bluuebunny/crossref_metadata_2025_split huggingface dataset:
FP4.14 - The Efficacy of Performing A Quantitative Faecal Immunochemical Test (qFIT) As A Predictor of Colorectal Cancer Before A 2-Week Wait Referral
Authors: Curtis-Lopez Carlos , Craddock Charles , Gomm Timothy , McCullough Jonathan , Moore Jonathan 
Published: September 2024

Abstract

Aim
2-week wait (2ww) Colorectal cancer (CRC) referrals have risen along with increased use of colonoscopy, potentially exposing patients to repeated invasive investigation. Current guidelines recommend the use of quantitative faecal immunochemical testing (qFIT) in primary care to prioritise patients for investigation. This study aims to characterise 2ww CRC referrals in a London hospital.

Method
This is a retrospective quality improvement study, analysing primary care 2ww CRC referrals in October 2022 in a London hospital. Data collected included referral symptoms, completion of a qFIT prior to referral, previous exclusion of CRC, and subsequent investigation outcome.

Results
Of 173 patients referred on the CRC 2ww pathway in October 2022, 21% did not require further investigation. 16% of patients had undergone a colonoscopy within 12 months excluding CRC. Only 61% of referrals included a qFIT. 71% of these were qFIT positive, and 11% were diagnosed with CRC. The overall CRC detection rate was 2.2%, all with qFIT &gt;200. The PPV of qFIT for CRC was 5%, and 53% for polyps.

Conclusion
39% of this patient cohort were referred without qFIT. Those who are qFIT negative or have had CRC excluded in the past 12 months may not require investigation on a 2WW pathway, may be suitable for investigation with lower priority, and may not need invasive investigation at all. Although the use of qFIT has been nationally recommended to prioritise the urgency of investigation, this study suggests this has not been universally adopted. Wider use of qFIT before 2ww referral may guide the use of resources and aid diagnosis and management of patients with symptoms of CRC.
FP4.16 - Impact of Clinician Factors and Judgement Biases on Delayed Referrals and Diagnosis of Colorectal Cancer (CRC)
Authors: Kewlani Bharti , Tjhin Yovita , Pawa Nikhil 
Published: September 2024

Abstract

Aim
Colorectal cancer (CRC) is the 4th most common cancer in the U.K. contributing to 10% of cancer-related fatalities. Despite clear NICE referral guidelines, there are various patient-, clinician- and system-related delays in referrals to the lower gastrointestinal (LGI) services. Our article investigated clinician-associated biases that govern the timeliness of referral to the LGI services.

Method
Our article is a narrative review. We searched Embase and Ovid Medline databases using a range of terms. Results yielded 36 articles relevant to our topic.

Results
GP referrals make up 44%-69% of suspected CRC referrals. Yet, national data highlights that emergency presentations range from 14%-30% nationwide, indicating missed opportunity in the primary care setting. Cognitive bias was commonly seen and included GP’s poor familiarity with referral criteria and failure to recognise red flags. Patient cultural and demographical biases played a significant role in decision-making often leading to misappraisal, with the patient’s age being the most common factor. Younger patients were less commonly referred onto the 2-week-wait (2ww) pathway, and faced an average delay in diagnosis of a month with 1.4 times more visits to care providers. In addition, information and communication biases were a recurring theme in the literature which discussed the effects of inadequate histories and physical examinations on missed diagnosis and delayed referrals.

Conclusions
Unintentional bias delays CRC referrals resulting in a substantial proportion of patients presenting as an emergency with advanced stage cancer that has poorer outcome. We need to increase awareness of these biases and find ways to negate their effects in clinical decision-making.
FP5.12 - Write what you know: A retrospective documentation audit
Authors: Ibanga Unyime , Lingam Gita , Sivarajah Vernon 
Published: September 2024

Abstract

Aims
The Royal College of Physicians (RCP) stipulates that every patient entry in the notes should be; dated, timed and signed by the author (name and designation included). Additionally, the content should have a standardised structure and layout with a chronological order to reflect a continuum of patient care. This audit aimed to assess the percentage of patient documentations that were compliant with these standards.

Methods
We retrospectively evaluated inpatient documentations for general, colorectal and vascular surgery for one week within a district general hospital setting. The data was obtained from electronic documentations. We assessed inpatient documentation for all relevant criteria as per RCP guidelines. Inpatient documentation included; the admission notes, post take ward round, daily ward rounds and inter-speciality discussions.

Results
A total of 88 patient related entries were reviewed. Of these 89.8% were dated. 42.0% of the entries were timed, with inter-specialty discussion having the highest percentage of recorded times. 93.2% had a standardised structure. The structure of admission entries was the most consistent with standards. 6.8% and 3.4% had the authors designation and signature respectively.

Conclusion
Clear informative documentation is pivotal for safe and effective patient care. Failure of patient documentation to meet the stipulated standards was established in this audit. Factors including inadequate junior doctor training, pace of ward rounds and reliance on electronic noting systems are potential reasons for poor compliance. Capitalising on opportunities to educate junior doctors is paramount in improving patient care.
FP6.10 - Improving Compliance & Implementation of WHO Surgical Safety Checklist At a Tertiary Level Hospital in India: A continuous process
Authors: Sinha Akatya , Kadam Sameer 
Published: September 2024

Abstract

Aim
To complete an audit on the level of compliance with the WHO surgical safety checklist in surgical operating theatres at a Tertiary level hospital in India.

Method
A total of 40 general surgeries were observed at the operating theatres at a tertiary-level hospital in India to confirm the practice of the WHO surgical safety checklist. The study was conducted for 1 month in September 2021. The results were compared with standard guidelines and further analyzed. Interventions were carried out through a series of rigorous departmental meetings and discussions with the medical and nursing staff. A re-audit was conducted.

Results
Of all the operations audited, 45% Sign-In and only 1% Sign-Out were performed in the first cycle. After the re-audit, a significant change was reported as the Sign-In improved to 80%, and a 55% Sign-Out was conducted. The Time-Out was observed to increase from 15% to 65%. Compliance in the final third cycle showed improvement in Sign-In at 95%, Sign-Out at 85%, and Time-Out at 90%.

Conclusion
Though in the first cycle of our audit, the compliance to the SSCL was found to be suboptimal, significant improvement was demonstrated in the second cycle and eventually in the final third cycle bringing it closer to 100% compliance, after rigorous awareness programs and training sessions. Compliance with all items in the checklist and active participation by all medical and nursing staff is mandatory for the successful implementation of the Surgical safety checklist.
FP7.2 - Single centre experience of laparoscopic management of acute small bowel obstruction
Authors: Subramanian Atreya , Swaminathan Christie , Singh Anurag , Adhya Sushmit , Gulab Adil , Sajid Muhammad 
Published: September 2024

Abstract

Objectives
The objective of this article is to present a single-centre experience of laparoscopic emergency surgery reporting outcomes by laparoscopic management of acute small bowel obstruction (ASBO).

Methods
A retrospective review of case notes to evaluate postoperative outcomes. 119 patients were included in this study of laparoscopic management of ASBO and data analysis was performed with SPSS software.

Results
There were 119 patients with primary aetiologies of adhesion bands (49.5%/59) and hernia (31.9%/38) were noted. Mortality and morbidity outcomes – 15 patients had minor complications, 37 had major complications and 3 patients had post-operative mortality. The average length of stay (LOS) was 10.86 days. The LOS Subgroup analysis showed that 13.8 days were average for adhesiolysis and 6.7 days for the hernia.

Discussion
On comparison with the published data global data suggest minor complications of 12.6 % (14% in this single-centre experience), major complications of 34 % (31 % in this single-centre experience) and mortality of 0.6% (2.5 % in this single-centre experience).

Conclusion
This study shows that this centre has comparable mortality and morbidity outcomes when compared to the global trend, but these outcomes.
FP7.12 - A Three-Year Retrospective Analysis of Variables and Their Relationships as Outcome Indicators Following Emergency Laparotomies in Octogenarians: Insights from a Single Institutional Experience
Authors: Haji Altaf , Zehra Sadaf , Zohdy Mohamed , Piramanayagam Bala , Marimuthu Kalimuthu , Selvam Lourdusamy Arul 
Published: September 2024

Abstract

Aim
This retrospective study aims to evaluate the morbidity and mortality outcomes associated with emergency laparotomies in individuals aged 80 years and above, referred to as octogenarians. Against the backdrop of the National Emergency Laparotomy Audit's data from the Eighth Year (2020–2021), which indicates a slight increase in overall in-hospital mortality rates across all age groups, the specific focus on octogenarians intends to provide insights into the unique challenges and outcomes experienced by this elderly population undergoing emergency laparotomies.

Methods
This retrospective analysis focused on emergency laparotomies in octogenarians between June 2020 and June 2023, comprising 62 cases out of 370. Using a standardized proforma, data was collected and statistical analysis was done with SPSS.

Results
In this study involving 62 elderly patients (mean age 84) undergoing emergency laparotomies, common diagnoses included Adhesional Small Bowel Obstruction and Large Bowel Obstruction due to Diverticular Disease. Despite the absence of geriatrician involvement, the overall mortality rate was 21%, emphasizing the potential impact of geriatrician reviews. While factors like sepsis and bowel resection did not significantly influence outcomes, the study identified associations between ASA Score, diagnosis type, and predicted mortality rate with patient survival. Complications and comorbidities, such as AKI and atrial fibrillation, were linked to increased mortality.

Conclusion
In summary, emergency major abdominal surgery poses significant risks, particularly for frail and elderly individuals with multiple co-morbidities. Recognizing frailty as an independent risk factor is crucial. While assessing frailty is complex, open discussions with patients and families about the substantial surgery-related risks are imperative. Establishing realistic expectations is vital for informed decision-making and patient-centered care.
FP7.19 - PIXEL: Patient Information and eXplanation following Emergency Laparotomy
Authors: Silva Louise , Amy Hillier , Williams Hayley , Cornish Julie Ann 
Published: September 2024

Abstract

Aims
80% of patients that survive an emergency laparotomy (EmLap) report that they would have preferred more information on “what to expect” during their recovery; information is often delivered on a variable adhoc inpatient basis. This work aims to assess the robustness of a multi-disciplinary prepared patient information leaflet (PIL), by use of a patient questionnaire, and the Ensuring Quality Information for Patients (EQIP) toolkit.

Methods
A 21-page PIL was prepared by the EmLap MDT at our institute. The PIL’s objective was to outline common issues encountered during recovery, factors that could aid recovery, and signpost relevant resources. POLO enrolled patients (ClinicalTrials.Gov:NCT05281627) were asked their opinion by completion of an 8-point questionnaire at their 12-month follow-up. The PIL was also scored using the EQIP tool by an independent healthcare professional.

Results
30 patients took part. 66.6% were female; average age was 63 years. 100% patients felt the PIL was easy to understand; 96.6% felt it covered all appropriate content. When asked about the length of the PIL: 93.3% felt the length of the leaflet was just right; 6.7% felt that the leaflet was too long. The PIL was found to be 93.3% compliant with the EQIP tool.

Conclusions
This is the first study to demonstrate the robustness of a PIL concerning EmLap recovery, suggesting it can be applied to a national audience. It is accepted that the leaflet is long; future iterations may benefit from being in a different format e.g. visuo-audio.
FP7.20 - Peri-orbital burns: A 5-Year Review of the Epidemiological Characteristics and Outcomes at a Regional Burns Centre in the UK 2019 – 2023
Authors: Hassan Rawan , Clements Jamie , Black Claire , Fogarty Brendan , Hodgins Nicholas , Rashid Abid 
Published: September 2024

Abstract

Background
Burn injuries are a major cause of global morbidity. Despite being infrequent, peri-orbital and ocular burns can have significant implications on a patient’s vision and overall quality of life. In Northern Ireland, the current epidemiological landscape of peri-orbital burns is not clear. This study aimed at assessing the incidence of peri-orbital and ocular burns and the management outcomes of patients admitted at the regional burns unit in Northern Ireland 2019-2023.

Methods
Patients admitted to the regional burns unit in Northern Ireland between January 2019 and September 2023 with periorbital burns were identified from the burns unit electronic records, the burns unit database and hospital image database.

Results
Over 5 years, 100 patients with facial burns were treated, including 60 patients with eyelid burns. 71% were males and 29% were females with a mean age of 47 years. The mean burn size was 14% total body surface area. The burn depth varied; 55% superficial partial thickness, 22% mixed, 17% full thickness and 6% deep dermal. Majority of burns were flame burns 64%. In total, 7 patients sustained corneal burns, one patient responded to steroids, one underwent amniotic membrane grafting, one lost complete vision in both eyes, one had physical debridement and topical antimicrobials and three patients required periorbital reconstruction to maintain eye closure.

Conclusion
60% of Facial burns were associated with eyelid burns, the majority of which were caused by flame burns and were managed conservatively with wound cleaning, physical debridement, and application of topical antimicrobials. Despite being rare, complete loss of vision was associated with mortality among our patients.
EP120 - A Retrospective Review of Pregnant Patients Referred to an Emergency General Surgery Service
Authors: Gahunia Sukhpreet , Bhobe Dhruvi , Kenington Cleo 
Published: September 2024

Abstract

Aims
To gain insight into the journey and outcomes of pregnant patients referred to an emergency general surgery service.

Methods
Surgical handover lists from Jan 2021-Dec 2023 were reviewed to identify pregnant patients referred to the service. Data was collected from the electronic patient record on demographics, timeline, imaging, diagnosis, management and subsequent delivery method if pregnancy reached term.

Results
There were 91 referrals of pregnant women to the emergency general surgery service over the 3 year period. 80% were for abdominal pain. 64% of patients received a documented review by a general surgery consultant, and 35% received a documented review by an obstetric consultant. For those presenting with abdominal pain, 79% had imaging other than plain film, the most common being ultrasound abdomen (75%). 5% of patients had an MRI abdomen and pelvis, and 4% of patients had a CT abdomen and pelvis. Of the 21 patients treated for a confirmed abdominal surgical diagnosis who had a documented delivery, 29% required emergency c-sections. In comparison, out of 17 patients who had either non-surgical pathologies or extra-abdominal surgical pathologies, excluding pregnancy-related complications, 0 went on to have emergency c-sections. This is statistically significant (p=0.0241).

Conclusion
The investigation and management of an acute abdomen in pregnancy poses a number of unique challenges. Our dataset, though small, has hinted at unacceptable rates of consultant review and under-utilisation of cross-sectional imaging. Furthermore, there is the suggestion that patients with confirmed abdominal surgical pathology may be at increased risk of delivering via emergency c-section. There is a need for further research into this patient population.
EP218 - A closed-loop audit on the assessment of the documentation of frailty at admission in emergency general surgery admission at a tertiary care hospital
Authors: Singh Anurag , Siby Jayas , Kaur Mandeep , Sajid Muhammad 
Published: September 2024

Abstract

Background
NHS frailty guidelines advise that frailty score should be documented at the first time of contact for patients aged 65+ years. The Aim of this quality improvement project (QIP) was to assess the adequate documentation of frailty at the time of first encounter by the general surgery department for patients aged 65+ years.

Method
Data was collected for October 2022 for the first cycle and January and February 2023 for the second cycle. Data collection was done from an electronic database in the trust and patient notes maintained throughout the admission.

Results
136 patients were included in the QIP for the first cycle. 3/136 (2.2%) patients had documented frailty at the first encounter. These findings were discussed in the clinical governance meeting, followed by a teaching session for the junior doctors. A specific section was added in the documentation as a reminder for the team to document the frailty upon the first encounter.
212 patients were included in the second cycle and documentation of frailty improved to 39/212 (18.4%).

Conclusion
There was a lack of documentation, which improved after the intervention advised by QIP. A teaching session for new junior doctors is planned at the induction session, to strengthen the importance of frailty documentation.
EP369 - Abscess as unplanned returns to theatres in Emergency General Surgery
Authors: Salam Ammara , Patel Bhavnisha , Alabri Badar , Osunlusi Oluwafemi , Waraich Naseem 
Published: September 2024

Abstract

Aim
Unplanned Return to Theatre (URTT) impacts patient care along with financial and legal implications on hospital resources. This can be reduced by identifying the contributing factors and measures taken to rectify them. This study was conducted at District General Hospital in England, aims to review the incidence of URTT in Emergency General Surgery and identify the preventable causes.

Method
A retrospective review was conducted for all Emergency General Surgical Procedures done between 1st January 2019 to 31st January 2021. The data was obtained from the Hospital data softwares Fusion and Bluespier, in addition to the paper notes. The operations were classified as index operation, followed by the number of returns and the indication for the URTT.

Result
A total number of 1578 emergency general surgery operations were performed during a period of 25 months (Jan 2019 to January 2021). The unplanned return to theatres (URTT) were 85 (5.3%), with a 90-day mortality of 16. Among these, 29.4% (25) URTT were abscess. The major reason (66%) for this URRT was inadequate drainage requiring redo/debridement. The other reasons were laying open of fistula/seton placement (30%) and stoma formation (4%). Level of operating surgeon was Consultant (8%), Registrar/Core Trainee (64%) and missing data (28%).

Conclusion
Abscess is a frequently performed operation in Emergency General Surgery. Knowledge of anatomy with adequate incision ensuring good drainage of the abscess can prevent URTT for abscess, improving patient outcomes and cost benefits.
EP376 - Portal Pyaemia and Fungal Septicaemia Associated with Mesenteric Venous Pneumatosis - Improving Patient Outcomes
Authors: Kumar Anusha , Bath Michael , Hussein Halil , Nair Manoj 
Published: September 2024

Abstract
An 82 year old female presented to A&E with a 1 week history of lower abdominal pain, fever, and nausea. She had a known history of sigmoid diverticulosis, however had not had any previous abdominal surgery, and had no other past medical history of note.
At presentation she was in septic shock, requiring vasopressor support to maintain her blood pressure. Her abdominal examination revealed left iliac fossa tenderness, however no features of peritonism. Initial investigations revealed a White Cell Count (WCC) 49.3x10^9/L, a C-Reactive Protein (CRP) 191mg/L, and an ALP of 434IU/L. A CT scan of the abdomen and pelvis confirmed acute sigmoid diverticulitis, with radiological features suggesting gas tracking along the inferior mesenteric vein (IMV).
An emergency Hartmann’s procedure was performed, and intra-operatively pus was evidence draining directly from the IMV. Pre-operative blood cultures and intra-operative tissue cultures grew Escherichia coli, for which the patient was treated with intravenous meropenem post-operatively. She was transferred to Intensive Care Unit and stepped down to the ward on post-operative day 5. Within the first 48 hours post-operative, the WCC had risen to 64x10^9/L, however within 72 hours of commencing anti-fungals, this dramatically decreased to 16x10^9/L. After this, her recovery was swift, and was discharged shortly after.
In the context of acute diverticulitis, any radiological evidence of gas within the portal venous system is likely secondary to portal pyaemia. Urgent operative intervention for source control remains the mainstay of management, with consideration of anti-fungals imperative.
EP392 - Different modalities used in the investigation of anorectal lesions: a case report and discussion
Authors: Saraee Danial , Pai Deepak , Kaur Geetinder 
Published: September 2024

Abstract

Introduction
Endoanal ultrasound scan (EAUS) /MRI rectum followed by early open/endoscopic, resection/biopsy for histology are important to plan management of all anorectal lesions. Here, we report an incidentally found inter-sphincteric lesion investigated with both EAUS and MRI scans, followed by excision.

Case report
A 55-year-old patient presented with post-menopausal bleeding and was investigated with an MRI pelvis which confirmed the causative subserosal fibroid. An incidental 15x12 mm focal soft tissue lesion at 2 o’clock between the internal and external anal canal sphincters was also picked up by the consultant GI radiologist. Her colonoscopy was normal but her digital rectal examination revealed a palpable submucosal elongated pea shaped lump at 2 o’clock. A lower GI specialist nurse performed an EAUS which suggested the lesion to be at 10 o’clock. At examination under anaesthetic (EUA), the mass in the inter-sphincter anal canal was confirmed at 2 o’clock, and excised after careful dissection from its intersphincteric location; histology confirmed a leiomyoma. The patient recovered well from the procedure.

Discussion
MRI and endoanal ultrasound are key imaging modalities in the diagnosis of rectal masses. EAUS provides more accurate assessment of depth of tumour invasion compared to MRI, and its relation to the anal sphincters; however, the scans are highly operator-dependent, as we found, and need to be interpreted with the benefit of clinical examination.

Conclusion
MRI and EAUS are complimentary in investigating rectal masses; however clinical examination, (especially under anaesthetic), as well as histology, gives the best information to plan subsequent management of common and unusual lesions (such as this) in the anorectum.