bluuebunny/crossref_metadata_2025_split huggingface dataset:
“I didn’t personally think it would change my life, but it has”: The experience following emergency laparotomy for older people living with frailty
Authors: Price Angeline , Pearce Lyndsay , Smith Jonathan , Martin Peter , Griffiths Jane 
Published: December 2023

Abstract

Introduction
Older people living with frailty are at high risk of adverse clinical outcomes following emergency laparotomy, including early death, hospital readmission and functional decline. Despite this, there is a paucity of literature exploring patient experience of surgery in this group, particularly following hospital discharge. There is therefore limited information to guide the development of service delivery models that support optimal post-operative recovery and improve overall experience.

Methods
Twenty older people, aged ≥65 years, with a Clinical Frailty Scale score of ≥ 4 and who had undergone emergency laparotomy were recruited from eight hospital sites. Participants were interviewed 3 weeks following their surgery, or the earliest convenient date. Interviews were undertaken either face to face or via telephone and explored the peri-operative and early recovery experience. Data were analysed using reflexive thematic analysis.

Results
Participants described physical, psychological, and social implications following emergency laparotomy which extended further than hospital discharge. Recovery was perceived to be an ongoing and slow process of returning to ‘normal self’. Although generally satisfied with in-hospital care, a lack of access to discharge advice and community follow up left some participants feeling ‘abandoned’ and uncertain once they returned home, hindering recovery.

Conclusions
Older people living with frailty experience multifaceted consequences of emergency laparotomy that result in a prolonged recovery phase and care needs. Multi-disciplinary post-operative pathways are imperative in addressing these holistic care needs. Better access to information and enhanced community support could improve patient experience and facilitate ongoing recovery.
Emergency general surgery exposure for core surgical trainees in Scotland – training or service provision?
Authors: Walter Amy , Gibson Simon 
Published: December 2023

Abstract

Introduction
Emergency general surgery (EGS) is a key aspect of general surgical training. The core surgical quality indicators (QI) suggest core trainees (CSTs) should be involved in dealing with emergency patients 1x week. However, there are ongoing concerns that CSTs miss important training prospects due to service provision. We aimed to compare the distribution of on-call vs elective work for CSTs across different EGS centres in Scotland.

Methods
CSTs in general surgery in Scotland were asked to volunteer an anonymised copy of their on-call rota in 2023, which was subsequently analysed for on-call vs elective shifts. An anonymous survey was distributed assessing compliance to QIs.

Results
Ten rotas were analysed, including 3 tertiary centres and 7 district general hospitals (DGH). 90% of trainees were involved in EGS at least 1x week; 6 were on a junior-tier rather than registrar rota. In a six-month period, CSTs average 51 (42-67) on-call shifts, correlating to &gt;60% of their rota. Those on a registrar rota and in DGHs tended to have less (45 vs 54, 50 vs 55 respectively). Four rotas have dedicated CEPOD shifts.

Conclusion
Increased exposure to EGS can have positive effects for CSTs. Our results show CSTs have ample on-call rota commitments, thus become familiar with EGS presentations. However, excess service provision for CSTs has been shown to negatively impact training. Thus, training centres must aim to protect training opportunities. Provision of dedicated CEPOD shifts alongside admitting shifts may help maximise satisfaction and training in EGS.
Offering Surgical Definitive Options For Sigmoid Volvulus: Lessons From WSES (World Society of Emergency Surgery) Consensus Guidelines
Authors: Mithany Reda 
Published: December 2023

Abstract

Aim
This study evaluates the quality of care provided to patients with sigmoid volvulus and assess compliance with the World Society of Emergency Surgery (WSES) Consensus Guidelines regarding offering definitive surgical intervention.

Methods
All emergency surgical admissions involving individuals aged 65 or older, diagnosed with sigmoid volvulus between 2021 and 2023, were retrospectively included. The evaluation was conducted in conjunction with five critical WSES recommendations, encompassing the assessment strategy and diagnostic imaging for sigmoid volvulus, initial flexible endoscopy, and the decision-making process for urgent or elective sigmoid resection in all initial presentations. Adherence to these standards was assessed in each domain and subsequently categorized as Red (Urgent Attention Needed), Amber (Room for Improvement), or Green (Satisfactory Compliance).

Results
The study included a total of 20 patients. Compliance with the recommendation to offer sigmoid colectomy for the prevention of recurrent volvulus after successful endoscopic decompression was found to be in the Red category, scoring at 25%. In contrast, the remaining recommendations demonstrated satisfactory levels of compliance.

Conclusion
25% of our patients have not been offered the option of definitive surgical resection, highlighting an area for urgent need of attention. Given that the recurrence rate of sigmoid volvulus after endoscopic detorsion and conservative management ranges from 45% to 71%, and offering sigmoid colectomy to prevent recurrent volvulus is crucial, even during the index admission. In cases where frailty is identified, there should be documented consideration of best interest during the planning of definitive care. We envisage a better compliance to WSES recommendations.
Lower GI bleed audit
Authors: Dasa Micheal , Peters Paul , Bose Sayantan , Adeboye Opeyemi 
Published: December 2023

Abstract

Introduction
In the UK, Lower GI Bleeding is common emergency presentation and accounts for 3% of emergency surgical referrals. The most common cause is Diverticular Bleeds. Other frequent causes are the benign anorectal conditions. 23% of patients admitted to Hospital with LGIB in the UK are discharged without diagnosis. Most LGIB resolves on its own but may require further interventions.

Aim
To describe current local practice of risk stratification with Shock Index and Oakland’s Score in comparison with existing national guidelines by the British Society of Gastroenterology (BSG).

Method
Retrospective Analysis of 36 patients who presented to the local A&E with lower GI bleed between Sept 2021 – Nov 2021.

Result
Male:Female 18:18. Median age 56 years (3months – 95years).
Haemorrhoids (9, 25%) accounted for most of the presentation.
1 patient (3%) had their shock index documented.
2 patients (6%) needed a CT angiogram.
16 patients (44%) were admitted under the EGS team. Out of these 16 patients, 7 (44%) needed inpatient endoscopy, while 3 (19%) required transfusion.

Discussion
There was a consistent finding of no documented shock index in the patients notes, likely because there is easy access to EWS that allow clinicians to interpret this in real time. The Oakland score was rarely used to determine if a patient could safely be discharged.
Other specialties, endoscopy/gastroenterology or the emergency department, likely have different guidelines for the assessment of lower GI bleed. This could account for poor uptake, locally, of risk stratification as proposed by the BSG.
Management of chest trauma in a District General Hospital - Audit of current practice
Authors: Willis Kelly , Fitz-Gerald Alice , Ali Saqib 
Published: December 2023

Abstract

Aim
Audit the management of chest trauma in a District General Hospital according to guidelines set by the regional major trauma centre (MTC).

Methods
Patients admitted with traumatic rib fractures over a six-month period were included. Clinical notes and imaging were reviewed. Primary outcomes were chest injury severity score (CISS), pain team review and referral to MTC. Secondary outcomes included 30-day readmission and mortality.

Results
37 patients were included and only 2 had a CISS calculated on admission. Scores were retrospectively calculated with 89.2% scoring over 11 – the threshold for admission and aggressive management. 28 (75.7%) of patients met the criteria for referral to the MTC for consideration of rib fixation but only 8 were referred. 27 (73.0%) were seen by the pain team and 16 patients received a nerve block. There were 5 patients (13.5%) readmitted within 30 days of discharge with complaints of pain or dyspnoea. 3 were discharged from the emergency department, 2 required an additional inpatient stay. There were 2 deaths (5.4%) within 30 days of discharge. Cause of death was only available for 1 patient who had died of pneumonia.

Conclusion
Chest trauma has a high morbidity and is often managed by emergency general surgeons in centres without cardiothoracic services. Clear management guidance is vital to improving outcomes. As a result of this audit the trust’s pathway for chest trauma has been updated and new tools developed on our electronic patient record system to facilitate calculation of the CISS and completing the necessary referrals.
Outcomes of Patients with Liver Metastases from Colorectal Cancer who mostly Presented as Emergencies (Obstruction and Perforation) in a District General Hospital from 2014 to 2021
Authors: Amankwah Dennis , Ezeoke Chidimma , Shamsu Zaman , Annan Pangeni , Chowdhury Ashim , Cooke Joanne 
Published: December 2023

Abstract

Background
In the UK, District General Hospitals (DGH) play a pivotal role as primary sites for CRC diagnosis and staging, as many patients initially present as emergencies. However, patients with CRC-related liver metastases often require specialized management at tertiary facilities.

Methods
This study conducted a retrospective data collection in 2023, analysing anonymized CRC patient records from 2014 to 2021. The findings shed light on various aspects of CRC with liver metastases.

Results
Notably, a significant gender-based difference emerged, with males comprising 62.5% of the diagnosed patient cohort and females making up the remaining 37.5%. Anatomically, 27.08% of cases were localized in the rectum, while the majority (72.91%) occurred in the colon.
A substantial proportion of patients were diagnosed at advanced T stages, with 81.25% categorized as stages 3 and 4, indicating locally advanced or metastatic disease. Conversely, 18.75% were identified at earlier T stages, stages 1 and 2.
Diverse biological marker profiles showed: 33.3% dual KRAS/BRAF, 22.9% KRAS-only, 17.9% no markers.
Patient management at tertiary care facilities encompassed diverse interventions, including surgical procedures (45.83%), chemotherapy (75%), and palliative care (25%).
Survival outcomes were varied, with 35.41% achieving a commendable 3-year survival rate, 31.25% attaining a commendable 5-year survival rate, and 27.08% exceeding the 5-year milestone. However, 6.25% experienced survival limited to a year or less.

Conclusion
This study provides comprehensive insights into CRC with liver metastases, emphasizing the importance of early detection and personalized care, with potential for improved survival rates while acknowledging the complexities of managing this disease.
A review of emergency general surgery (EGS) admissions via the direct access pathway (DAP) in a district general hospital
Authors: Pal Shreya , Bartolome Iesleen Abigaelle , Pangeni Anang , Nahid Md Abu Kamal , Shrestha Ashish 
Published: December 2023

Abstract

Aims
Patients presenting with emergency general surgical (EGS) conditions require urgent management - however, increased waiting time in A&E often leads to delayed diagnosis and subsequently delayed management.
Having a direct access pathway (DAP) to Surgical Emergency Assessment Unit (SEAU) helps minimize these delays - leading to better outcome in management of these patients.

Methods
A retrospective observational study of EGS admissions in May 2023 was performed. Structured DAP referral proforma was implemented for patients to be directly referred to SEAU from A&E triage. Factors taken into consideration were - initial presentation, source of referral, time of initial assessment and patient outcome.

Results
A total of 188 referrals were made to SEAU, of which 46 (24.5%) were DAP referrals. The average number was 18 over weekdays and 10 over weekends - of these, 97.8% of referrals were appropriate with correctly filled out proforma, whereas 2.2% were inappropriate referrals. 33% patients were discharged, 10% were admitted, and 10% were planned to return for investigations the following day. The median waiting time for initial assessment was 1.5hours. The most common presentations were RUQ Pain, subcutaneous abscess and RLQ pain which correlated with the final diagnosis. It was also noticed that when compared with May 2022 (176patients during the same 2-week period), there was 6.8% increased referral since commencement of DAP.

Conclusion
The DAP for EGS admissions has been seen to have improved patient outcome as a result of avoiding unnecessary steps and delays before being reviewed by the surgical team through A&E pathway.
Factors Affecting Length of Stay in Patients With Traumatic Rib Fractures in a District General Hospital.
Authors: Hodson Alex , Bradley Rebecca , Jarman Caroline , Harahwa Tinotenda 
Published: December 2023

Abstract

Objective
The objective of this study was to ascertain which patient factors, injury and treatment variables contributed to an increased length of stay (LOS).

Methods
Retrospective data collection from a prospectively updated dataset was conducted from 01.01.23 to 31.08.23. All adult patients admitted to the general surgical department were included. Transfers directly from ED to an MTC, and paediatric patients were excluded. Outcome parameters were: age, gender, clinical frailty score (CFS), preinjury antiplatelet/anticoagulant use, mechanism of injury, number of ribs fractured, battle score, presence of intrathoracic injury, presence of flail chest, chest drain insertion, performance of analgesic nerve block, discussion with local MTC, total LOS, and 30-day mortality. Statistical analysis was performed to ascertain which of these variables significantly affected patient LOS.

Results
92 patients were admitted to the DGH. Most were female (58.7%) and the median age was 73. Median LOS was 5.5 days. 7 patients died during admission, all with a CFS of 6 or over. Patients with a higher age, CFS, number of fractures, and battle score had a significantly longer LOS. Patients who underwent a nerve block also had a longer LOS than those who did not. Presence of intra-thoracic injury and placement of a surgical chest drain did not affect LOS.

Conclusions
LOS appears to be related to higher age, frailty, and battle score. To improve patient management at this DGH, it may be suggested that older patients with a high battle score be discussed with critical care and have early frailty team input.
The importance of weekly Radiology-General Surgery Multi-Disciplinary Meetings (MDMs) in the management of Emergency General Surgery (EGS) patients
Authors: Pal Shreya , Yi Zoengzhen , Bartolome Iesleen Abigaelle , Bareli Leonardo , Shrestha Anuj , Shrestha Ashish 
Published: December 2023

Abstract

Aims
Most patients in Emergency-General-Surgery (EGS) require radiological investigations as part of their management plan. However, unlike cancer services where structured multi-disciplinary-meetings (MDMs) form an integral part of patient management, MDMs are not commonly practised in EGS.
Having a weekly Radiology-General Surgery-MDM leads to better outcome in management of EGS-patients, & also improves learning of surgeons & junior-doctors.

Methods
A prospective study of weekly 1-hour Radiology-GeneralSurgery-MDMs over 10-weeks during May2023-September2023 was performed. These MDMs were led by a consultant radiologist who discussed the scans with consultant surgeons & other junior-doctors. Factors taken into consideration were clinical presentation, original scan report, any missed findings not mentioned in original scan report, any changes recommended in management plan that would lead to better patient outcome. The scans were also discussed with junior-doctors to improve their knowledge of interpretation of scans.

Results
A total of 70 cases were discussed during the study period, 25 (35.71%) initially reported by the out-of-hours reporting system. Few had missed findings that were noted as result of Radiology-GeneralSurgery-MDM, & 27(38.57%) had change in management plan.
The informal feedback collected after these MDMs noted over 85% junior-doctors agreed that these MDMs had significant impact on their understanding of interpretation of radiological-scans in EGS.

Conclusion
Weekly Radiology-GeneralSurgery-MDMs for EGS-admissions has been seen to improve patient outcome as a result of having an expert 2nd-opinion, & also recommending change in management plan in significant proportion of patients. It also had an impact on learning the clinical correlation of radiological-scans by junior-doctors who regularly attended these meetings.
Assessment of the quality of care in acute bowel obstruction patients at a tertiary care hospital with the NCEPOD guidelines
Authors: Siby Jayas , Singh Anurag , Marathe Kajol , Ellet Donna , Tonsi Alfredo 
Published: December 2023

Abstract

Background
Acute bowel obstruction (ABO) is a common cause of admission under the emergency general surgery services offered across the UK. The Aim of this quality improvement project (QIP) was to assess the quality of care for patients with ABO with the national and NCEPOD guidelines in a tertiary care hospital.

Method
Data was collected for two months in October and November 2022 from an electronic database in the trust and patient notes maintained throughout the admission.

Results
35 patients were included in the QIP (19 males and 16 females). Consultant review is recommended in &lt; 14 hours after admission and national statistics show a delay in 15.9% of cases, in our hospital, it was 73.33% (22/30). Pain assessment on admission, the national average is 57% but, in this hospital, it was 42.86% (15/35). Similarly, guidelines recommend assessment of MUST score, hydration status and Rockwood score at admission, which was documented in 0/35, 1/35 and 15/35 cases in our hospital.
QIP was presented in the local clinical governance meeting followed by a teaching session to improve the patient care in ABO.

Conclusion
This QIP showed a lack of documentation in the pain score, hydration status, Rockwood score, MUST score and a delay in the consultant review for patients with ABO when compared with the guidelines of NCEPOD and national statistics. A repeat cycle of this QIP will be conducted in 6 months' time to analyse the effectiveness of the intervention on patient care outcomes.
A Global Survey of Precision Medicine in Emergency General Surgery
Authors: Ng Oon-Hui , O’Connell Elizabeth , Mukherjee Rajarshi 
Published: December 2023

Abstract

Background
Since first sequencing the human genome, precision medicine has become a modern-day reality. However, translation to all areas of medicine has not been equal. This study aimed to provide a ‘status update’ of precision medicine in EGS to guide future priority setting.

Methodology
An observational study was conducted utilising two curated global on-line databases: 1. Pubmed publications from 2001 & 2. Clinical trials registered on ClinicalTrials.gov. The top 10 presenting conditions in EGS, Oncology, and Acute Medicine were identified from literature review. Publications/trials in these areas were identified using associated keywords: precision, personalised, genomics, genome-wide association studies, exome studies, epigenetics, transcriptomics, proteomics, metabolomics, microbiomics, and pharmacogenomics. Duplicated publications/trials were removed prior to final analysis and only active, recruiting or completed trials were included. Temporal trends were compared and annual growth rates were calculated.

Results
There were 209,423 EGS publications, 1807 (0.9%) being precision-focused. Oncology had 1,137,396 publications, with 127,556 precision-focused (11.2%), and Acute Medicine had 1,647,046 publications, with 80,240 (4.9%) precision-focused. The rate of rise of annual publications since 2001 (human genome project publication) was significantly (p&lt;0.05) lower for EGS (x2.9) versus oncology (x3.5) and medicine (x6.0). Only 7 precision-focused clinical trials were identified for EGS compared to 96 for Oncology and 39 for Medicine. x10 fewer precision-focused EGS publications and trials exist over 20 years, compared to covid-19 over 2 years.

Conclusion
Research and implementation of precision medicine in EGS remains inadequate. Increased investment and improved global implementation are warranted to address the widening gap in translation.
Rise of The Hot Clinic
Authors: Tamanna Rezuana , Pandey Vikas , Nayak Peramapally , Cheetham Drostan 
Published: December 2023

Abstract

Introduction
The surgical hot clinic was opened in December 2019 as part of our emergency surgical service. Despite initially poor uptake, the clinic has demonstrated its resilience through two national lockdowns and continuing pressures within the NHS. We report a two-month snapshot of activity in the unit.

Methods
Between June 1st and 1st August 2023, 299 patients were seen in the clinic. We analysed the data for patient demographics referral source and presenting complaint. Outcome measures included inpatient admission and patient discharge.

Results
299 patients attended the clinic during the study period. The number of patients seen each day varied between 4 and 12 (median 5). Of these, 147 (49.1%) were male and 152 (50.9%) were female. The referral source was primary care in 28%, Emergency Department in 37.2% and ward discharges accounted for 34.8%. Abdominal pain accounted for the majority of presentations (39.5%,), abscesses (22.4%), urological complaints (17%) complex wounds (5%), rectal bleeding (3.4%), hernial disease in 2%. Miscellaneous conditions accounted for the remainder (10.7%). 279 patients were discharged from the clinic, the admission rate from the clinic 6.7%

Conclusions
The surgical hot clinic has become an invaluable for patient assessment and emergency surgical care, remaining open even when other areas of the trust have been closed due to the pandemic or NHS pressures. We recommend an emergency surgical ‘hot clinic’ as part of the framework in the provision of emergency surgical services.