bluuebunny/crossref_metadata_2025_split huggingface dataset:
WTP4.13 The Quality of Service of Index Admission Laparoscopic Cholecystectomy For Patients With Acute Biliary Symptoms: Re-audit From a Rural District General Hospital
Authors: Mohamed Samy , Rees Ryan , Sonanis Sagar , Mohamed Omnia , Dean Thomas , Sallami Zeyad 
Published: August 2023

Abstract

Aims
To continue evaluating our service of index admission laparoscopic cholecystectomy for acute biliary diseases.

Methods
A retrospective analysis was conducted. All patients who had an index admission laparoscopic cholecystectomy between 2016 & 2021 were identified from the hospital database. Data including demographics, time to diagnostic imaging, surgical technique, complications, re-operation, re-admission and mortality were collected from the hospital clinical information system “Myrddin” and patients’ notes.

Results
There were 335 patients (male: female 128:207) with median age of 62 years (range 16- 92years) presented as emergency with acute biliary symptoms and had index admission cholecystectomy. The reasons for acute admission were acute cholecystitis (n=205) acute pancreatitis (n=60), biliary colic (n=43) and calcular obstructive jaundice (n=27). The time to diagnostic imaging ranges from same day of admission to 3 days (mean= 0.81 days). Laparoscopic cholecystectomy was done in 333/335 with conversion rate of 1.5% (n=5). Five patients (1.5%) required re-operation because of bile leak. There was no major bile duct injury, no bleeding requiring any intervention. The re-admission rates within one week and within 30 days of surgery were (2.4%) and (0.9%) consecutively. Mean length of in-hospital stay (LOS) was calculated only for patients with acute cholecystitis and biliary colic (n=248) and it was 6.8 days. Mortality over 9 years period was 0.579% (3/518).These results are comparable to the available data from the national and international published data.

Conclusions
Index admission laparoscopic cholecystectomy is still safe and meets the recommended quality standards. Time to surgery has reduced compared to previous cycle and this led to decrease in LOS.
WTP6.7 Implementation of a Trust-wide electronic operation note proforma – a quality improvement project
Authors: Anand Easan , Tong KinSeng 
Published: August 2023

Abstract

Aims
The operation note is an important document that records intra-operative details and provides post-operative instructions. It ensures continuity of care and may be used for medicolegal purposes. In our Trust, there is a move towards electronic operation notes in line with the digitisation of patient records. Here we report initial data from our multi-staged implementation of a Trust-wide electronic operation note proforma.

Method
The Plan/Do/Study/Act (PDSA) method was used. Regular key stakeholder meetings were held involving the Information Technology (IT) department and various surgical teams. The Royal College of Surgeons’ Good Surgical Practice (GSP) provided minimum standards for operation notes. Forms4Health was used as the platform for electronic operation notes.
In PDSA cycle 1, a retrospective audit was performed involving 50 randomly selected handwritten or typed operation notes. The operation notes were audited by two independent reviewers against GSP standards. Handwritten operation notes were also assessed for legibility.

Results
A total of 29 handwritten and 21 typed operation notes were analysed. Among the handwritten operation notes, 15 (52%) were legible. Handwritten notes demonstrated 68% compliance with GSP standards, as compared to 79% for typed notes (p &lt;0.05). Typed notes were superior at recording time of surgery (p &lt;0.01), whether it was elective or emergency (p &lt;0.01), complications encountered (p &lt;0.05) and thromboprophylaxis instructions (p &lt;0.01).

Conclusions
Our data indicate a significant improvement in GSP compliance via electronic notes. As next steps, we will integrate the proforma into existing Trust IT platforms and include additional features to increase user efficiency and re-audit service improvement.
WTP6.10 A validation & health economics review of a novel Augmented Reality solution to surgical training
Authors: Rawaf David , Sheikh Mohamed , Bahnasawi Mohammed El , Beghal Gurpreet , Toms Joseph , Harris Matthew 
Published: August 2023

Abstract

Aims
To validate the capability of AR in surgical training utilising objective & subjective assessment, health economics & systematic review (SR) of available literature.

Methods & Results
Initially an independent SR was conducted (n=26) comparing AR vs incumbent modalities (VR, box trainers, & cadaveric). We demonstrated that AR is preferred, improves procedural success & provides faster skill acquisition when compared to other modalities.
Several pilot studies were then conducted utilising the LapAR1. One (n=11) demonstrated through benchmarks of either appendicectomies (n=5) or vaginal vault (n=6) closures that intervening AR-based training under one hour with LapPass2 tasks significantly improved ‘completion time’ by 19% and 36.9%, and ‘distance travelled(m)’ by 25% and 56% respectively. Another (n=6) demonstrated through 10 appendicectomy benchmarks with three intervening LapPass tasks over the course of two weeks, significant savings in ‘completion time’ by 55-66% and ‘distance travelled’ by 39-72%. Finally, another study looking at self-confidence scores pre & post-LapAR exercises indicated that a mean improvement of 3.82 (likert, p=0.018) was found across all areas.
Finally, a BMJ peer-reviewed health economics review3 found that £79 could be saved per appendicectomy patient. Once validation of the efficiency assumptions were made using the study data, we can extrapolate and realise a potential cost saving of £455 through reduced anaesthetic time and shorter inpatient stay.

Conclusions
We can now infer that AR-based laparoscopic training with the LapAR is not only preferred, but it is more effective at providing clinically translatable, and scalable cost-effective laparoscopic training as a potential new gold standard.
WTP6.11 Are surgical technical errors inherited from lack of mental cognitive framework or lack of motor skills for a given surgical task? results of a pilot study
Authors: Mehmood Iftikhar , Riaz Mohammad , Kumwenda Ben , Tang Benjie 
Published: August 2023

Abstract

Aims
To study the impact of augmented terminal feedback designed by error type learning for developing surgical skill.

Methods
Twenty medical students were randomised in two groups, based on feedback they received; Video Feedback (VF) and Online Feedback (OF). Laparoscopic double square knot was selected as the task. Task was divided into subtasks and steps. Potential errors were studied and divided into types: Cognitive Based (CB) & Skill Based (SB). Laparoscopic Task was executed in four stages and feedback was provided after each stage. Error types and numbers were studied.

Results
9178 errors were studied in 80 tasks, 320 subtasks and 2080 steps in four stages. 5091 (55%) CB errors and 4087 (45%) SB errors were recorded. VF group enacted 2251 CB errors in stages (46%,29%, 18%,7%) and 1692 SB errors (41%, 28%, 18%, 13%). OF group enacted 2840 CB errors (29%, 26%, 25%, 20%): whereas, 2396 SB errors (22%, 23%, 21%, 34%). Both groups were comparable in enacting SB & CB errors in early stage of skill; nevertheless, highly significant difference was noted in 3 stages when SB errors are considered (p &lt; 0.01 vs OF group). Although, there was steady improvement in CB type errors, but no significant different was noted (p &gt; 0.5 vs OF group) in all stages of learning.

Conclusions
Augmented terminal feedback in the form of videos feedback is superior to current standards in terms of reducing cognitive based errors; whereas, skill based errors rely on time and experience rather than type of feedback.
WTP6.13 A closed loop audit on the Quality of Electronic Discharge Summaries within General Surgery
Authors: Yaqoob Omar , Wain Mehmood 
Published: August 2023

Abstract

Aim
Following surgical admissions, Electronic Discharge Summaries (EDS) are vital to ensure patient safety through continuity of care to the primary care setting. It is also an official record to the patient about the treatment and care they received including any further treatment or follow up appointments they require and is therefore important they are not only accurate but detailed with all the relevant information included.

Methods
An audit of Electronic Discharge Summaries within a busy Emergency General Surgery department was undertaken using a gold standard which was established by using the 20 most important parameters within the standardized proforma. If a discharge summary had 80% or more parameters sufficiently completed it was deemed to be adequate. A first and second cycle of data collection of 100 EDS’s were undertaken and analysed using the gold standard criteria.

Results
A first cycle data collection of 100 EDS’s were analysed, it was found only 55% of these were adequate following the standard set. An educational teaching session to doctors at a local meeting was carried out to explain why 45% of the discharge summaries were not complaint with the standard set. The second cycle showed 91% of EDS’s to be of adequate standard.

Conclusion
This audit has shown that adhering to a gold standard template can significantly improve the quality of discharge summaries. A re-audit in 12 months should be carried out to ensure standards have been maintained.
WTP7.2 Post COVID-19 Pandemic Impact on Surgical Assessment Unit (SAU) Activity
Authors: Hamid Osama , Harker Emma , Cook Tim 
Published: August 2023

Abstract

Aim
Emergency surgical services were consolidated to one of our two hospital sites at the onset of the COVID-19 pandemic. All hospital services are under increasing pressure. This study aimed to assess the ongoing post-pandemic impact on the activity of our surgical assessment unit (SAU).

Method
Data was recorded prospectively on patients attending SAU. Comparison was made between the first three months of the pandemic (March-May 2020) and the two 15-month periods since (June 2020-August 2021 and September 2021-November 2022 respectively). The number attending, proportion admitted, and time taken to see a senior decision maker were recorded.

Results
The average number of patients attending per month in the first three months was 364. This rose to 760 and 880 per month respectively in the two post-pandemic periods. The proportion admitted was initially 28.3% but fell to 22.7% and 20.4% in the following periods. Admission numbers in the two 15-month periods were similar (173 vs 180). There was a reduction in the proportion seen by a senior decision maker within two hours across the three time periods (60%, 52% and 35% respectively).

Conclusions
SAU attendances have more than doubled since the onset of the pandemic. Attendances have continued to rise in the 30 months since the initial outbreak, with little effect on admission numbers. Consequently, fewer patients are seen quickly which likely has a detrimental impact on patient experience. Lack of access to other areas of healthcare may have influenced these changes. This increased activity should inform future service planning.
WTP7.4 Is there a role for ambulatory management of acute pancreatitis in selected cases?
Authors: Javanmard-Emamghissi Hannah , Knight Stephen , Kosti Angeliki , Hollyman Marianne , Study PANC 
Published: August 2023

Abstract

Aim
Pancreatitis is a common general surgical condition that presents with variable severity. The usual management involves a hospital admission for observation, lasting a median of five days. However, there may be a role for ambulatory management. We aimed to determine which patients presenting with acute pancreatitis may be suitably managed in the community.

Method
This prospective, multicentre cohort study at 113 UK sites included adult patients diagnosed with pancreatitis. Potential for ambulatory management was defined as the presence of mild pancreatitis, tolerating oral fluids, and oral analgesic requirement only. Multilevel logistic regression models determined relationships, accounting for the clustering of patients within hospitals.

Results
Of 2580 patients included, only 13 (0.5%) patients were managed without admission and 150 (6.1%) patients were admitted a single night only. Overall 1836 (71%) of patients had mild pancreatitis, of which 928 (50.5%) were potentially suitable for ambulatory care.
After accounting for median CRP peak at 48 hours, a CRP of &lt;150 at 48 hours was associated with a lower risk of all complications (OR 0.35, 95% CI 0.30-0.42; P&lt;0.001) and CT-confirmed collection and/or necrosis (0.18, 0.15-0.22; P&lt;0.001). Patients were also twice as likely to be suitable for ambulation (OR 2.07, 1.75-2.44; P&lt;0.001).

Conclusion
Just over a third of patients with pancreatitis could potentially be managed ambulatory. CRP at 48 hours is a strong predictor of pancreatitis-associated complications and may help direct further follow up.
WTP7.8 Adult Bowel Intussusception: A Case Report and new insights
Authors: Bodapati Venkata , Alseifi Shaker , Kaur Geetinder 
Published: August 2023

Abstract

Introduction
Intussusception in adults is rare and constitutes 1-5% of small bowel obstructions. This rarity along with atypical presentation make diagnosis difficult, sometimes delayed and makes cross-sectional imaging mandatory for correct management. Prompt diagnosis and treatment are essential to prevent serious complications like perforation, peritonitis etc. Usually, lead points have been thought to be caused by neoplastic polyps but recently, non-malignant causes (lipomas or nodal masses) are coming to the forefront. Postoperative histology review is important to plan for further management. Here we present an adult patient with intussusception who needed surgical intervention but no post procedure treatment.

Case report
Our 78- year-old patient was admitted with sudden onset severe generalised abdominal pain for a day. Examination revealed a soft abdomen with a tender mass palpable in her right lower abdomen. CTAP revealed long segment ileocolic intussusception with a 3cm lipoma as the lead point. She underwent a laparotomy where oedematous bowel with irreducible intussusception and possible ischaemia were found; a right hemicolectomy was carried out. Histology revealed the intussuscipiens to be a lipoma. She made an uneventful recovery.

Discussion
It is important to consider intussusception in the differential diagnosis in adult patients with abdominal pain even in absence of typical obstructive symptoms. Adult cases are usually associated with neoplasm but there is increasing evidence of nonmalignant causes such as benign polyps, nodal masses or lipomas which act as the lead point in adult intussusception. Postoperative histology review is important to plan further management.
WTP7.9 Optimising Appropriate Referral, Early Diagnosis and Management of Patients Presenting to the Emergency Department with Right Iliac Fossa Pain; a Collaborative Approach in The Design of Local Right Iliac Fossa Pain Pathway
Authors: Forsyth Katrina , Pipe Michelle , Mellers Lucy , Mohamed Fatima , Vavasour Kate , Stewart-Parker Emma 
Published: August 2023

Abstract

Diagnostic uncertainty in patients presenting with right iliac fossa (RIF) pain to the Emergency Department (ED) is well established and multifactorial, leading to challenges in selecting the most appropriate specialty for initial referral. This study investigates local practice, which will form the basis for RIF pain pathway development.

Methods
We collected prospective data over one month for RIF pain presentations to our ED, with onward referral to General Surgery (December 2022 – January 2023). This included demographics, symptoms, appendicitis likelihood utilising validated scoring tools, investigations, management and final histology. The number of women undergoing gynaecological review was also assessed, as were negative laparoscopy rates.

Results
Data collection revealed 46 patients presented with RIF pain: 30(65%) female, median age 29(18-44), 16(35%) male median age 35(21-53.) Thirteen (28%) underwent diagnostic laparoscopy, two of which were negative, one male and one female. Ultrasound scan (USS) was conducted in 70% females, and 6% males; CT in 31% males, and 27% females. Gynaecology review & USS were conducted in 38% of women. Overall, 87% of women had imaging. Two women underwent a laparoscopy without imaging. Acute appendicitis was diagnosed definitively in 21%.

Conclusions
The majority of patients in this study were premenopausal women. This cohort poses a diagnostic challenge. Further data is required, with collection underway, to help understand the best way to manage these patients. The outcomes of our data collection highlight the need for a local right iliac fossa pathway to improve appropriate specialty referral, timely imaging, diagnostic certainty and avoidance of negative laparoscopy.
WTP7.13 Simultaneous pneumoperitoneum and pneumomediastinum- would you guess sigmoid diverticular perforation? A Case Report
Authors: Nevill Benjamin , Collier William , Lingam Gita , Sivarajah Vernon 
Published: August 2023

Abstract

Introduction
Simultaneous pneumoperitoneum and pneumomediastinum is a rare radiological finding. There are only 6 reported cases in the literature of this being due to a diverticular perforation.

Case report
A 78-year-old male presented with worsening shortness of breath, lower back pain and lower abdominal pain. Past medical history included myasthenia gravis, for which he took pyridostigmine. A computed tomography (CT) abdomen and pelvis with contrast identified pneumoperitoneum, pneumomediastinum and subcutaneous emphysema of the neck. The site of the perforation was unclear radiologically.
Urgent diagnostic laparoscopy revealed a sigmoid colon perforation secondary to sigmoid diverticulitis. The procedure was subsequently converted to an open Hartmann’s Procedure. Extensive emphysema within in the mesentery was noted intra-operatively.
Post-operative recovery was complicated by a chest infection but the patient recovered well and was discharged home on day 15.

Discussion
Colonic diverticular disease is increasing in prevalence worldwide. The most common site of diverticulitis is the sigmoid colon (an intraperitoneal structure). Perforation of diverticulitis is a serious complication that can require urgent surgery. Pneumoperitoneum is a well-recognised sign of sigmoid diverticular perforation, however pneumomediastinum is far rarer. Posterior perforations of the sigmoid colon have the potential to enter the posterior para-renal space, penetrate the diaphragmatic hiatus and present with pneumomediastinum.

Conclusion
Simultaneous pneumoperitoneum and pneumomediastinum is rarely caused by colonic perforation. This can lead to a delayed diagnosis and poorer patient prognosis.
WTP8.10 The ‘Let’s talk about Black Women and Breast Cancer’ Conference – a targeted healthcare intervention
Authors: Adeboye Teniola , Samuels Sabrina , Adomah Sarah , Oni Georgette 
Published: August 2023

Abstract

Aims
Studies show that targeted health interventions are more successful. The “Let’s talk about Black Women and Breast Cancer” (BWBC) annual conference was established to educate as well as empower the lay public but to also highlight the poorer breast cancer outcomes in the Black community for health care professionals (HCPs). The aim of the conference was to use a targeted intervention in the hope that it would contribute to the improvement of these poor outcomes through lectures and interactive workshops.

Methods
All those attending the conference were sent an online questionnaire. This consisted of 14 mixed method questions including qualitative data on whether the conference led to a change in health behaviours. Attendees were sent one reminder to complete the evaluation and were given 1 month to complete it.

Results
132 delegates attended the conference and 60 evaluation forms returned (45.5% response rate). 80% of responders attended in-person with the remainder online. 95% (57/60) of attendees felt the conference taught them something new, 81% (49/60) felt encouraged to go for breast screening, 85% (51/60) felt encouraged to examine themselves and 83% (50/60) felt more empowered to engage in health consultations.

Conclusions
The BWBC conference was successful in educating attendees regardless of background, and helped to empower regarding decisions around breast health. The shared learning allowed it to be mutually beneficial for HCPs and lay public alike. Whilst the conference was a success, it highlights that there is much needed work to be done to improve healthcare inequalities for Black women with breast cancer.
ThTP1.7 Staging laparoscopy in bilio-pancreatic malignancies compared to radiological staging: A comparative study
Authors: Noureldin Khaled , Issa Mohamed , Salman Mohamed , Agwa Hisham Agwa , Fadlallah Elijah Mujahid Gasemelseed , Shalaby Ahmed 
Published: August 2023

Abstract

Introduction
The study was to compare the accuracy of laparoscopy in staging and selecting patients diagnosed with malignant obstructive jaundice, to the traditional investigation.

Methods
A prospective study conducted in the period between September 2017 and December 2018.30 patients, having malignant jaundice, were divided into two groups for cancer staging to assess their resectability and operability. Staging of 15 patients in group A was limited to conventional diagnostic methods, while 15 patients were in group B, Where Laparoscopy was added.

Results
Results showed that the accuracy of routine investigations in staging was 73%, while that of laparoscopy was 93%. The number of cases under staged by imaging were 8 cases(these were 3 in Group A and 5 in group B) thus they were diagnosed as operable. On the other hand, just 1 case was misdiagnosed by the laparoscopy. Regarding the morbidity and mortality, there were variable complications among those who had unrequired laparotomies including one mortality case. On the other side, the incidence of complications were markedly decreased in group B, with no mortality incidence.

Conclusion
Diagnostic laparoscopy has a crucial role in staging people with malignant jaundice and may decrease the rate of unnecessary laparotomy in people found to have resectable disease by conventional imaging.