bluuebunny/crossref_metadata_2025_split huggingface dataset:
WP3.14 - A Single Unit Service Review in Northern Ireland: The Ever-increasing Acute Surgical Take and the Need for Service Adaptation
Authors: Lockhart Jessica , Bardon Aimee , Spence Rob 
Published: September 2024

Abstract

Aims
Referrals to the on-call general surgeons in the unit has increased significantly over the past year. Staff levels and hospital resources have not changed to reflect this increasing demand on the service. Our aim is to evaluate the increase in numbers and develop a strategic plan for resolution.

Methods
A database of referrals to the on-call surgical team was developed using the daily handover records. Two periods of data collection were undertaken, each lasting a duration of 30 days, taking place approximately one year apart. Patient demographics and clinical information was gathered using our electronic care record and electronic notes record. Data gathered included diagnosis, treatment, investigations, interventions, length of stay, suitability for ambulation and follow up.

Results
The total number of patients referred to the on-call team during cycle one was 233, compared with 405 in cycle two; this is a 74% increase in referrals. During the windows of data collection, 75% of patients with an unscheduled admission did not undergo any intervention and 80% were deemed suitable for ambulation.

Conclusion
Increasing demands on the NHS require a forward-thinking approach to how we provide an acute surgical service. This study demonstrates that a large proportion of patients are suitable for an ambulatory model of care and development of this service would be a valuable adjunct to the unit. To propose an ambulatory service providing urgent surgical assessment would be an asset to the Trust; potential outcomes would include improving the patient experience, reducing inpatient admissions and bed days, with the associated cost-saving.
WP4.5 - Changes in Social Care Post Major Emergency General Surgery Procedures
Authors: Niaz Osamah , Khalil Abdullah , Batt Mohammed , Al-Fagih Othman , Askari Alan , Al-Taan Omer 
Published: September 2024

Abstract

Introduction
Emergency General Surgery (EGS) is a major part of the provision of healthcare and patients undergoing EGS are at elevated risk of morbidity and mortality. The aim of this study is to determine factors contributing to patients losing their independence and being discharged to residential and nursing homes having previously lived in their own residences.

Methods
Data from patients in the NELA database (2014-2022) was analysed, considering demographics, ASA score, admission and discharge dates, presenting pathology, operation type, and discharge destination. Comparative analyses segmented patients based on post-discharge EGS destinations. Multivariable logistic regression identified factors linked to residential/nursing home placement post-discharge. Significance was set at p&lt;0.05.

Results
Data from all patients in the NELA database (n=1,611) was analysed. Nearly one in ten patients over the age of 70 never returned home. Patients requiring additional support were on average 8.6 years older (p=0.008). Over the age of 80 years, the need for extra social support increased substantially with each increasing year in age and those over the age of 85 years old were more than twice as likely to require extra support than 80-year-olds (p&lt;0.001). Patients who died were 11.4 years older compared to those discharged without additional support (p&lt;0.001).

Conclusion
A significant proportion of patients, particularly the elderly, do not return to their usual place of residence and require a higher level of care post-emergency surgery. These important social factors need to be considered before operating as they may have significant quality of life and economic implications.
WP5.4 - Uncomplicated acute diverticulitis can be managed in an ambulatory setting
Authors: James Nicole , Abbad Mutaz , Fung James , Bignell Mark , Bond-Smith Giles 
Published: September 2024

Abstract

Aims
We aimed to evaluate a treatment pathway for acute diverticulitis at our Surgical Emergency Unit (SEU) and analyse the outcomes. We hypothesised that a significant number of patients can be managed in an ambulatory setting.

Methods
We reviewed clinical records of all adult patients (aged ≥18 years) admitted with acute diverticulitis between April 2022 to March 2023. Those presenting with clinical suspicion of acute diverticulitis were assessed clinically, biochemically and radiologically with cross-sectional imaging. This allowed early detection and treatment for those with complications of diverticulitis, and early ambulation within 24 hours for those without. We evaluated their length of stay, modified Hinchey classification of disease severity, antibiotic prescription, and readmission for diverticulitis within 3 months after discharge.

Results
We included 370 patients (160 males, 210 females). The mean age was 63.2 (range 23-96) years. Fifty-five (14.9%) presented with acute complicated diverticulitis (Hinchey classification 1b or above). In total, 218 patients (58.9%) were ambulated within 24 hours of presentation. The proportion of patients ambulated early with and without complications of diverticulitis were 21.8% (12/55) and 65.4% (206/315) respectively (p&lt;0.001). The average length of stay in hospital was 54 (range 0.3-711) hours. Among those ambulated early, 196 were prescribed with oral antibiotics. Only 10 patients (4.6%) had persistent symptoms after 2 weeks from ambulation. Twenty-six patients (11.9%) were subsequently readmitted within 3 months.

Conclusions
In our experience, over half of patients diagnosed with acute diverticulitis were successfully managed on an ambulatory pathway. There was a low percentage with persistent symptoms or readmission. The development of appropriate patient pathways is crucial to improve efficient use of hospital resources.
WP5.7 - Do we follow-up our patients after emergency laparotomy?
Authors: Watson Hannah , Aljarad Feras , Payne Christopher , Gray Carol 
Published: September 2024

Abstract

Aim
Emergency Laparotomy (EL) carries a high risk of major morbidity and mortality and patients can require an extended period of recovery after surgery. Within our organisation, all patients who undergo EL are supported by a dedicated 7-day service to support their mobility, motivation and goal settings as well as wellbeing needs. However, this support does not extend beyond discharge and we do not have standardised follow-up protocol. This audit aimed to review the outpatient follow-up that EL patients received.

Methods
EL data is recorded prospectively and submitted to the Emergency Laparotomy and Laparoscopic Audit (ELLSA). All ELLSA patients admitted between June 2021 and July 2022 were included. Electronic records were reviewed to see what follow-up they received.

Results
258 patients underwent EL during this time period. Only 136 patients received follow-up (53%). Of the appointments carried out, 76% were review by Surgical Team and 45% were review by Colorectal Specialist Nurses. 70% of patients follow-up was face-to-face, with the remainder by telephone. The average time to surgical clinic follow-up was 111days (range 12-371 days).

Conclusions
Only half of the patients received any follow-up after EL, and even fewer received a face-to-face clinic with their consultant. There was also considerable delay for some patients. We feel this is evidence that a dedicated follow-up service for ELLSA patients is required to reduce this variation. We intend to implement a protocolised follow-up as a result of this audit.
WP5.19 - The undifferentiated general surgical take over 10 years: admissions
Authors: Hale Emily , Bowling Kirk 
Published: September 2024

Abstract

Aims
The aim of this study is to review the undifferentiated emergency general surgical take, with regards to admissions in July 2013 and July 2023, at a District General Hospital in order to understand the specific pressures on the department and to identify areas in which we could adapt to facilitate these demands.

Methods
Retrospective data regarding admission and re-admission on all patients treated by the emergency general surgical team in July 2013 and July 2023 was collected from electronic notes. If insufficient information was available, patients were excluded from analysis.

Results
Patient numbers increased by 50% from 2013 to 2023, from 395 to 594. Average length of stay in 2013 was 3.26 days (+/-0.2, p = 0.03), reducing to 2.58 days (+/-0.2, p = 0.03) in 2023. Number of patients admitted overnight has decreased from 74% (n=291/395) in 2013, to 54% (n=324/594) in 2023. Proportion of referrals from ED increased from 48% in 2013, to 69% in 2023. Planned reviews and patients ambulated for surgery the following day has increased from 4% of all patients seen in 2013, to 16% in 2023.

Conclusions
Volume of patients has increased significantly over this 10-year period. Simultaneously, duration and number of overnight admissions have decreased, alongside increasing use of ambulatory services. This reflects the aims of the Government, and the Royal College of Surgeons, with increasing investment in day-case and ambulatory services. However, without an increase in hospital bed numbers, the rising volume of patients may become difficult to manage.
WP6.1 - A survey of the estimated cost of surgical consumable items within Ear, Nose, Throat departments
Authors: Divekar Omkaar , Stephen Sarah , Tikka Theofana , Haymes Adam , Kanegaonkar Rahul 
Published: September 2024

Abstract

Aims
Studies suggest that practitioners lack knowledge on cost of consumables and fail to appreciate the financial consequences of waste. We aimed to investigate this claim amongst ENT practitioners.

Methods
An online questionnaire, requiring cost estimations for 20 consumable items, was distributed to London ENT departments. Each item’s actual cost was compared with the average, median and interquartile range of the estimated price. An estimate was deemed ‘correct’ if it was within 20% of the actual price.

Results
10.65% of all estimations were ‘correct’. There was no correlation between job role and cost-estimation accuracy. The most accurately estimated item was ‘fenestrated sterile drape’ (24.4%), the least was ‘1L bag of IV normal saline’ and ‘package of sterile sponges’ (0%).

Conclusions
We found poor cost appreciation of consumables amongst ENT surgeons. This could serve as a catalyst for the inclusion of health economics in specialty training curricula, improving cost-awareness.
WP6.3 - Neurodivergence Toolkit for Trainers, Supervisors and Educators
Authors: Badenoch Thomas , Ong Eng 
Published: September 2024

Abstract

Aim
To create a simple and easy to use reference toolkit for trainers, supervisors and educators to support neurodivergent trainees.

Methods
Around 15% of the UK population is neurodivergent, increasing annually. Between 2014-2020 the number of autistic medical students doubled. Neurodivergent doctors have little support, as few as 32% of neurodivergent doctors disclose to a supervisor and only 15% to Occupational Health. Only half of those who had asked for reasonable adjustments had them implemented.
Neurodivergence impacts training, delaying graduation for up to 25% of individuals, increasing acts of self-harm by 50% and 24% increase of attempted suicide.
We set out to create a simple reference toolkit of adjustments beneficial to neurodivergent doctors without negatively impacting neurotypical doctors, so it can be implemented without need for disclosure of neurodivergence.
A literature review was completed using the terms “neurodivergent”, “neurodiversity”, “autism” and “education”, “training”. Adjustments in different clinical settings were developed with experts in higher education, neurodivergence and supervising trainers.

Results
A reference toolkit divided by training setting and by level of adjustments has been completed and will be published by in full for use by trainers and trainees in early 2024.

Conclusions
Effective adjustments can be made in a number of domains with varying levels of required trainer effort:
Planning: Educational brief, Checklisting, Flexibility
Environment Modification: Ambient noise reduction, Task completion, Reduced distractions
Metacognition: Refocus on aims, Breaks from engagement, Two way communication
Feedback: Specific behavioural feedback, achieved competency frameworks, reframing of difficulties, written descriptive feedback
WP6.6 - Sentiment Analysis of Social Media Posts by Medical Professional in the UK
Authors: Aditya Kesav 
Published: September 2024

Abstract

Aims
Notoriously described as being controversial in nature, we aim to objectively assess the language used amongst medical professionals in social media (SM).

Methods
Data was extracted from the Reddit SM website under the sub-page "r/DoctorsUK" forum, through a data-extraction code written in the python language. This was then analysed through a Natural Language Toolkit algorithm to classify language used into positive, negative and neutral sentiments with an overall polarity score ranging from -1 noting most negative to 1 being most positive.

Results
A total of 992 articles were examined over a 24-day period, as limited by Reddit data application programme interface (API) protocols. A total of 210 positive, 218 negative and 564 neutral articles were noted with an average of 43 articles posted per day. Headlines sentiment on average was overall marginally positive at 0.0154. Comment tree within each headline was also examined, noting a more positive 0.173. Through regression analysis, it was noted that headline and comment sentiments was directly correlated, and this was statistically significant(P=1.24*10-10). It was also noted that more negative headlines had higher “likes” and were therefore featured more prominently within the forum.

Conclusions
Although SM posts are overall positive in sentiment, it is noted that more negative sentiments are often up-voted and therefore featured more prominently due to their more provocative nature and emotions incited amongst readers. As SM posts elicits strong psychological and psychosocial reactions from a community, there is an urgency to more accurate data driven models in developing future policies to maintain an effective professional morale within the NHS.
WP6.12 - What the bleep? Have we finally found a solution to the bleep system?: Exploring the efficacy of a WhatsApp-style messaging system as an alternative to traditional bleeps in the healthcare setting
Authors: Betts Daniel , Lingam Gita , Sivarajah Vernon 
Published: September 2024

Abstract

Aims
Traditionally, bleeps have been integral to the role of a doctor. A pre-pandemic study estimated that more than 10% of the world’s bleeps are currently being used by the NHS. However, in response to the 2021 directive by the health secretary to phase out bleeps within NHS England, new approaches to communication in healthcare are being implemented. One of these is Alertive, a WhatsApp-style messaging system. This study utilises a quality improvement approach to determine the efficacy of Alertive in conveying messages as a replacement for bleeps, and to investigate the reasons behind its perceived poor uptake.

Methods
A ten-day evaluation of the uptake of 15 distinct Alertive roles within the surgical department, accompanied by a satisfaction survey circulated among departmental juniors.

Results
The survey findings revealed a prevailing consensus among users endorsing the efficacy and superiority of Alertive as a concept over the previous bleep system. However, user-reported constraints related to functionality and application logistics. These have been identified as sources of frustration and thereby impeding the broader utilisation and efficacy of Alertive.

Conclusion
Effective multi-disciplinary communication is imperative in a hospital setting. While Alertive presents a potential alternative to traditional bleeps, challenges such as poor role uptake and communication appropriateness persist and represent significant barriers to full integration and staff satisfaction. Role uptake is variable with some surgical teams having better compliance than others. While users report that the concept of Alertive is beneficial, no single communication system has been identified as being superior, emphasising the ongoing need for solutions in healthcare communication.
WP6.14 - Automated analysis of operative video in surgical training: Scoping review
Authors: Dick Lachlan , Boyle Connor , Skipworth Richard J E , Smink Douglas S , Tallentire Victoria Ruth , Yule Steven 
Published: September 2024

Abstract

Aims
There is an increasing availability of operative video for use in surgical training. Emerging technologies can now assess video footage and automatically generate metrics that could be harnessed to improve the assessment of operative performance. This scoping review explores the current application of automated video analytics in surgical training.

Methods
PubMed, Scopus, Web of Science and the Cochrane database were searched to identify studies which applied automated video analytics to trainee-performed operations. Search terms included ‘trainee’, ‘video analytics’ and ‘education’. Two reviewers independently screened and extracted data on the methods of analysis, metrics generated and application to training. The Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Review (PRISMA-ScR) guidelines were followed.

Results
Thirteen studies were identified. Computer vision tracking was the most common method of video analysis. Metrics were generated for processes (e.g. movement of instruments) and outcomes (e.g. intraoperative phase duration). Two studies generated metrics to assess critical safety elements (e.g. critical view of safety in laparoscopic cholecystectomy). Automated metrics were able to differentiate between different skill levels (e.g. consultant vs. trainee) and correlated with traditional methods of assessment. There was a lack of longitudinal application to training and only one qualitative study reported the experience of trainees using automated video analytics.

Conclusion
Automated video analytics is an emerging field which provides an objective assessment of operative performance. Gathering evidence to demonstrate the impact of long-term use on training outcomes is a priority for future research.
WP7.1 - MRI for suspected acute appendicitis in pregnant females: What is the best imaging modality?
Authors: Davies Brooke , Day Nicholas , Aiynattu Sony , Guy Richard 
Published: September 2024

Abstract

Introduction/Aims
Acute appendicitis (AA) in pregnancy is the commonest non-obstetric cause of acute abdominal pain, but controversy surrounds the most appropriate imaging modality in this group. Ultrasound (USS) and Magnetic Resonance Imaging (MRI) have no known fetal risks. Hence, The World Society of Emergency Surgeons (WSES) recommends MRI in pregnant patients with suspected appendicitis, if available, but emphasises the preferred initial use of USS. This project explored the use of both imaging modalities in pregnant patients with suspected AA.

Method
Data was collected for all pregnant patients undergoing an MRI for suspected AA between 2015 and 2023.

Results
Of the 29 patients identified, the mean gestation was 23 weeks (range 2-36), and over half (15, 52%) of MRI scans were performed in 2022/3. Intra-abdominal pathology was seen in 17 (59%) patients, with 8 (47%) having MRI features of AA. 63% of those diagnosed with AA had an USS pre-MRI, and 40% identified the appendix as "normal." Other intra-abdominal pathologies picked up on MRI included pyelonephritis(1), small bowel obstruction(1), stercoral perforation(1), and ovarian torsion(2). Of the 8 patients with MRI-proven AA, all underwent appendicectomy: 3 laparoscopic, 2 open, and 3 with simultaneous Caesarean section, of whom 2 required ileocaecal resection.

Conclusions
Diagnosis of abdominal pain in pregnancy is a challenge. USS may be reasonably sensitive and specific in dedicated hands, but pathology may still be missed. In this patient group, for which appendicectomy for AA is associated with better outcomes than non-operative management, MRI should be obtained for accurate diagnosis.
WP7.15 - Surgical dogma… Why change?
Authors: Massie Eleanor , Robb Katie , Moug Susan 
Published: September 2024

Abstract

Aims
Surgical dogma still persists today despite up-to-date evidence. Implementation of evidence into clinical practice takes on average 17 years. Acute appendicitis is typically managed with surgery, despite evidence recommending a non-operative, antibiotic-only strategy as an appropriate first line treatment in uncomplicated cases. This study investigates barriers to, and facilitators of, changing practice with regards to management of acute appendicitis.

Methods
Surgeons involved in emergency general surgery in U.K. hospitals were invited to participate in online/telephone semi-structured interviews. Thematic analysis based on the theoretical domains framework was used to develop belief statements.

Results
16 interviews were conducted to achieve data saturation. 8 consultant surgeons, 8 surgical trainees from secondary and tertiary centres participated. Numerous barriers and facilitators were identified. There is a lack of awareness of current research with variable interpretation of evidence and its practical applications. There were concerns regarding loss of training opportunities in a “benchmark” procedure; failure of treatment and subsequent complications; missed malignancy and cost implications. Surgeons identified a reluctance to change from long standing practice and recognised their communication may skew patients’ decision making. Decision making practice varied from paternalistic to shared/supported. Surgeons believe they undertake a fully informed consent process, despite some not offering non-operative management as an alternative treatment.

Conclusions
Numerous barriers and facilitators exist to implementing change and are often based on surgeons’ personal experiences rather than evidence. The identified factors will be used to develop an implementation strategy to drive evidence-based practice and may be transferable to other surgical conditions.
WP7.17 - Routine Use of Validated Risk Prediction Model in the Management of Acute Appendicitis in a District General Hospital
Authors: Bowry Malika , Muthiah Akash , Francis Louise , Rahman Atiqur , Al-Khusheh Moutaz 
Published: September 2024

Abstract

Aim
Acute appendicitis is the most common general surgery emergency in the UK. Currently, there is no optimal diagnostic pathway for managing the right iliac fossa (RIF) pain. The right iliac fossa pain treatment (RIFT) study group has previously performed an analysis of different risk prediction models to search for the most specific one and made a website (appy-risk.org) to calculate risk scores on presentation. We aimed to look into our practice in a DGH and see how compliant we are in documenting risk scores on presentation with acute RIF pain.

Method
A list of patients presenting with acute RIF pain to the surgical assessment unit in September was prepared. Admission clerking notes were reviewed from the electronic patient record to look for the documentation of the appendicitis risk score. Standard statistical packages were used for data analysis.

Results
A total of 95 patients were presented with RIF pain. Of them, 17 were excluded from the analysis for being over 45 years old. Of the remaining 78 patients' records, only 7 (8.97%) had appendicitis risk scores documented in the clerking notes.

Conclusions
The RIFT study highlighted a high normal appendicectomy rate (NAR) in the UK in comparison to other European countries. In our hospital, NAR was 9.74% in the first six months of 2023. We are in the process of implementing a pathway to manage acute RIF pain using a risk prediction model as advised by the RIFT group to reduce our NAR to less than 5%.