bluuebunny/crossref_metadata_2025_split huggingface dataset:
O073 Triple neuroprotection during emergency carotid endarterectomy for acute stroke after failed TPA or beyond the 24-hour window of opportunity
Authors: Sultan S , Acharya Y , Hynes N 
Published: November 2022

Abstract

Introduction
Clinical dilemma during tissue plasminogen activator (tPA) failure in ischemic stroke management is a daunting challenge. We propose an innovative approach called triple neuro-protection (TNP), which encompasses three technical domains - targeted hypothermia, systemic induced hypertension, and barbiturates infusion.

Methods
From 2002–2019, we performed 832 carotid interventions amongst more than 12,000 patients referred to our tertiary vascular services with carotid artery disease. Amongst them, 25 patients presented between March 2015 and 2019 with acute dense stroke with either failed tPA or passed the recommended timing for acute stroke intervention. Fifteen (60%) had hemineglect with acute infarct on MRI brain and a Rankin score of 4 or 5, and 96% had 80–99% stenosis on the symptomatic side (mean ABCD3-I score 11.35). All patients underwent emergency carotid endarterectomy (CEA) with therapeutically induced hypothermia (32–34°C), targeted hypertension (systolic blood pressure 180–200 mm of Hg), and brain suppression with a barbiturate.

Results
There were no perioperative complications and mortality. There were no myocardial infarction cases, death, cranial nerve injury, wound hematoma, or procedural bleeding. Mean hospital stay was 8.4±5.5 days. All patients had resolution of neurological symptoms, except three (failed thrombolysis previously). Eighty percent had a postoperative Rankin score of 0 on discharge, and 88% of patients were discharged home with three requiring rehabilitation.

Conclusion
We observed positive neurological outcomes without serious adverse events with TNP during emergency CEA in acute brain injury patients. Based on our experience, we recommend a large scale study on TNP.

Take-home message
Triple neuroprotection showed positive neurological outcomes without serious adverse events during emergency carotid endarterectomy in acute brain injury patients.
O078 Why do patients decline to participate in clinical trials? The view of potential participants having varicose vein treatments
Authors: Sharma A , Belramman A , Bootun R , Lane T R A , Davies A H 
Published: November 2022

Abstract

Introduction
Varicose veins are prevalent throughout the UK population, affecting a third of adults. Various treatments exist and must be validated by rigorous testing. Randomised control trials (RCTs) are the accepted gold standard in the hierarchy of evidence, comparing the effectiveness of interventions. Poor recruitment is common among surgical trials and threatens their success. To ensure adequate participation, the underlying barriers to recruitment need to be identified. The objective of this study was to identify the reasons for refusal in four varicose vein RCTs. Secondary aims analysed patient characteristics to assess patient trends.

Methods
A qualitative survey was offered to eligible patients refusing recruitment, recording their reasons. Patients were identified and given an information leaflet before confirming a decision. Patient characteristics, demographics and themes were assessed using qualitative and statistical analysis. Ethical approval was not required.

Results
Overall, 115/429 of patients refused RCT participation and all (n=115) completed the survey. Patients mainly expressed refusal due to preferences for different treatments (25%) followed by employment commitments (14%). Follow-up procedures dissuade patients and anxiety was associated with patient characteristics. Females are more concerned about their autonomy (26.4%) whereas males express worry about external obligations (14.6%). Misunderstanding the severity of risks of treatments and varicose veins elevated concerns across both genders.

Conclusion
Unwillingness to participate is determined by individual circumstances, patient bias and altruism. Multiple factors influence decision making such as familial views and personal demographics. Creating a more robust recruitment process relies on encouraging the acceptance of clinical equipoise and targeting patient beliefs through enhanced communication and improving accessibility.

Take-home message
Patients undergoing recruitment into surgical trials are influenced by their ability to understand and recall information, patient preference and individual characteristics which are influenced by demographics such as anxiety and employment. Targeting these identified barriers to participation will improve accessibility into RCTs.
O083 A proof of principle study of cell targeted delivery of sirna guided by innate repair receptor epor/βcr highly expressed by injured tubular epithelial cells in porcine kidneys subjected to extended cold ischaemia times
Authors: Black J , Cox M , Chung W , Lowe M , Barber J , Dennison AR , Bagul A , Yang B 
Published: November 2022

Abstract

Introduction
Small interfering RNA (siRNA) has been used in biological models for disease modification. Whilst challenges remain with targeted cell delivery, caspase-3, an executing enzyme of apoptosis and inflammation, plays a crucial role in acute kidney injury. Using caspase-3 siRNA or erythropoietin derived peptide CHBP, we have demonstrated renoprotection against ischaemia-reperfusion injury in isolated kidney preservation, and further applied the conjugate of both.

Methods
Porcine kidneys (n = 3) subjected to 10 minutes of warm ischemia were retrieved and perfused with 500 mL hyperosmolar citrate. In comparison with the control (Kidney 1) caspase-3 siRNAHBSP (Kidney 2) or CHBP (Kidney 3) conjugate was administered into the kidney and autologous blood and stored for 22 hours in ice. Organs were then preserved by normothermic perfusion (NP) for 3 hours using clinical-grade cardiopulmonary bypass. Functional parameters were recorded, and kidney biopsies were taken at time zero (pre-perfusion) and hourly intervals following NP.

Results
Preliminary findings showed increased arterial flow rate and urine output together with neutralised perfusate pH in the kidneys (2 and 3) receiving both conjugates compared to the control.

Conclusion
Improved physiological outcomes in kidneys subjected to the novel agent treatment suggest protective effects against ischaemia. We hypothesise outcomes should be transferrable to human kidneys, which may facilitate the use of marginal kidneys following prolonged ischaemia, otherwise deemed unsuitable for transplantation. Renal histological and molecular studies of the effect of the agent are underway.

Take-home message
Despite a small sample, this pilot proof of principle study suggests that caspase-3 inhibitors may have a role in limiting the detrimental effects of ischaemia on renal tissues subjected to prolonged cold ischaemic times. It is hoped that this may be beneficial if replicated in the human kidney model at increasing the deceased donor organ pool by enabling use of marginal kidneys subjected to prolonged ischaemic times.
EP-195 The effect of medical and surgical rotations on confidence in managing acute kidney injury
Authors: Rees Chantal Olivia Blanch , George Jayan 
Published: November 2022

Abstract

Aims

Methods
FY1 doctors were surveyed throughout July – August 2021 and December 2021 across two sites. Six questions used Likert scales (1 to 5: not at all confident to very confident) to assess AKI management. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results
44 FY1 doctors (27 Surgery, 17 Medicine) completed the initial questionnaire.
19 FY1 doctors (13 Surgery, 6 Medicine) completed the questionnaire post rotation.
Confidence levels were greater for FY1 doctors in surgery than those in medicine at recalling the five most common drugs that cause AKI and understanding the significance of lactate and bicarbonate.
Confidence levels were greater for FY1 doctors in medicine than in surgery at assessing a patient's fluid status.
Confidence levels in identifying causes and management of AKI in both surgical and medical patients were similar for FY1 doctors in either group.

Conclusions
Confidence levels are similar post first rotation management of AKI between medical and surgical specialties. Confidence levels are slightly higher for surgical FY1 doctors overall. Further research is required in this area to improve FY1 doctor education.
EP-235 Improving working conditions of junior surgeons
Authors: Hammett Felix , Saha Arin , Hurley Anna , Fifer Helen , Moran Emily , Patel Bhavika 
Published: November 2022

Abstract

Aims
Significant exception reporting is reflective of difficult working conditions though well-recognised barriers exist to reporting which may reflect the culture within a unit. This study used exception reporting data to understand and improve the working conditions of juniors.

Methods
Junior surgeons were surveyed in December 2019 to evaluate additional hours worked, reasons for this work and whether exception reports were completed; where they were not, doctors were asked why.
After data analysis, rota structures and surgical teams were changed and formal education about exception reporting given at departmental induction. The main changes involved greater opportunities to take leave and enhanced staffing on evenings and weekends.
Surgical juniors were re-surveyed in September 2021.

Results
In December 2019, 49.2 additional hours were worked between 18 juniors. No exception reports were completed with the main reasons being a personal decision to stay late (for training opportunities), lack of understanding on how to report and cultural issues that made juniors unsure about how exception reports would be viewed.
In September 2021, only 30 additional hours were worked between 17 respondents. Again, no exception reports were completed with over 95% of respondents citing a personal decision to stay late. Cultural issues within the department were no longer cited and knowledge of how to exception report was greatly increased.

Conclusions
A positive and open culture, where consultants and surgical leaders engage with juniors about rotas and working conditions can lead to a reduction in additional hours and improve the understanding of exception reporting.
EP-262 Neoadjuvant imatinib for Resectable Gastrointestinal Stromal Tumors. A State-of-the-art
Authors: Peristeri Dimitra , Jaunoo Shameen 
Published: November 2022

Abstract

Aims
Surgical removal remains the cornerstone of primary GIST treatment and complete surgical resection offers prognostic value toward risk of relapse. However, primary tumors, particularly of the stomach, are of advanced size when detected, and multivisceral resection seems to be the treatment of choice. Existing results of recent clinical trials have established the feasibility of neoadjuvant imatinib therapy mainly in unresectable GISTs. Yet, proof of the survival effectiveness of neoadjuvant imatinib therapy in borderline resectable tumors has not been sufficiently demonstrated.

Methods
A review of the literature was performed to identify the current evidence for preoperative treatment of large GISTs with Imatinib regarding R0 resection and oncological outcome.

Results
Data supporting benefit of neoadjuvant imatinib are available from several case reports and small retrospective series, most of which include a mix of patients with borderline resectable and unresectable primary disease. In addition, a single-phase II United States Intergroup trial and an Asian phase II trial of neoadjuvant therapy in large stomach tumors, concluded that Neoadjuvant imatinib therapy is preferred for marginally resectable tumors. Progressive disease after neoadjuvant treatment was a rare event, and partial response was achieved in 40–80% of all patients.

Conclusion
Neoadjuvant therapy with imatinib is safe and recommended for patients with resectable, locally advanced GIST. It may also enable less invasive and organ-sparing surgery, increase the complete resection rate, and avoid the surgical rupture by decreasing the tumor size. Clinical questions still remain about the most appropriate period of pre- and post-operative imatinib administration in the neoadjuvant protocol.
EP-280 Title: The impact of agricultural injuries on a regional Major Trauma Service
Authors: Gribbon Mary Catherine , Magill Eilis , Houston Ruth , Yoong Susan 
Published: November 2022

Abstract

Aims
This study aims to review the impact of agricultural trauma on a Regional Major Trauma service. In this study we identify the patient demographic most likely to be admitted with agricultural injuries, and the most common mechanisms of injury in this patient cohort. Furthermore, we outline the proportion of patients who require surgical intervention, and examine which surgical specialties were involved in the care of these patients. Finally, this study reviews the mortality associated with agricultural injuries in our Regional Major Trauma Centre.

Methods
Using data from the electronic care record and the major trauma database we retrospectively identified patients admitted with agricultural trauma over a two year period from January 2019 to January 2022.

Results
58 patients were admitted to the Major Trauma service over the two year period. 72% required surgical intervention, while 28% were managed conservatively. Of the patients that required surgical intervention, the majority required orthopaedic surgery (68%) followed by thoracic surgery (14%), general surgery (8%) neurosurgery (6%), and interventional radiology (4%). There was a 3.3% mortality rate. Median length of stay was 12 days. The average patient age was 48 years.

Conclusions
Agricultural injuries represent a significant proportion of patients admitted to our major trauma centre. Many of these injuries are potentially avoidable, and ongoing work is required from a public health perspective to minimise the risk of injury and improve safety in this sector.
BJS Prize 4 PANC Study (Pancreatitis: A National Cohort Study)
Authors: Kosti Angeliki 
Published: November 2022

Abstract

Aims
Acute pancreatitis (AP) is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. This first UK, multicentre, prospective audit aims to assess variation in management of AP to guide resource planning and optimise treatment.

Method
All patients ≥18 years presenting with AP, as per the Atlanta criteria, from March-April 2021 were included and followed up for 30 days prospectively. Anonymised data was uploaded to a secure electronic database in line with local governance approvals.

Results
113 hospitals contributed data on 2580 patients, with 1287 (49.8%) female and a mean age of 57 years. The aetiology of AP was gallstones in 50.6% (n=1306), alcohol in 17.5% (n=452) and idiopathic in 22.4% (n=579). 34.7% (n=893) received antibiotics within 48 hours of which 4.7% (n=121) had confirmed infection. CT was performed in 54.5% (n=1406), most commonly within 24 hours of admission (41%). MRCP was performed in 39.9% (n=1029); gallstones were diagnosed in 18.3% (48/262) who had not been seen on ultrasound. EUS was performed in 1.1% (n=29). 34.1% (n=441) of patients with gallstone disease underwent cholecystectomy by 30 days.

Conclusion
Management of AP in the UK deviates from national and international guidelines. Recommendations include improving antibiotic stewardship, further investigation to be performed in idiopathic cases of AP, consideration of further biliary imaging when looking for gallstones and improving appropriate timing of CT. Further work will look at guidance for diagnostic pathways and development of protocols for ambulatory management in mild AP.
Moynihan Prize 2 Cholecystectomy in patients with cirrhosis: a population-based cohort study from England
Authors: Adiamah Alfred , Crooks Colin , Hammond John , Jepsen Peter , West Joe , Humes David 
Published: November 2022

Abstract

Introduction
There is an increased risk of cholelithiasis in patients with liver cirrhosis irrespective of the underling aetiology. Cholecystectomy is the recommended definitive treatment for symptomatic gallstones. However, in patients with cirrhosis the postoperative outcomes after cholecystectomy are not fully defined. This population-based cohort study aimed to determine postoperative outcomes after emergency and elective cholecystectomy in patients with cirrhosis.

Methods
Linked electronic healthcare data from England were used to identify all patients undergoing cholecystectomy between January 2000 and December 2017. Length of stay (LOS), 30-day re-admission, case fatality and the odds ratio (OR) of 90-day mortality were calculated for patients with and without cirrhosis, adjusting for age, sex and co-morbidity using logistic regression.

Results
Of the total 69141 eligible patients who underwent a cholecystectomy, 511 (0.74%) had cirrhosis. In patients without cirrhosis 86.55% underwent a laparoscopic procedure compared with 57.53% in patients with cirrhosis (p&lt;0.0001). LOS was longer in those with cirrhosis (3 IQR 1–8days vs 1 IQR 1–3days, p&lt;0.0001). The 30-day re-admission rate was greater in patients with cirrhosis, 36.79% compared with 14.95% in those without cirrhosis. The 90-day case fatality after elective cholecystectomy in patients with and without cirrhosis was 2.79% and 0.43%; and 12.82% and 2.39% following emergency cholecystectomy. This equated to a 3-fold (OR 3.22 (95%-CI 1.72–6.02)) and a 4-fold (OR 4.52 (95%-CI 2.46–8.33)) increased odds of death at 90-days following elective and emergency cholecystectomy after adjusting for confounders.

Conclusion
Patients with cirrhosis undergoing cholecystectomy have an increased 90-day risk of postoperative mortality, which is significantly worse after emergency procedures.
Sustainability Prize 2 Calculating the Carbon Footprint of Surgical Scrubbing
Authors: Cannings Ella , Kenington Cleo , Cox Kofi 
Published: November 2022

Abstract

Aims
This study aims to measure the estimated carbon emissions that could be saved if alcohol-based hand rubs (ABHRs), which have been shown to be as effective at antisepsis as antimicrobial soap and hot water (1), are used to scrub for all operations at a UK teaching hospital over 1 year.

Methods
The number of operations performed during October 2021 was obtained via hospital database.
Across 25 cases, the volume of water per case was estimated by multiplying the time using water by the volume calculated per second flow. This data was used to calculate an estimate of the total volume of hot water used per year and therefore the carbon, cost, and water savings that could be made.

Results

Conclusion
This study shows that 2.2 tonnes of carbon could be saved in a year if a single teaching hospital converted to ABHR. The outcome could contribute to the current Greener NHS trajectories: a Net Zero NHS by 2050.

Reference
1. WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care. Geneva: World Health Organization; 2009. 13, Surgical hand preparation: state-of-the-art.
Sustainability Prize 3 Surgeons’ awareness and opinions on sustainability in surgery: the ECOS-Surgery global survey
Authors:   ESCP ECOS-Surgery Collaborators, Cunha Miguel 
Published: November 2022

Abstract

Aims
Healthcare is one of the largest waste-generating activities contributing to climate change, with surgery the most energy-intense sector. This international survey aimed to evaluate current understanding and perspectives of colorectal surgeons on sustainability, with a specific focus on surgical practice.

Methods
The European Society of Coloproctology (ESCP) designed an online survey - ECOS-Surgery (ESCP Collecting Opinions on Sustainable Surgery). Questions were divided into three sections to capture demographic characteristics of participants, their awareness on global sustainability with its application to surgical practice, and their perspectives on future directions in sustainability.

Results
370 participants from 57 countries answered the survey (median age 39; 75% men; 73% consultant surgeons). Around 60% of them were unaware that the health sector contributed to global greenhouse gas emissions. Delivering sustainable surgery was perceived as a matter of great importance for most (92%), and 97% of participants were willing to change their practice to improve sustainability. However, 78% of them had no local or national guidance on this subject. Lack of understanding by the surgical community was recognised as the primary key barrier in improving sustainable pathways (63%). Research in sustainability was perceived to play a role in improving sustainability in surgery by the majority (97.5%). Promoting healthy lifestyle among patients (38%) and use of low-carbon alternatives in surgery (29%) were the solutions most commonly suggested.

Conclusion
Our survey shows the surgical community's interest in supporting a sustainable surgery pathway, although underlining the lack of contemporary guidance/support to achieve this goal.
NELA Prize The correlation between actual and predicted 30-day mortality for emergency laparotomies in adults, using National Emergency Laparotomy Audit (NELA) risk predicting tool – a multi-center, retrospective, observational, cohort study.
Authors: Moscalu Andrei , Saravanan Balakrishnan , Kamal Aryal , Sinclair Martin 
Published: November 2022

Abstract

Background
Emergency laparotomy (EL) is associated with a high 30-day-mortality (30-dm) risk. More than 22,000 EL are performed annually in the UK, half of patients being ≥70 years. To improve patient outcomes, reliable preoperative risk assessment is of paramount importance. 30-dm can be assessed by a multitude of tools, including the National-Emergency-Laparotomy-Audit risk prediction tool (NELA-RPT). No one tool is perfect in preoperative risk prediction, with over or underprediction requiring special consideration.

Methods
This is a multi-center, retrospective, observational, cohort study investigating the correlation between predicted 30-dm using NELA-RPT and actual 30-dm in patients aged ≥18, following EL, in two UK District General Hospitals, over a 2-year period. The correlation between actual 30-dm and the: day of the week the laparotomy took place, subspecialty of the main surgeon, grade of surgeon or primary-procedure performed were also analyzed. Sample size was calculated at 385. Statistical analysis was done using Stata Version 14.2.

Results
626 cases were analyzed. Male/female ratio was 1.17 and mean age 66.03. 50.65% cases were ≥70 years of age. Actual 30-dm for the entire cohort was 9.74% and 13.96% for the over 70's. Mean NELA-RPT 30-dm was 9.8% and 14.01% for over 70's. There was no statistically significant association between actual or NELA-RPT 30-dm and the day of the week the laparotomy took place, the subspecialty of the main operating surgeon, the grade of the main surgeon or the primary-procedure performed.

Conclusion
NELA-RPT is a tool that can reliably estimate the 30-dm risk following EL.