bluuebunny/crossref_metadata_2025_split huggingface dataset:
ThP6.12 - Pain relief prescribing in Surgical Emergency Unit triage: are prescribers helping to provide patients with humane care via prompt analgesia prescriptions, and can simple educational interventions improve timeliness?
Authors: Sadler Emma , Pearce Phill , Bond-Smith Giles 
Published: September 2024

Abstract

Aims
The RCEM target for receipt of analgesia for moderate-severe pain is within 15 minutes of arrival in ED. This study aimed to establish if a surgical emergency triage unit was achieving a more generous target of analgesia prescription within 60 minutes of clerking, and whether this could be improved with educational interventions.

Methods
Records of patients presenting to triage were reviewed. Patients were excluded if they did not report pain of any cause, were under 18 years old, or were prescribed adequate analgesia by the referring department. The integrated EPR system enabled straightforward comparison of timestamps for arrival in the department, clerking by a registered prescriber, and first prescription. Data were considered for a full continuous week each time, in late August, and in mid-December 2023. Educational interventions were made between collection periods: a teaching session about analgesia in emergency surgery; a presentation of first round results at a departmental meeting; and ‘postcards’ attached to all workstations highlighting the EPR pathway.

Results
Of encounters in which analgesia was prescribed, there was an increase in the proportion of prescriptions made within 60 minutes of clerking, from 67% to 86%. This increase was observed across all prescriber grades, both rotational and non-rotational.

Conclusions
The precise quantifiable impact of the educational interventions is unclear as the study period spans a changeover for FY1s, but the increase in timely prescription at all grades indicates some effect. This is reassuring from a perspective of considering human patient care.
ThP7.12 - Penetrating Neck Injuries as a form of deliberate self-harm: A Pre and Post COVID-19 Comparison
Authors: McGrath Chloe , Taylor John 
Published: September 2024

Abstract

Introduction
In March 2020, the UK government implemented the first national lockdown to contain the spread of COVID-19. Despite success at curbing infection rates, early studies suggested a rise mental health issues, including an increased incidence of violent self-harm. This included penetrating neck injuries. Limited research is available on the pandemic’s effect on self-harm in the UK.

Methods
Data was collected from self-harm major trauma activations to a regional trauma centre, between 01/01/17 to 31/12/22. All patients identified with neck-related self-harm injuries were included. Demographic information and injury data was grouped for analysis into pre-COVID-19 (2017-19), and post-COVID-19 outbreak (2020-22) groups.

Results
Penetrating neck injuries due to self-harm, post-2019, increased fourfold (12 vs 47). Men were the majority in both periods, but women had a larger proportional increase (men 10 vs 34, women 2 vs 13). Mean ages of Men presenting increased (Men 44 vs 53, Women 36 vs 35)

Conclusions
The frequency of self-harm related neck injuries increased following lock down. Older men were most likely to present, however there was an associated rise in the number of women. We must further investigate the impact the pandemic had on the population’s mental health and tendency towards violent self-harm, particularly in older men.
ThP8.5 - The Incidence and Characteristics of Complications Associated with Peripherally Inserted Central Venous Catheter and Midline Utilisation in Surgical Patients: A Retrospective Cohort Study
Authors: Lu Yanqiang , Tzatzidou Anastasia , Islam Mariam , Strachan Danielle , Smith Tanisha , Cheruvu Chandra , Karategos Athanasios 
Published: September 2024

Abstract

Background
Peripherally inserted Central venous catheters (PICC lines) and midlines are pervasive clinical interventions. However, they are not devoid of adverse events such as catheter-associated thrombosis, mechanical anomalies, catheter-related bloodstream infections, and cellulitis. This study aims to investigate the nature and prevalence of these complications within a high-volume tertiary care centre.

Methods
A retrospective cohort study was conducted, including 473 patients subjected to PICC line and midline insertion within the Department of General Surgery during the period from June 2022 to June 2023.

Results
Over 5949 catheter days, a total of 73 complications were identified, reflecting an incidence rate of 15.43% (12.27 per 1000 catheter days). Notably, catheter-associated infections were predominant, manifesting at a rate of 4.20 per 1000 catheter days (n=25, 5.20%). Accidental withdrawal occurred at a rate of 3.87 per 1000 catheter days (n=23, 4.86%), incorrect positioning at 2.02 per 1000 catheter days (n=12, 2.54%), occlusion at 1.51 per 1000 catheter days (n=9, 1.90%), and rupture at 0.67 per 1000 catheter days (n=4, 0.84%).

Conclusion
The insertion of PICC and midline is associated with a substantial burden of morbidity, primarily characterised by catheter-associated infections. Emphasis on early identification of catheter-associated bloodstream infections is imperative. Mitigating these complications warrants the institution of a multidisciplinary educational initiative to augment nursing proficiency, coupled with the implementation of a local guideline governing PICC line and midline insertion and care.
ThP8.10 - Diagnostic accuracy of aortic dissection detection risk score and D-dimer to rule out aortic emergencies in the emergency department – outcomes from a multicentre study
Authors: Khan Anas , Masoura Constantine , Mitra Anu , Smith Thomas 
Published: September 2024

Abstract

Background
Acute aortic syndromes (AAS) are rare but potentially fatal vascular emergencies affecting the aorta, including aortic dissection, penetrating aortic ulcers, intramural haematoma and occasionally aortic aneurysm rupture. The variety of presentations can make it difficult to decide which patients should have definitive computerised tomography aortogram (CTA) imaging. This study aims to evaluate the diagnostic accuracy of the aortic dissection detection risk score (ADD-RS) combined with D-dimer to rule out AAS in the emergency department.

Methods
This retrospective cohort study involved two centres. Results of patients who had CTAs between 1st March 2020 – 31st March 2022 were reviewed. Patient data including demographics and laboratory results were logged from day of presentation.

Results
A total of 435 CTAs were requested. Patients with diagnosis of AAS had higher mean total ADD-RS (1.6 vs 1.0, P&lt;0.05) and higher mean D-dimer (8,836 vs 1,462ng/mL, P&lt;0.05). The use of ADD-RS≤1/normal D-dimer had sensitivity of 100.0% and specificity of 27.9%. Negative predictive value (NPV) was 100%. In this cohort, there were no false negatives.

Conclusion
This study appears to support the implementation of a new guideline in these departments that incorporates ADD-RS and D-dimer to aid deciding next steps for suspected AAS. In this cohort ADD-RS ≤1 and negative D-dimer (&lt;500ng/mL) had high sensitivity, and low failure rate and could have prevented at least 70 and up to 229 patients from receiving unnecessary radiation. The results suggest that in low-risk patients, with ADD-RS≤1/negative D-dimer, AAS can be safely ruled out. New guidelines could prevent patients receiving unnecessary radiation, contrast induced nephropathy and reduce burden of stretched emergency departments.
ThP8.11 - Causes of delay to surgical interventions in patients with transient ischaemic attack and stroke
Authors: Lee Yeon Joo , Williams Debbie , Slim Hani , Valenti Domenico , Gambhir Raghvinder Pal Singh 
Published: September 2024

Abstract

Aims
The UK National Institute for Health and Care Excellence (NICE) guidelines and vascular society of surgery Great Britain and Ireland (VSGBI) emphasize the importance of scheduling carotid endarterectomy (CEA) within 2 weeks of symptom onset to reduce the risk of recurrent stroke. However the National vascular Surgery report for 2023 showed that this target was met in only 52% of patients. This study aimed to examine the possible causes of these delays.

Methods
This study analysed patient or hospital-derived factors impacting the timing of surgical intervention for patients with symptomatic carotid disease. A retrospective database was established to gather data on CEAs performed during an 8-month interval (January to August 2023) at a major teaching hospital.

Results
36 patients underwent CEA; 13 (36.1%) received the procedure within 2 weeks of symptom onset, while 23 (63.9%) experienced delays. The main reasons for not meeting the two-week timeframe were associated with surgical scheduling, patient presentation, and referral processes. Specifically, among the 23 patients facing delays, 10 (43.5%) were due to surgical scheduling, 6 (26.1%) encountered delays in presenting to medical services, 5 (21.7%) were affected by delayed patient referral or review, and 2 (8.7%) were from lack of patient fitness. None however ended up with recurrent stroke while awaiting surgery on best medical management.

Conclusions
Prompt surgical intervention can reduce the risk of recurrent strokes. 63.9% of CEAs encountered delays, primarily associated with surgical scheduling. Prioritised pooled lists may be the answer.
FP1.5 - Safety and efficacy of Ambulatory treatment of uncomplicated acute diverticulitis: A two-centre cohort study and a proposal of an Ambulatory pathway
Authors: Mohamedahmed Ali Yasen , Issa Mohamed Talaat , Gamage Pulasthi , Patel Nikhil Kieren , Sarma Diwaker , Thomas Pradeep , Husain Najam 
Published: September 2024

Abstract

Aim
This study aimed to assess the safety and efficacy of ambulatory treatment in patients with uncomplicated acute diverticulitis (AD) compared with inpatient treatment.

Methods
This is a retrospective comparative study conducted in two hospitals. All patients presented to the emergency department with CT-confirmed Hichney 1a AD during the period from 01/01/2022 to 31/12/2022 were included in this study. Patients with complicated diverticulitis or CT was not performed were excluded. All patients were followed for 12 months for re-admission and AD recurrence. Data analysis was performed with SPSS 27.

Results
A total of 137 patients were presented during the study period with CT-confirmed Hinchey 1a AD. The median age was 62 (24-94) years old, with a female-to-male ratio of 1.7:1. In the majority of patients (75.9%), WBCS was &lt; 15 and CRP &lt; 100. Moreover, 37.2% had previous AD, and it was complicated in 5.8%. For 12 months of follow-up, 19% of the cases developed diverticulitis recurrence. However, only 1 patient required surgery, and no patient required radiology intervention. No mortality was reported. A luminal investigation (CT colonoscopy or endoscopy) was organized in 61.3%, and colon cancer was detected in one patient. A comparison of patients who were treated as ambulatory (n=35) versus inpatient (n= 102) showed no significant difference regarding re-admission and recurrence of AD (P= 0.22) and surgical intervention (P=0.5) during 1-year follow-up.

Conclusion
With comparable results to inpatient treatment, the Ambulatory treatment of Hinchey 1a AD is safe and feasible and provides a reduction of treatment expenses.
FP3.4 - Identifying missed opportunities in emergency presentations of colorectal cancer to improve patient outcomes
Authors: Charavanamuttu Vidhya , Sargsyan Narek , Vijay Vardhini 
Published: September 2024

Abstract

Introduction and Aim
A significant proportion of patients diagnosed with colorectal cancer are diagnosed during emergency admissions with presentations such as bowel obstruction, perforation and bleeding. Despite increasing numbers of suspected colorectal cancers referrals from the community being sent straight to test, the proportion of patients presenting as emergencies in the United Kingdom remains at20%.
Emergency presentations of colorectal cancer are associated with significantly worse outcomes – both short- and long-term, with research suggestive that emergency presentations remain an independent poor prognostic factor following curative colorectal resection.
This study aims to assess if patients diagnosed with colorectal cancer following emergency presentation had missed opportunities of diagnosis on previous presentations in secondary care.

Methods
A database of patients who have been diagnosed with colorectal cancer following emergency presentation from January2020-October2023 was analysed. Previous attendances to the emergency department and outpatient department were identified and assessed for symptoms of colorectal cancer – including abdominal pain, change in bowel habits, rectal bleeding and iron deficiency anaemia – and if these prompted investigation.

Results
Of 100 patients – 6were identified that had previous presentations with symptoms suggestive of colorectal malignancy. 2 had been reviewed in colorectal clinic prior to their diagnosis, with appropriate planned investigations but were lost to follow up. A further 4 had been seen in ED with symptoms of colorectal cancer but further investigations were not performed.

Conclusion
The majority of patients diagnosed with colorectal malignancy following emergency presentation had no earlier opportunities of diagnosis in secondary care. Further work needs to be done ensuring the continuity of care of patients following discharge from both the emergency department and clinic.
FP3.11 - Postoperative ileus (POI) in colorectal cancer resections: A cohort study
Authors: Gok M A , Bughio M , Mathieson N O M , Yim S , Sadat M M , Khan U A 
Published: September 2024

Abstract

Aims
Postoperative ileus (POI) has reported incidence of &lt; 30 % in malignant colorectal surgery. POI leads to delayed recovery, increase morbidity, prolonged hepatization & increased healthcare costs. Aim of study is to assess management of POI at single centre.

Methods
Cohort study was carried out from Jan'2008 to Jan'2023. Descriptive demography & post-operative outcomes were evaluated for POI patients, with non-ileus used as controls.

Results
Ileus (n = 275) Non ileus (n = 1436) Mann Whitney U (p value) Age(yrs) 71.8 70.1 NS Sex(M:F) 191 : 84 766 : 670 &lt; 0.0001 ASA(median) 2 2 NS BMI(kg/m2) 26.9 26.4 NS Elective () 209 1139 Emergency(n) 66 297 Laparoscopic(n) 140 819 Open(n) 135 617 LN harvest(n) 12 12 NS Complications (n) (%) Leaks 14 52 HAP 64 125 Anaemia (transfusions) 10 43 Wound infections 41 115 Collection 27 69 Sepsis 37 49 Operation time(mins) 186.0 172.8 &lt; 0.05 LOS(days) 14 ± 6 7 ± 3.5 &lt; 0.0001 POI onset(days) 5 ± 2 NG tube(days) 3 ± 1 POI diagnosis (n) Clinical 62 AXR 70 Gastrograffin 64 CT scan 113 Mortality (n) 30 day 10 48 60 day 16 68 90 day 18 80 Survival rates (%) 1st year 89.0 87.6 Logrank 5th year 73.5 70.5 P = NS 10th year 64.3 62.4 (uncensored) 15th year 62.1 59.2

Conclusion
POI occurred in 15.6 % of all CRC resections. Prolonged operative time, resulted in ileus, but did not adversely affect survival. POI can be diagnosed clinically or radiologically. POI resulted in prolonged hospitalization. Early diagnosis & intervention (NG tube decompression, fasting, IV fluids, gastrograffin & prokinetics) is key to reducing the adversity of POI
FP4.3 - Right sided colonic cancers – to tattoo or not to tattoo?
Authors: Reid Rebecca , Magee Conor , Wilson Jeremy 
Published: September 2024

Abstract

Aim
Current evidence suggests that endoscopic tattooing for colonic cancer is associated with higher lymph node yield. However, the ACPGBI and BSG guidelines do not recommend tattooing for caecal tumours. Our aim was to identify whether tattooing in right sided colon cancers was associated with higher lymph node yield and if tattooing should be standardised for all colonic cancers.

Methods
Retrospective review of all patients endoscopically diagnosed with colonic cancer who underwent surgery between April 2018 to March 2021 at a single DGH. Patients with synchronous or rectal cancers, neoadjuvant therapy and emergency resections were excluded. All data were collected from Somerset database and electronic patient records.

Results
224 patients with colonic cancers were identified; 110 with tattoo and 114 without. Overall, there was no statistical difference in lymph node yield with tattoo vs no tattoo (mean 21 v 20, p=0.141). There were 92 patients with right sided cancer; 30 with tattoo and 62 without. There was significant difference in lymph node yield (mean 24 v 20, p=0.018). 10 out of 42 patients with caecal cancer were tattooed with statistically greater lymph node yield (26 v 20, p=0.016).

Conclusion
Whilst small sample sizes make interpretation challenging, our nodal yield results for right sided and caecal cancers with tattoo suggests significant difference in lymph node yield which could promote standardised use of tattooing throughout the colon. We recommend further analysis with a larger sample size to assess whether there is true difference.
FP4.6 - A Re-audit on the completion of pathology request forms following Colorectal Cancer Resection
Authors: Umenze Franklin , Saraee Danial , Khadka Subodh , Coup Andrew , Kaur Geetinder 
Published: September 2024

Abstract

Aim
Good Histopathology is key to accurate staging for Colorectal cancer. The Royal College of Pathologists have outlined a number of important parameters to detail on the pathology request form following colorectal cancer resection surgery including confirmation of specimen, diagram, approach, dissection plane, part of BCSP, biopsy details, pre-operative chemoradiotherapy, history of IBD/familial cancer and pre-op staging. The aim of this re-audit was to detect any improvement in our adherence to these guidelines in comparison with our 2019 audit.

Method
The forms for all colorectal cancer resections performed from 2019-2023 were interrogated for the various parameters using pathology software DART.

Result
Of 1615 cases, 320 were included. 30% mentioned the approach versus 78% in the previous audit. Diagrams were completed in 36% compared to 44% previously. Conversely, only 4.5% in the previous audit had information on preoperative therapy, as compared to the current 20%. There were marginal improvements in information on screening, familial cancer and IBD. In addition, the degree of completion showed significant difference in some parameters in the case of consultants who emphasized on correct completion of forms (e.g. 97% included type of surgery, 91% had diagrams).

Conclusion
It is important to complete the Colorectal cancer resection pathology forms according to recommended standards to enable the pathologist to provide accurate tumour staging and thus guide appropriate management. Disappointingly, we did not find significant improvement in our adherence to the recommended standards as compared to our previous audit. We therefore need to focus on wider scale education and ensure implementation of newly designed forms with active consultant involvement and a re-audit.
FP4.10 - Oncosurgical Outcome Differences of Left and Right Colonic Cancer Resections Still a Colorectal Enigma
Authors: Tan Chin Kiat , Shen Elliot Quay Fu , Mukherjee Arijit 
Published: September 2024

Abstract

Aims
The study aimed to compare surgical outcomes between right (RCC) and left colonic cancer (LCC) resections at a single centre (DGH) with special reference to 3 and 5-year survival rates.

Methods
100 colonic resections (2017-2021) were included. Length of stay (LOS), pathology results and 3 and 5-year survival rates were analysed. The Kaplan-Meier estimate was used for patients within 5 years post-operative.

Results
68 RCC and 32 LCC noted.
RCC:
37 female, 31 male, median age of 73. 66 R0 resections, 2 R1, none R2.
TNM: 52 (86.1%) had T3/4, 26 (38.2%) had N1/2.
20 had extramural venous invasion (EMVI), 26 intramural venous invasion (IMVI), 8 mucinous, 11 perineural invasion. Estimated 3-year survival rate 0.8530, 5-year 0.7766. No local recurrences, 4 subsequent distant metastases within 5 years.
LCC:
11 female, 21 male, median age of 67. 23 R0, 2 R1, 2 R2 resections.
TNM: 28 (87.5%) had T3/4, 15 (46.9%) had N1/2.
18 EMVI, 11 IMVI, 1 mucinous, 9 perineural invasion. Estimated 3-year survival rate 0.7498, 5-year 0.5965. No local recurrences, 9 subsequent distant metastases within 5 years.
Both cohorts’ median LOS similar (6 days).

Discussion
This study shows higher survival rates in RCC, contradicting acclaimed superiority of LCC survival in literature(1-5). The limited LCCs in this study (during Covid pandemic) being pathologically more advanced, possibly accounts for the statistically significant mortality. A prospective audit of tumour biology and oncological outcome is ongoing with intentions to validate our early observation.
FP7.7 - Evaluation of small bowel obstruction management: A local audit in comparison to NASBO guidelines
Authors: Holt Tristan , Rana Sarina , Wu Fiona 
Published: September 2024

Abstract

Aims
The National Audit of Small Bowel Obstruction (NASBO) report provides recommendations for optimising the management of small bowel obstruction (SBO). We aimed to audit our management and compare our outcomes with the NASBO report.

Methods
Retrospective case reviews were conducted for 115 patients admitted with SBO from July-December 2022, evaluating adherence to NASBO guidelines and assessing outcomes.

Results
The average age was 76 (21-94) years old; 53% male and 47% female. Adhesions (41.7%), hernias (30.4%), malignancy (13%) and inflammatory bowel disease (6.1%) were predominant causes. Treatment included conservative management in 67% of cases, surgery in 27% (of which, 6.1% had a trial of conservative management initially) and palliative care in 6.1%. A summary of the management and outcomes below.Table 1:Summary of managementCT scan on admissionAverage time to CTSurgery performedAverage time to surgeryNutritional screening assessmentLocal audit98.3%9 hours27%2.4 days100%NASBO80%2.2 days48%1 day90%Table 2:Summary of outcomesUnable to eat normally for ≥5 daysAverage length of stay30-day mortality30-day readmissionLocal audit12%7 days14%18%NASBO49%10.7 days8%13%

Conclusion
We are performing CT scans in a timely manner and screening for malnutrition. Despite a shorter length of stay compared to NASBO, our audit has identified opportunities to improve hospital readmission, suggesting that we may be discharging patients prematurely. We have introduced a SBO checklist to ensure NASBO recommendations are adhered to and to improve our 30-day outcomes.