bluuebunny/crossref_metadata_2025_split huggingface dataset:
FP1.1 - The relationship between tumour necrosis, the tumour microenvironment, systemic inflammation, body composition and survival in patients with operable colon cancer. Does tumour necrosis drive systemic inflammation and cachexia?
Authors: Dolan Ross , Pennel Kathryn , Thompson Joshua , McKenzie Molly , McMillan Donald , Edwards Joanne 
Published: September 2024

Abstract

Introduction
The prognostic value of the systemic inflammatory response and its incorporation into the definition of cancer cachexia (GLIM) is now established. However, the basis of the relationship between the tumour, its environment and the systemic inflammatory response is not clear. The aim of the present study is to examine this hypothesis in greater detail.

Methods
A total of 473 patients were included. Host and tumour characteristics were assessed including tumour cell signaling pathways, CT derived body composition and systemic inflammation (as assessed by SIG). Categorical variables were analysed using χ2 test for linear-by-linear association, or χ2 test for 2 by 2 tables. Survival analysis was carried out using univariate Cox regression.

Results
Tumour necrosis was associated with age (p&lt;0.01), tumour location (p&lt;0.01), T-stage (p&lt;0.001), margin involvement (p&lt;0.05), SIG (p&lt;0.001), SMI (Martin, p&lt;0.01), SMI (Dolan, p&lt;0.01), SMD (Dolan, p&lt;0.05) and 5-year survival (p&lt;0.001). No association was found between tumour necrosis and signalling markers of the IL-6/JAK/ STAT and NF-KB pathways. On univariate survival analysis age (p&lt;0.001), ASA (p&lt;0.001), T-stage (p&lt;0.001), N-stage (p&lt;0.001), tumour budding (p&lt;0.05), venous invasion (p&lt;0.01), adjuvant therapy (p&lt;0.01), margin involvement (p&lt;0.001), necrosis (p&lt;0.01), SIG (p&lt;0.001), MUST (p&lt;0.001), BMI (p&lt;0.05), sub cutaneous obesity (p&lt;0.001), visceral obesity (p&lt;0.05), Sarcopenia (Martin, p&lt;0.05), Sarcopenia (Dolan, p&lt;0.01), Myosteatosis (Dolan, p&lt;0.05) GMS (p&lt;0.001), Ki67 (p&lt;0.01) and TSP (p&lt;0.01) were independently associated with overall survival.

Conclusion
There is a clear association between tumour necrosis, the SIR and body composition in patients with colon cancer. These results are consistent with the hypothesis that tumour necrosis and the subsequent inflammatory response results in profound changes in body composition.
FP1.2 - Exploring Risk Factors and Incidence Patterns of Incisional Hernia following Colorectal Surgery: A Retrospective Cohort Study
Authors: Kishore Swetha , On Jason 
Published: September 2024

Abstract

Aims
This study aimed to determine the incidence rate of incisional hernias (IH) following colorectal resections and identify risk factors associated with their development.

Methods
A retrospective cohort of 942 patients undergoing colorectal surgical resection between January 2020 and March 2023 were analysed. Data collected encompassed patient demographics, medical history, operative details, and complications. Comparative statistical tests and logistic regression were employed.

Results
The incidence of IH was 10.2% during a median follow-up of 11 months (4,12). Multivariate analysis revealed significant risk factors, including increased BMI (OR 1.063; 95% CI 1.029 – 1.097, p &lt; 0.001), neoadjuvant chemotherapy (OR 2.098; 95% CI 1.021 – 4.314, p = 0.044) and midline extraction site (OR 15.465; 95% CI 3.292 – 31.591, p &lt; 0.001).

Conclusions
With an IH incidence of 10.2%, this study identifies high BMI, neoadjuvant chemotherapy, midline extraction site, and laparotomy procedures as significant risk factors. Data also indicated a pfannenstiel incision is the preferred incision site during robotic surgery thereby minimising the risk of developing an incisional hernia and improving patient outcomes.
FP1.8 - Optimizing Rectal Cancer Treatment: Comprehensive response to Neoadjuvant therapy
Authors: Anwar Kehkashan , Talal Muhammad Nasir , O' Connor Adam , Kamposioras Konstantinos , Arthur Claire , Ullah Sana 
Published: September 2024

Abstract

Aims
This study aimed to assess the outcomes and feasibility of a watch-and-wait strategy in patients with rectal cancer showing a complete response to neoadjuvant chemoradiotherapy (CRT). The primary objectives included evaluating the oncological results, disease-free interval, and survival rates in patients who underwent the watch-and-wait approach after a complete clinical response.

Methods
The study involved a retrospective analysis of last 10 years of rectal cancer patients enrolled in a complete responder surveillance program in an acute general hospital. Cohort characteristics, including age, performance status, tumor histology, distance from the anal verge, and treatment modalities, were documented.

Results
The median age was 74 (57-90), and the median performance status was 1, with the age at diagnosis being 69. All cohort members had a histologically confirmed rectal adenocarcinoma. The median tumor-to-anal-verge distance was 5 cm (1-10 cm). Neoadjuvant chemotherapy was administered to 55% of patients. All patients underwent long-course radiotherapy, and 35% received papillon contact brachytherapy. Total neoadjuvant therapy was received by 10%. The median follow-up involved approximately 9 colonoscopies. During follow-up, 25% of patients experienced recurrence, with a median disease-free interval of 3.5 years.

Conclusion
The findings of this study, in addition to ongoing prospective clinical trials and insights from databases such as EURECCA and OnCore, indicate that a watch-and-wait approach can be safe and effective for selected rectal cancer patients who have achieved a complete response to neoadjuvant CRT. This study highlights the significance of additional research to identify appropriate patients for this approach and to refine its implementation in rectal cancer management.
FP1.14 - A Re-audit of the prevalence of faecal incontinence in hospital inpatients
Authors: Saraee Danial , Khadka Subodh , Kaur Geetinder 
Published: September 2024

Abstract

Introduction
Faecal incontinence (FI) is a common and under-reported problem, with many patients too embarrassed to seek help. Patients often do not receive optimal care due to lack of identification. In-hospital identification when they are admitted for other reasons may be one method of improving the care of such patients.

Aims & Methods
We had assessed the identification of continence problems in our hospital inpatients via a simple ‘spot check’ audit of the different wards in 2015; we used the case notes for checking the documentation by both nursing and medical staff. We looked at care plans, stool charts, follow up plans etc. We repeated this audit in 2023 to check for any improvement.

Results
Overall,132 (163 in 2015) patient case notes were examined. 94%(previously 90) had nursing documentation about bowels documented in comparison to 47% (48) for medical documentation. 5.3% (10.8) were found to have FI. Only 28% (31) of these patients would have been identified by medical documentation. Most of the patients identified with FI were elderly, as expected; surprisingly, 28.57% were on general surgical wards. All patients (100%) in 2015 were then referred appropriately for further management. In 2023, though some action for FI was taken in 71.42 % patients, no referral was apparently arranged in any.

Conclusion
It is important to identify patients with FI, establish cause and initiate appropriate management. The impact on the individual patient’s QOL needs assessment prior to planning management/specialist referral etc. We found that our nursing documentation was still better than medical documentation which needs to be improved; however, onward referral/management needs improving significantly.
FP5.7 - Why I don’t want a career in surgery? - Uncovering obstacles and investigating barriers among year 3 UK medical students: A thematic analysis
Authors: ELsherbiney Saged , Alakus Conor , Kaur Harneet , Khera Goldie 
Published: September 2024

Abstract

Aims
Surgical training and placements can be stereotyped negatively by medical students. Our study aimed to identify barriers to pursuing a surgical career amongst UK year 3 medical students, to improve surgical educational policies.

Methods
An optional, anonymous, single-question, open-text survey was administered to 190, year 3 UK medical student, after they had completed an 11 week surgical clinical placement, comprising Breast, Emergency Department, Interventional Radiology, Orthopaedics, Peri-op anaesthetics, Plastics, Vascular, Upper/Lower GI and Urology.
The specific question asked was, 'Would you contemplate pursuing a career in surgery?'
Responses from students NOT considering a surgical career were analysed qualitatively using a thematic approach to identify perceived barriers to a surgical career.

Results
102 responses were received of which 35 were not suitable for analysis. Of the remaining 67 students, 30 (44.8%) demonstrated a negative view towards a surgical career. Following thematic analysis four main themes were identified:Pre-existing interest in another specialty.Nature of surgical training (long duration, competitive, poor work-life balance).Stressful clinical workload, high emotional pressure and burnout.Negative, masculine culture within surgical teams.
Positively, despite not planning to pursue surgery - some students reported surgery was not as intimidating as they had expected it to be and surgeons did not meet stereotypes they were expecting.

Conclusions
Medical students continue to comment on negative surgical working environment experiences. Our study highlights areas that high pressure surgical training placements, need to actively improve in order to ensure a positive working and teaching surgical environment for our future medical workforce.
FP6.9 - Improving Compliance & Implementation of the STAR Score at a tertiary level hospital in India: A continuous process
Authors: Sinha Akatya , Kadam Sameer 
Published: September 2024

Abstract

Aim
To perform an audit to check the Quality and compliance of Surgical documentation using STAR Score at a tertiary hospital in India.

Method
A total of 90 case files were studied and assessed in detail from all surgical departments. The “STAR: Surgical tool for auditing records” tool was used to collect data accordingly. The results were compared with standard guidelines and further analyzed. A series of departmental training and implementation meetings were carried out. Three cycles were carried out and a re-audit was performed at the end of every cycle.

Result
The overall compliance score of the hospital was found to be 74%. While the departments of General surgery and orthopaedics showed a higher rate of compliance, each constituting 82%, Neurosurgery showed the least compliance at 62%. It was also seen that the maximum percentage of missing information constituted anaesthetic records and subsequent entries. At the end of 3 cycles, a considerable improvement was observed, with the compliance rate improving to 98% in all departments.

Conclusion
We believe that compliance and implementation of the STAR Score is mandatory, as it can significantly improve the quality of documentation and can be implemented universally.
FP8.5 - QR Coded Patient Leaflets – Transforming the Sustainability of Patient Information Delivery in the Surgical Outpatient Department
Authors: Kumar Sidharth , Yeung Antoinette , Issa Mohammed Talaat , Farrugia Alexia , Sarma Diwakar 
Published: September 2024

Abstract

Introduction
Quick Response (QR) codes are becoming ubiquitous in all aspects of life, including healthcare. In outpatient clinics, the benefits of convenience, cost effectiveness and environmental sustainability of QR codes has great potential. We identified that our trust was lacking in both electronic and hardcopy patient information leaflets for Bascom’s Procedure and Endoscopic Pilonidal Sinus Treatment (EPSIT). Our aim was to create information leaflets on our trust website and link them via a QR code for easy access.

Methods
We audited our hardcopy information leaflets for both procedures for quality and satisfaction of information and patients were given a feedback questionnaire which specifically included a response for their preference for electronic QR code access.

Results
The initial feedback from 20 patients showed 85% support for QR codes. 90% found the information clear, informative and easy to understand. There was a suggestion to include diagrams in our leaflets.

Conclusion
We had positive feedback regarding the following: quality of information, clarity of the leaflet, and accessibility (particularly the use of QR codes). The latter reflects the younger age demographic of patients that were surveyed. We plan to prospectively audit QR coded leaflets in our outpatients. We will evaluate success through both patient and clinician feedback forms. QR coded leaflets could be implemented trust wide and even nationally, to increase sustainability in outpatients and the wider NHS, without compromising patient understanding or satisfaction.
FP8.9 - Surgical Synergy: Rethinking waste for a greener tomorrow in General Surgery
Authors: Kabir Tahmid , Lingam Gita , Sivarajah Vernon , Hussein Adam 
Published: September 2024

Abstract

Aims
Every year in the UK, the NHS sends approximately 156,000 tonnes of clinical waste for processing via high temperature incineration or other treatments, and then to landfill sites. Majority of the waste produced by hospitals comes from the operating theatres (OTs). In this study, we aim to assess the current implementation of waste management strategies at an NHS district general hospital (DGH) in general surgery. We have investigated a variety of cases and have surveyed the volume of waste produced.

Methods
We observed elective and emergency general surgery cases across 2 weeks. For each case, we weighed the waste produced- both recyclable and non-recyclable (clinical).

Results
This study included four umbilical hernia repairs, two right hemicolectomies, one examination of rectum under anaesthesia with seton insertion and three laparoscopic cholecystectomies. Across the operations, the average total waste produced was 5.9kg. The average clinical waste and recyclable waste was 4.7kg and 1.2kg, respectively. Additionally, a significant proportion of non-infectious recyclable waste was incorrectly placed into the clinical waste bin.

Conclusion
On average 5.9kg of waste is produced after a general surgery operation. Most of this waste is clinical and not recycled. However, the clinical waste can be cut down by appropriate waste segregation, thus reducing the impact on the environment as well as reducing the cost of incineration.
EP160 - A comparison of pre-rotation confidence levels over a year of surgical foundation year one doctors in a busy district general hospital
Authors: George Jayan , Savage Daniella , Brown Denise , Yeluri Sashidhar 
Published: September 2024

Abstract

Aims
Assess the confidence levels of foundation year one (FY1) doctors in managing surgical patients pre-rotation. Identify areas where further support could be given to improve confidence levels.

Methods
Ten questions used Likert scales (1 to 5: not at all confident to very confident) to assess general surgical patient management. One question focused on education methods and one open question. Cohort One (August 2022) were asked to reflect in December 2022. Cohort Two (December 2022) and Cohort 3 (April 2023) were surveyed at the start of their general surgical rotation. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results
100% (10/10) cohort one, 75% (6/8) cohort two and 100% (10/10) cohort three completed the survey.
Pre-rotation confidence levels mostly improved between the first cohort and last cohort.
Areas where modal scores were below three in the last cohort were in managing the acutely unwell general surgical patient, managing biliary disease and managing non-specific abdominal pain.
Common concerns of FY1 doctors were not being able to contact a senior in theatre and the busyness of the specialty.
Most FY1 doctors felt that group teaching would be the preferred method to increase understanding of general surgery.

Conclusions
Confidence levels were higher in the final cohort. This suggests core skills are picked up in different specialties which are transferrable to aspects of general surgery. Further work needs to be done to target improvement in areas of lower confidence.
EP181 - The role of abdominal X-rays in the acute abdomen: a retrospective audit
Authors: Alkaissy Riem , Manimaran Natarajan 
Published: September 2024

Abstract

Introduction
Abdominal x-rays (AXR) are commonly performed as part of the diagnostic work up for acute abdomen despite wide availability of CT. Several studies dispute the role of AXR in acute abdomen, due to low accuracy, uncertain role in diagnosis & management and superiority of CT (1). There are calls to replace AXRs with CT altogether where possible, as patients often end up having CT scans, thereby receiving larger doses of radiation (2). The Royal College of Radiologists (RCR) have produced guidelines to reduce the use of AXR in the acute setting (3). The aim of this audit was to clarify if we adhere to the RCR Guidelines at our DGH.

Methods
62 consecutive adult surgical patients admitted to our surgical admissions unit as emergency, between September and November 2023 were included in this retrospective audit. Data was collected regarding patient demographics, reason for request, AXR report, whether patient underwent CT, CT report and time between AXR and CT.

Results
97% of AXR requests were compliant with RCR guidelines. 30/62 patients also had a CT scan following initial AXR. Of these, 13 had normal AXR and CT. 9 had normal AXR but abnormal CT. 8 had abnormal AXR which was confirmed on subsequent CT.

Discussion
We identified that our surgical unit has good compliance with RCR guidelines. However, nearly half of our patients also had a CT scan, in addition to AXR. Although the AXR has lower radiation dose, it may be prudent to restrict the addition of AXR, if a CT is required to assess acute abdomen. We now aim to discuss and propose change in our practice for the future.
EP474 - Recycling Theatre Waste: A Quality Improvement Project
Authors: Wong Zhen Yu , Herrod Philip 
Published: September 2024

Abstract

Background
Theatre waste recycling is a crucial aspect of sustainable theatre production. Staff are usually under time pressure to empty and clean the theatre. This quality improvement project (QIP) aims to assess and reduce waste-related cost and carbon footprint by improving the proportion of waste recycled.

Methods
A retrospective review of the waste data and related cost for main theatres in Nottingham City Hospital (NCH) in 2022 was audited. A quick guide for waste disposal and recycling was made with the help of environmental department and was disseminated to the theatre staff electronically and physically. Data was reaudited for February to March 2023 post intervention.

Results
86.6 tons of waste was generated from the main theatres in NCH in 2022 and 18.4% of the waste was recycled. Monthly proportion of waste recycled ranged from 9.3% (January 2022) to 35.0% (December 2022). The proportion of waste recycled for February and March was 36.7% and 26.4% respectively.

Conclusion
The findings of this QIP demonstrate the potential for significant improvements in theatre waste recycling rates, which can lead to reduced cost and carbon footprint. The use of a quick guide for waste disposal and recycling proved to be an effective intervention in improving recycling rates among theatre staff. This QIP highlights the importance of promoting sustainable practices in the theatre industry, and the necessity to sustain the effort to maintain the impact.
EP496 - Metastatic Invasive Lobular Carcinoma of the Breast mimicking healed Gastric Ulcer: A Case Report
Authors: Hobeita Wesam , Curry Heather , Mahmud Sajid , Lannigan Alison , Khan Khurram S 
Published: September 2024

Abstract

Introduction
Breast cancer metastasizing to the stomach as a new presentation is highly unusual. We report a 77-year-old female with such presentation.

Case Presentation
A 77-year-old female investigated for significant weight loss. She denied any upper or lower gastrointestinal symptoms. She had bidirectional scopes. Colonoscopy showed only diverticulosis. Two gastroscopies revealed non-specific stellar shaped areas in the anterior antrum wall mimicking a healed gastric ulcer. Biopsies confirmed metastatic lobular carcinoma of the breast, ER+ve, HER2 negative.
On further clinical examination she had large mass upper outer quadrant with palpable enlarged nodes. Staging CT scan showed couple of hyper enhancing foci in the right breast which may be potential candidates for primary tumour and enlarged right axillary nodes. Subsequently she had an ultrasound guided biopsy of the breast lesion confirmed invasive lobular cancer.
Patient has been referred to the breast MDT for breast and lymph node biopsy.

Discussion
The incidence of GI metastatic disease from a primary breast cancer is less than 1%. It is more common to diagnose in patients with prior history and treatment for primary breast malignancy. However, occasionally it can be encountered prior to the diagnosis of the primary tumour. Hence, index of high suspicion is required as the endoscopic findings are non-specific.
EP537 - Revolutionizing informed consent: A quantum leap in precision for chronic pain awareness in inguinal hernia operations through electronic consent
Authors: Ahmad Shakil , Kirmani Naveed 
Published: September 2024

Abstract

Aim
The study aimed to assess the extent to which clinicians provide information to patients about the occurrence of chronic pain during consultations, recognizing it's significance as a prevalent postoperative complication following inguinal hernia repair.

Methods
Data were gathered by two teams at distinct time periods within the same trust. One team utilized the standard paper-based consenting method, while the other employed a recently introduced electronic consenting process. A comparison of these approaches was undertaken to derive the study's results, making it a retrospective and comparative analysis.

Results
An investigation on this subject conducted initially uncovered that 84% of patients were not informed about the risk of chronic pain and did not provide consent for this common occurrence via standard paper based method. Consequently, the study recommended the implementation of an e-consent facility in the Trust. This facility would feature a template encompassing all pertinent risks associated with inguinal hernia surgery.
Following the introduction of e-consent later, we conducted a subsequent analysis on patients who underwent inguinal hernia surgery. The findings indicated a notable improvement, with 98% of patients having given their consent for chronic pain.Manner of consentingPatient who was informed about chronic pain during consentingPatient who wasn't informed about chronic pain during consentingPaper consent16%84%e-Consent982%

Conclusion
The incorporation of chronic pain as a potential complication in the consenting process for inguinal hernia surgery has seen improvement since the introduction of the e-consent software. However, to achieve full compliance, there is a need for further enhancement and increased utilization of the e-consent software.