bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP9.3 - Introducing Frailty Assessment into The Suspected Lower GI Cancer Pathway – Results of a 2 Year Pilot
Authors: Sargsyan Narek , Bernardo Janice , Sreekanth Sakthi , Aruachalam Ganesh , Humphries Francesca , Vijay Vardhini 
Published: September 2024

Abstract

Introduction & Aim
An Increasing number of patients with suspected lowerGI cancer are being sent Straight-To-Test to achieve the 28 Day Faster Diagnosis Standards (FDS) following GP referral. This means that elderly frail patients may not get personalised care unique to their needs and undergo unnecessary investigations. Since 2022, we have been piloting a frailty pathway incorporated into the protocol for secondary care management of LowerGI 2ww referrals. Aiming to provide a holistic and personalised geriatric assessment to improve outcomes and reduce health inequality. This study analyses the outcomes.

Methods
A prospectively maintained database of all 2ww lowerGI cancer referrals between January2022-January2024 was analysed. Patients aged&gt;75 with a frailty score of &gt;=5 or performance status&gt;=3, dementia, poly-pharmacy or from care home were referred straight to the frailty unit for assessment and discussion of the value of further investigation, based on a locally designed SOP. The patient journey was mapped and outcomes compared to the standard-pathway.

Results
Over a 24-month period, 228patients with suspected cancer were seen on the frailty pathway. 49.5%(113patients) were found to be unfit for further investigations or declined/self-discharged. The 2ww standard was met in80%of frail patients compared to55% in&gt;75s who were sent straight-to-test on the standard pathway. The 28day-FDS standard was met in50%of frail patients compared with18%in the other&gt;75s.The average number of investigations per referral was0.5for frail patients compared to 1 for patients on the standard-pathway. 5patients required optimisation prior to investigation. Only 1patient was diagnosed with cancer.

Conclusion
The frailty pathway is an effective initiative in reducing unnecessary invasive investigations, whilst providing timely investigations on the suspected cancer pathway.
SP9.5 - Peri-operative Comprehensive Geriatric Assessment (CGA): A new benchmark for Acute General Surgery patients
Authors: Sabbagh Hadi , Abu Al-Ryan , Reese George , Hudson Murray , Koizia Louis 
Published: September 2024

Abstract

Aims
More than 50% of patients undergoing emergency general surgery are over 65 years of age. NICE guidelines emphasise frailty assessment in acute surgical settings, particularly in the preoperative period. Similarly, the Emergency Laparotomy and Frailty (ELF) study showed associations between frailty (CFS ≥ 5) and 90-day mortality, increased complication and length of hospital stay in older emergency laparotomy patients. NELA best practice tariff (BPT) April 2023 heavily focuses on perioperative team involvement in frailer, older patients. This is an audit from a city teaching hospital, with a surgical liaison team against standards set by NELA.

Methods
Review of patients aged ≥ 65 undergoing emergency laparotomies between August and November 2023 (pre-intervention) then December and January 2024 (post-intervention). Data collected includes whether patients had a documented frailty score, a clearly documented CPR decision & treatment escalation plan (TEP), pre- or post-operative medical review, and advanced-care planning (ACP) post-operatively. Intervention included dedicated members of surgical liaison team following patients throughout admission, weekly meetings to discuss laparotomy patients, older patient template being created capturing ceilings of care, frailty score, and social history.

Results
Post intervention, improvement in clear documentation regarding escalation, frailty level. Greater level of MDT collaboration with regards to older patients undergoing laparotomies.

Conclusion
Changes in NELA BPT emphasise the importance of comprehensive geriatric assessment in the management of older laparotomy patients. Even a basic surgical liaison service can achieve high levels of compliance with a few simple strategies, resulting in better outcomes for patients as well as financial benefits for Trusts.
WP1.4 - Iliac Crest Bone Grafts and Hernia Formation: Insights from a Case Series And Review of Literature
Authors: Kirengo Thomas , Rafiq Sarmad , Maraqa Abdelrahman , Azhar Zubair , Ramanand Bangalore 
Published: September 2024

Abstract

Introduction
Hernias following iliac bone grafting are a rare but significant complication, with the earliest case reported in 1945. Repair of these hernia is challenging. There is a need for appropriate repair techniques to minimize morbidity and recurrence. We present our experience with 3 cases of post-iliac graft hernia repair and a systematic review of current literature.

Method
We conducted a systematic review of literature in two online databases, PubMed®/ MEDLINE and EMBASE) February 2024, following PRISMA guidelines. Keywords used were “Hernia”, “iliac”, and “Graft”. Data on demographics, initial pathology, time to presentation, type of hernia repair, and outcome were collected. Studies not in English and related to other types of hernia were excluded.

Results
31 studies, spanning from 1975-2023, were included of 751 results. There were 41 reported cases of hernias post iliac bone grafting. Age distribution ranged from 37-88 years, with an average age of 59 years. Average time of presentation was 4 years. 8 cases (25.8%) of recurrence were reported. The main indication for bone grafting was fracture with delayed/ non-union in 20 cases (64.5%). Mesh repair was performed in 70% of cases. Average follow-up period was approximately 17 months.

Conclusion
Hernias post iliac bone grafting should be suspected as a probable complication. If identified, most can be managed with mesh, however patients need to be followed up due to risk of recurrence.
WP2.14 - Lung Mycetoma - Chronicles from the Pandemic
Authors: Bhatti Hamza Waqar , Farooqui Marryam Riaz , Shafique Muhammad Salman , Hanif Muhammad 
Published: September 2024

Abstract

Introduction
COVID-19 is a global pandemic which obeys no geographical borders. Post Covid pneumonia sequalae is still an unpredictable course especially with patients with a pre-existing lung compromise. In such scenario, a cohort of patients must also be looked for a fungal infection.

Case Study
A 31-year-old male presented with history of fever, hemoptysis, and weight loss for 1 month. He suffered from Covid-19 pneumonia 3 months back. He was also diagnosed with Pulmonary tuberculosis 4 years back. Examination revealed right sided tracheal deviation with dull percussion note on the upper and middle zones of the right side of chest. Pulmonary function tests showed a restrictive pattern with a FEV1/FVC ratio of 0.9 (FEV1=2.02, FVC=2.22). Transthoracic echocardiography revealed dextrocardia, moderate TR, and a pulmonary arterial systolic pressure of 25 mm Hg. Contrast enhanced CT scan of thoracic cavity showed reduced right hemithorax, well-defined thick-walled cavities in the upper and lower lobe of the right lung and a ground glass appearance in the bilateral lower lobes. A diagnosis of Lung mycetoma was made along with post covid-19 pneumonia changes. Right posterolateral thoracotomy and right pneumonectomy was performed. Per-operatively, a collapsed lower lobe and stony hard upper and middle lobes of right lung with associated fungal balls were found. Patient was clinically well after a 30-day follow-up period.

Conclusion
Covid-19 patients with pre-existing pulmonary co-morbidities should be followed with caution and pulmonary symptoms in the post pneumonia patient should raise the suspicion of fungal infections as well.
WP3.1 - Retrospective analysis of gallbladder polyps: correlation between ultrasound imaging and histology findings – a single center study
Authors: Khalid Muhammad Abdullah , Azaini Wan , Aktas Mikail , Kassem Ahmed , Junkin Amy , Marzouk Ahmed 
Published: September 2024

Abstract

Aims
To investigate ultrasound imaging findings in patients with gallbladder polyps requiring cholecystectomy and compare them with histopathological results.

Methods
Patients with ultrasound diagnosis of gallbladder polyps who underwent cholecystectomy between January 2019 and September 2023 were included.

Results
A total of 701 patients’ records who had cholecystectomy were reviewed, 45 patients were included as per the inclusion criteria, of whom 73% were women. Mean age was 52±15 years. Average size of the polyps on ultrasound was 7.26mm and approximately 26.7% of polyps were noted to be bigger than 10mm. Histopathological findings confirmed the presence of polyps in only 46.7%. Out of these, size of the polyps was documented in 62% of histology reports which was compared with ultrasound findings. Mean size on USG was 9.13±2.73mm in comparison to histological size of 6±2.94mm. Mean difference in measurements was 3.13mm.

Conclusion
This study examines the relationship between ultrasound imaging and histological findings of gallbladder polyps. From our 45 patients identified with gallbladder polyps the majority were women. Larger sized polyps are more likely to be confirmed on histology and our findings suggest that ultrasound can overestimate polyp-size by up to 3mm. Finally, 53.3% of polyps diagnosed via ultrasound were not confirmed on histological examination. Further studies on larger cohorts are required to validate above findings and refine diagnostic protocols.
WP3.4 - Partial gastrectomy as a day case procedure for the treatment of Gastrointestinal Stromal Tumours – a single centre experience
Authors: James Stuart , Carey Charles , Richardson Gemma , Jaunoo Shameen 
Published: September 2024

Abstract

Aims
Gastrointestinal stromal tumours (GISTs) are malignant growths that may be managed effectively with radical surgery if diagnosed at an early stage. The majority of GISTs are found in the stomach and many may be managed effectively via a laparoscopic partial gastrectomy (PG). Day case surgery is becoming a more feasible option for patients undergoing laparoscopic PG. This study examined the outcomes of patients who underwent laparoscopic PG as a day case procedure at a UK tertiary centre.

Methods
The records of patients who underwent a partial gastrectomy to treat extra-luminal gastric GISTs between January 2021 to December 2023 were retrospectively reviewed. The rates of readmission and post-operative complications were noted for the patients were assessed. Patients with tumours near the gastro-oesophageal junction, lesser curve or with a significant intraluminal component were excluded.

Results
42 patients aged between 52 - 81 years were ultimately included in this analysis and 31 (73.8%) underwent surgery as a day case procedure. There were no readmissions, peri- or post-operative complications and none of the patients required a conversion from a laparoscopic to an open approach.

Conclusions
This single centre analysis suggests that laparoscopic day case PG is a safe option for selected patients. Overall this experience suggests that day case surgery should be carefully considered in those deemed likely to be able to recover well post-operatively. Additional larger studies are required to further evaluate the safety of day case laparoscopic PG.
WP3.8 - Estimating the Disease Burden and Epidemiological Characteristics of Burn Injuries in the United Kingdom: a systematic analysis of the global burden of disease study 2019
Authors: Ou Kai Qi , Wong Zhen Ning , Wong Zhen Yu 
Published: September 2024

Abstract

Background
Burn injuries pose a substantial public health challenge globally, with profound physical, psychosocial, and financial consequences for individuals, households, and communities. This study aims to assess the disease burden and epidemiological characteristics of burn injuries in the United Kingdom (UK).

Methods
Utilising data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we estimated the prevalence, age-standardised incidence, and years lived with disability (YLD) for burn injuries in the UK. Burn injuries were further classified based on the total burn surface area (TBSA), distinguishing between &lt;20% and &gt;= 20% TBSA.

Result
In 2019, the age-standardised incidence rate of burn injuries in the UK was estimated at 330.65 per 100,000 (268.59-409.52). Incidence rates have demonstrated a stable downtrend since 1990. Over 90% of burn injuries in the UK were categorised as &lt;20% TBSA. Younger age groups experienced a higher disease burden. England exhibited the highest age-standardised incidence rate of burn injuries (344.98 per 100,000), along with a threefold higher rate of burn injuries &gt;20% TBSA (29.64 per 100,000) compared to Wales, Northern Ireland, and Scotland. The burden of disability attributed to burn injuries in the UK was estimated at 84.38 YLD per 100,000 (49.16-139.56), with the highest burden observed in England (88.90 per 100,000).

Conclusion
This study underscores the substantial disease burden imposed by burn injuries in the UK, alongside disparities in their distribution and warrant further studies in addressing the social and economic determinants of burn injuries.
WP3.9 - Characteristics and outcomes of an emergency hot clinic in a district general hospital - are they still a useful resource?
Authors: Martinez Alison Infante , Mapara Rahee , Leung Edward 
Published: September 2024

Abstract

Introduction
Hot clinics with ambulatory imaging have become integral to service provision in emergency general surgery, reducing admissions and expediting diagnoses. However they can come under criticism over a lack of senior decision making and perceived unnecessary reviews.

Aims
We aimed to evaluate the service in our department, by characterising the seniority level of the decision makers and assessors in the hot clinic, and outcomes of patients seen.

Methods
Retrospective analysis over a 3 month period of patients seen in the hot clinic of a district general hospital was performed.

Results
Total number of patients seen was 128. Median time from referral to appointment was 1 day. Abdominal pain formed 70.3% original presenting complaints. Over half of patients (52.3%, n=67) had review arranged by a registrar, and 46.9% (n=60) of patients were seen by a registrar at their appointment. 7% (n=9) had their hot clinic review arranged by a consultant. 63.3% (n=81) of patients had imaging performed as part of their review, and 53.1% (n =43) of these patients had pathology identified. 13.3% (n=17) of patients seen at the clinic required admission, and 43.0% (n=55) were discharged. 21.4% (n=3) of those brought back for a further hot clinic review had been seen by a consultant, versus 64.3% (n=9) seen by a registrar.

Discussion
Hot clinics are a valuable resource, and in our department a senior decision maker at a registrar level is involved in majority of decision making. The admission rate is low, demonstrating that the service is effective in helping to avoid admissions. Consultant input can help avoid repeated reviews.
WP4.6 - Reducing Unnecessary Transfusion of Blood Products – A Quality Improvement Project in a General Surgical Department in a District General Hospital
Authors: Arbis Alexander , Hamawandi Aveen , Donnellan Imelda 
Published: September 2024

Abstract

Aims
To audit adherence of transfusion of blood products against NICE guideline thresholds. To reduce unnecessary blood transfusions following departmental teaching sessions and installation of posters on surgical wards.

Methods
We retrospectively audited all patients receiving packed red cells transfusions consecutively across two consecutive four-month periods in a general surgery department. Departmental teaching sessions were held after the first audit cycle, supplemented by installation of posters including NICE guideline thresholds on surgical wards. The medical notes for each patient were assessed for pre-transfusion haemoglobin, indication for transfusion, and whether each transfusion was prescribed according to NICE guidelines.

Results
A total of 112 units of packed red blood cells in 42 patients and 133 units in 43 patients were transfused, respectively, before and after intervention. 45 units (40.2%) were prescribed according to NICE guidelines on first audit, improving to 67 units (50.4%) following intervention. 23 units of blood (20.5% of total) were transfused back-to-back inappropriately on first audit, reducing to 6 units (4.51% of total) after intervention. There were 2 self-limiting transfusion-related reactions (1.79%) on first audit, both in patients transfused above guidance thresholds, and no reactions following intervention. At a raw cost of approximately £135 per unit of donated blood, savings of £1830 were made over a four-month period (£5493pa), not including nursing and administration costs

Conclusions
Through simple local interventions and stricter adherence to transfusion thresholds, we reduced inappropriate above-threshold blood product transfusions in our hospital. This corresponded to a reduction in unnecessary blood-transfusion reactions and significant hospital savings.
WP4.14 - Association of Socioeconomical Status and Disparity In Paediatric Burn: Results From The Global Burden Of Disease Study 2019
Authors: Ou Kai Qi , Wong Zhen Ning , Wong Zhen Yu 
Published: September 2024

Abstract

Background
Burn represents a significant contributor to both morbidity and mortality in the paediatric population and is closely related to socioeconomic and geographic factors but is often overlooked. This study aims to estimate the unbalanced distributions, temporal trends and quality of care in paediatric burn.

Methods
Data focusing on paediatric population (&lt;20 years old) was sourced from the Global Burden of Disease (GBD) Study 2019 stratified by Socio-demographic Index (SDI) and WHO region, including incidence, mortality and disability-adjusted life-years (DALYs). Joinpoint regression analysis and principal component analysis were conducted to compute the temporal trend and quality of care (QCI) index respectively.

Result
In 2019, 3,719,806 paediatric burn cases were reported, resulting in 23,986 deaths and 2,240,311 DALYs globally. Over 40% of deaths and DALYs attributable to burn occur in the African region, despite the region accounting for around 20% of the total incidence. The age-standardised incidence rate (ASIR) from 2010-2019 was 0.419 per 100,000 but death (ASDR) and DALYs (ASDALYs) were reduced at the rate of 3.04 per 100,000 and 2.92 per 100,000 respectively. The global QCI for paediatric burn was 88 with a proportional trend observed across SDI quintiles Significant association in between SDI scores and gender disparity and quality of care was observed.

Conclusion
This study highlights the significant burden of paediatric burn and its disproportionate global distribution. Preventive measures, enhancing access to quality healthcare, and addressing the social and economic determinants of burn should be addressed in future studies.
WP4.17 - Laparoscopic versus open repair of perforated peptic ulcer: a systematic scoping review and in-depth evaluation of existing evidence
Authors: Chalmers Katy , Lee Matthew , Cousins Sian , Peckham-Cooper Adam , Coe Peter , Blencowe Natalie 
Published: September 2024

Abstract

Background
Perforated peptic ulcer remains a common cause of morbidity and mortality worldwide. Surgical treatment includes a trend towards minimally invasive surgery. To safely implement this, it is important to understand the key steps that have been assessed in clinical trials. The aim of this review is to assess the reporting of intervention steps in laparoscopic and open ulcer repair.

Methods
A systematic search was performed of the MEDLINE, EMBASE, & clinical trial databases (PROSPERO (CRD42023404537)). Randomised trials on laparoscopic vs open repair of peptic ulcer were included. Data extracted included study metadata, as well as technical aspects of interventions, use of co-interventions. Study design was assessed using the PRECIS-2 tool, to explore whether trials were predominantly pragmatic or explanatory, and also using the Cochrane Risk of Bias tool.

Results
408 studies were screened for eligibility, and nine full-texts were included. This included six studies from China, two from India, and one from the Netherlands. Incision, ulcer closure details, and lavage, were the best reported aspects of laparoscopic repair (n=7). Method of access, incision, and ulcer closure were well described in 8 studies. Co-interventions such as antibiotic use, analgesia, and H pylori eradication were poorly described. Interventions were delivered by high volume laparoscopic surgeons. Studies were considered at high risk of bias. PRECIS-2 assessment found studies were neither fully pragmatic nor explanatory.

Conclusions
Laparoscopic repair of perforated peptic ulcer is a poorly defined intervention. Standardisation of key steps and co-interventions is required to facilitate a well designed randomised trial.
WP5.1 - An audit of Escherichia coli bacteraemia from a hepatobiliary origin
Authors: Holmes Paul , Narula Shaima , Payne Christopher 
Published: September 2024

Abstract

Aims
Gallstone disease is the commonest cause of biliary sepsis, which in turn is a frequent source of Escherichia coli bacteraemia (ECB). In 2022, our health board was an outlier for ECB infection rates. It was hypothesized that this may be related to extended waiting times to be seen at the surgical clinic or rising numbers on the waiting list for cholecystectomy, caused by the COVID-19 backlogs. This study aims to assess the prevalence and characteristics of ECB infections associated with hepatobiliary conditions in a tertiary centre in Scotland, and review any associations with waiting lists.

Methods
A retrospective analysis of ECB cases linked to hepatobiliary conditions between 01/01/2022 and 31/12/2022 was conducted. Parameters studied included infection acquisition (community, hospital, healthcare-associated), biliary disease history, inpatient/outpatient status, waiting list status, admission specialty and treatment modalities.

Results
Of the 71 cases analysed, 68% were community-acquired, while only 15% were healthcare or hospital-associated. Non-malignant biliary disease was present in 43% of patients, and 39% had prior inpatient history. The majority were not on clinic (89%) or surgery (92%) waiting lists. General surgery was the commonest admitting speciality (51%). Mortality rate was 17%.

Conclusions
This audit did not identify an association between increases in ECB rates and waiting lists for clinic review or surgery, and very few patients were awaiting cholecystectomy. The study confirms the clinical significance of hepatobiliary-associated ECB infection, with mortality rates similar to that of previously published reports.