bluuebunny/crossref_metadata_2025_split huggingface dataset:
FP3.7 - Do we need to follow up perianal abscesses in clinic?
Authors: Arokianathar Doreena , Lingam Gita , Sivarajah Vernon 
Published: September 2024

Abstract

Aim
The Association of Coloproctology of Great Britain and Ireland (ACPGBI) states those who present with their first perianal abscess do not require routine follow up in clinic after surgical intervention. This audit aimed to assess the percentage of perianal abscess patients being referred to clinic and their subsequent clinic outcome. An additional outcome was a cost analysis of clinic waste.

Methods
We reviewed the patient records of all patients who underwent an incision and drainage of perianal abscess between 1st January 2022 to 31st December 2022 within a district general hospital setting. We recorded the number of these patients being referred to clinic and their clinic outcome. The 2022/23 National Tariff Workbook resource was used to analyse the cost of clinic wastage.

Results
A total of 72 incision and drainages of perianal abscesses were performed in 2022 and 92% (N=66) were first presentation perianal abscesses. 46% (N=33) had a post-operative outpatient clinic appointment requested; and of these 67% (N=22) were first presentation perianal abscesses. This culminated in a total cost burden of £1568; in addition to prolonging patient anxiety, increasing their need for time off work and adding to NHS clinic wait time.

Conclusion
As per guidance, first presentation perianal abscesses do not need to be seen in clinic. The results suggest that we are referring too many patients to colorectal or general surgery outpatient clinics, which is increasing workload, adding to financial costs and affecting patient care.
FP3.10 - Do endoscopic tattoos upstage colorectal cancers?
Authors: Lim William , Chaudhury Madhu P , Manatakis Dimitri , Peristerakis Ioannis X , Kearsey Christopher C 
Published: September 2024

Abstract

Aims
Endoscopic tattooing in suspected bowel cancer is encouraged in all lesions &gt;2cm by the national bowel cancer screening guidelines. However, a known risk of the procedure is tumour cell seeding leading to upstaging of cancers. Our aim is to investigate the relationship between endoscopic tattoos and recurrence rates. Additionally, we aim to investigate if overall survival (OS) is affected by endoscopic tattoos.

Methods
Data was collected retrospectively using electronic medical records (EMR) on all patients with colorectal cancer who had a resection between January 2017 and May 2021 (n=614) in our local trust. Data was also collected on patient demographics, site of tumour, type of resection, whether an endoscopic tattoo was applied or not, length of follow-up, recurrences, outcomes of recurrences and all-cause mortality.

Results
3 patients were excluded due to lack of information on EMR. In our cohort, the male:female ratio was 1.41:1. Patients ranged from 22-92 years old. 33.7% (n=206) of patients had an endoscopic tattoo and 66.3% (n=405) did not. At the time of data collection, 24.5% (n=150) of patients had a recurrence. Of these, 28.7%(n=43) had tattoos and 71.3% (n=107) did not.

Conclusions
Statistical analysis showed that OS remained similar in both groups (tattoo versus non-tattoo). However, we found that patients who had an endoscopic tattoo were less likely to have a recurrence (longer disease-free survival) than those who did not. Although this was not statistically significant, we can conclude from our study that endoscopic tattoos do not appear to upstage colorectal cancers.
FP4.4 - Everything is not always as it seems – Discordance between cross-sectional imaging and pathology. A case report
Authors: Thompson Luke , Fultang Joshua , Schmigylski Rudi , Nale Krsty , Maruthachalam Karthik 
Published: September 2024

Abstract
Cross-sectional imaging of colonic pathology is usually correlated with other investigations such as optical colonoscopy (OC) prior to surgical treatment. In situations such as acute inflammation, this is not possible and surgery is undertaken based on cross-sectional imaging without histopathological confirmation.
This case reports describes a 78-year-old female who presented with progressive shortness of breath associated with fatigue and unintentional weight loss. Initial bloods demonstrated a normocytic anaemia (Hb 105g/L, MCV 86fl), raised D-dimer (3460ng/mL) and raised C-reactive protein (133mg/L) with normal white cell count (8.6 x109/L). An unprepared computed tomography (CT) of the abdomen and pelvis revealed extensive bowel thickening in the caecum with radiological appearances consistent with a primary caecal malignancy. Preoperative colonoscopy was not performed as suspicion of perforation on CT imaging precluded the use of mechanical bowel preparation.
Preoperative optimisation of the patient was commenced and an elective right hemicolectomy performed. The patient had an uneventful post-operative recovery. Results on histopathology inspection revealed chronic xanthogranulomatous inflammation but no macroscopic or microscopic evidence of dysplasia or malignancy.
There continues to be an emerging role for the use of CT imaging, especially CT colonography, in the investigation and diagnosis of CRC. However, difficulty in distinguishing between malignant and non-malignant inflammation on CT endorses the quintessential place of OC with biopsy as the definitive investigation of CRC, especially if suspicion of CRC on unprepared CT. Xanthogranulomatous inflammation should be considered by clinicians, radiologists and pathologists as a differential diagnosis when CRC is suspected clinically and radiologically, without biopsy confirmation.
FP4.5 - An assessment of web-based patient information on bowel resection in Crohn's disease
Authors: Whitman Alexandra , Johnston Judith , Husnoo Nilofer 
Published: September 2024

Abstract

Aim
Most patients with Crohn’s disease (CD) have at least one bowel resection during their lifetime. 80% of patients with terminal ileal CD (the most common phenotype) will require a bowel resection at some point. Patients considering a bowel resection for CD will likely look for information online, as is common practice among patients with chronic illnesses. The aim of this study is to assess the quality and readability of web-based patient information on bowel resection for CD.

Methods
GoogleTM was searched using pre-defined search terms that were developed with input from patient experts. For each term, results from the first two pages were screened for eligibility. Patient-focused websites on bowel resection for CD were included. The quality of the information was assessed using the DISCERN tool, and the readability with the Flesch-Kincaid ease of readability (FK) score.

Results
Of the 118 sources identified, 91 were excluded and 27 sources were analysed. A third (n=10) did not discuss the different types of resections. Ileocaecal resection (the most commonly performed resection) was described in 7 sources. Discussion of management post-resection (n=7) and of lifestyle changes (n=12) were sparse. There were some instances of factually incorrect information. The mean DISCERN score was 3.2±0.31 (range 1-5), indicating moderate quality information. The mean FK score was 49.9 (corresponding to “difficult to read”).

Conclusion
Professional bodies and clinicians should work alongside patient groups to develop online sources which are in appropriate lay language and evidence-based, and suit patients’ informational needs to aid patient decision making.
FP5.13 - Implementing a Lumbar Puncture Teaching Course at a General District Hospital
Authors: Patel Minesh , Katsura Chie 
Published: September 2024

Abstract

Aim
Prior to our course, there had been no formal lumbar puncture (LP) teaching at the hospital. Furthermore, a pre-course questionnaire had determined 50% of respondents (9/18) were “not so familiar” OR “not at all familiar” in describing the steps involved in performing an LP. 72% (13/18) were “not at all” confident in conducting the procedure. As the need for practical LP teaching was noted, a course was devised to familiarise trainees with LPs and improve confidence.

Method
The course was implemented with supervision from the anaesthetics department at the hospital. This included an E-module, face to face simulation of consenting and practicing LPs on a back model. The course was offered to foundation trainees and medical students from several universities in the region.

Results
From the post-course questionnaire the following results had been gathered 1) 7 out of 9 participants reported that they were “very familiar” in performing the steps of an LP (78%) 2) 5/9 were now “moderately” confident in performing an LP 3) 78% were “very familiar” with the indications and contraindications of LPs.

Conclusion
The course had led to a significant improvement in the understanding and confidence in performing LPs among the participants. Simulated learning is an effective method of teaching complex practical skills to junior trainees. Further work includes inviting trainees from within the region and implementing an online demonstration as part of the E-module.
FP6.7 - Assessing knowledge and effective utilisation of incentive spirometer across surgical floor
Authors: Alaeq Ali , Costello Amy , Zino Samer 
Published: September 2024

Abstract

Aim
to assess the level of knowledge of healthcare workers providing incentive spirometer and instruction provided to patient.

Methods
Snapshot audit between 25&28/05/23 assessing the knowledge and practice using two for patient and staff questionnaires.
Inclusions criteria were all adult patients in surgical wards, all healthcare staff. Exclusion criteria were patients who did not receive a spirometer and patients or staff who were not willing to participate in the study.

Results
75% of staff provided incentive spirometers, 84% of them never received formal education or training in the use of incentive spirometer. Only one staff member (1.85%) answered all the questions correctly. 83% of patients were not given the correct instructions and approximately 16% were instructed to exhale.

Implemented Changes
A video created with e-link; explaining the use of incentive spirometer. Training of medical and nursing staff by presenting the project in our local departmental meeting, the results and poster emailed to health professionals. A new patient leaflet was created containing clear instructions, the video link, and a table to record their usage.
Random sampling showed significant improvement. The Second cycle will be conducted at beginning of the new year and the results will be presented at the conference

Conclusion
The lack of training led to incorrect instructions being given to patients. This could lead to false reassurance to the senior medical staff, by assuming that patients are using spirometers correctly which could delay recovery and discharge. Simple training has resulted in significant increase in knowledge and correct use of a spirometer. Checking the staff knowledge is recommended, especially in common daily practice
FP7.6 - Comprehensive Analysis of Emergency Laparotomy in the Geriatric Population: A Retrospective Study
Authors: Lee Shiela , Kok Yu Ying , Ting Nicholas , Thambi Prem 
Published: September 2024

Abstract

Aims
The British Society of Geriatrics recommends that all patients undergoing emergency laparotomy aged &gt;= 65 who score more than 5 on Clinical Frailty Score (CFS) or &gt;= 80 years with any CFS should receive comprehensive geriatric assessment within 72 hours of admission to a ward or step down from critical care. Despite substantial evidence outlining an improvement in postoperative outcomes, efforts to refer patients and record CFS are still insufficient. The aim of our study is to evaluate the use of CFS assessment in patients aged ≥ 65 years undergoing emergency laparotomy.

Methods
This was a retrospective audit of 94 patients aged ≥ 65 years old undergoing emergency laparotomy between September 2022 to October 2023.

Results
The mean age of the cohort was 75 years old. The average length of hospital stay was 21 days. 50% of patients were referred for an in-patient geriatrician review. The interval between surgery and geriatrician referral averaged 7 days. However, the average duration between geriatrician referral and assessment only spanned 1 day. CFS were recorded for only 11% of patients during their hospitalisation, pointing to an area for potential improvement.

Conclusion
Understanding the factors contributing to prolonged stays is pivotal in enhancing postoperative care. These insights not only shed light on the procedural intricacies surrounding emergency laparotomies in the elderly but also highlight opportunities for refining patient care pathways and optimising interdisciplinary care.
FP7.9 - Caecal Volvulus with Ischaemia in Pregnancy Requiring Right Hemicolectomy
Authors: Gahunia Sukhpreet , Bayyari Abedalaziz , Kenington Cleo , Mohamed Yusuf Abdi Karim 
Published: September 2024

Abstract

Background
Caecal volvulus is a rare but significant pathology, accounting for 1-3% of all bowel obstructions. There are only 3 published case reports in pregnancy, and there is often a significant delay in diagnosis.

Presentation
A patient in her 30s was 22 weeks pregnant with her first baby conceived through IVF. She presented with a 2 hour history of severe epigastric pain and vomiting. Inflammatory markers were normal with lactate 3.5, which normalised after fluids. This was her third presentation of pain during pregnancy. She was treated as gastritis and kept in for observation. An ultrasound demonstrated free fluid with no cause. The patient remained in severe pain and repeat bloods demonstrated worsening inflammatory markers. By this time, MRI was no longer available so a CT occurred at 9pm which showed caecal volvulus with acute ischaemia.

Treatment
At emergency laparotomy, the diagnosis of caecal volvulus was confirmed with a non-viable ascending colon but no perforation or enteric contamination. A right hemicolectomy with ileocolic anastomosis was performed. She was admitted to ITU post-operatively, then stepped down to the ward on day 2 where she continued to make a good recovery and was discharged on day 5.

Conclusion
Caecal volvulus is a recognised cause of mechanical bowel obstruction in pregnancy but can be difficult to diagnose. Optimum outcome of surgical complications in pregnancy relies on optimum treatment of the mother. Pregnant patients with pain out of proportion to their clinical presentation need a low threshold for cross-sectional imaging, which should be discussed promptly with radiology.
FP8.1 - Environmental Sustainability and Surgery: what are the attitudes and barriers to implementing sustainable change in operating theatres? A Qualitative Study
Authors: Boag Katie , Chapman Stephen , Sara Xenia , Scarborough Oliver , Please Helen , Peckham-Cooper Adam 
Published: September 2024

Abstract

Aims
Sustainability in surgery is an increasingly important focus in the bid to halt climate change. This study aimed to better understand how environmentally sustainable change can be made in theatre environments by exploring attitudes of healthcare professionals and patients, and identifying barriers to implementing change.

Methods
A mixed-method qualitative study was undertaken involving a national survey of 157 healthcare professionals (HCP’s), and follow-up semi-structured interviews with ten HCP’s and five patients. Participants were targeted via the survey and public engagement mailing lists. Interviews were informed by a topic guide developed with responses from the survey. Data were analysed thematically and presented as major topic themes.

Results
100% of participants agreed that operating theatres needed to make sustainable changes and reduce waste. Respondents understanding of the key issues centred around physical waste production and its effect on climate change. HCP’s identified issues around infection prevention and challenging current behaviour, whilst patients focused on maintaining current standards. Barriers to change included safety concerns, current clinical pressures, single-use culture and the perceived resistance to change within the NHS. HCP’s identified staff habits, lack of information and patient expectations as a barrier, whilst patients identified cost to be the main issue.

Conclusions
This study provides key insights into the current attitudes and perceived barriers of HCP’s and patients to implementing environmental change in surgery and aligned working environments. These provide useful data to aid future change strategies and implementation and ensure effective sustainable changes are made and delivered in theatre environments.
FP8.2 - Sustainability Within the Abscess Pathway
Authors: Ho Ning Xuan , Innes Ailsa , Kammath Vipin , Ali Oroog , Dent Barry 
Published: September 2024

Abstract

Background
Global warming and the current climate crisis remain a threat to global health. It is estimated that 5% of the total carbon footprint of an acute NHS organisation was attributable to general anaesthetic (GA) gases, which contributes to ongoing ozone depletion.

Aims
To review current practices in managing abscesses and improve sustainability within the abscess pathway in our trust.

Methods
Retrospective data on all patients who underwent incision and drainages (I&D) between January – July 2022 were collected and analysed. A new abscess pathway was introduced in June 2023 and departmental teaching provided to junior doctors on incision and drainage of abscesses under local anaesthetic (LA). Data on patients who underwent I&D between June – September 2023 were collected and analysed to assess the impact of the new abscess pathway.

Results
In the first-cycle audit, 162 patients underwent I&D, of which 119 (92%) were done under GA. Of these, 71 (60%) were suitable for LA I&Ds, 91% were admitted for their procedures. The estimated carbon footprint was 4525kg CO2e/year. In the second-cycle audit, 68 patients underwent I&D, of which 37 (76%) were done under GA. Of these, 31 (46%) were suitable for LA I&Ds, 41% were admitted for their procedures. The estimated carbon footprint was 3735kg CO2e/year.

Conclusions
Following implementation of the new abscess pathway, we reduced the number of patients having general anaesthetic procedures and inpatient admission. This not only improves the sustainability of our practice, but makes treatment and recovery quicker for patients, and has a lower financial burden.
FP8.7 - Standardising Sustainability: Towards reducing single-use items in elective surgery
Authors: McFarland Elise , Steuart Lois , Gough Vivienne 
Published: September 2024

Abstract

Aims
To examine the prevalence of single-use items routinely given to patients undergoing surgery in 5 hospitals within a single health board and to propose interventions to improve environmental sustainability.

Methods
Systems in five hospitals were examined. Patients were shadowed through their pre and post-operative journey, observing the distribution of single-use items at each stage. Structured interviews were conducted with 52 patients and 79 nursing staff across the 5 sites.

Results
Process maps produced for each hospital found large variability in items given out routinely at each site e.g. disposable underwear, anti-slip socks, scrub hats, plastic storage bags and cups
85% of patients cared about the negative environmental impact of healthcare. The majority felt that disposable hats (65%), underwear (71%) and socks (75%) were unnecessary. Only 1 patient was against bringing their own items.
84% of staff thought an overuse of single-use items existed. However, most staff felt that disposable items were necessary sometimes. 84% though it was acceptable for patients to bring in reusable dressing gown, slippers, and water bottles.
Exploring potential barriers to using patients’ own items identified concerns around infection control, hygiene, and losing patient’s items.

Conclusions
Unnecessary variation in disposable item use in the surgical journey exists between hospitals. Patients and nursing staff agree that too many single-use items are used. Use of disposable items should be standardised and minimised to reduce waste, cost and improve environmental sustainability. Pre-operative instructions to patients should include bringing their own bags, slippers and water bottles.
FP8.12 - Theatre time utilisation in General Surgery at a district hospital in NHS
Authors: Arifuzaman Mohammed 
Published: September 2024

Abstract

Aim
To understand the operation theatre time utilisation in the Department of General Surgery at a busy district NHS hospital. The time spent in each step of surgery and operating list at large and understand the patterns of cancellations and its’ predictors.

Method
Retrospective study of all elective general surgical patients from 1 Dec 2021 to 15 May 2022. Emergency cases were excluded and statistics were performed on Statsdirect3.

Results
Total surgeries performed were 182 with 153 true and 41 false cancellations. Mean surgical time was 84.5 minutes (mean 73min) for all general surgical cases. Lap cholecystectomies had a mean time of 92.3mins, upper GI surgeries took 178.6mins (mean) EUA and other procedures was 30.86mins, inguinal hernia 77.2mins, umbilical hernia 68.5mins. Mean anaesthesia time was 33 mins (median 31mins). Theatre time utilised was 56.45%, anaesthesia time utilised was 15.85%, surgery time utilised was 40.60% and non-clinical time was 43.55%. Mean delay in sending for first patient was 31.58mins (median 29min). Delay in calling for first patient is statistically significant (p=0.00015) for cancellation for the last patient in the list. Mean gap in between 2 consecutive cases was 35.74mins (median 22min).

Conclusion
Delay in sending for the patient will lead to cancellation of the last patient on the list which is proven statistically. We utilised 82.19% of the total surgery days and cancelled 17.81% days. Non clinical time comprised of 43.55%.
EP16 - Local Excision of Rectal Cancer by Transanal Endoscopic Microsurgery (TEM) – Review of outcomes and completeness of surveillance
Authors: Sebregts Sara , Wood J 
Published: September 2024

Abstract

Aim
To review outcomes and completeness of follow-up for patients undergoing TEM for rectal cancer.

Method
Retrospective review of outcomes of all TEM cancer operations performed by a single surgeon. Where completion surgery was not indicated, adherence to local surveillance protocol was assessed.

Results
20 Patients underwent TEM for cancer from January 2014-March 2022. 55.0% (n=11) Had submucosal excision and 45.0% (n=9) full-thickness excision.
35.0% (n=7) Went on to have completion surgery, 40.0%(n=8) had surveillance only, 10.0% (n=2) received adjuvant treatment then underwent surveillance and 15.0% (n=3) declined further treatment/follow-up or were unfit.
Histology was T1 in 75.0%(n=15), T2 in 20.0% (n=4) and T3 in 5.0% (n=1). Of T1 cancers 40.0% (n=6) received completion surgery, 46.7% (n=7) surveillance only and 13.3% (n=2) declined further treatment or were too unwell. Of T2 cancers 25.0% (n=1) received completion surgery, 50.0% (n=2) were considered high risk for surgery and underwent adjuvant treatment then surveillance and 25.0% (n=1) surveillance only. The patient with T3 cancer declined anything further.
Overall recurrence during TEM surveillance was 30.0% (n=3). For T1 and T2 recurrence was 14.3% (n=1) and 66.7% (n=2) respectively. Two patients underwent salvage surgery, and one underwent palliative chemotherapy.
Of 10 patients in surveillance after TEM, 80.0% (n=8) have currently received up to date follow-up 20.0% (n=2) have not, due to patient choice.

Conclusion
All patients undergoing surveillance have been offered time appropriate follow-up tests. In this sample all patients received timely and appropriate treatment.