bluuebunny/crossref_metadata_2025_split huggingface dataset:
FP8.10 - Sustainability in Hand Surgery
Authors: Dias Ana , Sebastiao Alexandra , Kennedy Grace , Dunlop Rebecca 
Published: September 2024

Abstract

Aims
Carpal tunnel release surgery (CTR) is a widely performed procedure in the NHS with significant contributions to waste and carbon emissions within surgery. 36,704 CTRs were preformed from 2022-2023 with an average carbon footprint of 12.0 kg CO2e. The aim of this quality improvement project is to reduce the carbon footprint of CTR through a lean and green model, and examine the rates of infection with this model compared to standard practice.

Methods
Retrospective data was collected for CTRs performed at the Royal Cornwall Hospital between 31/05/2022 and 01/02/2023 for the first audit cycle using standard set up and equipment. The primary outcome was rates of infection post-CTR. The lean and green model included reducing the number of instruments in the handset (36 items to 14 items), use of a smaller drape, and no gown for the procedure. The second cycle will be examining rates of infection following this intervention.

Results
Out of 100 patients in the first cycle, 1 patient was treated with antibiotics via a General Practitioner telephone consultation. These eco-changes were well received by staff members, with significant waste reduction this far (over 50 gowns and 25 aperture drapes). Data collection for the second cycle is currently underway.

Conclusions
CTR surgery is a commonly performed procedure with significant contributions to waste and carbon footprint within surgery. Through simple and low-cost changes to current practice we can promote sustainability in surgery and have a lasting positive impact on the environment.
EP4 - Beyond the Surface: A Comprehensive Clinical Audit of Radiological Studies in Mastalgia
Authors: Borg David , Borg Justine , Zammit Clive , Borg Luke , Galea Joseph , Farrugia Ronnie , Agius John 
Published: September 2024

Abstract

Aims
Breast pain is a common symptom in women, frequently presenting to primary care physicians and breast specialists. Despite its prevalence, the causes and optimal treatment of mastalgia often remain unclear (1).

Methods
We established predefined inclusion and exclusion criteria to create a patient cohort comprising individuals who underwent radiological investigations for mastalgia between January 2021 and December 2021.

Results
The choice of initial investigation varied based on the patient's age and clinical examination findings. Mammography was the initial investigation for 91 patients (55.49%), while 73 patients (44.51%) underwent ultrasound examinations. No patients required histological investigations due to the absence of significant findings suitable for biopsy.

Conclusions
Our results suggest that diagnostic imaging for breast pain does not significantly contribute to increased cancer detection. This observation held true when we stratified the data by patient status, age, gender, and imaging modality. Notably, the rate of cancer diagnoses in our audit population was 0%, which contrasts with international literature reporting rates within the range of 0-3% (9)(10).
Our findings highlight the concern of overutilization of diagnostic imaging in healthcare settings. Furthermore, it underscores that normal test results do not necessarily offer reassurance to patients and can sometimes increase their anxiety levels (10)(11).
EP24 - Ileal metastasis masquerading as Crohn’s in lobular carcinoma of the breast, years after initial treatment- a rare case and review of literature
Authors: Haji Altaf , Vijayaraghavalu Shashikanth , Sivakumar Naveen , Zehra Sadaf , Lourdusamy Selvam , Kalimuthu Marimuthu , Piramanayagam Bala 
Published: September 2024

Abstract
Gastrointestinal (GI) metastases masquerading as Crohn’s years after treated lobular carcinoma of breast is a diagnostic challenge. In some cases, the interval between the primary breast cancer and gastrointestinal metastasis is so long (3- 20 years) that the medical records for diagnosis including history might be missed. The susceptibility of invasive lobular cancer (ILC) to metastasize to gut is many times greater than invasive ductal carcinoma (IDC) (4.5% versus 0.2%, respectively). We report the case of lobular breast carcinoma metastasizing to the terminal ileum and ileocecal junction 7 years following treatment of right sided lobular breast cancer in 60 plus-year-old women. Radiological and endoscopic findings can be difficult to distinguish from inflammatory bowel disease or from primary carcinoma of the GI tract. Histopathological and immunochemistry assessments usually help in reaching the diagnosis. A high index of suspicion and awareness regarding such presentations can help in making an accurate diagnosis and subsequent treatment planning.
EP41 - A Terrorist drone attack: A tragic experience with learning potential
Authors: Almoshantaf Mohammad Badr 
Published: September 2024

Abstract

Introduction
A drone strike struck at the Homs Military Academy on October 2023. The strike injured over 277 persons and killed at least 89.
One nearby public hospital was the first to receive the first wave of casualties. With a very limited staff and resources, huge efforts were employed to save as many lives as possible even if this meant breaking common protocols.

Purpose
to remind doctors, especially surgeons that desperate times call for desperate measures and wise judgment is critical in the darkest times.

Overview
Right after receiving the tragic news of the incident, the hospital declared to give up paperwork, discharge observational admissions, stop non-life-threatening admissions, assign non-clinical staff to assist clinical staff, and call for off-duty workers. As injuries started to present, the hospital prioritized head, thorax, and abdominal injuries. The nurse workforce was assigned to manage the minor injuries while doctors focused on the major ones. While treating and operating on patients, the healthcare providers overlooked sterilization protocols. Due to a shortage of operation rooms, surgical teams have performed operations on some patients in non-operative rooms without monitors, relying solely on IV anaesthesia and portable oxygen cylinders. Some have died, some have suffered from a lifetime disability, yet the prioritizing mentality has saved a lot of lives that day.

Conclusion
Adhering to protocols is essential. However, many experienced surgeons have come across numerous puzzling situations for which there are no clear standards. We stress the need for a surgeon to take action during these challenging periods and act with their wise judgment.
EP94 - Occurrence of Clavicle Tumors and its Surgical Outcome
Authors: Vasantha Rahul Ananda , Shankar Kiran 
Published: September 2024

Abstract
Clavicle tumors have an occurrence of around 1% of all bone tumors. They have a very limited literature regarding their features and outcome which makes the treating physician face a big diagnostic obstacle. This study aims to provide a systematic review on the clinicopathological characteristics and the management outcome. Twenty seven cases of primary clavicle tumors were studied and analyzed during 2021-2023. All cases underwent the initial investigations and were confirmed on histopathology. The Age, sex, location, type and surgical outcome was analyzed and compared.
Malignant tumors were found in 55.6%of the cases, 44.4% were benign.
The histopathological types in this group were osteosarcoma(9 cases),giant cell tumour(6 cases),Ewing sarcoma(5 cases), Aneurysmal Bone Cyst(4 cases), Simple bone cyst(2 cases),Mixed fibroma(1 case). Majority were located in the sternal end and the middle area was the least. Complete or Partial Claviculectomy was done in all our cases. Resection of the medial end/partial claviculectomy was done in 66.6% of the total 18 cases and 33.33% of the cases were giant cell carcinoma (6 cases), no complications found post operatively.
The patients were examined for functioning and adequacy of the involved limb and the end result of all were satisfactory. No patients had any limitations in their daily activities and all patients had a full range of motion. No neurovascular deficit was found. Reconstruction of any manner was not required following claviculectomy which is supported by the above assessed report. Our study also highlights that the dispersal of tumors in the clavicle is quite different as compared to long bone tumors.
EP127 - Audit on Acute PR Bleed Admissions to the Surgical Assessment Unit and the Use of the Shock Index and Oakland Score
Authors: Arshad Serish , Lockwood Sonia 
Published: September 2024

Abstract

Aims
The British Society of Gastroenterology recommend using the Shock Index (SI) and Oakland Score (OS) as an assessment tool to safely discharge patients presenting with acute PR bleeding. This study audited the use of these scores in the surgical assessment unit (SAU) of a large teaching hospital.

Methods
A retrospective list of patients presenting to SAU in October and November 2023 and their main presenting concerns were sought. Patients presenting with PR bleeding were identified and their notes reviewed. Data including age, sex and use of OS and SI were retrieved. OS and SI was calculated. A threshold of ≤1 for SI and ≤8 for OS was used for safe discharge. A threshold of ≤8 for OS equates to a 95% safe discharge probability.

Results
44 PR bleed admissions were identified but 7 excluded due to known cause. 18/37 were male and 19/37 females. The median age was 53, with interquartile range 33-76. On surgical clerking, 0/37 patients had SI documented and 1/37 patients had OS calculated. 3 further patients were excluded due to lack of clinical information. No patient had SI over 1. 12/34 (35%) patients were managed appropriately. OS (threshold ≤8) identified 20/34 (58.9%) were incorrectly discharged. 2 other patients inappropriately had a CTA: one could have been safely discharged and the other managed with inpatient endoscopy.

Conclusion
Currently, discharges of PR bleed presentations to General Surgery does not follow national guidance. The validated OS should be used to provide a safe and objective tool for discharge.
EP187 - Can appendiceal adhesions cause small bowel obstruction? A rare case presentation managed laparoscopically
Authors: Pal Shreya , Pangeni Anang , Allu Veera 
Published: September 2024

Abstract

Aims
Adhesions are the commonest cause of small bowel obstruction world-wide. However, a band adhesion from the appendicular tip to the small bowel causing small bowel obstruction is rarely reported in literature. We report such a presentation and successful management by laparoscopic approach with good outcome.

Methods
61-year-old female, presented with abdominal pain, mild distension & vomiting for 3-days. She had undergone ultrasound-guided-drainage of appendicular abscess 3-months ago. CTAP showed small-bowel obstruction with transition point in pelvis - possible cause being adhesions. After initial conservative management, since she was not improving for 2-days, she was consented for diagnostic laparoscopy.

Results
Intraoperatively, an adhesive band was found between the appendicular tip and distal ileum around 100cm proximal to Ileo-colic junction, resulting in mechanical bowel obstruction.
Laparoscopic division of band was performed followed by appendicectomy, and patient had an uneventful recovery and discharged on post-operative day-2.

Conclusion
Though an uncommon cause of adhesive small bowel obstruction, a band from appendicular tip causing mechanical bowel obstruction can be managed effectively by laparoscopic approach. In future when dealing with complications of appendicitis, like appendicular abscess - it needs to be addressed with clinical suspicion in such presentations.
EP194 - Colorectal cancer TNM staging: A single centre Cohort Study
Authors: Gok M A , Bughio M , Riaz K , Aris R , Sadat M M , Khan U A 
Published: September 2024

Abstract

Aims
AJCC has replaced Dukes staging with TNM classification for colorectal cancer. It relies on characteristics of primary tumour(T), regional lymph nodes involvement(N) and metastasis(M). Aim of study to assess prognostic value of TNM staging at a single centre.

Methods
Cohort study evaluated post-operative outcomes in malignant CRC resections from Jan'2008 to Jan'2024. Descriptive demographic data was obtained for stage 0, 1, 2, 3 & 4 CRC disease.

Results
Stage 0(n = 25) 1(n = 373) 2(n = 564) 3(n = 603) 4(n = 96) Kruskall Wallis(p value) Age(yrs) 55.0 69.2 72.4 70.1 71.3 &lt; 0.0001 Sex(M:F) 10 : 15 214 : 159 307 : 257 340 : 263 54 : 42 NS ASA(median) 2 2 2 2 3 &lt; 0.0001 BMI 27.5 27.5 26.2 26.5 24.9 NS Lap (n) 21 244 306 318 53 &lt; 0.0001 Op time(mins) 114.9 198.3 176.2 179.9 88.0 &lt; 0.0001 LOS(days) 2 ± 2.5 7 9 8 8 &lt; 0.0001 LN(n) 12 14 17 18 14 NS Mortality(n) 30 D 1 8 21 16 8 60 D 1 10 26 26 18 90 D 1 11 28 28 23 Surv rate(%) 1styear 96.2 96.1 92.4 86.1 43.6 5thyear 84.8 86.7 77.2 63.8 16.7 10thyear 84.8 76.5 67.2 58.2 13.0 Logrank 15thyear 84.8 72.9 63.7 55.8 0 p &lt; 0.0001

Conclusion
Short & long term survival rate decreases with worsening TNM stage. Stage 0 CRC disease were younger, with shorter LOS. Clinically TNM staging of colorectal tumour usually dictates treatment modality (surgery, radiotherapy, chemotherapy, immunotherapy), whereas pathological classification estimates prognosis.
EP198 - Negative appendicectomy: A cohort study
Authors: Gok M A , Bughio M , Yim S , Khan S , Riaz K , Khan U A 
Published: September 2024

Abstract

Aims
Negative appendectomy is charaterized as removal of normal appendix histopatholigically. Diagnosis of appendicitis remains a challenge, despites improved diagnostic algorithms (including scoring systems, serological & radiological tests), negative appendectomy rate remains &lt; 20%. The aim of the study is to assess negative appendicectomy at a single centre.

Methods
Cohort study was carried out on all appendicectomies from Mar’2020 to Jan’2024. Descriptive demography & post-operative outcomes were evaluated for negative appendicectomies (Histopathological HPA confirmed normal appendix), all other appendicectomies (HPA confirmed appendicitis) were recruited as controls.

Results
Normal HPA(n = 41) Appendicitis HPA(n = 477) Mann-Whitney U(p value) Age(yrs) 26.4 36.7 &lt; 0.005 Sex(M : F) 16 : 25 235 : 242 NS BMI(kg/m2) 24.7 25.5 NS GP 8 135 NS A & E 33 342 NS WCC(x109/L) 10.7 13.5 &lt; 0.0001 CRP(mg/L) 43.4 ± 10.5 68.3 ± 3.9 &lt; 0.005 Open(n) 0 8 NS Lap(n) 41 469 NS ASA(median) 1 1 NS Diagnostic(n) Clinical 0 33 USS scan 23 117 &lt; 0.001 CT scan 18 327 &lt; 0.01 AB (days) Inpatient 2 ± 0.5 2 ± 1 NS Discharge 0 ± 2 ± 2.5 &lt; 0.005 Operation time (mins) 66.2 75.7 &lt; 0.01 LOS (days) (med) 2 2 NS Appendix HPA (mm) Length 62.4 67.0 NS Diameter 8.6 11.5 &lt; 0.0001 Cost (£) 3376 4341 &lt; 0.05

Conclusions
Despite radiological diagnostics, the negative appendicectomy rate was 7.9 %. Laparoscopy offers an additional diagnostic modality especially in women & post op recovery is quicker. The negative appendicectomy rate has been declining in recent years, but cannot be abolished. A negative appendicectomy rate of &lt; 10 % must be deemed acceptable, to achieve a 90 % therapeutic appendectomy (HPA confirmed appendicitis) rate.
EP244 - Improving communication and accessibility to surgical doctors with introduction of a baton bleep system
Authors: Gurung Ishani , Spellar Kayleigh , Halme Helmi , Sharma Anita , Beaton Ceri 
Published: September 2024

Abstract

Aims
Communication between allied health professionals and doctors is vital to patient care. When not effective and delayed, patient safety is at risk due to failure of critical information being shared resulting in medical errors. Within general surgery at our trust there are three surgical teams, with 25 doctors holding individual bleeps. Due to shift patterns, contacting the correct doctor for the correct team has resulted in concerns of poor accessibility. A team baton bleep system was therefore introduced to improve communication.

Methods
A baton bleep was introduced to each of the three surgical teams, with a doctor from each team being allocated each day. Information was sent to allied health professionals and doctors to make them aware of the new bleep, with posters places on all surgical wards. A qualitative survey was created for allied health professionals and one for doctors to assess perceived effectiveness of the new system.

Results
16 members of the surgical team were surveyed, over half found the bleep system helpful with 69% agreeing that it improved communication and collaboration within the team. 12 allied health professionals were also surveyed, 67% were satisfied with the new system. The main suggestion for improvement overall was to clearly document in the ward notes the consultant and team responsible for each patient.

Conclusions
A baton bleep system appears to be helping enhance communication and streamline workflow within the department through improving accessibility of surgical teams which is crucial for effective patient care and timely responses to critical situations.
EP274 - A clinical audit on nasogastric tube placement documentation and adherence with NICE guidelines in general surgical patients across a district general hospital
Authors: Vickers Corinna , Mukhtar Insha , Dhavala Pooja , Arbis Alexander 
Published: September 2024

Abstract

Aims
NICE provide clear guidelines on confirming correct nasogastric (NG) tube siting using pH testing of aspirates or with X-rays where indeterminate samples are drawn. We aimed to audit documentation following nasogastric tube insertion to ascertain adherence to NICE guidelines.

Methods
A single-cycle snapshot audit was conducted on all surgical inpatients who had nasogastric tubes inserted over their admission across a single-centre district general hospital general surgery department. Data was collected on indication for NG tube insertion (drainage or feeding), length of initial tube insertion, whether pH testing was used to confirm position, and whether correct tube placement has been confirmed by a competent person through x-ray where indeterminate samples were tested from NG aspirate (pH &gt; 5.5).

Results
A total of 15 patients had an NG tube inserted over their admission with mean age 77.3 years (range 47-97). 60% of patients had correctly documented confirmation of NG tube siting. 4/15 NG tubes were inserted for feeding purposes (26.7%), all of which were documented correctly. Only 45.5% of NG tubes for drainage were documented correctly and only 33.3% of all NG tubes had length of insertion documented. Where pH testing was inconclusive, a chest X-ray was requested for all patients and sufficiently documented by a doctor qualified to confirm position. No complications relating to NG tubes occurred across the audit study.

Conclusions
Implementation of improvement measures are warranted to improve overall adherence with NICE guidelines and prevent risk of incorrect confirmation of NG tube siting.
EP291 - Drinking, Eating, Mobilising after elective colorectal surgery- ‘DrEaMing’, a CQUIN project
Authors: Khan Nida , Singh Anurag , Janakan Gnananandan , Hodge Sarah , Adhya Sushmit , Alnabhan Ahmad 
Published: September 2024

Abstract

Introduction
DrEAMing- Early drinking, eating and mobilising after elective surgery, is a simplified and key part of enhanced recovery programmes. It helps decrease post operative complications and length of hospital stay. It also helps reduce the backlog of patients waiting for surgery.

Objectives
As per commissioning for quality and innovation (CQUIN) 2023/2024 guidelines, our aim was to ensure that at least 80 percent of patients are supported to DrEaM- Drink, Eat, Mobilise, within 24 hours of surgery. Our audit includes only colorectal surgeries.

Methods
21 patients underwent elective colorectal surgery from July-September,2023. Patient’s notes, post operative notes and nursing notes were analysed to identify the inadequacies in each of the three limbs of DrEaMing.

Results
Free fluids were ordered for 21/21 (100%) and administered to 17/21 (81%) patients. Food was ordered for 16/21 (76%) and given to 12/21(57%) patients. Lastly, 16/21 patients had orders for mobilisation and 10/21 (48%) were supported for the same. The results were discussed at clinical governance meeting and interventions were advised for better implementation and compliance to guidelines.

Conclusion
There is a deficiency in effective implementation of DrEaMing project and this can be improved by better communication between surgeons and nurses. Surgeons should clearly document patients who aren’t suitable for enhanced recovery programme. We also requested changes to the built operative notes about post operative orders so that the instructions are not missed. We intend to adopt these measures and repeat the cycle of this QIP.
EP335 - Audit of the Use of WHO Surgical Safety Checklist and its Awareness, Perception and Acceptability Amongst Theatre Personnel in a Tertiary Hospital in Sub-Saharan Africa
Authors: Amusat Olanrewaju , Soneye Oluwafunmilayo , Ogundipe Habeeb , Ekwuazi Hyginus , Ogunlade Samuel , Adedeji Olufunso 
Published: September 2024

Abstract

Aims
The World Health Organization Surgical Safety Checklist (SSC) was developed to prevent perioperative adverse events. This study aimed to assess the utilization of the SSC and evaluate awareness and acceptability among theatre staff at a tertiary centre in sub-Saharan Africa.

Methods
We conducted a prospective audit of the SSC utilization during elective and emergency surgery, and a survey of awareness, perception and acceptability amongst theatre personnel (nurses, surgeons and anaesthetists) using a 15-item self-administered questionnaire between May 2022 and January 2023.

Results
117 surgeries were observed for compliance with SSC and 81 theatre personnel took part in the survey. The checklist was used in 52.1% of all surgeries, 80% and 5.4% of major and minor surgeries respectively.
In Time Out phase, activities were stopped in 23% of cases, and scrub nurses were asked relevant questions 31-47% of the time. Sign Out was the least completed phase. Three of five questions were asked 23-48% of the time. 28% of respondents who previously witnessed adverse events agreed that they could have been prevented by proper implementation of the SSC.
65.4% of members of the surgical team had not had any formal training on the SSC. There was no difference in its awareness, perception and acceptability based on profession of the respondents.

Conclusion
SSC was not fully utilized during the audit period. Lack of formal training may be contributory. There is broad awareness of SSC and its ability to prevent advert events.
Key words: WHO, Surgical Safety Checklist, Awareness