bluuebunny/crossref_metadata_2025_split huggingface dataset:
WE3.5 Audit of Operative Note Standard: A Retrospective Case Series Over Two Cycles
Authors: Qaoud Yazan , Beattie Kate , Dorovenis Andrew , Williams Orla , Aketch Safari , Dhannoon Amenah , Hill Arnold 
Published: November 2022

Abstract

Aims
Clear, legible, and comprehensive operative notes allow for safe transfer of patient information and form important documentation in medical-legal cases. Compliance with criteria identified by the RCSG for the appropriate documentation of operative notes is variable and often poor. We aimed to audit the operative notes within the breast surgical department in a Dublin hospital.

Methods
A retrospective review of randomly selected operative notes, between December 2020 and September 2021, was conducted. Compliance with RCSG criteria was recorded. A poster and an educational program were delivered to surgical registrars.

Results
A total of 49 op notes were analyzed, majority of which were of elective procedures. There was at least 90% compliance in 10/20 of the RCSG criteria. Presence of signature, name of assistant, name of anesthetist, and operative diagnosis were assessed as 82%, 80%, 71% and 61% compliant, respectively. 88% of Op notes contained the start time only, whereas 51% contained both start and finishing times. Among the criteria with poorest compliance were presence of problems/complications (4%), any extra procedures performed (4%), details of any prosthesis used (2%), elective or emergency procedure (0%) and anticipated blood loss (0%). Additional criteria were assessed including legibility (88% compliance) and use of a diagram (65% compliance).

Conclusion
Our results are consistent with previous similar published work, highlighting the potential for variability in appropriate documentation of surgical procedures. Impact of an educational intervention as well as inclusion of more emergency procedures will be further explored in second cycle of this audit.
WE3.8 Surgical Escape Rooms: A Novel Approach for teaching surgical skills
Authors: Thakkar Rudrik , Wharf Olivia , Hanson Mark , Badenoch Tom , Hunter Ian 
Published: November 2022

Abstract

Aim
Escape rooms are a novel form of a practical teaching and simulation demonstrated to be effective in medical education. We compared the effectiveness of the traditional didactic teaching compared to a novel escape room style teaching of basic surgical skills

Method
A crossover study was delivered to two groups of third year medical students. Each group received either the classroom based teaching or the escape room teaching first, were assessed, then received the remaining style. Each student was asked to complete a questionnaire before the session, then after each teaching session. Teaching covered interrupted suturing, simple wound management and administration of local anaesthesia. Assessment was undertaken with confidence scoring with Likert scales, a 10 questions quiz and 5 minute suturing assessment after each teaching session.

Results
24 third year medical students attended. 100% either agreed or strongly agreed the classroom teaching was useful, compared to 75% for the escape room. 79% either agree or strongly agree that escape room style teaching is a useful adjunct to the traditional teaching. 21% either strongly agree or agree they felt confident about suturing before the session compared to 88%. The average number of correctly answered questions were 8 post teaching sessions, compared to 5 post escape rooms. The mean number of correctly applied sutures were 3 post teaching sessions compared to 2 post escape rooms.

Conclusion
Traditional practical teaching is still the preferred method of teaching and effective form of teaching. Although escape room teaching is a useful adjunct to the traditional classroom based surgical teaching.
WE4.5 Meta-analysis of the outcomes of Trans Rectus Sheath Extra-Peritoneal Procedure (TREPP) for inguinal hernia
Authors: Anwer Amal Azhar , Hajibandeh Shahab , Hajibandeh Shahin , Evans Louis , Naguib Nader Naeem , Havard Tim , Helmy Ahmed Hazem 
Published: November 2022

Abstract

Aims
To evaluate the outcomes of Trans Rectus Sheath Extra-Peritoneal Procedure (TREPP) in patients undergoing elective inguinal hernia repair

Methods
In compliance with PRISMA statement standards, electronic databases were searched to identify all studies reporting the outcomes of TREPP in patients undergoing elective inguinal hernia repair. The outcomes of interest included recurrence, chronic pain, haematoma, and wound infection. Proportion meta-analysis model was constructed to quantify the risk of postoperative complications and direct comparison meta-analysis model was constructed to compare the outcomes of TREPP and other open techniques. Random-effects modelling was applied to calculate pooled outcome data.

Results
Seven studies enrolling 1891 patients undergoing TREPP were included. Pooled analyses showed that TREPP was associated with 3.00% (95% CI 1.00–6.00%) risk of recurrence, 3.00% (95% CI 2.00–6.00%) risk of chronic pain, 8.00% (95% CI 0.00–20.00%) risk of haematoma, and 3.00% (95% CI 0.00–6.00%) risk of wound infection. The results remained consistent through subgroup analysis of patients with primary hernias and those with recurrent hernias. Analysis of a limited number of comparative studies showed no difference between TREPP and Lichtenstein technique in terms of recurrence (OR: 1.57, P=0.26) and chronic pain (OR: 1.16, P=0.59).

Conclusions
The best available evidence suggests that TREPP may be a promising technique for elective repair of inguinal hernias as indicated by low risks of recurrence, chronic pain, haematoma, and wound infection. Moreover, there is a lack of comparative evidence on outcomes of TREPP versus other techniques highlighting a need for high quality randomised controlled trials for definite conclusions.
WE4.6 Postoperative muscle atrophy: an overlooked cause of morbidity
Authors: Hardy Edward , Hatt Jacob , Doleman Brett , Phillips Beth , Lund Jon 
Published: November 2022

Abstract

Aims
A significant proportion of patients never fully recover baseline activity levels following major abdominal surgery. Postoperative muscle atrophy may be a major contributing factor to this, but is often overlooked. This study aimed to quantify the degree of muscle loss in patients undergoing routine recovery following major abdominal surgery and in patients admitted to critical care.

Methods
Fifteen patients undergoing major open colorectal resection were recruited. Cross surface area (CSA) and muscle thickness (MT) of a quadriceps muscle, Vastus Lateralis (VL) were measured pre-operatively and on post-operative day (POD) 5 using ultrasound. Knee extension strength was also measured pre-operatively and on POD5 using a handheld dynamometer. A systematic literature review was performed to identify studies reporting muscle loss in patients admitted to an intensive treatment unit (ITU), with pooled means of changes in quadriceps muscle CSA calculated.

Results
By POD 5 VL CSA had decreased by 9.16% (± 2.0), and MT had decreased by 8.14% (± 5.93). Associated with this, knee extensor strength decreased by 19.69% (± 12.91). Systematic review identified 4 studies reporting muscle loss in ITU patients, including a total of 126 patients. Pooled mean of quadriceps CSA in patient admitted to ITU decreased by 13.9% (-12.5% -20.75%) by POD7.

Conclusions
Major abdominal surgery is associated with a significant loss of muscle mass and function. Losses are larger in patients requiring ITU admission. This may have a significant impact on patients’ full recovery to baseline function and further work is required to investigate this.
WE5.10 Death in the early post-operative period: recognising the concept of non-beneficiality in emergency laparotomy and modelling its predictors
Authors: Javanmard-Emamghissi Hannah , Doleman Brett , Hare Sarah , Lund Jon N , Tierney Gillian M , Moug Susan J 
Published: November 2022

Abstract

Background
The publication of data from the National Emergency Laparotomy Audit (NELA) has resulted in overall improvement in post-operative mortality rates. However, little is known about the characteristics of patients that die in the immediate post-operative period. These patients may represent a missed opportunity for the consideration of palliation. We describe this specific group of patients where death occurred within three days of emergency laparotomy, and investigate predictors of early mortality.

Methods
All patients enrolled in the NELA database from December 2013–2020 were included. Early post-operative death was defined as all-cause mortality within three days of emergency laparotomy. Multi-level logistic regression was carried out with potentially clinically important predictors defined a priori. Frailty was modelled separately due to missing data.

Results
Four per cent of patients (7,442/180,987) died in the early post-operative period and 85% were admitted to critical care post-operatively. Median NELA risk score was 32.4% compared to 3.8% in the rest of the cohort (p&lt;0.001). One in four patients were commenced on an end-of-life pathway following laparotomy. Significant predictors on multivariate analysis included female sex, increasing age, higher ASA, surgery for intestinal ischaemia or perforation, hypotension, reduced GCS, urgency of surgery, cardiac and respiratory signs (n=178,442). The addition of frailty (n=52,766) was also predictive (OR 1.37; 95% CI 1.22–1.55) when added to the model.

Conclusion
Early post-operative mortality is associated with quantifiable predictable factors in addition to the NELA risk score. This finding has significant implications for the multi-disciplinary team having shared decision-making discussions with extremely high-risk patients.
WE5.12 Stress During Laparoscopic Appendicectomy: A Study into the Measurement of Surgeon's Heart Rate During The Critical Steps of A Laparoscopic Appendicectomy
Authors: Kersey James , Clements Caterina , Bezzaa Sabrina , Jamal Karim , Nehra Dhiren , Lewis Trystan 
Published: November 2022

Abstract

Aims
Heart rate variability (HRV) is a validated marker of physiological stress, a lower HRV indicating increased stress. We aim to evaluate the HRV of an on call surgical registrar during a laparoscopic appendicectomy to determine which step of an operation is most stressful and any attributing factors to trainee stress.

Methods
An observational study was performed using a commercially available chest strap to measure HRV. HRV was recorded on different surgical registrars performing laparoscopic appendicectomy at a DGH. HRV was analysed during four critical steps: insertion of ports, dissection of mesoappendix, endoloop placement and ligation of appendix. Impact of registrar grade and consultant presence were also evaluated.

Results
15 recordings from seven different registrar's (ST3 – ST8) were obtained. Average heart rate was 74–130bpm. HRV was observed to be less during port insertion (9.22) and mesoappendix dissection (8.42) compared to the rest of the operation (9.86) indicating a higher level of stress. Ligation of the appendix showed an increased HRV indicating less stress (9.34). A significant difference was observed between ST3/4 and ST5+ grade for mesoappendix dissection (7.39 and 9.46 respectively), the step associated with most stress (p&lt;0.05 using paired T-test)

Conclusions
HRV is highest during mesoappendix dissection compared to that of the whole operation. HRV increases after this step showing that trainees experience increased stress up to and including this step of the operation. The ST3/4 group showed a significantly lower HRV during this step compared to the ST5+ group. Consultant presence did not significantly affect HRV.
WE6.4 Antimicrobial Stewardship in General Surgery
Authors: Leiberman Christopher , Kizis Georgis 
Published: November 2022

Abstract

Aims
National guidance states that prolonged treatment of gentamicin must be discussed with an infection specialist or microbiology if it is to continue beyond 3 to 4 days. This project aimed to audit gentamicin prescribing in a General Surgical ward, against national guidelines and improve prescribing practice.

Methods
Data was collected prospectively over the course of seven days. General surgical admissions were analysed for any gentamicin therapy received, how many days of treatment were received, and if discussion with a specialist occurred if they received prolonged treatment.
A novel sticker was introduced in patient notes to notify clinicians to review gentamicin therapy where appropriate. Data was re-audited 6 weeks later after interventions were introduced.

Results
Initially, 12 patients were identified as receiving gentamicin. Of these, 5 patients received prolonged treatment, 0 of whom had any formal discussion with a specialist documented.
After interventions were introduced, 12 patients were again identified as receiving gentamicin. Of these, 2 received prolonged treatment, 100% of whom were discussed with a specialist and the decision was made for prolonged treatment in the absence of alternatives.

Conclusions
This small audit identified an area of improvement with regards to the prolonged treatment of gentamicin. A simple intervention proved to be effective and managed to improve prescribing practice by 100%.
WE6.7 Abdominal X-rays in Emergency Department: Assessing compliance with RCR iRefer guidelines in a Tertiary Hospital's Emergency Department
Authors: Nolan Oscar , Anderson Robert , Gall Lewis , Khan Khurram 
Published: November 2022

Abstract

Aims
Attendance of adult patients to the Emergency Department (ED) with acute abdominal symptoms is common. Abdominal X-ray (AXR) is commonly the first line of imaging preformed. Our aim was to audit the indication(s) of AXR against Royal College of Radiologists (RCR) iRefer guidelines.

Methods
A retrospective cohort study of consecutive adult patients who had AXR in the ED of a busy tertiary hospital. The study period was from 1st October 2021 to 30th November 2021. Paediatric patients (&lt; 16 years) and AXR performed out with the ED were excluded from the study. Patient's demographics and the indication for AXR were analysed. The indications were audited against the RCR iRefer AXR guidelines (8th edition, 2017).

Results
A total of 295 patients were included in the study. 171 (58.0%) were female and median age was 64 years (16–96). 170 (57.6%) were performed out of hours. Median time delay from request to AXR preformed was 31 minutes.
The indications for AXR were: perforation/obstruction 78.3%; renal colic/foreign body 6.8%; constipation 4.7%; acute exacerbation of IBD 1.6% and palpable mass 1.0%. Overall, 92.9% of AXR requests were compliant with iRefer guidelines.

Conclusions
The compliance with RCR iRefer guideline is high in ED. However, there is room for improvement and ongoing education for junior doctors and dissemination of the latest RCR iRefer guideline will ensure that high standards are achieved and maintained.
WE7.5 Hand trauma Tetanus Immunisation: a tertiary trauma centre experience
Authors: Labib Amir , Nguyen Nga , Banks Jamie , Moledina Jamil 
Published: November 2022

Abstract

Aims
To evaluate adherence of hand trauma service at a tertiary trauma centre to Public Health of England guidance on tetanus immunisation.

Methods
Prospective data collection of all adult hand trauma injuries between March and June 2021. The first cycle was conducted within the first two weeks of March followed by the introduction of a tetanus immunisation booster flowchart based on the Public Health England guidance. The second cycle was conducted within the first two weeks of June.

Results
Of 435 cases reviewed, 380 patients met the inclusion criteria. 69% of cases were male with a mean age of 40 years. Laceration via a sharp object was the most common mechanism of injury followed by machine-related injury representing 44% and 21% respectively. Soft tissue lacerations were by far the most common injury representing 46% of cases. This is the percentage of unnecessary prescription of tetanus booster doses in patients presented with clean wounds falls from 80% in the first cycle to 17% in the second cycle. This reflected in saving the trust £693 within just the period of the first two weeks of June.

Conclusions
The use of an easy-to-follow chart for tetanus immunisation when dealing with hand trauma patients led to a significant reduction of unnecessary prescriptions and costs.
WE7.6 Failure of intensive monitoring in high grade blunt splenic injury: an important consideration beyond NOM failure
Authors: Lee Sheah Lin , Long Joe , Rizkallah George , Modi Sachin , Elberm Hassan 
Published: November 2022

Abstract

Aims
Non-operative management (NOM), including intensive monitoring (IM) and angioembolisation (AE), is the standard of care for haemodynamically stable patients with blunt splenic injury to preserve spleen and it's function. Internal review of local Level 1 Trauma Center revealed a NOM failure rate of 4.4%, but an IM failure rate of 16.2% in high grade blunt splenic injury (HGBSI). Age, Injury Severity Score (ISS) and moderate to severe injuries are predictors for NOM failure. However, predictors of IM failure, which can be successfully treated with AE, is not well understood, motivating the current study.

Methods
Patients with BSI are identified from Trauma Audit and Research Network (TARN) databse from 2015–2020. Clinical, biochemical and radiological data were collated from TARN database and electronic medical records. HGBSI is defined as AAST grade III to V.

Results
Sixty-eight patients with HGBSI were identified. Seventy-eight percent (n=53) were initially managed with IM, with 21% (n=11) requiring subsequent interventions. Majority who failed IM were involved in road traffic accident compared to other causes (p-value=0.035). In addition, a higher proportion had systole blood pressure&lt;90mmHg (p-value=0.033) and pH&lt;7.2 (p-value=0.038) at presentation. AAST grade, ISS or age did not influence requirement for further intervention. Nine of the eleven patients were treated successfully with AE.

Conclusion
Understanding predictors of IM failure will enable better selection of patients for AE at initial presentation, leading to potential reduction in duration of IM, length of stay and blood transfusion. Preliminary work using machine learning algorithm to predict IM failure with larger dataset is on-going.
WE8.8 Analgesia prescribing in a Surgical Assessment Unit
Authors: Stienstra Roxane , Slevin Zack , Cannings Elizabeth 
Published: November 2022

Abstract

Aim
Efficient analgesia administration is paramount to delivering good patient care and is an important factor in the safe assessment of patients. The aim of this audit was to assess analgesia prescribing and administration in the local Surgical Assessment Unit (SAU) and compare it with the standard of care set out by the Royal College of Emergency Medicine guidelines.

Methods
A retrospective audit was performed. Paper and electronic notes, including electronic prescribing data via HEPMA and pain scores were analysed for all patients referred with abdominal pain to SAU by GP's between the 21st of October and the 30th of October 2021. Data was compared with the RCEM best practice guidelines.

Results
A total of 33 patients were included. 39% of patients had a documented first pain score within 15 minutes of arrival, with a median time of 20 minutes. Of all patients presenting with moderate to severe pain, none received analgesia within 20 minutes. Earliest analgesia administration for this group was 1 hour 42 minutes. Overall median time to first analgesia prescription was 2 hours and 4 minutes and median time to administration was 4 hours and 8 minutes.

Conclusion
Since the COVID pandemic, NHS hospital staff- and bed shortages have put increased pressure on the delivery of safe patient care. This audit has found significant delays in both prescribing and administering analgesia for patients presenting to SAU. An electronic prescribing protocol was developed to increase efficiency in prescribing and another audit will be conducted to assess impact.
WE8.10 Management and outcomes of gallstone disease during the SARS-COV-2 Coronavirus pandemic
Authors: Patel Maitreyi , Chaloupkova Dita , Aguayo Xavier , Sivapragasm Princely , Thomas Joel Joy , Sarwary Haschmatullah 
Published: November 2022

Abstract

Aims
The aim of this study was to compare the patient demographics and management of acute manifestations of gallstone disease during the COVID-19 pandemic with an equivalent period in 2019 and assess the differences in recurrence patterns over the period of first and second wave of the pandemic.

Methods
A retrospective cohort study of all adult patients aged &gt;16 years presenting to the emergency department at a large District General Hospital with symptoms related to gallstones was conducted. Data was obtained from electronic patient records. Primary outcome assessed were incidence and management of gallstone disease while secondary outcome studied included length of Stay, re-admission rate and recurrence. Data was tabulated and analyzed using Excel (Microsoft, 2016 version). Chi square, t-test and One way ANOVA tests were used.

Results
51 patients presented during the period of first wave and 105 patients during second wave as compared to 71 patients in the study period during 2019. The median age of patients during the first wave of COVID was significantly higher than pre COVID and that in second wave. During both the waves of the pandemic, there was a no significant difference in patients presenting with cholecystitis compared with 2019 (47 and 94 versus 60; p value 0.39). There was no significant increase in use of cholecystostomy. There was no significant difference in recurrence and readmissions. Majority of the patients still await surgery.

Conclusion
During the pandemic, older patients with higher comorbidity presented with acute gallstone disease. Conservative management was effective in the management of these patients.
TH1.2 Referral of patients with breast pain to breast clinic: a retrospective analysis
Authors: Dyer Marcus , Gate Tim , Ward Thomas 
Published: November 2022

Abstract

Aims
Previous literature provides evidence that in patients with breast pain and a normal breast examination, the incidence of ipsilateral breast cancer is approximately equivalent to the screening incidence. Isolated breast pain is not an indication for a suspected cancer pathway referral as per NICE guidance. We assessed all breast clinic referrals in one month for use of the appropriate referral pathway for patients with isolated breast pain, and correct primary care management of breast pain.

Methods
GP referral letters and breast clinic letters were analysed retrospectively using an electronic clinical data system for all 173 patients referred to breast clinic in September 2021, of which, 47 patients satisfied eligibility criteria. Letters were assessed for urgency of referral and documentation of GP interventions for breast pain (bra fitting advice, simple oral analgesics and topical NSAIDs).

Results
62% of patients presenting with isolated breast pain were referred under a USC or urgent referral pathway to breast clinic. Only one patient with breast pain as a symptom, had documented evidence of GP interventions for breast pain.

Conclusions
The majority of patients presenting with isolated breast pain were inappropriately referred under urgent pathways, potentially impeding capacity in breast clinic for patients that satisfied USC criteria. There was little evidence of GP interventions for breast pain which could negate need for a clinic appointment or alleviate symptoms in the interim. Further GP education could reduce inappropriate urgent referrals of patients with isolated breast pain and improve breast pain management.