bluuebunny/crossref_metadata_2025_split huggingface dataset:
WP7.3 - FAMiSH: FAsting prior to eMergency general Surgery in Hospital – Quality improvement project protocol
Authors: Khirfan Hamzeh , Shams Ola , Alexiadis Aris , Ragatha Ram 
Published: September 2024

Abstract
This study was conducted to evaluate adherence to preoperative fasting guidelines at the RD&E hospital, focusing on safety and reducing prolonged fasting complications particularly in patients with extremes of age, diabetic or co-morbid.
Data were gathered anonymously over 2 cycles for 4 weeks through patient records and questionnaire to access patient given instructions for fasting. All patients with planned procedures were included, excluding emergency operations (NCEPOD) 1 or 2a/2b classification. Issues such as inadequate communication, excessive fasting, insufficient monitoring, and medication mismanagement were addressed.
Cycle one revealed 25% of patients fasted for more than 6 hours, 56.25% did not consume liquids for more than 12 hours, and 25% abstained from drinking for more than 8 hours preoperatively. It was noted that guidelines were not thoroughly adhered to. Some patients have missed their medications, as well as diabetic patients with prolonged hours of fasting. We have provided a session for junior doctors and nurses aiming education on ASA guidelines and encouraging individualised fasting plans for patients. Information leaflets were created to be distributed to patients planned for surgery. In the second cycle only 20% and 24% of patients didn’t follow fasting guidelines for solids and liquids respectively as compared to 68.75% of the patients receiving inappropriate instructions in 1st cycle, showing significant improvement in patient care.
In our study at the RD&E we have noted an improvement in departmental focus on adherence to fasting guidelines, which focus on abstaining from solid foods up to 6 hours and drinks up to 2 hours prior to surgery, aiding patient safety and improvement of quality of care.
WP7.13 - Recognising Clinical frailty in the Periooperative setting in the Acute Surgical Unit
Authors: Small Sarah , McGucken Sara , Yoong Susan 
Published: September 2024

Abstract

Aim
Due to an ageing population the number of elderly patients undergoing surgery is increasing. The literature and NELA guidance has highlighted frailty can lead to increased risks related to surgery, quantified by Clinical frailty scoring. With the introduction of the regions first Perioperative care for Older People undergoing Surgery (POPS) service, we aim to determine if formal documentation of clinical frailty score improved awareness of these patients and impacted on clinical outcomes.

Methods
A 3 week note review was completed of all patients over 65 admitted to the acute surgical emergency unit. Frailty was scored using the Rockall Score. The first cycle was a review of current documentation practice, with a subsequent cycle of documentation of frailty score following interventions included; clinical posters in clinical areas, teaching and medical and nursing staff handover.

Results
At baseline zero patient had a Rockall Clinical frailty score CFS documented. There has been an increase in the number of patients &gt;65 years old who have a frailty score documented within 24 hours of admission. 15/40 patients over 65 had a CFS documented improved by 37.8%.

Conclusion
Overall improvement of documentation and awareness has been demonstrated highlighting higher frailty patients and those for POPS review to improve perioperative outcomes.
ThP1.7 - Moving to a specialist nurse-led service for genetic testing in breast cancer
Authors: Jones Stacey , Booker Susan , Frame Richard , Hamilton-Burke Werbena , Waterworth Alison 
Published: September 2024

Abstract

Aims
To assess the impact of a genetics nurse led clinic in breast cancer patients treatment.

Methods
A specialist, nurse-led breast cancer genetics service was set up in September 2022 for patients meeting the R208 and R444 criteria. A prospective data collection was performed from September 2022 to October 2023 and included patient demographics, test result and if the result led to any alteration in management of patient.

Results
78 eligible patients, with a mean age of 52.8 (31-90) years. 4 (5.1%) were male. 1 (1.3%) patient declined testing, a further 1 (1.3%) patient was undecided and 1 (1.3%) wished for storage only. Patients waited 1-2 weeks following a breast cancer diagnosis to see the nurse specialist and 4-6 weeks for urgent results. The pathogenic variants identified were BRCA1 (5.3%), BRCA2 (6.7%), CHEK2 (2.7%) and PALB2 (1.3%). Of the remainder 84% of patients tested negative. Altered management occurred in 8 (10.7%) patients, 4 (50%) received risk reducing surgery, 2 (25%) received Olaparib and 2 (25%) received Olaparib and underwent risk reducing surgery.

Conclusion
The move to a nurse-led service has proved to be successful in terms of reduced waiting times for genetic testing appointments and results. It also ensured that all appropriate patients with breast cancer were offered genetic testing, leading to more effective and efficient treatment decisions, such as risk reducing surgery and tailored chemotherapy which could improve long-term health outcomes.
ThP1.11 - Harnessing digital consent analytics to highlight multicentre operative and consent trends in breast surgery
Authors: John Edward St , Moore Connor 
Published: September 2024

Abstract

Introduction
Paper-based consent is difficult to audit at scale, therefore hospital episode statistics data is used to provide insights into national breast surgical practice. However, as digital consent is becoming routine, analysis of amalgamated data is possible to provide a better understanding of consent practice.

Methods
Between 22/04/2020-29/11/23, patient anonymised digital consent data was analysed retrospectively using Concentric Health analytics (Audit ID:1123ABS). Inclusion criteria required the responsible clinician to be a breast surgeon, with non-breast surgical procedures excluded.

Results
n=6860 digital consent episodes were performed across 10 NHS Trusts and 4 private institutions (n=890 unique operations. n=82 unique responsible clinicians, n=191 consenting clinicians). 45.6% (n=3125/6860) of the cases were consented by consultants. 18.7% (n=1286/6860) underwent a mastectomy; 78.5% simple & 21.5% reconstruction (of which 82.6% implant and 17.4% autologous reconstruction). 40.1% (n=2750/6860) underwent breast conserving surgery (79.2% WLE, 18.9% therapeutic mammoplasty, 1.9% Intercostal perforator). Re-excision of margins accounted for 16% of BCS cases (n=441/2750). SLNB was performed in 40.6% and ANC in 11.5% of all breast surgery cases. Regarding localisation; 44.5% Seed, 30.6% Wire, 21.7% palpable/other, 3.2% USS skin mark.

Conclusion
As well as providing benefits in terms of information sharing and improved patient satisfaction, digital consent also provides an opportunity to provide high-level data, regarding which operations are being consented to, when and by whom.
ThP1.13 - Short term safety outcomes of immediate pre-pectoral implant based reconstruction
Authors: Jones Stacey , Frame Richard , Hamilton-Burke Werbena , Waterworth Alison 
Published: September 2024

Abstract

Aims
In the UK up to 43% of women undergo immediate breast reconstruction (IBR) following mastectomy for breast cancer. Implant reconstruction is the commonest form of breast reconstruction and pre-pectoral techniques have been introduced with the aim of improving cosmetic outcome and avoiding animation.
To assess the safety of pre-pectoral implant based breast reconstruction (PPBR), including infection rates, 30 day re-admission to hospital, need for unplanned surgery and implant loss at 3 months.

Methods
A retrospective study of 80 consecutive women who underwent PPBR for breast cancer or risk reduction between October 2020 and October 2023. Demographic, operative and complication data were collected.

Results
Eighty women (70 cancer, 8 risk reducing and 2 cancer/risk reducing) underwent 94 PPBR procedures (80 Skin sparing mastectomies and 14 Nipple and skin sparing mastectomies) with a mean age of 51.5 (range 28 to 79) years and a BMI of 25.2 kg/m2. 7 (8.8%) of women were smokers. The mean implant size used was 385cc (range 160cc to 650cc) with a mean breast weight of 448.6g (range 45g to 1700g). 10 (12.5%) women required oral antibiotics for wound infection with a further 2 (2.5%) women requiring re-admission within 30 days for IV antibiotics. 17 (21.3%) developed a seroma with 8 (47.1%) requiring drainage. No implant losses were recorded within 3 months of reconstruction.

Conclusion
We have demonstrated that PPBR is a good option for patients of a wide age range with a large variation in breast size with minimal complications and no implant losses.
ThP2.15 - Investigating the use of autologous stem cell therapy in the treatment of Androgenetic Alopecia
Authors: Lim Jun Sing , Cui Xiangmei 
Published: September 2024

Abstract

Background and Introduction
Androgenetic alopecia (AGA) is the commonest form of alopecia and is characterised by progressive degeneration of hair follicles and programmed cell death, impacting individuals of both genders. This affects 80% of individuals in the Caucasian population and causes impairment of quality of life. The cause of AGA is complex and involves androgens, genetics, and hormonal miniaturisation. Dihydrotestosterone (DHT) is the primary androgen responsible for activating pathogenic pathways, resulting in the shortening of terminal follicles. Existing treatment methods are currently limited, and the development of a therapeutic approach that overcomes these limits might be of importance in plastic surgery.

Method
A comprehensive search is conducted on databases including Pubmed, Medline, Ovid, and Embase. Research studies are extracted and analysed using the PRISMA table.

Results
The bulge region serves as a vital reservoir of epidermal and melanocytic stem cells. The use of Rigenera® and autologous stem cell therapy has the capability to collect and separate these stem cells (SCs), leading to a 29% ± 5% augmentation in hair density over a span of 6 months. Additional types of multipotent stem cells, such as those found in adipose tissue, bone marrow, and human umbilical cord blood, might potentially be suitable for the purpose of hair regeneration. Possible advantages include a reduced number of biopsies, a shorter treatment duration, and not being limited by the number of donor follicles compared to surgical intervention.

Conclusion
Autologous stem cell therapy demonstrates potential effectiveness and warrants additional investigation to enhance the therapeutic efficacy of AGA.
ThP3.5 - A systematic review of comparing the outcomes of per-oral endoscopic myotomy vs pneumatic dilation in patients diagnosed with achalasia
Authors: Singh Anurag , Khan Nida , Kanagasundaram Sivanthi , Swaminathan Christie , Singh Krishna , Sajid Muhammad 
Published: September 2024

Abstract

Objective
The objective of this meta-analysis is to compare the success rate of per-oral endoscopic myotomy (POEM) versus pneumatic dilation (PD) for patients with achalasia.

Methods
Studies reporting success rates and symptoms in patients undergoing POEM versus PD were selected from medical electronic databases and meta-analysis was conducted by following the guidelines of the Cochrane Collaboration using statistical software RevMan version 5.

Results
Four studies on 319 patients reporting success rates and Eckardt scores were included. In the random effect model analysis, the success rate [odds ratio (OR) 6.22, 95%, CI (3.23, 11.97), Z = 5.47, p = 0.00001] favoured the PD and there was no heterogeneity (Tau2 = 0; Chi2 = 1.29, df = 2 (P = 0.53; I2 = 0 %) among included studies. Eckardt scores [mean difference -0.36, 95%, CI (-0.76, 0.03), Z = 1.79, p = 0.07] suggesting the achalasia symptoms severity was also similar in both interventions. There was moderate heterogeneity (Tau2 = 0.10; Chi2 = 7.47, df = 3 (P = 0.06; I2 = 60 %) among the included studies.

Conclusion
The POEM seems to be more successful when compared to the PD for patients with achalasia. On comparison of Eckardt score, there was no statistical difference seen between the two groups.
ThP3.9 - Direct to PET-CT in oesophagogastric cancers: A pilot project at a tertiary upper gastrointestinal surgical referral centre
Authors: Ahmed Yazeed , Vaz Osborne , Jeffry Farah , Bektasoglu Ilyas , Khan Meshaal , Stockwell Robert , Shetty Vinutha 
Published: September 2024

Abstract

Background
Oesophageal cancer contributes to 18% of cancer mortalities worldwide. The aim of this pilot project was to offer direct positron emission tomography- computed tomography (PET-CT) imaging and observe any differences in time to investigation and treatment in the cohorts.

Methods
Patients referred with a diagnosis of oesophageal cancer between 1st January 2022 to 31st December 2022 were included. Data was collected from the electronic patient record and retrospective analysis was performed using Microsoft Excel.

Results
A total of 189 patients with OG cancer were included. There were 89 local and 100 network patients. Median age was 71[range 37 – 93]. Locally male female ratio was 52:37 and in the network 73:27 [“p” 0.03]. Of 35 patients who had direct PET-CT (A) 31(88%) were local and 4(12%) from the network. Among 115 patients who had a CT followed by PET scan (B) 29(25%) were local and 86 (75%) from the network [ “p” 0.00001]. Waiting times were 27 days for a PET-CT as compared to 32 days for PET after CT scan [ “p” 0.09]. Reports were available in a median 4 days in group A compared to 3.5 days in group B [ “p” 0.66]. In group A 12 (35%) had metastases with nodal metastases in 9(75%) and distant metastases in 3(25%).

Conclusion
Whilst direct to PET-CT improved patient experience there were no statistically significant differences in the time to investigations and treatment. Three patients with distant metastases offered direct PET-CT could have been diagnosed by CT.
ThP3.12 - Assessing Photo-documentation Compliance in Oesophago-Gastroduodenoscopy: A Review of Adherence to BSG and AUGIS Recommendations
Authors: Ali-Qazalbash Zeeshan M , Khopekar Faid Z , Khan Khurram S 
Published: September 2024

Abstract

Aim
In 2017, the British Gastroenterology Society (BSG) and the Association of Upper GI Surgeons of Great Britain and Ireland (ASGBI) issued a position statement outlining specific quality parameters for oesophago-gastroduodenoscopy (OGD), including photo-documentation of eight specified anatomical sites. This audit assesses the appropriate utilization of photo-documentation for diagnostic OGD.

Methods
A retrospective analysis of diagnostic OGD preformed in a single centre. General surgeons, gastroenterologist and nurse endoscopists performed OGDs. Patient with incomplete OGD or those carried out for therapeutic purposes were excluded. OGD report included photo-documentation was analysed.

Results
250 OGD were included; 54.8% were male and median age was 61 years. Indications for OGD were: 28% for nausea/vomiting, 26% for dysphagia, 22.4% for upper GI bleed, 12.4% for abdominal pain, 12% for anaemia, 11.2% for weight loss and 8.4% for dyspepsia.
62% of OGDs had photo-documentation: 9.6% upper oesophagus, 45.2% gastro-oesophageal junction, 36.8% fundus in retroflexion, 26% body of stomach, 8% incisura in retroflexion, 30.8% antrum, 17.2% duodenal bulb and 36% distal duodenum. Overall, 1.2% of OGDs had all eight anatomical sites photo-documented, all by the same endoscopist.

Conclusion
Robust photo-documentation plays a crucial role in ensuring both accurate clinical assessments and meeting medico-legal requirements. Our audit indicates that the current level of photo-documentation in OGD is less than optimal. Enhancing endoscopist education and raising awareness about recommended practices may lead to improved results. Further research is imperative to explore the underlying factors contributing to suboptimal photo-documentation, fostering a deeper understanding and facilitating targeted interventions for improvement.
ThP4.2 - Role of LiMAx in the Risk Assessment of Postoperative Outcomes in Patients undergoing Liver Resection: A Systematic Review and Meta-Regression Analysis
Authors: Patel Eashan , Joshi Anushri , Weston Chris , Clarke George , Hodson James , Dasari Bobby V M 
Published: September 2024

Abstract

Background
LiMAx is a novel test for assessing the metabolic capacity and dynamic function of the liver. The current review aims to investigate the predictive role of LiMAx for postoperative outcomes in patients undergoing liver resection.

Methods
A systematic review was conducted using EMBASE, Web of Science, Medline and Cochrane Library databases. Preoperative LiMAx values and various postoperative outcomes were extracted (e.g. mortality, post-hepatectomy liver failure). Pooled averages were calculated where appropriate. Postoperative complications in relation to the extent of resection and LiMAx values were the outcomes assessed.

Results
13 studies, comprising 1668 participants and 20 separate cohorts in total, were included. The meta-regression of preoperative LiMAx and postoperative outcomes yielded non-significant results (p&gt;0.05). A second meta-regression highlighted significant correlations between extra major surgery rate and various outcomes (p&lt;0.05), suggesting its confounding role in the first regression. A further analysis found a non-significant tendency for mortality to correlate with LiMAx as expected in patients undergoing minor resection.

Conclusion
In this review, there was no statistical correlation between LiMAx values and post-hepatectomy outcomes. The LiMAx test was relatively more helpful in predicting mortality in patients undergoing minor resection; this was likely confounded by selection bias in the low quality studies. Larger multi-centre studies with standardised reporting of outcomes are required.
ThP5.11 - Reducing Gallstone Related Patient Episodes Through Index Admission Management: A Multicentre Retrospective Study
Authors: Curry Heather , Nassar Ahmad H M , Khan Khurram S 
Published: September 2024

Abstract

Aim
Gallstones represent a significant portion of acute general surgical admissions, with widespread management practices across the UK. Our objective was to assess the effects of implementing proactive management strategies for symptomatic gallstones and their complications on admissions related to gallstone.

Methods
A retrospective multicentre study of three acute general surgical units within a single health board with similar population coverage between 2014 and 2018. In site A, the standard of care was definitive management of gallstone disease in the index admission; whereas in site B & C this was not the case. All gallstone related presentations were included. The data was extracted from the health board coding data. Number of biliary related admissions compared between the three sites.

Results
3,790 episodes were identified. Biliary colic was the most common (54.9%) reason for presentation followed by acute cholecystitis (22.7%), acute pancreatitis (16.2%) and ascending cholangitis (6.2%).
For biliary colic: site A had 361 presentations, site B had 853 presentations and site C had 867 presentations. The occurrences of more than one admission were 22.7%, 36.3%, and 42.3% for Site A, B, and C, respectively.
Overall, site A had 796 biliary presentations; compared to 1497 each at site B and C.

Conclusion
Implementing definitive surgical interventions during the index admission for biliary-related cases offers a substantial reduction in re-admission rates, leading to an overall decrease in hospital attendance. This not only yields significant cost benefits for the health board but also enhances the quality of life for patients.
ThP5.12 - Safety of emergency laparoscopic cholecystectomy in the treatment of gall stone disease: A single centre observational study from a District General Hospital
Authors: Sukumaran Sreekanth Nedumparambil , Thomas Pradeep , Narayanasamy Sangara Narayanan 
Published: September 2024

Abstract

Aim
To evaluate the safety of emergency laparoscopic cholecystectomy in the treatment of gallstone disease.

Methods
This was a retrospective, single-centre observational study of 267 patients who were admitted with abdominal pain due to a gallstone related pathology during June 2021 to June 2022. The parameters studied were age, gender, duration of symptoms, previous admissions, investigations, imaging, conservative or surgical treatment, emergency surgery or elective interval surgery, utilisation of dedicated "hot gallbladder list", re-admissions, and re-operations.

Results
Out of the 267 patients, 163 were female and 104 were male. The median age was 61 with the age ranging from 20 to 96. The median duration of symptoms was 2 days before admission. First-time admissions were 226 and re-admissions were 41. Ultrasound, CT and MRI were done on 188, 123 and 64 patients respectively. 178 patients were diagnosed to have acute calculous cholecystitis, 51 patients had acute gallstone pancreatitis and 38 had biliary colic due to lithiasis. 172 patients were treated with surgery of which 104 were operated on during the same admission, 20 in readmission and 48 as an interval elective surgery. Of the 124 emergency operations, 37 were performed on the dedicated "hot gallbladder list" and 87 were performed on the emergency CEPOD list. 2 patients were re-operated due to post-operative complications. 95 patients were managed conservatively.

Conclusions
Emergency laparoscopic cholecystectomy is a safe option when performed by experienced surgeons. A dedicated "hot gall bladder list" provides a safe and effective way to reduce the disease burden.
ThP6.1 - Revisiting outcomes of laparoscopic cholecystectomy in an elderly population
Authors: Thompson Luke , Gao Neng , Fultang Joshua , Maruthachalam Karthik , Apollos Jeyakumar 
Published: September 2024

Abstract

Aims
Laparoscopic cholecystectomy in the elderly patient is a challenging operation with variable outcomes. We evaluate the outcome of patients who underwent laparoscopic cholecystectomy in a hospital that serves a large ageing population.

Methods
Retrospective analysis of 53 patients over the age of 70 years who underwent cholecystectomy between January and December 2023. Outcomes were compared between elective vs emergency procedures, indications, age groups (70-74, 75-79, 80-84, 85+) and Charlson comorbidity index (CCI).

Results
The mean age was 77±4.9 years, and the mean CCI was 4±1. Of 53 procedures performed, 30.2% (n=16) were emergency and 69.8% (n=37) were elective. 6.3% (n=1) was converted to open. 11.3% (n=6) of patients underwent Rendezvous ERCP. Emergency patients had increased length of stay (LOS) (5.1±2.8 vs 1.6±4.1, p=0.04). The indication for surgery was noted to have a significant influence on LOS (p=0.003), however, age groups and CCI did not influence LOS. Non-biliary complications occurred in 13.2% (n=7) of patients. 7.5% (n=4) of patients had readmission within 30 days. 3.75% (n=2) had retained CBD stone and underwent postoperative ERCP. No significant differences between age groups in relation to complications were identified.

Conclusions
Emergency cholecystectomy in patients over the age of 70 is associated with a longer LOS. Rates of complications are not influenced by age or CCI. Laparoscopic Cholecystectomy can be safely offered to a diverse elderly population.