bluuebunny/crossref_metadata_2025_split huggingface dataset:
FTP8.12 An Audit Evaluating Collection of Urine for Culture Prior To Administration of Antibiotic In The Treatment of Urinary Tract Infection
Authors: Bryce Amy , Clayton Elizabeth , Thu-Ta Flora , Lavin Victoria 
Published: August 2023

Abstract

Aims
This audit aims to evaluate current practice, and potentially improve adherence to NICE guidelines, of collection of urine for culture prior to the administration of antibiotics for suspected urinary tract infections (UTI).

Methods
A retrospective audit was completed of patients seen by the urology on-call team at Freeman hospital, who were treated for a UTI at any point during their admission during the month of December 2022. It was noted if they had a urine culture obtained during their presentation, and if obtained whether this was collected before or after administration of the antibiotic. Other information collected included choice of antibiotic and if culture returned positive for growth.

Results
A total of 45 patients received antibiotics for a UTI during this time period. Of those treated 41 (91%), had a urine culture sent during this presentation, whilst 4 (9%) had no culture sent. Of those who had cultures sent, (34, 83%) were sent prior to commencing antibiotics, and 7 (17%) sent after the first dose.

Conclusions
NICE guidelines recommend that urine should be obtained for culture for if a UTI is suspected, ideally prior to commencing treatment to allow for reliable identification of organisms and their sensitivities. Most patients treated for a UTI during this time did have a urine culture sent for culture. As a department, we were less adherent to guidelines in our timing of culture being obtained prior to antibiotic. We will be making interventions to improve our adherence and re-auditing data in the coming months.
10 Ward and Hospital Simulation in Unity
Authors: Hutton Michael 
Published: August 2023

Abstract

Aims
To investigate ward and hospital design and its effects on efficiency and queues.

Methods
A starter project in C# and Unity simulates two different ward designs and the effects of gender on waiting times.

Results
Initial results show the queue for single bed bays can be substantially reduced (possibly by up to a half) in appropriately designed wards. Video: https://youtu.be/Hw9NXONCRTc

Conclusions
Due to gender issues, it is common for bays to be assigned single genders which can create virtual ring fencing of beds which can impact on waiting times. Current models are often Excel based and are static and do not reflect the actual physical properties of the hospital. This project shows the potential of a dynamic simulation in new ward designs. It is possible that each hospital in the NHS could have its own model, linking its physical attributes (the actual building) to a mathematical model and these can be compared for efficiency. New buildings could be simulated and compared for costs and efficiencies substantially reducing guesswork and challenge building orthodoxy and introduce evidence into hospital design.
28 ‘’Junior doctor confidence in conducting and documenting microbiology ward rounds on neurosurgical wards: A single centre study’’
Authors: Shams Sahar 
Published: August 2023

Abstract

Aims
This study aims to analyse junior doctors’ confidence in conducting and safely documenting microbiology rounds, across two neurosurgical wards in a large tertiary hospital. It also aims to make locating microbiological plans easier and in doing so identity potential areas for improvement.

Methods
Initial feedback from junior doctors (n=12) on their confidence conducting and safely documenting the discussions from the microbiology round was received through a survey sent out. Subsequent documentation guidance was provided and developed using the ‘Start Smart, Then Focus’ antimicrobial stewardship toolkit set out by Public Health England. The initial survey along with two further questions was used to reassess confidence after 2 weeks of implementing the guidance.

Results
There was a 37% increase in confidence with 91.7% of doctors rating their confidence at 5 on the 5-point Likert scale after implementation of the guidance. The guidance was well received and found to be helpful by 100% of respondents. Improvements were seen as there was a 75% increase in responses saying ‘Yes’ it was easy to locate entries. The responses from the qualitative questions identified time restraints as the main theme in determining (1) overall difficulty of the microbiology round (2) ability to document effectively and (3) barriers to using the guidance.

Conclusion
Although there was an increase in confidence in the junior doctors’ ability to conduct and document the microbiology round well the data suggests improvements are required. Recommended improvements include setting dedicated time for all staff to conduct the round and enhancing senior support available.
51 Evaluating the Impact of International Surgical Society Research Grant Funding
Authors: Huo Bright , McClean Adam , Kwan Jing Yi , Antoniou Stavros , Francis Nader , Yiasemidou Marina 
Published: August 2023

Abstract

Introduction
Research impact is defined as the influence of research beyond academia. The European Association of Endoscopic Surgery (EAES) supports research through financial and training support. With the current project we aim to define and objectively measure the impact of research supported by one of the biggest surgical societies in Europe.

Methods & Procedures
A Steering Committee finalised the questionnaire through a Delphi process. This was disseminated to all previous EAES Research Grant recipients since 2011. Results were used to generate open ended questions for semi-structured interviews. Thematic analysis was performed.

Results
The questionnaire response rate was 22/30(73%). The median number of presentations was 2.5, highest number of citations/year was 19. Seven respondents participated on guideline committees, while 15 were involved in further research, including six multicentre trials. Three studies instigated changes in clinical policies. Two intellectual property designs were produced. Eight recipients received further funding. Experts rated a median positive impact of 5/7 on their career progression, while supervised non-experts rated 6/7. The framework from interview thematic analysis included the following topics: (i)benefits of EAES involvement (ii)career progression (academic-clinical) (iii)impact on skills (iv)network impact (v) overall impact (vi)EAES project support (vii)project challenges (viii)EAES project results (ix)study design suitability, and (x)EAES future scope.

Conclusions
The impact of research funding by EAES was significant; both academically and outside academia. The semi-structured interviews identified the facilitators and barriers to project progression and impact.
80 Has the global pandemic health and social situation affected the management of obstructive jaundice secondary to tumuor pathology? A review of our experience in two years of the pandemic
Authors: Aguilera Beatriz Carrasco , Garcia Lorena Solar , de Leon Alberto Miyar , del Val Ruiz Pablo , López-Negrete Emilio , Pinto Ignacio Gonzalez 
Published: August 2023

Abstract

Objectives
SARS-CoV-2(COVID19) infection forced a redistribution of hospital resources, including reduction and delay of scheduled surgical activity. We analysed the management of obstructive jaundice (OJ) in patients with potentially resectable periampullary pathology in a tertiary care centre during the pandemic.

Methods
Observational, single-centre, retrospective study, during the years 2020-2021. The main inclusion criterion was the indication for cephalic duodenopancreatectomy. Patients with criteria of unresectability or indication for neoadjuvant treatment were excluded. We analysed OJ drainage techniques (endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary drainage (PTCD) as well as associated complications. Indications for drainage were: bilirubin &gt;10 mg/dl, cholangitis or expected surgery &gt;2 weeks after inclusion on the waiting list.

Results
We analysed 75 patients (53.3% male) with an age range of 28-80 years. 59% of patients required drainage by OJ, ERCP was performed in 23 cases and PTCD in 21 cases. Twenty-three stents were placed, 52.1% of which were metal-covered. The most frequent complications associated with ERCP (43.4%) were cholangitis and pancreatitis. The most frequent complication associated with PTCD (28.5%) was cholangitis.

Conclusion
The correct management of OJ secondary to resectable periampullary tumours is early surgery without preoperative drainage. In case drainage is necessary, the endoscopic approach with placement of a metallic stent seems to be the most indicated. In our series, the COVID19 pandemic led to more preoperative biliary drainage due to longer delays in surgical scheduling, as well as more PTCD approaches due to greater accessibility, this technique also being valid.
84 Emergency General Surgery medical records standards at a tertiary referral hospital: Lessons learned from Royal College of Physicians
Authors: Youssef Mark , Nada Hany , Boghdady Michael El 
Published: August 2023

Abstract

Introduction
The record keeping standards published by the Royal College of Physicians (RCP) aimed to maximize patient safety, quality of care, support professional best practice and assist compliance with Information Governance and NHS Litigation Authority. We aimed to study the medical records keeping in emergency general surgery admissions at a London tertiary hospital.

Methods
A randomized retrospective analysis of 30 patients was performed in a period from 1st May 2022 to 1st August 2022. Results of the first cycle were presented at a local meeting, followed by action plans and recommendations. A teaching session has been delivered for junior doctors about the RCP standards and planned to be delivered every 4 months for all new staff members. A closing loop has been carried with same methodology and number of emergency surgical admissions from 1st November 2022 to 22nd of November 2022.

Results
Good standards of records keeping in the first cycle was reached in 8 (100%) out of the 12 RCP criteria, with multiple areas that needed improvement. In the closing loop, a significant improvement was reached: discharge letters standards with 93.3% compared to 86.7 % in the first cycle, 3.3% records contained information filled in irrelevant section compared to 20%, 10 % of the cases in the second cycle had advanced decisions documentation compared to 0% in the first cycle.

Conclusions
The maintenance of good medical record keeping requires regular audit and formal education of junior doctors to reach a high standard in emergency surgical admissions according to the RCP record keeping criteria.
103 Botulinum Toxin Type A (Botox) Injection for Plantar Fasciitis: An Audit of Findings
Authors: Olivelle Joseph , Olivelle Arun 
Published: August 2023

Abstract

Introduction
Plantar fasciitis is commonly seen in the musculoskeletal clinic and accounts for around 8-10% of running injuries. NICE recommended corticosteroid injections for patients whose “symptoms are having a significant impact on the person”, however, symptoms lasted for 4 weeks post injection. The use of Botox for the treatment of myofascial pain has increased, with studies showing greater reduction in patients symptoms and improved duration of action.

Material and methods
42 patients (27 male, 15 female) were included in this audit. All patients received 100 units of botox.

Inclusion/Exclusion criteria
All patients who had clinically diagnosed plantar fasciitis and had received the first line treatments of stretching and orthotics.
Patients yet to begin a stretching program or had systemic disease or previous surgery were excluded.

Outcome measure
A patient assessed (VAS) and a physician assessed (Heel Tenderness Index) outcome measure was used.

Results
42 patients were assessed.
VAS
All the patients reported an improvement in symptoms at the 4 week follow up, 38 (90.48%) of whom reported pain free. Of the remaining 4 all advised their symptoms had improved by at least 50%
HTI
38 (90.48%) had no pain on palpation of the heel post injection, whilst prior to the injection all patients had pain in differing degrees. 15 patients (35.71%) had severe pain prior to the injection, post injection no patient had severe pain. 40 (95.24%) patients had improved HTI scores.

Conclusions
Botox is effective in the treatment of plantar fasciitis, however, its effectiveness in the longer term needs to be assessed.
106 Life expectancy of octogenarians following EVAR
Authors: Sultana Emiko , Seraj Shaikh , Jones Steven 
Published: August 2023

Abstract

Background
The aim of elective Abdominal Aortic Aneurysm (AAA) repair is to prevent premature death from rupture. The Endovascular Aneurysm Repair (EVAR) 2 trial showed that patients with AAA who are not fit for open repair do not benefit in terms of life-expectancy from EVAR. In our region, the average life expectancy for men is above the national average but controversy remains when offering octogenarians expensive procedures with the aim of prolonging life. This study aimed to quantify the life-expectancy following an EVAR between octogenarians and younger patients.

Methods
A retrospective review was performed of the electronic notes of all patients receiving EVAR at our unit between October 2009 to October2019. Survival post EVAR was compared between the octogenarian group and the younger patient group. A survival analysis was undertaken using SPSS software to calculate a Kaplan-Meier curve.

Results
294 patients received EVAR between 2009-2019. Patients were between ages 45 and 89 (Median 75); 87.4% were male. 169 patients died during follow up (n=64 ≥80 years, n=105 &lt;80 years). Time of death post-EVAR in octogenarians (average age 82.91 years) ranged between 0- 131 months, whilst those under 80 years (average age 71.77 years) ranged between 1-152 months. Log rank (Mantel-Cox) analysis demonstrated statistical significance (p=0.017). Median years post-EVAR for ≥80 years was 3.02-4.98 and &lt;80 years was 5.12 – 6.87.

Conclusion
Octogenarians undergoing EVAR have a shorter life-expectancy compared to those under 80 years of age. This should be taken into account when discussing elective options with patients and their relatives.
130 Using Abdominal Fat Ratio to predict difficult laparoscopy – a potential indicator for Robotics/TaTME?
Authors: Walls Martin , Winstanley Joseph , Wallace-King Sabina , Collier Toni , Mishreki Andrew 
Published: August 2023

Abstract

Introduction
Minimally-invasive surgery has revolutionised colorectal cancer surgery. Intra-abdominal/visceral adiposity increases the chance of conversion to open surgery. Abdominal fat ratio (AFR) has been identified as predictive for this. New techniques, such as robotic platforms and Trans-anal Total Mesorectal Excision (TaTME), are generally less susceptible to visceral obesity. We hypothesise that AFR can predict difficult laparoscopic surgery and promote selective use of alternative surgical techniques.

Methods
Hospital coding data identified 117 anterior resection and abdominoperineal excision of the rectum procedures between April 2017 and March 2020. Planned/actual procedure and histological factors were recorded. AFR was calculated using the method from Scott et al (Ann R Coll Surg Engl 2017). Mann-Whitney U testing and binomial logistic regression were used to compare AFR between laparoscopic completed (LC) and conversion to open (CtO) groups.

Results
73 cases were completed laparoscopically, 35 converted to open. 9 cases were planned open. AFR between LC and CtO groups was comparable (Median LC = 3.94; CtO = 3.64; U = 1220, p=0.71). Binomial logistic regression showed no relationship between AFR and conversion to open surgery (OR 1.11 95% confidence interval 0.92-1.36, p=0.27).

Conclusion
No statistically significant differences were found. This may result from the small numbers included but may also reflect the multifactorial nature of intra-operative decision-making. Post-chemoradiotherapy effects and difficulties obtaining safe views through inadequate small bowel retraction or bulky mesentery were cited more often in the conversion group than problematic visceral obesity. Other recognised factors should be considered in future, larger series analysis.
151 Isolated tuberculosis liver abscess in an immuno-competent patient – A case report
Authors: Sabir Alifa , Rauf Fatima , Hamza Muhammad , Khan Huma Sabir , Malik Naveed Akhtar , Hanif Muhammad 
Published: August 2023

Abstract

Introduction
Tuberculosis presenting as an isolated liver abscess is extremely rare.

Case Summary
A 55 year old woman presented with complaints of pain right hypochondrium associated with low grade fever and weight loss for last 1 year. Abdominal examination revealed mild tenderness in right hypochondrium. Rest of system examination was unremarkable. Laboratory investigations and chest radiograph were normal. Ultrasound abdomen showed coarse heterogeneous liver parenchyma with increased echogenicity. Single irregular hypoechoic area in segment IV A of the liver was noted. CECT scan of abdomen showed a single well defined focal lesion of 4.2*5.5*4.9 cm in segment V/VI, which was hypovascular on both arterial and venous phases. Delayed imaging revealed thick rim of contrast enhancement suggestive of fibrous capsule. Ultrasound guided biopsy of the lesion was done which showed chronic caseating granulomatous inflammation suggestive of tuberculosis. Patient was started on anti- tuberculous therapy. However, she showed worsening of symptoms. A repeat triphasic CT scan showed a complex multiseptated thick-walled necrotic lesion measuring 8.5*6.9*6.4 cm in segment V/VI of the liver. Her total leucocyte count was 14,500/mm3, CRP levels 19.4 mg/l and ESR 99mm3. Ultrasound guided drainage was done and a drain was placed in right hypochondrium. Patient was discharged on oral antibiotics. The follow- up CT scan showed a significant decrease in the size of abscess (3.8*4.2*5.8 cm) with marked improvement in the symptoms.

Conclusion
An isolated tuberculous liver abscess poses challenge to the clinical acumen of the treating physician and an early diagnosis can help reducing the morbidity and mortality associated with it.
178 Damage Control Surgery in Severe Ballistic Trauma
Authors: Lamara Abdelhak 
Published: August 2023

Abstract

Introduction
Severe ballistic lesions are the cause of hemodynamic disorders and early coagulopathy causing a high mortality rate, their management needs to be adapted to each situation.

Materials & Methods
This retrospective study aims to evaluate the feasibility and outcomes of abbreviated laparotomy and early re-exploration. It includes patients suffering from severe ballistic injuries who had to undergo a Damage Control Surgery (DCS) due to a high severity trauma score. Moreover, morbidity and mortality rates were analysed.

Results
The sample included 73 male patients with an average age of 31years.
Most patients suffered from haemorrhagic shock 74%, respiratory distress 40%, and peritoneal contamination 63%. The severity score was 64. After (DCS), the re-exploration was impossible in certain cases. The mortality rate was 28, 8%.

Conclusion
Abbreviated laparotomy and DCS are effective practices for stabilizing victims of gunshot and maintaining the function and integrity of the organism.
191 Minimally Invasive General Surgery Landmark Trials and Lessons Learned - A Narrative Review
Authors: Walshaw Josephine , Huo Bright , McClean Adam , Gajos Samantha , Kwan Jing Yi , Yiasemidou Marina 
Published: August 2023

Abstract

Aims
The aim of this review is to explore the history of minimally invasive (MI) surgery and landmark trials that guide modern practice.

Methods
A narrative review was conducted according to the four steps outlined by Demiris et al.

Results
MI surgery has become the gold-standard for many operations. Laparoscopic surgery has equivalent operative outcomes to open surgery with reduced recovery time and hospital stay. Randomised controlled trials (RCTs) investigating complex laparoscopic upper gastrointestinal oncological resections demonstrate reduced blood loss and postoperative pain.
Within colorectal surgery, the CLASSIC and COREAN trials described comparable mortality and oncological clearance in MI colorectal cancer resections versus open surgery. Conversely, ALaCaRT and ACOSOG raised concerns about oncological results.
Robotic surgery provides a high degree of instrument freedom and stabilises hand tremors, however substantial associated costs remain a barrier. Robotic cholecystectomy (RC) is a safe and effective tool, and RC outcomes are comparable to laparoscopic surgery in the elective setting; although more evidence is required for more complex disease outcomes. For rectal cancer, the ROLARR trial found no difference in complications, conversion rate, or circumferential margin positivity for robotic-assisted versus laparoscopic surgery. Recently, the Smart Tissue Autonomous Robot performed the first autonomous intestinal anastomosis on porcupines, outperforming expert surgeons for both consistency and accuracy, demonstrating the potential future of robotic surgery.

Conclusion
This review gives an overview of MI general surgery; demonstrating the advantages as well as some concerns for the different surgical techniques, and raises suggestions for future uses.
206 Impact of theatre cancellation on surgical training
Authors: Nessa Ashrafun , Pawloy Karola , Ganeshamoorthy Kajenthiny , Ganesh Radhakrishnan , Ghazanfar Mudassar 
Published: August 2023

Abstract

Introduction
The COVID-19 pandemic has had significant consequences on healthcare delivery worldwide, with a particular impact on surgical services and training. In preparation for the influx of COVID cases, non-urgent appointments, investigations, and operations were cancelled. As a result of the cancellation of cases, elective and emergency case exposure was inevitably reduced. Over 65 percent of trainees lost all training and only 9% reported that they would meet the essential skills. One in eight trainees in their final year have had their training extended due to failure to meet curricular requirements, while a quarter of trainees reach their final year behind their planned training trajectory. The primary objective was to identify the case with the highest cancellation rate to perceive its impact on surgical training.

Method
This is a retrospective study of data gathered by Department of eHealth in a tertiary hospital. Data collected from December 2020 to September 2021were analysed.

Results
121 elective cases were cancelled over the course of 9.5 months. More than thirty types of elective operations were cancelled, with Laparoscopic cholecystectomy - 33 (27.3%) and EUA rectum - 10 (8.3%) being the two most often cancelled procedures. Twenty percent (n=20) of the cancelled cases were malignant.

Conclusion
The recovery of surgical training requires a joint effort from all – the trainers, the trainees and those involved in the delivery of surgical training. The training opportunities for trainees of any grade should be maximised in the theatre setting along with other training opportunities focussed on specific index procedure.