bluuebunny/crossref_metadata_2025_split huggingface dataset:
ThTP5.9 Are readmission rates in a new surgical SDEC department acceptable? A service evaluation of a Healthboard’s new department
Authors: White Angus , Wong Eleanor , Anwar Salman , Koonara Kalhar , Thomas Charlotte 
Published: August 2023

Abstract

Aims
Unplanned patient readmission after discharge is a costly and potentially preventable occurrence, which can negatively impact both the patient’s experience and overall outcomes. Readmission rates across the country vary depending on location, population demographics and presenting complaint, but most departments have rates between 4 – 10%.
Our health board has recently implemented a new surgical Same Day Emergency Care (SDEC) department in response to rising pressures on beds. There have already been promising drops in patient waiting times since its inception, however patient readmission rates have not been formally evaluated.
We aimed to investigate 30 day unplanned patient readmission rates in this new SDEC department.

Methods
All patients that came in to the SDEC department in October 2022 were placed on a prospective database. We used the healthboard’s Clinical Workstation (CWS) database application to track whether they had re-presented to the Emergency or surgical departments within 30 days of their discharge from SDEC.

Results
344 patients were seen in SDEC over the course of 31 days. Of these 238 were discharged, 34 were planned readmissions and 71 were admitted. Of the discharged patients 13 came back as unplanned readmissions within 30 days. This gives an unplanned readmission rate of 5.5%.

Conclusion
SDEC is providing an excellent surgical service, with low unplanned readmission rates. SDEC has proven to be an effective way to divert patients from the Surgical Assessment Unit and ease the acute on call surgical take pressures.
ThTP5.10 A clinical audit of assessment of the risk of malnutrition and the subsequent nutritional support prescribed for older emergency laparotomy patients
Authors: Windle Angela , Burke Dermot , Ispoglou Theocharis , Nair Sherena 
Published: August 2023

Abstract

Aims
Patients should have assessment of the risk for malnutrition on admission using a Malnutrition Universal Screening Tool (MUST) and this should trigger a response if patients are categorised as high risk (National Institute for Health Care and Excellence, 2017). This clinical audit sought to identify if older patients undergoing emergency laparotomy were identified as at risk of malnutrition with subsequent interventions to address protein and energy deficiencies.

Methods
Patients entered onto the National Emergency Laparotomy Audit (NELA) database who were over 65 years of age during 1/1/21 to 31/12/22 were included. The patient records were screened for the MUST score on admission and whether nutritional supplementation was prescribed, or dietetic referral made, following the recording of a high-risk MUST score.

Results
Three hundred patients were included in the audit with 99.3% of the patients having a MUST score recorded on admission. One hundred and fourteen patients recorded a high MUST score, with 35% of the high MUST patients not receiving a dietetic review and 24% receiving neither oral nor parenteral supplementation. Mortality at 30 days was 13.9%. The wide variety of supplementation prescribed was changed to a protein and energy-based supplement upon dietetic review.

Conclusions
MUST scores are available to surgical teams, but high-risk scores do not always trigger an intervention to address deficiencies in older NELA patients. A protocol to ensure consistent approaches to supplementation before dietetic review would reduce variation and education of prescribers is needed to address the importance of prescribing protein-based supplements is needed.
ThTP7.4 Role of transanal irrigation in the management of low anterior resection syndrome: an evidence synthesis by meta-analysis
Authors: Shafique Muhammad Salman , Umair Musab Bin , Tahir Irtesam , Sains Parv , Baig Mirza Khurrum , Sajid Muhammad S 
Published: August 2023

Abstract

Objective
Low anterior resection syndrome (LARS) may be a debilitating postoperative anorectal dysfunction causing negative impact on the health-related quality of life in patients undergoing low anterior resection for rectal diseases. The objective of this review is to evaluate the role of transanal irrigation (TAI) in patients with LARS.

Methods
Randomized controlled trials (RCTs) comparing the effectiveness of TAI against baseline conventional therapies in patients with diagnosed LARS were retrieved from the search of standard medical electronic databases and analysis was conducted by using the principles of meta-analysis on the statistical software RevMan version 5.4.

Results
Three RCTs reported the effectiveness of TAI on 109 patients with LARS. Two RCTs compared TAI against conventional conservative therapies whereas one RCT reported the comparison of TAI versus tibial nerve stimulation. There were 53 patients in the TAI group and 56 patients were in no-TIA group. In the random effects model analysis, TAI was associated with the reduced low anterior resection score [standardised mean difference -2.32, 95%, CI (-3.98, -0.67), Z = 2.75, P=0.006] and lower faecal incontinence score [standardised mean difference -1.62, 95%, CI (-3.06, -0.17), Z = 2.19, P=0.03] compared to other therapies. There was significant heterogeneity (Tau2 = 1.85; Chi2 = 20.78, df = 2; (p &lt; 0.0001; I2 = 90 %) among included studies.

Conclusion
TAI has shown clinically proven advantage to improve LARS related anorectal dysfunction. However, due to paucity of the randomised trials, and significant clinical as well methodological diversity among included studies, these findings should be taken cautiously.
ThTP7.7 Anastomotic leakage in colorectal cancer resections: A 15 year cohort study
Authors: Gok M A , Mughal H N , Bughio M , Khan U A 
Published: August 2023

Abstract

Aims
Anastomotic leakage is serious event in restorative colorectal cancer resections, reported incidence of &lt; 10%. Aim of study is to assess management of anastomotic leakage at single centre.

Methods
Single-centre cohort study was carried out: Jan' 08 to Feb' 23. Descriptive demographics + post-op outcomes were analysed for colorectal cancer resections with “non-leaks” as controls.

Results

Conclusion
Anastomotic leakage rate 3.5 % of colorectal cancer resections, surgical intervention in 1.5 %. Type C leakage are believed to have worst prognosis (recurrence & shorter survival). Despite prolonged hospital stay (p &lt; 0.0001), there was no reduced survival or increased mortality rate with anastomotic leaks. Early diagnosis & intervention is crucial in the management of anastomotic leakage. A diversion stoma reduces the adversity of anastomotic leakage.
ThTP7.12 Effect of COVID-19 lockdown on surgical outcomes of patients undergoing colorectal surgeries
Authors: Gowda Manoj Srinivas , Mesut Erel , Peter Bennett , Venkatesan Gowtham , Thulasiraman Sri , Jha Madan 
Published: August 2023

Abstract

Aims
When the UK entered the lockdown, the referral pathways and hospital policies changed in order to deal with the pandemic and protect healthcare staff and patients from the virus. The objective of our study is to compare the surgical outcomes of patients having colorectal (CR) surgeries during and after lockdown.

Methods
Patients who underwent CR surgeries between Feb-2020 to Aug-2022 were included in the study. All patient related, disease specific and surgical details were obtained from the prospectively collected database. Patients were divided in to two groups: Surgeries before (group-A: during lockdown) and after 22/2/21(group-B: after lockdown). Patient demographics, surgical details and postoperative complications were collected and analysed using standard statistical tests.

Results
A total of 528 patients underwent surgeries during this period, of which 422 had cancer resections. During lockdown 230 patients had surgery (Group-A) and 298 patients had surgery after lockdown (Group-B). The median age of patients is 72 and 73 years in group A and B respectively (p-value 0.29). In group-A, 16% of patients had emergency presentation and in group-B,10% had emergency presentation (p-value:0.039). Emergency operations were undertaken in 21.74% of patients in group-A compared to 14.43% in group-B (p value:0.028). Minimal invasive surgery was done in 189 (82.17%) patients during lockdown compared with 253 (84.90%) after lockdown (p-value:0.102). The complications rate was higher in group-A compared to group-B (19.56% in group-A vs 12.75% in group-B, p- value:0.032).

Conclusions
Emergency presentation, emergency operations and postoperative complications were higher during lockdown compared with post lockdown. There was no difference with respect to mode of surgery.
ThTP8.1 Improving Adherence to NCEPOD Guidelines in a District General Hospital
Authors: Mactier Mhairi , Shahid Mishal , Chung Lucia 
Published: August 2023

Abstract

Background
NCEPOD classification defines urgency for appropriate surgical intervention. Use of this classification ensures patient safety, clinical governance, and promotes communication and teamwork. NCEPOD advises classification is allocated at time of the decision to operate; classification should be recorded both in the patient casenotes and on the theatre management system.

Aim
To assess use of NCEPOD classification in a district general hospital and improve adherence to national guidelines.

Methods
Retrospective data review of theatre management system (OPRA) for all emergency cases performed at a district general hospital between 01-14/09/2021. Data reviewed included procedure performed, NCEPOD classification and adherence to selected classification (time of booking ◊ time to theatre). Theatre booking form was amended to include NCEPOD classification and distributed throughout the department. Further data collection 14-28/01/2022 to assess for improvement, and 02-13/05/2022 to assess for sustained change.

Results
Cycle 1
Cycle 2
Cycle 3

Conclusion
Introduction of new theatre booking form has improved adherence to NCEPOD guidelines. There is scope to improve this further. Ongoing efforts include more departmental education and introduction of a WHO surgical sign-out.
FTP1.1 Using the STUMBL score to assess blunt chest wall trauma - does improving accuracy lead to improved patient care?
Authors: Clymo Jonathon , Perikleous Yianna , Wickham Alex 
Published: August 2023

Abstract

The STUMBL score is widely used to assess risk of complications in patients with blunt chest wall trauma. We audited its use in guiding the management of patients with rib fractures at a London major trauma centre.

Methods
This was a closed-loop audit. Data were collected retrospectively from electronic patient records for a period of one month (October 2021). Results were disseminated at the Regional Major Trauma Network Governance meeting. Educational updates were provided for the multidisciplinary team. After this intervention, a second one month audit cycle was completed (December 2021).

Results
Thirty-nine patients were included in cycle 1, of whom 41% (n=16) had care stratified using the STUMBL score. Calculation accuracy was poor: 0% had a correct score and 56.3% (n=9) had a score calculated within ±3 of the correct figure. Post-intervention, there was a significant improvement in STUMBL use in the 34 patients assessed in cycle 2: 85.3% (n=29; p=0.0001) had a documented score. Accuracy also improved, with 44.8% (n=13) within ±3 of correct and 31.0% (n=9) correct. There was no significant difference in the proportion of patients who were treated according to guidelines (74.3% vs 53.8%) or who were under-treated (23.1% vs. 38.2%) following our intervention (p=0.18).

Conclusions
We found a number of barriers to implementing the STUMBL score. Its use and calculation accuracy was improved by education, but this did not result in more patients following the suggested treatment pathway. Further evaluation is required to understand this discrepancy.
FTP1.4 Computer Blast wave and Shrapnel Simulation in Unity
Authors: Hutton Michael 
Published: August 2023

Abstract

Aims
A computer simulation to show the effects of an explosive device's blast wave and shrapnel injuries to humans.

Methods
Unity 3D project written in C# with real time physics showing the effects on people and listing probable injuries sustained.

Results
An explosive mass of 0.1kg to 100kg PTEN can be simulated showing the evolving blast wave and up to 100,000 shrapnel particles. The blast wave can show the maximum overpressure, velocity of the shock front and temperature Video: https://youtu.be/ICH2xHR6678. The shrapnel is simulated with the physics engine including velocity, energy of injury and body/limb hit points to calculate their effect. A model of the Manchester Arena is used as an example. Example blastwave data:

Conclusions
This novel approach to simulation showcases what is possible with computer simulation. Next steps are verification of data and building of more models. A higher detailed human model is being worked on which includes organs and bones.
FTP1.7 Critical decision analysis of pre-hospital major haemorrhage protocol activation
Authors: Wohlgemut Jared , McMullen Heather , Marsden Max , Marsh William , Perkins Zane , Tai Nigel 
Published: August 2023

Abstract

Aims
Major haemorrhage protocol activation (MHPA) facilitates immediate blood product availability and institutional capacity readiness for bleeding trauma patients. MHPA is a difficult decision pre-hospital, where two thirds of MHPAs occur. We aimed to identify the determinants and influences of the pre-hospital MHPA decision.

Methods
This prospective qualitative study had Health Research Authority approval (REC 22/PR/0089). Physicians from one helicopter emergency medical service (HEMS) were purposively sampled. Written informed consent was obtained. Cases representing difficult MHPA decisions within the previous six months were included. Semi-structured interviews were conducted via Microsoft Teams, following the critical decision analysis method. Interviews were transcribed and analysed using a 6-step inductive thematic analysis method on NVivo.

Results
Twelve interviews were conducted with nine participants: median age 37 years (range 34-45), median post-graduate experience 12 years (IQR 10.5-14.8), and median HEMS experience 1 year (IQR 0.5-4.9). Cues for (and against) the MHPA decision included: hard evidence of bleeding (or bleeding judged to be non-severe); initial information fit their mental model of a bleeding patient (or did not); patient deterioration (or response to resuscitation); acknowledgement that injuries and bleeding can be missed (or uncertainty of clinical findings); and alternative diagnoses were considered less likely (or more likely). Other influences of the MHPA decision were heuristics (especially anchoring bias), situational awareness, previous experience, colleagues on-scene, time- and task-pressure, and the desire for diagnostic accuracy and professional reputation.

Conclusions
Multiple determinants and influences affect the pre-hospital MHPA decision. Acknowledging these cognitive processes will inform efforts to improve decision-making in trauma.
FTP1.8 Thoracic spine stab injury with a retained knife: a rare case and the lessons learnt
Authors: Ingram-Walpole Shannon , Shah Shaneel , Campana Luca , Griffiths Ben , Almerie Qutayba 
Published: August 2023

Abstract
A 52-year-old female patient was admitted to the Emergency Department with an isolated thoracic spinal stabbing with a retained knife. She was haemodynamically stable a normal peripheral neurological examination. CT scan with 3D image reconstruction showed the blade had collided and lodged into the T11 vertebrae with the tip in close proximity but missing the spinal cord, aorta and inferior vena cava. A multidisciplinary team, including anaesthetists and vascular, neuro, and general surgeons, agreed upon the treatment strategy. The lodged knife was safely withdrawn in the operating theatre with the patient in prone position and under sedation and local anaesthesia. Following the procedure, neurological examination remained normal, and MRI scan revealed no spinal cord injuries.
In this case report we discuss the initial approach to managing patients with a penetrating spinal injury. We elaborate on the role of pre-operative imaging using CT scan with 3D reconstruction, where possible, to assess the extent of injuries, as well as, the importance of timely input from multidisciplinary specialties based on the extent of the injuries. In case of a retained foreign body, we discuss how to extract it and importance of having contingency planning for any potential post withdrawal complications.
FTP2.5 Clinical audit following initial experience from a dedicated botox clinic for the treatment of anal fissure
Authors: Brandie Emma , Jabbar Salman Ahmed Abdul , Nicholson Gary 
Published: August 2023

Abstract

Background and Aims
Chronic anal fissure is a common and debilitating disease. Intersphincteric injection of Botulinum Toxin A during examination under anaesthesia (EUA) is an established treatment option following failed conservative management. The aim of this study was to investigate the effectiveness of clinic-based Botox injection for treatment of chronic anal fissure as an alternative to injection under anaesthesia. Feasibility was evaluated in terms of cost, safety and sustainability.

Methods
This was a retrospective single centre study of prospectively collected data between August 2021 and August 2022. Demographic data, treatment protocols and follow-up outcomes at three months were collated. The relative costs were provided by the regional financial department.

Results
Sixty-four patients were referred to clinic in the first year. Anal fissure was confirmed in 63% of patients with 89% receiving Botox injection in the clinic setting with no major complications. Healed fissure was induced in 85% of patients reviewed at a three-month follow-up. Five patients required referral for EUA with injection of botox. An estimated cost saving of £1,308.50 per case was achieved for clinic-based Botox versus Botox administered via EUA. Clinic-based administration of Botox reduced theatre resource utilisation during the study period.

Conclusion
Clinic-based Botox administration is feasible, safe and effective in the treatment of chronic anal fissure. This treatment approach not only provides a clinically effective, cost-efficient alternative to surgery but reduces resource utilisation and waste which is environmentally beneficial.
FTP3.3 Pelvic intraoperative neuromonitoring during anterior or abdominoperineal resections: a critical appraisal of published studies by meta-analysis
Authors: Singh Anurag , Kaur Mandeep , Sains Parv , Baig Mirza , Swaminathan Christi , Sajid Muhammad 
Published: August 2023

Abstract

Objective
Anorectal, urinary and sexual dysfunction following rectal resections (RR) is a clinical problem influencing the health related quality of life significantly. The objective of this review is to evaluate the role of intraoperative neuromonitoring (pIONM) to prevent pelvic nerve damage leading to urogenital dysfunction in patients undergoing RR.

Materials and methods
All types of comparative studies reporting the role of pIONM to avoid pelvic nerve damage leading to urogenital dysfunction in patients undergoing RR were retrieved from the search of standard medical electronic databases and analysis was conducted by using the principles of meta-analysis on the statistical software RevMan version 5.

Results
The search of medical databases yielded 6 comparative studies (one randomised trial and 3 retrospective and 2 prospective studies) on 489 patients undergoing RR. In the random effects model analysis, pIONM failed to reduce the incidence of erectile dysfunction (p = 0.27), urinary dysfunction (p = 0.78), and sexual dysfunction (p = 0.18). However, the risk of anorectal dysfunction [standardised mean difference -0.57, 95%, CI (-0.81, -0.34), Z = 4.85, P=0.00001] reduced significantly by use of pIONM during open/laparoscopic or robotic RR. There was no heterogeneity (Tau2 = 0.0; Chi2 = 1.48, df = 3; (p &lt; 0.48; I2 = 0 %) among included studies.

Conclusion
pIONM may reduce the risk of anorectal dysfunction following RR but the outcomes related to urinary and sexual dysfunction seem to be unchanged. However, due to paucity of the randomised trials, these findings should be taken cautiously.
FTP3.4 Robotic bladder-sparing exenterations for advanced rectal cancers - Short term outcomes
Authors: Kazi Mufaddal , Desouza Ashwin , Sharma Vivekanand , Saklani Avanish 
Published: August 2023

Abstract

Introduction
Pelvic exenterations are the standard of care for anterior urogenital invasion from advanced rectal cancers. In select cases, bladder preservation is possible. The present study aims to report the surgical and short-term oncological outcomes for the largest series of robotic bladder-sparing exenterations for locally-advanced rectal cancers.

Methods
Single-centre, retrospective analysis of patients that underwent robotic bladder-sparing exenterations for primary advanced rectal cancers between December 2019 and November 2022. Primary outcomes were major morbidity rate (≥ grade IIIA), R0 resections, and local recurrences.

Results
Sixteen patients underwent robotic bladder-sparing exenterations. The median hospital stay was 8.5 days and six patients (38%) experienced grade IIIA or more morbidity. There was no operative mortality. Five patients had a urinary leak; four from the bladder neck and one from the posterior wall of the bladder secondary to necrosis. A pathologically involved circumferential margin was observed in one patient and one patient had a local recurrence.

Conclusions
Robotic bladder-sparing exenterations are technically feasible for select locally-advanced rectal cancers with prostatic or urethral invasion. Operative morbidity is largely related to bladder neck leaks. Short-term oncological outcomes appear favourable in terms of R0 resections and local recurrence rates.
FTP4.1 Compliance With Antimicrobial Prescribing Guideline Recommendations
Authors: Ayantunde Boluwatife , Opaluwa Abdu , Vaghela Devan , Zach Rudolf 
Published: August 2023

Abstract

Aims
Due to concerns regarding the quality of antimicrobial prescribing in the General Surgery department at a District General Hospital, a prospective quality improvement project was undertaken to guide local antimicrobial stewardship.
To assess the compliance of the General Surgery department with local antimicrobial prescribing guidelines and policies, and recommendations in the BNF and electronic medicines compendium (EMC).
The aim was to evaluate the extent of change in compliance of the General Surgery junior doctors during after intervention.

Methodology
Prospectively collected data on the patients admitted and started on antimicrobial agents over two 3-week periods under the General Surgery department. Educational interventions were initiated in the interval between the periods of data collection.

Results
91 patients were audited in Cycle 1 with a median age of 57 (9-93) years including 36 males and 55 females. Cycle 2 involved 89 patients with a median age of 60 (9-87) with 48 males and 41 females.
After intervention, there was an increase in correct prescribing regime (51.6 to 56.2%), correct dose (91.2 to 98.9%), correct frequency (59.3 to 79.8%), and correct duration; when included (78.8 to 83.3%). There was a decrease in the duration being included on the prescription (36.3 to 33.7%). The increases in correct antimicrobial dosing and correct antimicrobial frequency prescriptions were statistically significant at p ≤ 0.05.

Conclusion
Areas for improvement in the compliance to prescribing guidelines in the department could be influenced successfully through appropriate intervention. The audit highlighted particular areas to be targeted by education.