bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP-351 Extended VTE prophylaxis in patients undergoing elective surgery for colorectal cancer in a district general hospital and its Compliance with NICE guidelines
Authors: Elzaafarany Ahmed , Tawfik Ahmed , Igbekele Tosin , Day Andrew 
Published: November 2022

Abstract

Aim
A This audit aims to assess the department's current compliance with guidance, understand reasons for non-adherence and implement a plan of action to improve future compliance and subsequent patient outcomes.

Background
NICE guidance recommends extended VTE prophylaxis for up to 28 days post colonic resection for cancer

Methods
A single centre, retrospective, observational study was performed between January 2018 –January 2019. We included all the Patients who underwent elective colorectal resections for cancer.

Results
A total of 123 patients had elective elective colorectal resections for cancer. 91 (73%) were laparoscopically, 8 (6.5%) laparoscopic converted to open and 24 (19.5%) were done as open operations from the start. The summary of the operations done were as follows; 62 RHC, 25 HAR and 36 LAR. LMWH for extended VTE prophylaxis for 28 days was prescribed for 91% (112/123) of the patients among the studied period. 5.7% (7/123) were already receiving alternative anticoagulation thus the NICE guidance was achieved for 96.7% (119/123). The patients who did not receive VTE prophylaxis were 3.3%, 4/123), there was no clinical reason documented or identified for this omission. A postoperative VTE was experienced in 4.8% (6/123), 3 of them required a hospital admission (50%). There was no VTE related mortality documented

Conclusion
This audit has demonstrated 96.7% of patients who underwent surgery for colorectal cancer received extended VTE prophylaxis as per NICE guidelines. This is a significant improvement from previous audit cycle, though the aim is for 100% compliance with guidelines. We implement plan of action to achieve that
EP-369 Examining EphA2 expression in Colorectal Cancer
Authors: Lyons Nicholas , Hooper John , Kryza Thomas , Clark David , Riddell Andrew 
Published: November 2022

Abstract

Aims
EphA2 is a potential therapeutic target for the treatment of colorectal cancer (CRC), however reports of EphA2 expression in CRC are inconsistent and often lack the context of a normal tissue comparator. The aim of this investigation is to undertake a detailed assessment of EphA2 protein expression across a range of pathological and normal specimens.

Methods
177 patient specimens (100 paired primary and normal colon, 42 paired primary and metastasis and 35 unpaired samples as part of a multi-tumour TMA) underwent immunohistochemical analysis (IHC) probing for EphA2 expression alongside a normal tissue array.

Results
Weak/moderate EphA2 expression was noted in normal tissues of the proximal GI tract (stomach, small intestine) with little expression in the colon/rectum with a significant upregulation of EphA2 noted in primary lesions compared to matched normal tissue controls (p&lt;0.0001). No difference in expression between stage of disease, sex or effect of patient age, location of samples (edge vs centre), stage of disease, T-stage or N-stage. EphA2 expression was significantly higher in primary lesions associated with M1 disease primaries (p=0.03). No difference in EphA2 expression was noted between matched primary and metastatic lesions (p&gt;0.05).

Conclusion
In this study, EphA2 protein expression was significantly higher in CRC lesions compared to healthy tissue (p&lt;0.0001) with no diminution noted across a wide range of stages or lesion types. On this basis, diagnostic or therapeutic interventions targeting EphA2 are likely to be useful across a wide spectrum of disease.
EP-449 Gall Bladder Torsion - A twist in tale
Authors: Jayasankar Balaji , Aal Yasser Abdul , Porte Francois , Saeed Shoaib 
Published: November 2022

Abstract

Introduction
A 90 year old lady presented with history of sudden onset abdominal pain. The pain was continuous, severe with a tender abdomen.

Methods
Blood investigations were not conclusive. A CT of the abdomen revealed a possible torsion of the gall bladder around its axis with impending gangrene. She went on to have a successful emergency laparoscopic cholecystectomy.

Results
A work up and successful surgical intervention with an extremely unusual gall bladder presentation of torsion.
EP-505 Audit assessing compliance with General Medical Council (GMC) guidelines at Whittington Hospital Colorectal Department (NHS Trust)
Authors: Efthymiou Nikolaos , Braithwaite William , Benhimda Rami , Iskandarani Mohamad , Mukhtar Hasan 
Published: November 2022

Abstract

Introduction
The General Medical Council (GMC) released new guidelines titled ‘Decision making and consent’, which came into effect on the 9th of November 2020. It contains guidelines and standards for consenting patients for elective procedures and the documentation of said consent. Within the Colorectal Department of the Whittington Hospital, an audit was conducted to determine how closely the guidelines are being followed and whether that is reflected in the documentation.

Methodology
We evaluated 57 outpatient letters in the first cycle and 36 in the second. Our intervention was a poster of the guidelines in all clinic rooms for all consenting doctors to see prior to talking to patients.
The four criteria were:

Results

Conclusion
We see slight improvement during the second cycle. Still, the numbers are not satisfactory. A third audit cycle will be conducted once another round of interventions is implemented.
EP-524 Implementing Simulation Based Learning (SBL) to Reduce the Gap in Surgical Training, A Theoretical Evaluation Approach
Authors: Badawi Marwa , Sharmin Afroza , Shamardal Aliaa , Shalaby Ahmed 
Published: November 2022

Abstract

Background
The current surgical training is severely affected by COVID-19 pandemic with redeployment and reduced number of elective procedure across NHS hospitals, this has affected both core and higher surgical trainees, rendering the traditional apprenticeship model obsolete. It became evident that the future of Surgical training and innovation will require a combination of simulation and operative exposure to overcome the obstacle of reduced exposure in surgical education and operative training.

Discussion
In our theoretical analysis, we will discuss the efficacy, safety and impact of relying on SBL to fill the gaps in surgical training.
Clinical exposure alone will not be sufficient to train procedure based speciality trainees to their highest proficiency. SBL is one design that is supported by learning theories such as Transformational Learning and Experiential Learning Theory.
In a high fidelity simulation, such as laparoscopic simulation courses, all concepts of facilitated learning are fulfilled which strongly supports our hypothesis.
On balance, given the complexity of skills learnt, it remains difficult to measure the efficacy of transferring the learnt capabilities into practice and standardise this among learners. SBL also leaves non-technical skills un-assessed in depth.

Conclusion
The disruption of training due to COVID-19 affected our procedure based learning, this leaves us with a dilemma to catch-up with these unmet training needs. SBL could be one of the adjuncts that fill in the gaps on the short and medium term. Implementing SBL in surgical training curriculum, should be evaluated for efficacy and cost effectiveness.
EP-565 Four different causes of bowel obstruction in single patient – case report and review of management of small bowel obstruction
Authors: Shah Ugam , Lau Simon , Javed Tasveer , Kaur G 
Published: November 2022

Abstract

Introduction
The most common causes of Small bowel obstruction (SBO) in adults are adhesions, hernias, cancer, Crohn's, Diverticulitis, volvulus, etc; in children, intussusception. Overall mortality is 10%, increasing to 30% with complications. Urgent investigation, aggressive medical management and appropriate timely surgery are key to successful outcome.

Aim
We present a patient with 4 causes of bowel obstruction due to a single pathology, to highlight different causes and management of SBO with the aim of improving patient outcomes.

Case presentation
A 55 year old lady presented with SBO, and mass RIF. CT demonstrated subacute SBO. Four causes of obstruction were found at laparotomy 1. intraluminal lesion proximal jejunum 2. intussuscepting ileal lesion 3. terminal - ileal lesion perforated /adherent to pelvic side wall, and 4. RIF mass lesion from ascending colon. Right hemicolectomy + terminal ileal resection (lesions 2, 3, 4) and jejunal resection-anastomosis (lesion 1) were performed. She made a good post- operative recovery. Histology found the morphological appearances and immunoprofile were soft tissue sarcoma arising in the GIT: gastrointestinal clear cell sarcoma/ malignant gastrointestinal neuroectodermal tumour. She is under review with the specialist regional sarcoma team.

Conclusion
There are over 22 000 admissions for bowel obstruction in England/Wales each year; 6.4% result in death within 90 days. Depending on the cause, SBO may resolve with medical therapy but timely surgery is needed for total obstruction, complications such as bowel perforation, ischaemia, or failure of conservative therapy. Our case report highlights the importance of urgent investigations and appropriate management of SBO.
EP-566 A case series analysis of intestinal ischemia in COVID- 19 pandemic
Authors: B M Darshan , Somasekhar Kasa 
Published: November 2022

Abstract

Aims
To determine the presentation and outcomes of cases of intestinal Ischemia amidst COVID -19 pandemic and to review latest guidelines in its management.

Methods
A case series analysis of 11 patients admitted and managed under Department of Surgery, over a duration of 17 months from September 2020 to January 2022.

Results
Out of the total of 11 cases of intestinal ischemia, 4 were COVID-19 positive, overall mortality was 54.5% and patients with COVID-19 were found to have 100% mortality. Mortality in conservatively managed patients was also 100%, Mortality in surgically managed patients was 55.5%. Preoperative acidosis, hypoxia and hypotension were found to be important determinants of outcome of the disease.

Conclusion
Occurrence of intestinal Ischemia in COVID - 19 patients is a life threatening complication which demands surgical management with significant mortality.
Treatment of COVID - 19 and intestinal Ischemia should go simultaneously and in line with the latest evidence based guidelines of COVID 19, Patients who survive an acute event are likely to die of other complications related to the COVID-19 like ARDS, Disseminated Intravascular Coagulation etc that could have predisposed them to intestinal ischemia
EP-574 Improving gentamicin prescribing for intra-abdominal sepsis on a general surgical firm
Authors: Fardanesh Armin , Koo Hei-Fen , Van den Berghe Christen , Gathercole George , Dilke Stella , Sengupta Neel 
Published: November 2022

Abstract

Aim
Gentamicin is recommended by local guidelines for the empirical treatment of intra-abdominal sepsis. However, severe side effects that can occur through prolonged raised trough levels requires its use through a specific dosing protocol. Challenges of this means it often “falls off” the drug chart, leading to suboptimal drug-levels. The aim of this quality improvement project was to improve the process of gentamicin prescription.

Methods
A two-week retrospective analysis of all patients admitted was performed to obtain baseline data. Information was collected on gentamicin use, if levels were taken at 6–14 hours post-dose, and if subsequently correctly re-prescribed. PDSA 1 involved placing posters in the surgical office, reminding the clerking doctor of the gentamicin protocol. PDSA 2 involved a departmental teaching session to reiterate the above intervention.

Results
At baseline, only 7% (1/15) of patients prescribed gentamicin had a correct post-dose level taken and subsequently received a correct second dose. After PDSA 1, this rose to 67% (2/3). After PDSA 2, this level was similar at 60% (3/5). Furthermore, at baseline 47% (15/32) of patients deemed to have intra-abdominal sepsis received gentamicin. After PDSA 1, this proportion fell to 11% (3/28) and after PDSA 2 this was 38% (5/13).

Conclusion
Education sessions and posters were effective at increasing the proportion of patients that received a safely prescribed second dose of gentamicin, as a result of correctly taken trough levels. However, a reduction in the percentage of patients receiving gentamicin for intra-abdominal sepsis possibly suggests further education on the role of gentamicin is required.
EP-584 An evaluation of plastic surgery operation note documentation in line with RCS standards
Authors: Carhart Benjamin , Khanna Rahul , Mwaura William 
Published: November 2022

Abstract

Aim
To assess the extent to which operation note documentation had been completed accurately, in line with Royal College of Surgeons (RCS) standards, in a local plastic surgery department.

Methods
Using an RCS good surgical practice guideline, operation notes from cases in January 2021 were reviewed. A total of 112 procedures that were undertaken in both theatres and plastics dressing clinic were audited. The results were collated and analysed using Microsoft Excel. As a result of data analysis, interventions were created whereby results were presented at a local meeting and guidelines were disseminated via WhatsApp to members of the surgical team. A re-audit then occurred using all plastic surgery procedures in May 2021, totalling 112 patients again.

Results
The first cycle demonstrated that the majority of the guideline subsections were met well. This included a defined operative diagnosis (96% of notes) and operative findings (97% of notes). However, some guidelines including problems/complications (17% of notes) and DVT prophylaxis (0.01% notes) were not adhered to as appropriately. The re-audit concluded that nine subsections of the guideline improved from the first cycle. This included operative diagnosis (96% first cycle, 100% second cycle) and details of closure technique (81% first cycle, 95% second cycle). Notably problems/complications (17% first cycle, 41% second cycle) also improved.

Conclusions
Initially, the guideline was met to a reasonable standard, however, improvements were made following the intervention. This led to an improvement in the documentation of nine subsections of this guideline.
EP-589 Acute Surgical Referrals from Emergency Department - A Retrospective Audit
Authors: Nordin Mohamad Nazmi M , Sutton Lynne 
Published: November 2022

Abstract

Aim
Emergency Department (ED) is a major source of admission for patients presenting with acute surgical issues. The Royal College of Surgeons of England recommends that a patient requiring an emergency surgical assessment, will receive an appropriate assessment within 30 minutes of referral being made in the case of life- or limb- threatening emergencies, and within 60 minutes for a routine emergency referral. However, there is a huge challenge to achieve this, given the limited time, capacity and resources, in ED and inpatient services. We aim to evaluate abdominal pain referral to general surgery from ED, with an emphasis on the initial diagnosis, admission rate, time from referral to assessment and operative management.

Methods
All patients with abdominal pain who were referred to general surgeons, were retrieved from a local electronic database. Primary outcomes include the diagnosis for abdominal pain, admission rate, time from referral to surgical review and operative management.

Results
81 patients with abdominal pain were referred to general surgeons within a period of seven days. 56 patients (69.1%) had a surgical diagnosis, and 25 patients (30.9%) had a non-surgical diagnosis. 63 patients (77.8%) were admitted as inpatients and 16 patients (19.8%) were discharged. The time from referral to surgical review ranged between 5 minutes to 476 minutes (mean = 103 minutes). 16 patients (19.8%) had surgical intervention.

Conclusion
The mean time from referral to surgical assessment is 103 minutes, which is longer than the standard recommendation from RCS England. Measures should be taken to expedite surgical assessment following referral from ED.
EP-630 Pheochromocytoma Associated with SDHB Mutation: A case report
Authors: Rezkallah Emad , Elsaify Wael 
Published: November 2022

Abstract

Introduction
Pheochromocytomas and paragangliomas are rare neuroendocrine tumors arising from the chromaffin cells of the adrenal medulla or extra-adrenal tissues. 10% to 20% of tumors are detected before age 18 years. Approximately 10%–15% of pheochromocytoma and 20%–50% of paraganglioma are malignant. Up to 24% of the cases are familial where they may be associated with genetic syndromes like MEN 2, succinate dehydrogenase subunit B (SDHB) gene mutations and VHL syndrome. Germline mutations in SDHB gene increase the risk of PGLs/ PHEOs and RCC with 38%-83% risk of malignancy.
We represent a rare case of pheochromocytoma associated with SDHB mutation in a child.

Case presentation
A 17-year old patient presented with repeated vomiting and hypertension. BMI was 14.4 kg/m2, BP was 140/112 mmgh, PR was127 peats/min. The rest of the clinical examination was unremarkable. Plasma and 24-hour urinary metanephrines levels were highly elevated together with Chromogranin A level. Abdominal CT and MRI scans revealed an enlarged right adrenal gland measuring approximately 45 mm, indenting but not invading the posterior aspect of the IVC.

Management
Treatment was initiated with α-blockers; (Doxazosin then phenoxybenzamine); followed by β-blockers. The patient underwent laparoscopic right adrenalectomy. The tumor was 50×30×30 mm and weighting 58g. The tumor was positive with chromogranin, and S100. The PASS score was 2. Genetic mutation was detected at SDGB (c.72+1G&gt;A).

Conclusion
We recommend genetic testing for all suspecting cases of PHEO/PGLs to establish the appropriate follow-up plan.
Sustainability Prize 1 Green Endoscopy to reduce CO2e generated by endoscopic waste – the GECO2e interventional study
Authors: Cunha Neves João A , Roseira Joana , Queirós Patrícia , de Sousa Helena Tavares , Pellino Gianluca , Cunha Miguel 
Published: November 2022

Abstract

Aims
Endoscopy is healthcare's third-largest waste-generating procedure. This study aimed to measure a single unit's waste carbon footprint and to perform a pioneer evaluation applying the principles of green endoscopy towards a more sustainable unit.

Methods
This was a 3-stage, prospective study. Stage 1: 4-week observational audit, during which daily endoscopic waste (landfill, biohazard) was weighed. Stage 2: 1-week intervention with presentation of retrieved data and education of the team towards waste handling. Recycling bins were placed in endoscopy rooms, and landfill and biohazard bins were relocated. Stage 3: 4-week post-interventional period, during which daily endoscopic waste was weighed. An engineer-calibrated scale was used. Equivalence of 1kg of landfill waste to 1kg carbon dioxide equivalent (CO2e) and 1kg of biohazard waste to 3kgCO2e was applied. Paired samples T-tests were used for comparisons before and after the intervention. The opinion of the staff was collected.

Results
Total waste and biohazard waste were diminished by 12.2% (p=0.166) and 41.4% (p=0.010), respectively, whereas landfill waste (p=0.059) and recycling waste increased (paper: p=0.001; plastic: p=0.007). In terms of CO2e, a total decrease of 31.6% (138.8kgCO2e) was found (mean kgCO2e 109.7 vs 74.9, pre- vs post-intervention, p=0.018). Mean endoscopy load was similar (46.2 vs 44.5, p=0.275). The endoscopy unit may achieve an estimated annual reduction of 1665.6kgCO2e. The personnel agreed “the project did not disturb daily work”.

Conclusions
In this interventional study applying green endoscopy principles to a real-world scenario, biohazard waste reduction and daily recycling were achieved, without compromising endoscopy productivity.
SP1.2.9 Stylish surgical writing: the state of the art surveyed
Authors: Mellor Katie , Luton Oliver , Ling Jerome , Fabre Ismay , Powell Arfon , Lewis Wyn 
Published: November 2022

Abstract

Introduction
Glaring gaps exist between what most readers consider proficient writing and what academics typically publish. This study aimed to assess the writing styles of the 13 journals held in the highest esteem by 11 surgical specialties.

Methods
The first 1,000 words of the initial 10 articles published in January 2018 from the 11 journals affiliated with surgical specialty associations were assessed as well as the BMJ and Lancet. The primary effect measures were Flesch-Kincaid Readability Ease (FRES, range zero (difficult) to 100 (easy)) and Flesch-Kincaid Grade Level (FGL, range -3.40 to infinity), related to journal Impact Factor and article citations.

Results
FRES median was 18.2 (1.4–38.2) and FGL 16.3 (12–26.2). FRES was directly related to the use of be verbs (p=0.004), but inversely proportional to numbers of common abstract nouns, words per sentence, characters per word, authors, references, level of evidence, and Journal Impact Factor (all p&lt;0.04). Citations were inversely related to FRES (rho -0.292, p&lt;0.001; critical value 14.5 (OR 0.20 p&lt;0.001)) and directly proportional to FGL (rho 0.279, p=0.001; critical value of 15.5 (OR 5.04 p=0.05)). The journal with the highest FRES (most readable) was the British Journal of Oral & Maxillo-Facial Surgery (median 30.4; total citations 5).

Conclusion
Big differences in writing style and readability were plain with FRES varying 28- and FGL two-fold. No journals had a FGL of &lt;12 (reading age of &gt;17 yr.). Superior Journal prestige, Impact Factor, and citations were not associated with better Flesch-Kincaid reading ease.
SP2.2.1 Surgical Resection of metastases to the adrenal gland
Authors: Allan Jennifer , Anderson Hannah , Eatock Fiona 
Published: November 2022

Abstract

Aims
The adrenal gland is a common metastatic site for lung, breast, skin, renal, thyroid, and colorectal cancers. Our aim was to review resection of adrenal metastases and their primary pathology and the impact of adrenalectomy on the survival and disease free survival rate.

Methods
Retrospective review of adrenalectomy for adrenal metastases in a single regional centre between June 2010–2020.

Results
34 adrenalectomies in 33 patients were performed. Median age of patients was 70 (39–82). All adrenal lesions were diagnosed on staging or surveillance CT scan. Isolated adrenal metastases were seen in 26 patients.
The most common primary malignancy was renal cell carcinoma (RCC) (n=20), followed by non small cell lung cancer (NSCLC) (n=6), colorectal adenocarcinoma (n=2) and infiltrating ductal breast carcinoma (n=2). Other primaries include malignant melanoma, oesophageal adenocarcinoma, prostate adenocarcinoma and hepatocellular carcinoma (each n=1).
Adrenalectomy was carried out for diagnosis in 5 cases, 4 where no resection of the primary lesion was performed. Median time from resection of primary lesion was 4 years (1–16). 5 patients had synchronous adrenal metastases, 1 with synchronous resection of primary.
At the time of writing, there was a 38% mortality. 84% of deaths were due to disease progression. Median survival from adrenalectomy was 23 months (4–52 months). Of the surviving patients 76% are disease free and under oncological or clinical surveillance. 24% underwent further systemic or localised oncological therapy.

Conclusions
Survival rate following adrenalectomy for metastatic deposits is 62%. Better outcomes are observed in patients with RCC metastases.