). The proportion of admissions requiring operative management showed no significant change, with 26% in pre-COVID measures verse 23% in post- COVID measures (p = 0.91). Short term morbidity, mortality and length of stay outcomes also demonstrated no significant change.

Conclusion
Fewer patients were referred following the implementation of government and Royal College guidance, however these patients demonstrated greater disease severity. Guidance likely modified patients help seeking behaviours and delayed presentation time. Surgeons demonstrated good compliance to Royal College guidance by reducing laparoscopic procedures, however operative management rates remained constant.