bluuebunny/crossref_metadata_2025_split huggingface dataset:
WTP5.10 Developing Walking Routes to Encourage Post-Surgical Mobilisation in Hospital, and Assessment of Patient Satisfaction
Authors: Hall Susanne , Burke Dermot 
Published: August 2023

Abstract

Aims
Physical activity soon after surgery contributes to earlier discharge and better outcomes. However, patients often feel anxious to leave their ward and walk around. This project aimed to develop walking routes for patients in order to reduce this anxiety and encourage people to walk post-surgery. Once developed, we evaluated patients' views.

Methods
In a large hospital with five separate wings, we created a multi-professional team to advise on development. Safe walking routes were measured, timed, photographed and assessed for interest. We then produced a walking routes website, informed by multi-professional opinion, for use by patients from 21 surgical wards. This website was accessible to patients at the bedside, via a QR code scanned on their mobile phone. An electronic questionnaire on the website was used to assess patient satisfaction with the new resource.

Results
The majority of respondents (69.2%) felt that the walking routes website lead to them being more active during their admission (n=13). Respondents also felt that the website provided them with enjoyment, benefitted their mental health and made them feel more informed and involved in their recovery. Respondents felt their experience of the walking routes website would be improved by access to the website earlier in their hospital stay.

Conclusion
Despite the small sample size, this evaluation suggests the walking routes website has the potential to be a useful tool for surgical patients to increase early postoperative mobilisation, and improve patient hospital experiences.
WTP6.3 Evolution of a Five-Year, Multi-Specialty Surgical Course for Foundation Doctors Transitioning into Surgical Training: An Educational Paradigm
Authors: Kwan Jing Yi , Banks Philippa , Biyani Chandra Shekhar , Phillipson Mark , Palit Victor , Yiasemidou Marina 
Published: August 2023

Abstract

Background
The Essential Surgical Skills Course (ESSC) is a multi-specialty surgical stimulation embedded course that has been run successfully for five years, acting as an educational paradigm for bridging the gap between two levels of training. This report aims to describe the evolving process of designing and delivering a successful ‘hands-on’ course and assess its validity through trainee feedback.

Methods
The face validity of the course was assessed through the cumulative (free-text and quantitative) five-year feedback from trainees. The design and process of content adjustment according to feedback is described in detail to allow for easy replication by other educators.

Results
Face validity of the different sessions of the course ranged from 8.17-9.42 out of 10. Feedback driven changes to the curriculum with positive reception. Key themes identified as beneficial including teaching style, course structure and responsiveness.

Conclusion
The ESSC has demonstrated good face validity and was well received by trainees. The key factors contributing to the success of the course include the structured method of curriculum design, outstanding teaching delivery methods, the availability of appropriate faculty and infrastructure and the willingness to learn from trainee feedback and adjust the content of the course accordingly. It acts as a paradigm for courses aimed to prepare surgical trainees for a ‘step-up’ in their careers.
WTP6.6 The Major Trauma TIG Fellowship: lessons learned. Perspectives of a paediatric surgeon training in adult trauma surgery
Authors: Morris Louise , Brooks Adam 
Published: August 2023

Abstract

Introduction
Major Trauma Training Interface Group (TIG) Fellowships were introduced in 2018 to formalise and enhance the training of surgeons and allied specialists in trauma care. Paediatric surgery is a non-traditional route to trauma surgery. Lessons learned from a fresh perspective may be relevant to surgeons who may not include trauma in their regular practice but may occasionally encounter seriously injured patients requiring emergency management.

Method
Training involves a 12 month placement; fellows are trained to deliver effective trauma team leadership and/or in the skills and decision making required to perform resuscitative trauma surgery. Important learning points were documented throughout the fellowship. A selection are described below.

Results

Conclusion
Integrated training is immensely valuable in trauma care. Collaboration between trauma units and the regional MTC could optimise shared learning outside formal fellowships.
WTP7.3 Advanced Clinical Practitioner (ACP) led Surgical Same Day Emergency Care (SSDEC) has transformed emergency surgical workflow with high levels of satisfaction
Authors: Hanley-Hine Rachael , Polisena Stephanie , Capozzi Patrizia , Duff Sarah 
Published: August 2023

Abstract

Aims
ACPs offer senior assessment to emergency general surgical patients and have changed the face of emergency surgical assessment and care.
To demonstrate success of SSDEC through increasing numbers seen though the service, less patients assessed through ED, more timely assessment, and expedited ward discharges within a competent and safe environment.
To demonstrate staff (ACP and Consultant) and patient confidence and satisfaction.

Methods
Data will be collected from service provision dashboards, locally collected data including Incident Reporting and the newly introduced electronic patient record. Surveys are used for patient, consultant and ACP feedback.

Results
The number of patients seen through SSDEC has increased from an average of 25 per week in 2017 to 125 per week in 2023. Patients dealt with in SSDEC alleviate pressure on ED and the surgical team.
Survey results demonstrate that surgical consultants feel that SSDEC has improved their emergency experience, patient experience and there is confidence in the ACPs competence.
Surgical ACPs felt clinically supported and had confidence in their own clinical autonomy.
93% of patients were very satisfied or satisfied with their practitioner and experience.

Conclusion
An ACP led surgical SDEC leads to high levels of patient satisfaction with consultants feeling confident in ACP competence to assess and manage emergency surgical patients.
Moreover, the ACPs report feeling autonomous, confident, supported and satisfied in their job.
WTP7.5 The shift in practice Toward Laparoscopic emergency surgery over period of 7 years in a district hospital
Authors: Jabri Yamen , Husain Elham , Ezeme Constantine , Pring Chris 
Published: August 2023

Abstract

Aim
Many studies showed the advantages of laparoscopic surgery when compared to open surgery both in elective and emergency surgery. The Aim of this study is to compare Laparoscopic and open surgical procedures in managing Emergency surgery in a district hospital over a period of 7 years.

Methods
We reviewed 1776 emergency cases in 2015 and 1836 cases in 2022 in the emergency theatre register. We included all the abdominal emergency surgeries that qualifies for the NELA inclusion/ exclusion criteria. We excluded all non-general surgery cases. We also excluded Appendectomies, Hernia repair and Laparoscopic cholecystectomies.

Results
We included 207 in 2015 and 234 in 2022. There was significant increase in Laparoscopic surgery performed between 2015 and 2022 (63%Vs40%).
Less open surgeries were performed (46%Vs24%) and no change in the conversion rate (13%vs12%).
Operating time was (89min) for Laparoscopic cases. Compared to open procedures (119min) and converted cases (141min).

Conclusion
There has been more than 50 % increase in laparoscopic cases. However, there was no significant reduction in conversion rate.
The laparoscopic surgery time was significantly less when compared to open or converted cases, however this might simply be sure to the complexity of those cases rather than the advantage of laparoscopic surgery.

Key statement
There has been significant shift toward laparoscopic surgery over the last few years due to better understanding of the benefit of laparoscopic surgery and increase confidence in performing laparoscopic surgery.
There is a room of improvement in case selection to decrease the conversion rate avoiding unnecessary increase of operating time.
WTP7.7 A novel sexually transmitted infection (STI) testing and screening programme in an Ambulatory Surgical Clinic (ASC) for female patients presenting with abdominal pain
Authors: Jones Sian , Ganesh Divolka , Mahon Ciara , Please Helen , Hughes Michael , Cooper Adam Peckham 
Published: August 2023

Abstract

Aims

Methods
Women aged 18-44 years presenting to ASC were offered a voluntary self-collected high vulvovaginal swab for chlamydia and gonorrhoea at triage. Data was collected over one year (Dec 2021-Dec 2022). Testing was offered to 299 patients, 20 declined to participate and 18 samples were rejected. Positive results were referred to the Sexual Health service for treatment and contact tracing as agreed on a pre-planned referral pathway.

Results
5.4% of swabs were positive (2 Gonorrhoea and 12 Chlamydia). The mean age of those testing positive was 24.5. All positive patients presented initially with lower abdominal pain. Of those testing positive 7 had further imaging (USS pelvis) and only 25% had a documented sexual history taken. 4 women had diagnostic imaging indicative of PID and 4 patients were treated for PID empirically. The remaining patients were treated for non-specific abdominal pain or unrelated pathology.

Conclusions
Undiagnosed sexually transmitted disease is prevalent and young females presenting with lower abdominal pain provide an excellent testing cohort. Given the high incidence of positive tests, further training of surgeons to consider and ask pertinent questions regarding an STI diagnosis is vital. The introduction of self-swab testing has been successful in assisting as a diagnostic tool and screening programme.
WTP8.2 How the healthcare system fails to provide continued care for patients
Authors: Mahalingam Praveena , Mantova Maria , Gambhir Raghvinder Pal Singh 
Published: August 2023

Abstract

Aims
In the current climate of dissatisfaction with the healthcare system due to oversaturation of outpatient services that has left around 7 million people waiting to be seen for the first time, we wanted to evaluate the number of post-surgical patients who have failed to receive appropriate follow-up.

Methods
We retrospectively looked at all patients admitted under the vascular department at a tertiary centre hospital over a 3-month period. We excluded the following patients from our data collection:
1. Those who passed away in hospital.
2. Those who did not require follow-up after discharge.
We looked at the Electronic Patient Records (EPR) to identify if they had been given a follow-up appointment.

Results
A total of 127 of the 150 patients admitted in the 3 month study period were advised a follow-up in their Electric discharge notifications (EDNs). Of these, 83 patients were admitted electively and 44 as emergencies.
For a follow-up appointment to be booked there are two steps:
For the elective admissions, 88% had follow-up booked compared to 86% for the emergency admissions.

Conclusions
Our study shows that the failure to follow up rate was 12-14% despite a dual notification method. This can have an adverse impact on both the quality and continuity of patient care. The system still continues to fail the patients.
WTP8.13 Expression of Integrin Subunit Alpha 7 (ITGA7) predicts survival from breast cancer following adjuvant chemotherapy
Authors: Jones Stacey 
Published: August 2023

Abstract

Aim
To investigate the relevance of ITGA7 expression with respect to clinical prognostic markers, disease-free survival (DFS) and disease-specific survival (DSS) after adjuvant chemotherapy in breast cancer.

Methods
Breast cancer tissue was obtained from a tissue microarray comprising all tumour subtypes in 305 women. Expression of ITGA7 was determined by immunohistochemistry. Relative expression of ITGA7 was assessed.

Results
Overall, it was concluded that ITGA7 levels were independent of the clinical prognostic markers, tumour grade, lymph node status, oestrogen receptor status and molecular subtype. Kaplan-Meier survival analyses showed, high ITGA7 nuclear protein expression was associated with longer DFS, mean 647 days; p=0.036 in the whole cohort. The same trend was visible for ITGA7 cytoplasmic protein expression albeit that this was not significant. Sub-analysis of ER-positive breast cancers also showed that high ITGA7 nuclear protein expression was associated with both a longer DFS and DSS, 682 days, p=0.05 and 604 days, p=0.005 respectively. Kaplan-Meier survival analysis was performed separately on the patients who received either taxanes with anthracyclines or anthracyclines without taxanes. This demonstrated a significant increase in DFS, 806 days; p=0.004 in primary breast cancers that had high ITGA7 nuclear protein expression in the group that received anthracycline-based chemotherapy alone. No statistically significant difference in DFS or DSS was noted between high and low ITGA7 expression in the group that received anthracycline and taxane based adjuvant chemotherapy.

Conclusion
ITGA7 has been identified as impacting upon DFS and DSS in breast cancer potentially via the modification of chemoresponse.
ThTP2.2 Correlation between conventional endoscopic and histopathological diagnosis of Barrett’s oesophagus
Authors: Verma Harsh , Asarbakhsh Mariam , Singh Gautum , Megson Tyler , Olejnik Hannah , Saha Arin 
Published: August 2023

Abstract

Introduction
The diagnosis of Barrett’s oesophagus is currently made with a combination of endoscopic appearances and presence of intestinal metaplasia (IM) on oesophageal biopsies. There have been minimum endoscopy and pathology reporting standards proposed by the British Society of Gastroenterologists and these include the use of high resolution endoscopy and the use of a comprehensive proforma for biopsies. This study compared the diagnosis of Barrett’s oesophagus between conventional endoscopy and histopathological analysis.

Methods
All patients who were due for surveillance endoscopy for Barrett’s oesophagus in 2022 were identified from a prospectively maintained waiting list. Endoscopy reports, biopsy results and outcomes were recorded. Correlation between endoscopic and histopathological results, with particular attention to the presence of intestinal metaplasia, was recorded.

Results
There were 192 patients identified for this study. All had endoscopic diagnosis of Barrett’s oesophagus (between 2016 and 2020) and were entered into a surveillance programme based on endoscopic diagnosis alone.
36 patients (19%) did not have a Prague classification (C and M grading) recorded on their primary endoscopy report and 55 patients (29%) did not have images available for review. None had HRE (all had conventional endoscopy). Only 127 patients (66%) had IM from original endoscopic biopsies and none had documentation of p53 status.

Conclusion
There was relatively poor compliance between current practice and gold-standard recommendations for endoscopy and pathology reporting. Just 66% of patients who had an endoscopic diagnosis of Barrett’s had IM on histopathology. These findings have implications for the accurate diagnosis and surveillance of Barrett’s oesophagus.
ThTP2.5 Diagnosis of intestinal metaplasia (IM) in the surveillance of Barrett’s oesophagus – a comparison between Cytosponge and endoscopic biopsy
Authors: Asarbakhsh Mariam , Singh Gautam , Verma Harsh , Megson Tyler , McDonald Claire , Saha Arin 
Published: August 2023

Abstract

Introduction
Regular endoscopy with oesophageal biopsies is recommended for the surveillance of Barrett’s oesophagus. Intestinal metaplasia (of all subtypes) carries the highest risk of progression to dysplasia and adenocarcinoma; thus, it is important for diagnosis of Barrett’s. Concerns exist about the accuracy of endoscopic diagnosis when obtaining biopsies and in ‘missing’ metaplasia between biopsies. Cytosponge is a novel, minimally invasive oesophageal cytology sampling device; this study assessed the correlation between endoscopic biopsies and Cytosponge cytology in the diagnosis of IM.

Methods
192 patients with endoscopic Barrett’s oesophagus who were due for surveillance endoscopy in 2022 were identified and screened for suitability for Cytosponge. If suitable, patients were offered a Cytosponge. Cytosponge cytology results were compared with previous histopathological biopsy results.

Results
127 patients (66%) had IM from original endoscopic biopsies. Many of these patients did not have images available for review to assess accuracy of original endoscopic diagnosis. Cytosponge detected IM in 88 cases (45%). Sensitivity was 67.77% (95% CI, 58.67%-75.98%) and specificity of 91.55% (95% CI, 82.51%-96.84%). The positive predictive value was 93.18% (95%CI, 86%-96%) and negative predictive value of 62.50% (95% CI, 56.04%-68.54%).

Conclusion
The accuracy of cytosponge is favourable and comparable to screening endoscopy. Cytosponge can be used as a screening tool and, potentially, as an alternative to endoscopy to identify IM. Further work is needed to determine accuracy of endoscopic diagnosis, given the high proportion (over one-third) of patients who are currently on a Barrett’s surveillance programme but do not have any histological diagnosis of IM.
ThTP2.9 Managing Choledochal Cysts in Adults at a DGH
Authors: Buksh Md-Mahfooz , Kerans George , Menezes Neville , Al Samaraee Ahmad 
Published: August 2023

Abstract

Aims
Choledochal Cycts (ChDCs) in adults are rare and mostly benign, although 7-11% can be associated with malignancy. This study explored a DGH experience in managing ChDCs.

Methods
Retrospective study from April 2019-April 2022. All patients ≥18 years diagnosed with ChDCs on MRCP/MRI-pancreas (regardless of MR indication) were included in the final analysis. HPB-MDT records were checked for relevant cases/management plans.

Results
2013 MRCP/MRI-pancreas scans were performed. 29 (1.4%) patients were found to have ChDCs with around half reported as Type I. The mean age was 48 years, with a female: male ratio of 2.6:1. 70% of patients were white. In 55% of cases the main symptom was upper abdominal pain, with 3.4% of ChDCs found incidentally. There were 33 hospital admissions in total (including readmissions), mainly for pain control, with an average duration of 72 hours. 9 patients with ChDC had symptomatic gallstones over the study period, with nearly all requiring laparoscopic cholecystectomy. No patients had objective evidence of malignancy warranting ChDC excision/hepatico-jejunostomy. The management and annual surveillance plans were decided at the regional HPB-MDT.

Conclusions
ChDCs management in adults is challenging, since it requires long-term clinical/radiological surveillance. This is the largest DGH study of ChDCs in our region. Our findings are close to other studies, although we found a higher prevalence of ChDCs in white patients (usually well reported in Asian populations). Due to the rarity of this condition and paucity in the literature regarding its management challenges, we propose the implementation of standardised national databases/guidelines.
ThTP2.11 Three-year follow up outcomes in mesh-augmented vs sutured cruroplasty in giant hiatal hernia repair
Authors: Hammett Felix , Fairbrass Dominic , Dexter Eloise , Pellen Michael , Wilkins Alexander 
Published: August 2023

Abstract

Aims
There is no consensus for indications on mesh-augmentation of crural repair in hiatus hernia. We evaluated outcomes following mesh-augmented versus suture repair of giant hiatus hernia.

Methods
Giant hiatus hernia was defined as a hernia containing at least 30% of the stomach in the thorax. We undertook a retrospective analysis of records for patients undergoing surgical repair of hiatus hernia in a tertiary centre between 2016 and 2019, with a minimum follow up of three years. Patients were identified using clinical coding. Pre-operative investigations (OGD, barium swallow, CT) and operative findings were used to identify those patients with giant hiatus hernias. Outcomes assessed included morbidity, recurrence and revisional surgery.

Results
58 patients of median age 72 (27-90) underwent repair of a giant hiatus hernia. 56 (97%) were performed laparoscopically (1 conversion, 1 open). All were primary procedures, 50 elective and 8 emergency. 20 had mesh-augmented suture repair (19 BIO-A, 1 Permacol) and 38 had primary suture repair alone. 26 (44.8%) had additional fundoplication.
By three years post-surgery 14/58 (24%) recurrent hiatus hernias were identified on further investigation, similar in both groups (5/20 vs 9/38). Symptomatic revisional surgery was undertaken in 2/20 (10%) mesh-augmented and 2/38 (5%) suture only repairs.
30-day mortality was 0%. Morbidity (Clavien-Dindo 3+) was recorded in 5 patients (8.6%).

Conclusion
Giant hiatal hernia repair complication and recurrence rates were comparable to published studies. Those patients with recurrence following mesh-augmented repair were more likely to require revision surgery. However mesh may be used in cruroplasty for perceived weaker or wider crura.
ThTP3.1 Development and early validation of ‘SuturePal’: a novel mixed reality laparoscopic suturing training module
Authors: Chidi-Egeolu Chibueze , Lam Kyle , Lawson Jason , Kinross James M 
Published: August 2023

Abstract

Aims
Laparoscopic suturing is a challenging skill to acquire, requiring extensive training. This study aims firstly to develop a novel self-directed mixed reality laparoscopic suturing training module using the Microsoft Hololens 2 headset and secondly to assess the feasibility of this training tool and advantages over conventional training methods.

Methods
SuturePal is a self-directed mixed reality training module which combines didactic videos, text, and bespoke interactive 3D models. Ten medical students and surgical trainees participated in a single-blinded prospective randomised feasibility study. Participants received baseline teaching for laparoscopic intracorporeal knot tying and were subsequently randomised to either SuturePal (n=5) or conventional training (n=5). Baseline and post-training knots were recorded and assessed by two blinded examiners for time taken, precision, errors, and proficiency according to two previously validated objective assessment tools. Cognitive load was measured via the validated NASA-TLX tool and participant feedback was recorded.

Results
SuturePal users reported higher confidence levels (p=0.0476) and lower mental demand (p=0.0397) following training compared to those taught by conventional means. No statistical differences, however, were shown between groups when comparing objective measures of knot tying performance.

Conclusions
SuturePal provides evidence for how mixed reality technology may enhance engagement in surgical skill acquisition by improving user experience and lowering mental demand. This contributes to the growing body of evidence that mixed reality may have a role in enhancing surgical training. However, further research in the form of larger scale studies is required to determine whether mixed reality improves objective performance of surgical trainees.