bluuebunny/crossref_metadata_2025_split huggingface dataset:
WP5.2 - Acute Pancreatitis: challenging the relevance of the modified Glasgow score and bridging the gap to optimise management
Authors: Manku Bhagat , O’Sullivan Arun , Bleehen Laura , Ramcharan Sean , Marriott Paul , Singh Sandeep 
Published: September 2024

Abstract

Aims
Acute pancreatitis is a frequently encountered emergency surgical presentation, with an incidence of 56 cases per 100,000 per year. 10%- 20% of patients develop a rapidly progressive inflammatory response with an overall mortality rate of 5%. Deciding the need for intervention during pancreatitis is variable. Predicting severity is challenging and multifactorial. Scoring systems aid in standardisation of treatment, however they do not factor in the evolving knowledge on factors that predict mortality in severe acute pancreatitis. The aim of this audit was to identify any gaps in optimising the management of acute pancreatitis.

Methods
Prospective data was collected between January 2023 – May 2023 and analysed against current NICE and UK working Party on Acute Pancreatitis guidelines.

Results
41 patients were identified with a median age of 60 (53.7% male, 46.3% female). No cases required admission to intensive care. Gallstones (56.2%) and alcohol (19.6%) were identified as leading causes. Key gaps in management were identified: 12.2% of patients were scored via the modified Glasgow score, 24.4% received antibiotics without a clinical indication, 34% received aggressive fluid therapy and 19.5% received education on disease diagnosis and management.

Conclusion
Supportive management can be optimised, with a significant need to address patient education to minimise recurrence. Our data supports the use of targeted scoring systems in patients who are already critically ill. As the majority of cases were mild, we propose that the Modified Glasgow score is a useful aide but should not replace clinical judgment and careful monitoring of patients. Potential ambulatory pathways could be considered for mild acute pancreatitis.
WP5.9 - Emergency laparotomies in the elderly: a patient perspective
Authors: Hale Emily , Davis Heather , Sert Sena , Bowling Kirk 
Published: September 2024

Abstract

Aims
Emergency laparotomy is known to convey worse morbidity and mortality for elderly patients. Despite a growing elderly population, there is a limited understanding of the patient experience in emergency laparotomy. This study aims to assess patient satisfaction following emergency laparotomy.

Methods
Patients were identified from the National Emergency Laparotomy Audit (NELA) database, who were aged 80 and above, and underwent surgery between: January 2020 and August 2023 at Torbay Hospital. Of the patients who survived to discharge, a telephone-based interview was undertaken in January 2024. Exclusion criteria included: confusion, severe illness and relook laparotomy. Data were collected on functional status and satisfaction with the procedure. Patients were also asked what they wished they known prior to the operation. Post-operative outcomes were assessed in a separate study.

Results
132 cases were undertaken in this period. 72 cases met inclusion criteria. We achieved a 61% response rate. 59% of respondents were living independently post operatively and 61% had no functional decline. 93% of respondents were happy to have had the operation and if given the opportunity again would still have had the procedure. Patients were overall very happy with the information offered prior to the procedure, 7% felt they had no alternative option. One patient was not satisfied with the follow up received.

Conclusions
Although emergency laparotomy in the elderly is high risk, our data demonstrate excellent patient satisfaction. This study provides a better understanding of what is important to patients; this should be considered in the consent process and communication.
WP5.12 - Assessing the safety of managing and discharging appendicitis patients within 24 hours of presentation to hospital
Authors: James Stuart , Carey Charles , Richardson Gemma , Jaunoo Shameen 
Published: September 2024

Abstract

Aims
Acute appendicitis (AA) has an incidence of 81 per 100,000 person-years and is a common reason for admission in acute general surgery units. Laparoscopic appendicectomy (LA) is well established as the main treatment method for patients with AA and many are deemed fit for discharge soon after this operation. This study aimed to assess the proportion of AA patients who underwent LA who were able to be successfully discharged within 24 hours of their surgery.

Methods
The notes from AA patients admitted to Royal Sussex County Hospital between December 2021 and December 2023 were retrospectively analysed for their time to post-operative discharge. Within this group, cases who were uncomplicated and who could be discharged within 8 hours of surgery were noted. The notes were further assessed for patients who required readmission within 24 hours of surgery.

Results
462 cases of AA admitted were identified and of these, 152 (32.9%) underwent LA and were discharged within 24 hours of admission. 91 (59.8%) of this subgroup were discharged within 8 hours and 81 (53.3%) had uncomplicated appendicitis. None of these cohorts of patients were readmitted within 24 hours.

Conclusions
Discharging patients within 8 hours of LA was shown to be a safe option for patients who underwent surgery. The findings in this study suggest that pathways encouraging the prompt assessment and management of appendicitis cases should be considered in all hospitals to facilitate effective patient flow.
WP6.5 - Setting Up For Success: Supporting New General Surgical Registrars' Non-Operative Technical Skills Development
Authors: Kuligowska Anna , Clarke Rory , Biyani Shekhar , Peckham-Cooper Adam , Ng Oliver 
Published: September 2024

Abstract

Aim
Entry into Higher Surgical Training is associated with new challenges to trainees’ clinical, technical, professional and inter-personal skills. A three-day modular “bootcamp” course was designed for new General Surgery ST3s transitioning from Core Surgical Training to bridge the gap and support areas of developmental need.

Methods
Four varied modules were undertaken by candidates; one focussed on non-operative technical skills in surgery (NOTSS). Following pre-interviews with all stakeholders, immersive scenarios were developed. The programme encompassed operating in a stressful environment with a focus on crisis resource management principles, ward round leadership, theatre prioritisation, difficult communication, and a further workshop on managing bullying and sexual harassment. A multi-professional faculty included anaesthetists, theatre staff, psychiatrists and geriatricians alongside surgeons.

Results
All 26 trainees were invited to self-rate confidence using a 5-point Likert scale, as well as free text annotation. 13 (50%) completed both pre- and post-course confidence questionnaires. Data showed significant improvement in self-rated confidence across all NOTSS domains, particularly for operating in a stressful environment ("Confident"/ "Strongly Confident" = 69% pre-course to 100% post-course). Free text responses included highly positive feedback for high faculty to trainee ratio allowing detailed personalised feedback, exposure to multi-professional perspectives and opportunities to reflect on difficult professional scenarios.

Conclusion
Following the success of this course, it has now become part of ST3 Induction in Yorkshire - an opportunity to promote a positive working culture and strengthen professional relationships. A multi-specialty faculty allows for sharing of transferable inter-specialty skills. We recommend all transitional training stages would benefit from embedded induction courses.
WP6.9 - Essential Surgery Skills Course: A One Week Training Program to Prepare Surgeons for Humanitarian Deployment
Authors: Sherif Youmna , Pham Kala , Davis Rachel 
Published: September 2024

Abstract

Background
Medical students, surgical trainees, and surgical faculty are increasingly interested in incorporating global surgery into their clinical practices and professional careers. However, many concerns remain about the preparation of surgeons for operating in resource-limited settings and their exposure to critical procedures such as cesarean sections, hysterectomies, or fracture reductions. In an attempt to address these concerns, academic institutions have developed advanced professional training programs for the global surgeon.

Methods
A six-day essential surgery skills conference was created at a large academic institution that provides trainees and surgeons with an overview of common surgical scenarios across orthopedics, urology, obstetrics, gynecology, general surgery, anesthesia and ultrasound in the form of didactics, simulations, and wet labs.

Results
11 surgical trainees from four large academic institutions attended the essential surgery skills conference. Trainees attended sessions on point of care ultrasound, regional anesthesia, general anesthesia, hysterectomies, cesarean sections, post-partum hemorrhage, fracture reduction and fixation, ureteral injuries, and humanitarian deployment. A pre and post-test was administered. Improvement was noted in the trainees scores on the post-test in their knowledge of surgical subspecialty care. Trainees also reported feeling better prepared for humanitarian deployment.

Conclusion
Global surgery conferences can be designed to provide a networking and collaboration forum for improving access to surgical services worldwide. One-week predeparture conferences that discuss essential technical skills and relevant global surgery knowledge may better prepare surgeons to operate in resource-limited settings.
WP7.5 - Primary Repair of Obstetric Anal Sphincter Injuries (OASIS): a Survey of Surgeons’ Experience
Authors: Elsaid Nada , Thomas Gregory , Carrington Emma , Vaizey Carolynne 
Published: September 2024

Abstract

Purpose
OASIS is associated with devastating consequences; namely incontinence. Timely, satisfactory repair of OASIS is necessary to mitigate the risk of maternal morbidity. Primary repair is typically undertaken by an obstetrician. In cases of profound anatomical disruption, the on-call surgeon may be called. The aim was to explore the experience and current practice of surgeons in the acute repair of OASIS.

Methods
A cross-sectional, observational study was performed. Registrars and consultants who participate in an on-call rota in the UK were included. The survey was disseminated to members of ASGBI and ACPGBI. It was also advertised via social media platforms, including Twitter and LinkedIn. A chain-sampling method was advocated. A descriptive analysis of the data was undertaken.

Results
318 responses have been recorded so far. 32% of surgeons had been contacted to assist in an acute repair, of which 23% had a specialist interest in pelvic floor surgery. Of those who were contacted, 53% would typically be called for a 3c or 4 tear. Of these, 73% had not performed any primary repairs over the preceding year. 77% of all respondents had not received any training. Of those awarded the FRCS, 36% were not confident at all in performing an acute repair.

Conclusion
There remains a lack of consensus on who is responsible for the repair of these injuries. Surgeon involvement should only occur if adequate exposure and training is assured. Involvement may be reserved for cases where secondary repair is considered, when specialist pelvic floor opinion should be sought.
WP7.6 - Unplanned Re-admisisons - How are we doing; Phase 1 study
Authors: Laulloo Sufia , Connell Benedict , Barnes Stephanie , Laulloo Faqih , Ilayaraja Rajendran 
Published: September 2024

Abstract

Introduction
30-day unplanned re-admissions provide an indicator of performance in the NHS Framework. Average readmission rate is around 15 to 17%, however surgical re-admission is less published. Therefore, a study was set up to assess the factors influencing surgical re-admissions in a Tertiary Centre.

Methods
Retrospective study of prospectively collected data from the tertiary centre database including all ‘Unplanned Re-admissions’(URA) aged &gt;15 years in general surgery between January and December 2022. URA &lt;15 years old and to other surgical specialties were excluded. ANOVA test and descriptive statistics were used to analyse the data.

Results
289 (58%) of 498 readmissions were URA with 150 (52%) female and 139 (48%) male. 57 (19%) were aged 15-30 years, 121 (42%) 31-60 years, 109 (38%) 61-90 years and 2 &gt; 90 years (Median age 54 years; p&lt;0.05). 191 (66%) were from ED, 84 (29%) were GP referrals, 10 (3%) from clinics and 4 (2%) transferred from network. 178 (62%) URA were within 10 days of discharge, 72 (25%) between 11-20 days and 39 (13%) &gt; 20 days (p &lt; 0.05). The commonest cause of URA was biliary diseases (n = 40, 14%) followed by lower (n=32, 11%) and upper abdominal pain (n=17, 5%) and nonspecific abdominal pain (n=22, 7%). Other causes included appendicitis (n=8, 3%), pancreatitis (n=8, 3%), post-op complications (n=14, 5%) and obstruction (n=24, 8%).

Conclusions
URA significantly impacts health care provision and patients’ confidence. An initial study has identified reasons and patterns of re-admissions, the next phase involves analysing specific reasons to mitigate factors leading to URA.
WP7.7 - TRUST: Transvaginal Ultrasound for Surgery Evaluation and Treatment. The use of invasive tests in the right iliac fossa surgical pathway
Authors: Rankin Sally , Badminton Rebecca , Saia Laura , Tudball Daisy , Gurung Fiona , Taylor Lucy , Slim Naim , Okocha Michael 
Published: September 2024

Abstract

Transvaginal ultrasound (TVUS) is an invasive intimate test with strict guidance on its utilisation. This tool is commonly used in General surgery (GS) as a decision aid for operative or non-operative management.

Aims
Ensure patient selection for TVUS was equivalent in Gynae and GS pathways. Determine the influence of TVUS on the decision to operate. Ensure patients were consented adequately comparatively between general surgery and gynaecology.

Methods
This was a mixed methods study with retrospectively collected data from 1400 woman undergoing TVUS for RIF pain presenting to Gynae or GS in a DGH. Interviews were conducted with 50 GS and 50 Gynae patients. Ultrasound, blood, and histology results were reviewed. A positive GS TVUS was defined as free fluid or appendicitis, Gynae pathology was excluded. Interviews consisted of 8 likert scale questions on the process. Ethical approval was given by the hospital ethics committee.

Results
A total of 1445 patients were included (825 admitted under GS and 620 under gynae). Median age for the GS cohort was 28 and gynae 31 with no statistical difference in baseline characteristics. TVUS was positive in 14.8% of GS patients. Positive patients were more likely to proceed to laparoscopy (OR 2.43, 95% CI 1.46-4.03, p &lt;.05). 50% of these had histologically confirmed appendicitis. Similarly, patients with raised WCC or CRP were more likely to proceed to laparoscopy (OR 1.87, 95% CI 1.26-2.76, p &lt;.05); 56% had histologically confirmed appendicitis. There were no significant differences interviews.

Conclusion
TVUS remains an invasive tool, with similar diagnostic profile to blood tests. Careful consideration should be given to its use.
WP7.14 - The change of a DGH emergency surgical service leads to marked improvements in timing of cholecystectomy for gallstone pancreatitis, in line with international guidance
Authors: Ainley Paul , Kerr Barry , Davis Helen , Gallagher Charles , Byrnes Colman , McAree Barry 
Published: September 2024

Abstract

Background
International Association of Pancreatology (IAP) guidelines recommend that cholecystectomy should be performed on patients with mild biliary pancreatitis during their index admission. This retrospective study compares how a paradigm shift in the provision of emergency surgical services in one district general hospital (DGH) significantly improved ability to follow this guideline. With input from the surgical ambulatory emergency care network (SAEC), our team transformed care via an Emergency Surgery Unit (EmSU) system. This includes surgical assessment with ambulation, linked radiology slots, semi-emergency theatre lists twice weekly in addition to NCEPOD theatre and the emergency take divided in two according to sex of patient ensuring appropriate patient load for each of the surgeons of the week.

Methods
A retrospective study of patients with mild biliary pancreatitis for three years before (n = 107) and after (n=108) the EmSU system. Cholecystectomy on index admission was recorded, as was overall time to surgery (days). Data was analysed using GraphPad Prism Version 9.5.1. Data is expressed as Mean + SEM. Percentages underwent Arcsine transformation prior to inferential analysis. Groups of data were analysed using Students T-Tests.

Results
The percentage of patients operated on index admission increased 13.1-fold (4.8% to 62.9%; P &lt; 0.01).
Days to surgery saw a 10.1-fold reduction (332.5 + 41.1 to 32.9 + 6.3 days; P &lt; 0.0001).

Conclusions
Adoption of our EmSU system has drastically improved care for patients with gallstone pancreatitis, now closer to best practice guidance. Further improvement is likely with increased buy-in from all members of staff.
WP8.5 - Operative Documentation of Laparoscopic Appendicectomies at FVRH based on GIRFT - An Audit
Authors: Ng Alvin Yuan Liang , Macpherson Laura , Mehta Arnav , Graves-Morris Katie , Wilson Michael 
Published: September 2024

Abstract

Introduction
Laparoscopic appendicectomy (LA) is the most performed abdominal surgery in the UK. Clear documentation is required to ensure safe and effective patient care.

Aims
To assess compliance with LA operative documentation at Forth Valley Royal Hospital using Getting It Right First Time (GIRFT) guidelines.

Methods
27 data points selected from GIRFT Guidelines were examined retrospectively for 172 LA procedures between 01/08/2022 and 29/09/2023. Completed numbers and percentages for each data point were calculated.

Results
Most consistently documented data points were intra-operative findings 168 (98%), details of closure 168 (98%) and method to secure appendix stump 161 (94%). Least consistently documented were drain insertion 7 (4%), estimated blood loss 5 (3%) and instructions for suture removal 6 (3%). 6 (37%) operative notes explicitly confirmed whether the appendix was removed in those with a macroscopically normal appendix.

Conclusion
Many data points had a high completion rate, whilst others had a low completion rate. We have highlighted discrepancies in documentation between surgeons which the department is hoping to streamline to avoid any gaps that could have patient care, legal or cost implications in the future.
WP8.7 - Systematic review and meta-analysis of interventions to improve the informed consent process for patients undergoing invasive interventions
Authors: Clements Joshua , Clements Jake , Convie Liam , Clarke Mike , Kirk Stephen 
Published: September 2024

Abstract

Aims
This systematic review and meta-analysis aimed to assess the impact of various information based interventions used during the informed consent process for adults (over 18 years) with capacity undergoing invasive procedures.

Methods
The systematic review was conducted according to the predefined protocol developed and registered on PROSPERO (CRD42023380406). The Cochrane risk of Bias (ROB) tool was used to assess study quality. Effect measurements were assessed using standard mean differences and risk ratios for continuous variables and dichotomous variables respectively. Meta- analyses were performed using Review Manager (RevMan) version 5.4.

Results
127 studies contributing 15022 patients met the inclusion criteria from 22 countries. 120 studies were conducted in an elective setting across a variety of surgical, radiological, endoscopic, oncological, and medical disciplines. Statistically significant improvement was demonstrated in objective (SMD 0.45, (95% CI 0.14 to 0.77) I2=86% and subjective understanding (SMD 0.62, (95% CI 0.28 to 0.96) I2=74%, immediate (SMD 0.68 (95% CI 0.53 to 0.83) I2=81%, short (SMD 0.70, (95% CI 0.43 to 0.97) I2=83% and long-term knowledge (SMD 0.57, (95% CI 0.30 to 0.84) I2=82% and satisfaction with the informed consent process (SMD 0.32, (95% CI 0.19 to 0.45) I2=78%.

Conclusions
This review provides a global overview of the impact of various intervention modalities employed to enhance the informed consent process with demonstrable improvement in a variety of outcomes measures. Where available, consideration should be given by clinicians to the use of such adjuncts during the informed consent process.
WP8.10 - Ultrasound Cannulation Training Programme: Quality Improvement Project
Authors: Horner Nathan , Bruce Nikki , Dornan Ronnie 
Published: September 2024

Abstract

Aim
Familiarisation with ultrasound skills can be very useful. This reduces stress for patients from multiple access attempts and preserves venous access. In our District General Hospital (DGH), no teaching on ultrasound-guided venous access was available. Our aim was to create a formal training programme on ultrasound-guided venous access for junior doctors.

Methods
Discussions were held with the medical education team at our DGH to understand how to organise a formal teaching programme. The interest of junior doctors was gathered through informal discussion. Those interested were then asked to complete course evaluation forms. Data was gathered on experience using ultrasound, confidence (out of 5) in performing ultrasound cannulation, and usefulness of the session (out of 5).

Results
Of the 49 participants, only 65% (n=32) filled in the course forms. Data was only analysed from these individuals. 47% (n=15) had previous experience using an ultrasound machine. Of the 32 participants analysed, 87.5% (n=28) felt the session was very useful and the other 12.5% (n=4) found the session to be useful. 100% (n=32) felt more confident performing ultrasound-guided access after the session. The average confidence score pre vs post-session was 1.59/5 vs 3.88/5, respectively.

Conclusions
This programme can improve confidence in procedural skills amongst junior doctors, whilst also minimising stress for patients of multiple access attempts. Though the sample obtained was small, it is clear to see increased confidence in participants, regardless of prior experience. The results obtained will be critical in continuing this programme in our hospital and hopefully roll out to a wider audience.