bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP1.2.8 Applying Kolb's Experiential Learning Theory Improves Medical Student Confidence in Reviewing Post-Operative Patients
Authors: Marlow Neale J 
Published: November 2022

Abstract

Aims
To see if a structured teaching programme designed according to Kolb's Experiential Learning Theory could be applied to improve medical student confidence in reviewing post-operative general surgery patients.

Methods
Post-final examination medical students at a UK university agreed to participate in the educational pilot in 2019 (n=18). The cohort were interviewed to evaluate any anxieties around undertaking FY1 surgical posts and responses were grouped thematically; reviewing the post-operative patient emerged as a dominant concern. Subsequently, a four-part teaching session was designed to move the learner through ‘Abstract Conceptualisation’ (Before the Bedside), ‘Active Experimentation’ (At the Bedside), ‘Concrete Experience’ (After the Bedside) and ‘Reflective Observation’ (Expert Example). Pre- and post-intervention interviews and Likert scale-based surveys were employed to evaluate impact (Kirkpatrick Level One).

Results
18/18 (100%) participants reported feeling more confident reviewing the post-operative patient after the intervention. Learner feedback included “very little of the subject covered previously so helpful to get a structured approach”, “useful to discuss the history and examination before reviewing the patient” and “observing a consultant post-op review at the end really cemented what we were learning”.

Conclusions
A graded approach to developing confidence in assessing the post-operative patient, as proposed by Kolb's Experiential Learning Theory, seems to offer a useful teaching method and is valued by the learner. Ongoing expansion of this educational pilot will further evaluate its impact.
SP2.1.4 Predictors of Type-2 Diabetes Remission Following Bariatric Surgery After a Two-Year Follow Up
Authors: Noureldin Khaled , Salman Mohamed , Badawi Marwa , Shalaby Ahmed , Tourky Mohamed , Maryosh Sally 
Published: November 2022

Abstract

Purpose
Bariatric surgery is evolving as a successful tool for managing morbid obesity and T2DM. This study aimed to identify predictors of diabetes remission after two types of bariatric procedures.

Methods
This prospective study enrolled 172 patients with morbid obesity associated with T2DM scheduled for bariatric surgery. Two laparoscopic bariatric procedures were done; single anastomosis gastric bypass (SAGB, n=83) and sleeve gastrectomy (LSG, n=68). Lipid accumulation product index (LAP) and quantitative insulin sensitivity check index (QUICKI) were used to evaluate lipid profile and insulin sensitivity. Two years after surgery condition of DM was evaluated as complete remission (CR), partial remission (PR), or improvement. The primary outcome measure was predictors of diabetes remission.

Results
Two years after surgery, 151 patients were available for evaluation, where 75 patients (49.7%) achieved CR, while PR was found in 36 (23.8%). CR was significantly associated with younger age, shorter duration of DM (p &lt; 0.001, for both), higher C-peptide and GLP-1 levels (p &lt; 0.001 and p = 0.002, respectively), and bypass surgery (p = 0.027). On multivariate analysis, shorter duration of DM, lower BMI, and higher C-peptide levels were the independent factors predicting CR.

Conclusion
Complete remission of T2DM can be achieved in nearly half of the patients two years after SG or SAGB. The duration of diabetes and preoperative BMI and C-peptide levels are the independent factors predicting complete remissions.
SP2.1.6 A Systematic Review of the Incidence and Predictors of Incisional Hernias in Robotic Prostatectomy
Authors: Aseem Rabiya , Lau Ashley , Prakash Samip , Ikechi Chijioke , Shrestha Ashish 
Published: November 2022

Abstract

Aims
To conduct a systematic review of the literature to identify the incidence and predictors of incisional hernia (IH) following robotic prostatectomy; and to provide recommendations to reduce the risk factors for IH development post-operatively.

Methods
The review was performed adhering to PRISMA guidelines, using search terms pertaining to robotic prostatectomy and incidence of IH via electronic databases (MEDLINE, EMBASE and Cochrane database). All original peer-reviewed articles in English were assessed for inclusion and quality by two independent reviewers. A quantitative analysis was conducted to evaluate methodologies, patient demographics, and the incidence of IH following robotic prostatectomy.

Results
We included 18 studies with a total of 17,965 patients. Average age of patients was 61.83 years and with an average BMI of 27.35. A transperitoneal, 6 port technique was the commonest robotic approach. Main sites of herniation included supraumbilical and lateral ports. The estimated incidence of IH was 1.49% (95% CI 1.28 to 4.25). Studies examining risk factors found age, high BMI, previous hernia repair and wound infections to be contributory to IH development. Only 6 studies reported surgical repair of IH with 3 patients requiring emergency operations. 5 studies reported reduction in IH following modifications in surgical technique.

Conclusions
Incisional hernias following robotic prostatectomy are a rare complication which can result in high patient morbidity. Our review demonstrated a variable incidence rate with increasing age and high BMI as common potential risk factors. Prevention strategies can result in reduction of IH; however, the studies were heterogenous with inconsistent data quality.
SP2.1.7 The Croydon Elective Centre - Surgical Hub supporting patient care and surgical training
Authors: Rizkallah Georges , Moumni Chouari Tarak Agrebi , Zhao Sarah , Yang Narisu , Vig Stella , Patel Nikheel , Nanda Akriti 
Published: November 2022

Abstract

Aims
NHSE/I and the RCS England have advocated that the separation of elective and surgical care is fundamental in recovering surgical services. It is suggested that the separation is physical and many Trusts are transforming pathways into elective and emergency hospitals. Croydon Hospital (CHS) have created an alternative, with ‘a Hospital within a Hospital’, separating these pathways within one estate, and considers whether this is a successful model for the future.

Methods
The day surgery unit on the ground floor was converted into an emergency centre with an ambulatory surgical hub, a hot clinic, clinical space, 4 emergency theatres and an USS room. The main theatre suite was converted into the Croydon Elective Centre (CEC) with a 12-bedded coronary catheter suite, a lift onto the second floor, 10 theatres, a 12 bedded children's day unit, Moorfields’ eye unit, a new canteen, an admissions unit as well as a 28-bedded elective ward with a new 4-bedded level 1.5 critical care unit.

Results
At the end of wave 1, 3,068 patients awaited treatment, an increase of 30.44% of baseline activity with theatre activity at 28% of normal activity. Activity resumed to 100% within 6 weeks of CEC go live. 2/9,606 patients were Covid-19 positive in the first year. During wave 2, 60% of pre-Covid-19 activity continued. Currently, 2,098 patients await treatment.

Conclusion
The implementation of a surgical hub has supported the treatment of patients as well as provided continuous training opportunities for surgical and anaesthetic trainees as well as the theatre team.
SP2.1.8 Informed consent – Are we appropriately assessing the process?
Authors: Convie Liam , Clements Joshua , McCain Scott , Campbell Jeffrey , Clarke Mike , Kirk Stephen 
Published: November 2022

Abstract

Aims
There is no standardised measure of the validity of consent. Over 300 million invasive procedures take place globally each year. This study aims to define a core outcome set (COS) for informed consent for therapy.

Methods
A prospective mixed method study was undertaken in line with a published protocol and the COS was developed in accordance with Core Outcome Measures in Effectiveness Trials (COMET) methodology. This included a systematic review of outcomes in studies of consent, semi-structured interviews and prioritisation of outcomes using a 2-round modified Delphi technique. Two consensus webinars were used to ratify outcomes for inclusion in the final COS.

Results
36 outcome domains for valid consent were identified and developed by systematic review. 41 semi-structured interviews were conducted with key consent stakeholders (with significant patient involvement) 164 participants from key stakeholder groups across 8 countries completed Delphi Round 1 and 125 completed round 2. 11 of 40 outcomes met the “consensus in” criteria, with 6 meeting “consensus in” in all stakeholder groups. These were included directly in the final COS and the other 5 that met “consensus in” in some but not all stakeholder groups were discussed in consensus webinars. 9 outcomes were defined for the final COS.

Conclusion
This is the first study to define a COS for research into informed consent for therapy. It defines what outcomes are most important to all key stakeholders in the consent process and is a step forward in standardising consent research.
SP2.2.2 Thyroid Ultrasound reporting – an audit of practice
Authors: Oladeji Emmanuel , Dunstan Matthew , Katsos Konstantinos , Tabbakh Yasmin , Burney Kashif , Jamal Karim 
Published: November 2022

Abstract

Aims
Ultrasound (US) is the first line investigation for evaluating thyroid nodules. British Thyroid Association (BTA) guidelines set out a structured characterisation of thyroid nodules to guide further investigation. We conducted a closed loop audit at a District General Hospital to assess compliance of US reporting with BTA guidelines.

Methods
208 examinations were retrospectively analysed in the initial audit cycle. The reports were assessed for U status; number, measurements, characteristics and locations of nodules; comment on lymph nodes; whether FNA was performed or recommended; FNA histology; and the number of examinations performed by each radiologist/radiographer. Departmental teaching was then provided. A re-audit of 100 thyroid ultrasounds was then conducted.

Results
In the initial audit and re-audit, respectively, the number of reporting clinicians decreased from 21 to 15, however the vast majority had reported fewer than 5 scans in each time period. Where nodules were present, the use of U classification in reports increased from 32.5% to 85.3%. Reporting of measurements, characteristics and location of nodules increased from 86.4%, 92.9% and 96.8% to 96.0%, 100.0% and 100.0% of reports, respectively. In both audits, 4.5% of U1/2 nodules were recommended for FNA. For U3–5 nodules, FNA or referral to specialty increased from 71.4% to 75.0%. Comment on lymph nodes increased from 89.4% to 95.9%.

Conclusions
Following education, improvement in compliance was seen in nearly all domains, particularly in the utilisation of U classification. Further work is needed regarding the appropriate use of FNA, and caseload variation between clinicians.
SP2.2.3 Mapping the Landscape of Surgical Registries in the United Kingdom: A Review According to the Synthesis Without Meta-Analysis (SWiM) Methodology
Authors: Moore Connor , Avery Kerry , Young Amber , Hinchliffe Robert , Griffin Xavier , Potter Shelley 
Published: November 2022

Abstract

Aims
Well-designed surgical registries are essential for high-quality patient-centred evaluation of implantable devices and surgical procedures. However, there is currently a lack of information about how existing registries are designed and funded; what data is collected and how this can be used. The aim of this work is to identify existing surgical registries in the UK and describe and summarise their key characteristics to inform recommendations for how surgical registries may be improved.

Methods
Existing surgical registries were identified using multiple different sources, including: society websites; search engine review; a targeted search of Medline and Embase databases and expert knowledge. Details of each registry were extracted using a standardised data extraction proforma developed by the study team. Characteristics of identified registries were summarised into a narrative review.

Results
47 active national surgical registries have been identified, with further identification of registries ongoing. 29 (62%) registries monitor surgical devices and all monitor surgical procedures, with 18 (38%) being mandatory. 40 (87%) registries were accessible online, and 24 (51%) linked with other datasets. 39 (83%) collected clinical outcomes with no core outcome set, and 1 collected clinical outcomes with a core outcome set. 15 (32%) collected patient-reported outcome measures. All registries operated in England with 41 (87%) active in Wales, 28 (60%) in Scotland, and 24 (51%) in Northern Ireland. Length of follow up varied from in hospital to 10 years.

Conclusions
There is considerable heterogeneity in existing surgical registries. Further work is needed to establish a consensus for surgical registry development.
SP2.2.5 Sarcopenia and lymphopenia in patients undergoing chemotherapy and surgery for oesophageal cancer. Can prehabilitive exercise be used to reverse the decline?
Authors: Knight William , Zylstra Janine , Gervais-Andre Louise , Goh Vicky , White Greg , Davies Andrew 
Published: November 2022

Abstract

Introduction
Studies have demonstrated that sarcopenia and lymphopenia are associated with poor oncological and survival outcomes in patients with oesophageal cancer. Neo-adjuvant chemotherapy (NAC) for oesophageal cancer is associated with muscle wasting and sarcopenic obesity. Lymphocytes are essential component of anti-tumour immunity. This study assesses the body composition and peripheral blood markers in patients undergoing a structured exercise program, during neo-adjuvant chemotherapy, as part of a non-randomised trial.

Methods
A prospective non-randomised trial compared a standard care pathway to a structured prehabilitation exercise programme undertaken before and during NAC and surgery for oesophageal cancer. CT determined body composition analysis and peripheral blood markers were collected at multiple timepoints.

Results
Comparison of the Intervention (n=21) and Control (n=19) showed Fat Free Mass increased during NAC in the intervention group (16.1 to 17.3 kg/m2; control 15.4 vs. 14.8 kg/m2, p=0.056) and Fat Mass Index to Fat Free Mass Index ratio (-5.51% Intervention, 10.74% control p=0.043) decreased in the treatment group. Lymphocyte subsets showed a marked increase in the intervention group after chemotherapy (CD3 10.92% vs 84.92% p=0.015, CD4 13.27% vs 107.75% p=0.0147, CD8 12% vs 69% p=0.033).

Conclusion
A structured exercise programme prior to neoadjuvant chemotherapy reverses levels of sarcopenia, reduces visceral adiposity and increases levels of lymphocytes in patients with oesophageal cancer. Further studies will be needed to assess the oncological and clinical implications.
SP2.2.6 Long-term outcome predictors in laparoscopic minor hepatectomy for hepatocellular carcinoma in the UK
Authors: Schneider Crispin , Bogatu Diana , Leahy John , Patel Priya , Heaton Nigel , Menon Krish 
Published: November 2022

Abstract

Aims
Minor hepatectomy, which is increasingly carried out laparoscopically (LLR), is a cornerstone of curative treatment for hepatocellular carcinoma (HCC). The majority of relevant publications however originate from regions with endemic viral hepatitis. Although the incidence of HCC in the UK is increasing, little is known about outcomes following LLR.

Methods
Consecutive patients undergoing minor (involving ≤2 segments) LLR or open resection (OLR) at our institute between 2014–2021 were compared. Selection from a plethora of factors potentially impacting disease free survival (DFS) was optimised with Lasso regression. To enable analysis of patients having repeat resection, multivariate frailty modelling was utilised to calculate hazard ratios (HR).

Results
There were 111 liver resections with 55 and 56 patients undergoing LLR or OLR, respectively. LLR patients had a shorter hospital stay (5±2 vs. 7±2 days; p&lt;0.001) and a lower comprehensive complication index (4.43 vs. 9.96; p=0.006). Mean DFS (33.9±3.4 vs. 36.5±3.6 months; p=0.59) were comparable between LLR and OLR, respectively (median not reached). Presence of mixed cholangiocarcinoma/HCC (HR 3.79; C.I. 1.56–9.22; p=0.0033) or satellite lesions (HR 3.32; C.I. 1.80–6.10; p=0.0001), tumour size (HR 1.15; C.I. 1.03–1.28; p=0.0107) and AFP level (HR 1.01; C.I. 1.00–1.01; p=0.016) predicted DFS.

Conclusions
In the studied population minor LLR was associated with shorter hospital stay and fewer complications while offering non-inferior long-term outcomes. Neoadjuvant and adjuvant therapy for HCC are increasingly being employed and it is hoped that the outcome predictors identified here, may aid in selecting patients who are most likely to benefit from these adjuncts.
SP3.1.1 Follow-up After Acute Diverticulitis: Can We Reduce the Burden on Endoscopy Services?
Authors: Dean Harry , Britton Emily , Farrow Emily , Abdel-Khaleq Sameerah , Bradbury Molly , Cook Tim 
Published: November 2022

Abstract

Background
Acute diverticulitis (AD) is a common cause of presentation to emergency surgical services. Follow-up with endoluminal investigation to exclude colorectal cancer (CRC) remains controversial. Guidelines are increasingly moving to a more restrictive follow up based on severity of disease and age. The purpose of this study was to assess the prevalence of CRC in AD patients and the impact of follow-up on endoscopy services.

Methods
Patients admitted with a diagnosis of AD over a 2-year period were reviewed. The proportion of patients undergoing endoscopic follow-up and the CRC detection rate were recorded. The potential impact of a more conservative approach to follow-up was evaluated.

Results
There were 484 patients with AD presenting 546 times (M:F = 198:286; median age = 63 years). 80% of admissions were aged 50 or older. There were 43 emergency interventions in 39 patients (10 percutaneous drain; 33 surgery). The remainder were managed conservatively. 28 patients (5.1%) underwent colonic resection with cancer found in one specimen (3.6%). 286 patients underwent endoluminal follow-up with cancer diagnosed in 3 cases (1.0%). There was no significant difference in the prevalence of CRC between patients requiring emergency surgery and those managed conservatively, or between patients with complicated versus uncomplicated diverticulitis.

Conclusion
CRC masquerading as acute diverticulitis is rare. The incidence of neoplasia both at endoscopic follow-up and in patients requiring emergency intervention is low. Conservative follow-up strategies appear safe, but their effectiveness in reducing the burden on endoscopy services may be limited by current age-based recommendations.
SP3.1.2 Antibiotics therapy may not be required in patients with CT proven uncomplicated acute diverticulitis: A systematic review
Authors: Imsirovic Anja , Peristeri Dimitra V , Nour Hussameldin M , Swaminathan Christie , Sajid Muhammad S 
Published: November 2022

Abstract

Aims
Acute diverticulitis (AD) is one of the major acute surgical conditions which need either hospital admission or a dedicated ambulatory care services in order to provide conventional antibiotics therapy. Regular use of antibiotics for all cases of acute diverticulitis has recently been challenged. The aim is to evaluate the necessity of antibiotics in patients presenting with CT proven uncomplicated AD.

Method
A systematic search was undertaken and relevant published randomized controlled trials (RCT) were shortlisted according to the inclusion criteria. Summated outcomes, including failure to response to intervention, recurrence rates and surgery during the acute admission, were analyzed using the principles of meta-analysis on RevMan 5 statistical software.

Result
Four RCTs on 1756 patients who presented with CT-proven uncomplicated diverticulitis were included in this review. There were 879 patients in the antibiotics group (AG) and 877 patients in the no-antibiotics group (NAG). The failure to response to intervention (use of intravenous antibiotics) was not statistically significant between the two groups, however slight statistical favour was observed in AG [OR 0.49, 95% CI (0.22–1.06), z=1.81, p=0.07]. There was no statistical difference related to recurrence rates of acute diverticulitis between the two groups. Finally, the need of surgical intervention following both interventions was also statistically similar [OR 0.63, 95% CI (0.29–1.36), z=1.18, p=0.24].

Conclusion
The use of antibiotics in patients with CT proven uncomplicated AD does not seem to improve the short-term outcomes; therefore it can be carefully omitted in selected patients. More RCTs of robust quality are required to validate these findings.
SP3.1.5 Can Acute Uncomplicated Diverticulitis be managed Ambulatory?
Authors: Kronberga Madara , Hussain Shaista , Hama Bawan , McLaughin Kate , Peter Mark , Saha Arin 
Published: November 2022

Abstract

Introduction
The most common complication of diverticulosis is diverticulitis, which can be described as complicated or uncomplicated if the inflammation is confined to the bowel wall and/or pericolonic fat. Acute uncomplicated diverticulitis (AUD) is traditionally managed by inpatient admission for bowel rest, intravenous fluids and intravenous antibiotics. However, newest World Society of Emergency Surgery (WSES), ACPGBI and NICE guidance suggest that AUD should be managed in ambulatory setting.

Aims
To establish if Calderdale and Huddersfield NHS Foundation Trust is complaint with national standards and if this can be carried out safely.

Methods
Retrospective data collection of patients diagnosed with AUD between June and August 2021. Inclusion criteria used: CT proven AUD, age &lt;80, patient able to tolerate oral intake, have full capacity and be immunocompetent.

Results
69 patients were diagnosed with acute diverticulitis between June and August 2021. 31 of these patients matched inclusion criteria, with 17 been treated as inpatient (IP) and 14 as outpatient (OP). The average length of hospital stay was of 24h for IP vs 4,5h for OP. The average deprivation index for IP was 16891 vs 15961 for OP. From the OP group, 2 patients re-presented in hospital, however, none of them needed admission.

Conclusions
Our results show that despite our low compliance with national standards (45%), patients with AUD can be safely managed in OP setting with low risk of re-admission. Additionally, by improving our compliance, Trust resources could be saved and bed pressures alleviated without compromising patient safety.