bluuebunny/crossref_metadata_2025_split huggingface dataset:
SPOD1 Effect of BMI on Safety of Bariatric Surgery during the COVID-19 pandemic, Procedure Choice, and Safety Protocols – an analysis from the GENEVA Study
Authors: Singhal Rishi , Omar Islam , Madhok Brijesh , Ludwig Christian , Tahrani Abd A , Mahawar Kamal 
Published: November 2022

Abstract

Background
It has been suggested that patients with a Body Mass Index (BMI) of &gt;60 kg/m2 should be offered expedited Bariatric Surgery (BS) during the Coronavirus Disease-2019 (COVID-19) pandemic. The main objective of this study was to assess the safety of this approach.

Methods
We conducted a global study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into three groups according to their preoperative BMI - Group I (BMI&lt;50 kg/m2), Group II (BMI 50–60 kg/m2), and Group III (BMI&gt;60 kg/m2). The effect of preoperative BMI on 30-day morbidity and mortality, procedure choice, COVID-19 specific safety protocols, and comorbidities was assessed.

Results
This study included 7084 patients (5197;73.4% females). The mean preoperative weight and BMI were 119.49±24.4 Kgs and 43.03±6.9 Kg/m2, respectively. Group I included 6024 (85%) patients, whereas Groups II and III included 905 (13%) and 155 (2%) patients, respectively.
The 30-day mortality rate was higher in Group III (p=0.001). The complication rate and COVID-19 infection were not different. Comorbidities were significantly more likely in Group III (p=&lt;0.001). A significantly higher proportion of patients in group III received Sleeve Gastrectomy or One Anastomosis Gastric Bypass compared to other groups. Patients with a BMI of &gt;70 kg/m2 had a 30-day mortality of 7.7% (2/26). None of these patients underwent a Roux-en-Y Gastric Bypass.

Conclusion
The 30-day mortality rate was significantly higher in patients with BMI &gt;60 kg/m2. There was, however, no significant difference in complications rates in different BMI groups, probably due to differences in procedure selection.
SPOD2 Microvesicles as biomarkers for the screening of colorectal neoplasm
Authors: Eddama Mohammad , Gurung Rijan , Fragkos Konstantinos , Cohen Richard , Loizidou Marilena , Clapp Lucie 
Published: November 2022

Abstract

Background
Colorectal cancer (CRC) is the second cause of cancer death worldwide. Screening for CRC by Faecal Immunochemical Test (FIT) aims to detect early cases before symptoms occur. Yet, the FIT has poor predictive value and low compliance rate. To address this, the role of circulating microvesicles as potential screening tool is a novel approach that warrants prioritised research.

Methods
In a two-gate diagnostic accuracy study, 35 patients with benign colorectal polyps (BCRP) (n=16) and colorectal cancer (CRC) (n=19) were compared to 17 age-matched healthy controls. Total annexin-V positive microvesicles and sub-populations positive for selected biomarkers relevant to bowel neoplasm were evaluated in patients’ plasma using flow cytometry.

Results
Total plasma microvesicles, and sub-populations positive for CD31, CD42a, CD31+/CD42a-, EPHB2, ICAM and LGR5 (component factor-1) were able to identify patients with BCRP and CRC with a receiver operator curve (AUC) accuracy of a 100% (95% CI: 100% to 100%) and 95% (95% CI: 88% to 100%) respectively. To identify patients with BCRP, a cut-off point value of component factor-1 ≥761 microvesicles/µL demonstrated a 100% sensitivity, specificity and negative predictive value (NPV) and a 93% positive predictive value (PPV). To identify patients with CRC, a cut-off value of component factor-1 ≥439 microvesicles/µL demonstrated a 100% sensitivity, specificity and NPV and a 65% PPV. CEA+ microvesicles sub-population were significantly (p&lt;0.02) higher in CRC in comparison to BCRP.

Conclusion
Microvesicles as biomarkers for the early detection of CRC is a simple and effective tool that yields a potential breakthrough in clinical management.
SPOD3 F.I.T for Discharge? Role of Faecal Immunochemical Testing (FIT) in ruling out Primary Bowel Cancer: A review of current outcomes.
Authors: Krishna Arun , Ferrara Giovanni , Edwards Joshua , Chaudhary Baber , Lala Anil 
Published: November 2022

Abstract

Aim
NICE recommends that a FIT &lt;10µgHb/g may not warrant an Urgent Suspected Cancer (USC) Referral. Our primary aim was to assess outcomes at a local level for FIT &lt;10µgHb/g. Secondary aims included whether a high FIT(&gt;100µgHb/g) determines increased cancer risk and whether a moderate FIT(10–100µgHb/g) warrants USC inv: estigations.

Methods
A retrospective review of all symptomatic patients who received a FIT in a District General Hospital in North Wales between June-December 2020. These were divided into 3 groups: negative FIT(&lt;10µgHb/g), moderate FIT(10–100µgHb/g) and high FIT(&gt;100µgHb/g). The results of any subsequent investigations such as Endoscopies, CT Colons or CTs were recorded along with the histology results from polyps/biopsies/specimens from Endoscopy/Surgery. Simple sensitivity and negative predictive value(NPV) analyses were performed.

Results
A total of 722 patients returned a FIT result. 544 were negative, 106 moderate and 72 high. 2/544(0.37%) in the negative FIT group had cancer, however histology of both showed Squamous Cell Carcinoma from Anal Cancer. 3/106(2.83%) in the moderate FIT and 15/72(20.83%) in the high FIT group had cancer. Polyp histology demonstrated high-grade dysplasia in 2(2.78%) in the high, 2(1.89%) in the moderate and 0 in the negative group. FIT sensitivity of 90% and NPV of 99.62% was demonstrated.

Conclusions
A negative FIT can adequately exclude primary bowel cancer in symptomatic patients. Patients with high FIT could proceed “straight-to-test”, while moderate FIT may need further outpatient assessment. Inappropriate investigations and delayed diagnosis have drastic clinical and financial implications.
SP1.1.1 Barriers for cadaveric kidney organ utilisation: Results of a National Transplant Access to Theatre (NTACT) pilot study
Authors: Mujeeb Mariyam , Borbas Balint , Tanase Andrei , Aroori Somaiah 
Published: November 2022

Abstract

Aims
There are various barriers to cadaveric organ utilisation across the UK. However, there is a paucity of data on these barriers after the arrival of organ/s at the implanting centre. We set up the national “NTACT” study to identify barriers after arrival of organs at implanting centre.

Methods
Prospective pilot study collecting data on adult kidney/pancreas cadaveric organs across five UK centres in July 2021. Data collected includes time intervals between significant checkpoints prior to transplantation and perceived reasons for delays after arrival at implanting centre. Data was recorded on RedCap and analysed for delays using descriptive statistics.

Results
Between five transplant centres, data was entered on 27 transplants. Five patients were excluded from the study (live transplant-2, incomplete data-3). There were six donation after circulatory death (DCD) and 16 donation after brainstem death (DBD) organs. Fifty percent (n=3/6) of DCD and 12.5% (n=2/16) of DBD allografts surpassed the national recommendations for cold ischaemia time (CIT). Majority of cross-matches were virtual (15-virtual and seven-full). Delays included cross-match results (median=03:37:30), time between arrival of the kidney and patient into theatre (median=03:13:00), time between anaesthetic induction and knife to skin (median=00:52:00). The median warm ischaemia time was 00:41:30 (IQR-00:33:00–00:49:30). Qualitative answers highlight themes including “surgical team occupied in another case”, “emergency theatre occupied”, and “porter availability for transporting patients”.

Conclusion
Our pilot study identified various barriers to implantation, and a significant proportion of kidneys are implanted beyond nationally accepted CIT. Further work is required to get a national picture over an extended period.
SP1.1.3 Feasibility, safety and cost effectiveness of outpatient removal of ureteric stent following kidney transplantation
Authors: Tasleem Sadia , Shetty Kartik , Gulnaz Nadia , Chidambaram Nathan 
Published: November 2022

Abstract

Aims
The aim of this study was to evaluate the feasibility, safety, and costs associated with a dedicated flexible cystoscope for the removal of ureteric stents from transplant recipients in the outpatient setting.

Methods
In our centre, we routinely performed post renal transplant ureteric stent removal in theatres. Recently we have switched this practice to outpatient settings. We performed retrospective analysis of prospectively collected data from two settings between Aug 2018-Dec 2021 to compare the impact on the timing of post renal transplant ureteric stent removal, associated complications, cost effectiveness and patient satisfaction.

Results
In total 99 ureteric stents were removed from 100 transplant recipients in theatre and 100 stents in outpatient department. 2 patients in clinic cohort did not tolerate procedure under LA. 5 patients in theatre cohort and 6 patients in clinic cohort underwent PD catheter removal in theatres along with stent removal.
Earlier stent removal was achieved in clinic compared with theatre with (36 versus 55 days after transplant; p=0.001)
There was no statistically significant difference in infection rates following stent removal in either groups.
Outpatient stent removal proved to be very cost effective to the trust with savings of over £250 per procedure in comparison to the theatre setting.
Patient satisfaction was measured by numerical rating score for pain and discomfort which showed that the patients tolerated the outpatient procedure under local anaesthesia very well,(mean score 4/10).

Conclusions
A dedicated outpatient ureteric stent removal service for kidney transplant recipients seems to be feasible, cost effective, and safe.
SP1.1.4 Caveat Chirurgicus - Opioid use following surgery
Authors: Vijayagopal Kesav Aditya , Majeed Talal , Wilson Jeremy , Magee Conor 
Published: November 2022

Abstract

Introduction
Over the last 20-years there has been increasing opioid related deaths, in the context of a worldwide epidemic of misuse including addiction and overdose. Startlingly, opioid commencement is usually iatrogenic. Most published data is from the USA with little evidence from UK surgical practice.

Methods
Retrospective analysis of surgical unit opioid prescriptions. Data included opioids prescribed on discharge, 1, 3- and 6-months post-discharge usage and milligrams-of-morphine equivalence(mgEq) used to compare regimes.

Results
One hundred cases reviewed. 35% of patients were opioid naïve on admission and of these 20%, 5.71% and 8.57% remained on opioids at 1, 3- and 6-months post discharge respectively.
Females more likely to remain on long-term opioids at 6 months at lower doses (42% v 30%).
Only 6% of discharge summaries recommended GP follow-up and assessment of opioid requirements. Furthermore, none were prescribed a tapering dosage regime on-discharge.
Patients receiving Acute Pain Team reviews, more likely to remain on long-term opioids, at lower doses (30.67mgEq, 29.25mgEq and 32.63mgEq at 1-, 3- and 6-months post-discharge) compared to those without (69.16mgEq, 74.25mgEq and 65.13mgEq).
Only 11% of patients with pre-existing opioid prescriptions were reviewed by the acute pain team.
Worryingly, no documented assessment of opioid misuse risk in patients.

Conclusion
Standardised assessments i.e., opioid Risk Assessment Tools and mgEq need to be documented and monitored in primary and tertiary care. Acute pain team services should be offered to more patients. Our study hopes to raise awareness of the need for effective opioid stewardship in surgical patients.
SP1.2.1 The Theatre Training Checklist (TTC): A toolkit to improve training within the operating theatre
Authors: Aldoori Joanna , Peter Mark , O'Regan David , Robson Andrew 
Published: November 2022

Abstract

Aims
The operating theatre is a crucial learning environment for different trainees (nurses, anaesthetists, surgeons etc.) Equity of access is essential to achieve their individual training requirements. Traditionally, opportunities within a theatre list are informally discussed between trainers and trainees at some point during the list. Furthermore, there is currently limited discussion between different members of the full team. The Theatre Training Checklist (TTC) is a simple framework that aims to facilitate coordination of training for all team members.

Methods
The TTC was devised as an extension of the WHO checklist. It consists of four stages: Trainer/Trainee discussion before theatre brief regarding training goals for the list, formal identification of all trainees within the theatre brief, explanation to the team of what each trainee will undertake, followed by use of theatre debrief to reprise whether training goals were met. The TTC was piloted and outcomes measured using an anonymised structured questionnaire from across the entire team.

Results
27 staff participated, including 7 trainees. Individuals’ understanding of trainees’ objectives improved as a result of the TTC (25/27, 92.6%) along with perceived improved theatre list efficiency (18/27, 66.6%). All trainees agreed that the checklist improved achievement of their training objectives. Qualitative feedback included: “This is a great way to identify what students and trainees want to achieve in theatre and how we can work together to overcome any difficulties”

Conclusion
Initial data suggests the checklist qualitatively improves training. The TTC Toolkit is available for use and consists of the checklist tool and an instructional video.
SP1.2.2 Core Surgical Training Bootcamp- a five year review
Authors: Brewster Oliver , Merker Louise , Bamford Richard 
Published: November 2022

Abstract

Aims
Surgical bootcamps may improve abilities across cognitive, affective and psychomotor domains. This deanery bootcamp is an intensive program involving induction, focussed teaching of core content, technical and non-technical skills. We aim to describe the successes and areas for development for this course through five years of feedback.

Method
A free three-day programme is delivered with lectures, workshops, skills teaching and simulation. Trainees are loaned equipment for self-taught surgical skills practice and laparoscopic simulation. Trainees must meet simulator proficiency targets which may improve early laparoscopic skills. Five years of feedback was analysed and previous attendees were contacted for retrospective focussed feedback.

Results
Across five years, 96–100% of trainees reported that they enjoyed the experience and would recommend attendance to others. 88–100% felt more confident to assess a surgical patient and 100% of responding attendees felt more prepared to begin core training. In the retrospective survey, 75% felt that Bootcamp helped them to get the best out of training and 70% felt that Bootcamp had improved their chances of passing annual progression meetings. There is evidence that attendance at induction core surgical bootcamps correlates with appointment to a national training number. In our study 50% of attendees regarded Bootcamp as helpful towards gaining their specialty training post.

Conclusion
This annual deanery bootcamp has benefited from five years of feedback and improvement. The program has evolved to reflect changes in the surgical curriculum and to tackle new challenges in education. We believe that each deanery should offer this and our format is applicable nationally and internationally.
SP1.2.3 The SIMple Things: Using Simulation Models to Improve Junior and Undergraduate Surgical Teaching in a DGH
Authors: Bruce Nikki 
Published: November 2022

Abstract

Aims
Many clinical activities remain cancelled or uncertain in the COVID world. We established a Surgical Skills Club in our DGH, where students and juniors are rotated far from their home institution. We also aimed to improve our undergraduate teaching by incorporating new surgical Sim sessions.

Methods
We established a weekly Surgical Skills Club by trainees, and promoted this through MedEd to all juniors, students and ANPs. We used a combination of higher-fidelity models owned by the hospital and low fidelity models designed by ourselves such as lap-appendix and hernia. We utilised social media to share ideas. We recorded attendance and sought written feedback. We also set up dedicated simulation sessions as part of ongoing undergraduate teaching.

Results
Anonymous feedback was documented weekly via app/online. For skills club, 100% of attendees documented experience as “great” or “good” (options great, good, average, fair, poor). Attendance varied from 2–15 each week. The best attendance was a formalised session with consultant input. For undergraduate Sim, 100% of attendees rated experience as “great” or “good”. All attendees agreed Sim teaching improved their experience of surgery. 20% stated it made them consider a career in surgery.

Conclusions
Surgical simulation is an excellent tool for improving experience of general surgery especially in a COVID environment, and can widen access to surgical training by allowing juniors to explore their skills in a controlled, informal environment. Lap Skills gave students real-world confidence. A combination of low fidelity models provided the best experience showing that the barrier of cost can be broken.
SP1.2.4 A pilot study: Developing bespoke high volume low complexity (HVLC) theatre lists with a focus on training, in order to address the impact of COVID-19 on training and elective waiting lists
Authors: Moumni Chouari Tarak Agrebi , Zhao Sarah , Rizkallah Georges , Yang Narisu , Vig Stella , Patel Nikheel , Nanda Akriti 
Published: November 2022

Abstract

Introduction
We are faced with long waiting lists coupled with a loss of training opportunities for surgical trainees as a result of COVID-19. It is imperative to ensure training opportunities are optimised and trainees are encouraged to contribute to the service recovery efforts we are faced with.

Methods
A pilot ‘the hernia fest’ was undertaken with the aim of training core trainees, supporting senior trainees as independent practitioners coupled with supporting the delivery of high volume, low complexity (HVLC) care. Parallel bespoke theatre lists with the grouping of specific cases (hernias), have been run with a consultant surgeon overseeing 2–3 lists. Each list includes a selected senior trainee who is suitable to train colleagues. Cases were screened prior to booking. All theatre staff were briefed on the purpose of the lists. All patients, trainees and theatre staff completed a questionnaire.

Results
50 hernia training cases were carried out over 15 sessions. 100% of patients were confident with their treatment and would recommend the service. 100% of trainees felt they had progressed in their operative competence and skill acquisition. 100% of trainees were satisfied. Senior trainees enjoyed the responsibility of running an independent list. 100% of theatre staff felt they would participate in future lists.

Conclusion
This model cultivates a learning environment whilst addressing waiting lists. The grouping of operations together allows for repetitive practice and may encourage rapid skill acquisition. We discuss lessons learnt and a proposed framework & checklist which can be applied to the future planning of such lists.
SP1.2.5 A Prospective Evaluation of Out of Hours Operations: Informing ENT Training Bootcamps
Authors: Dunne Henry , McGilligan Tony 
Published: November 2022

Abstract

Introduction
All trainees are invited to attend national trainee bootcamps upon commencing ENT speciality training. This induction course uses simulations to teach technical and non-technical skills and includes teaching on various emergency procedures. We aimed to prospectively record which procedures are being performed out of hours by ENT trainees to inform training programmes.

Methods
We recorded all operations out of hours performed by ENT speciality trainees in Kent Surrey and Sussex over 6 months. In January - February 2020 and August - November 2021 trainees completed data sheets detailing operations they were involved in that took place between 18:00 and 08:00 on weekdays or on weekends. Responses were analysed using Excel.

Results
Trainee response rate was 92%. In total 89 operations were performed out of hours. The speciality trainee was the most senior surgeon present in 58% of these cases (n=52). 27 different operations were performed. 5 procedures made up 53% of all operations performed: Oesophagoscopy and removal of foreign body (n=23); Tracheostomy (n=10); Removal of foreign body from nose (n=8); Drainage of neck abscess (n=6); and SPA ligation (n=5).

Discussion and Conclusions
To our knowledge, this is the first study to investigate the frequency of ENT procedures performed out of hours by trainees. Our findings can be used to plan and prioritise teaching of procedural skills in national trainee bootcamps. Oesophagoscopy and removal of foreign body was the most commonly performed out of hours procedure and along with other emergency procedures it should be prioritised in training camps.
SP1.2.6 Expanding the General Surgery Extended Surgical Team improves service delivery and provides increased training opportunities for surgical trainees
Authors: Luffman William , Duff Sarah , Capozzi Patrizia , Sharpe Gail , Hine Rachael 
Published: November 2022

Abstract

Aim
The Extended Surgical Team (EST) provides an additional surgical workforce with transferable skills. By expanding our EST and developing our Surgical Ambulatory Care service, we aimed to improve the delivery of acute surgical care to our patients. This also allowed us to improve CST training experience by supporting the CST on-call, providing an admissions base, helping decision making and maximising trainee educational opportunities.

Method
As part of an HEE EST Project, we used funding to expand the ambulatory care unit and employ/train further surgical ACPs. We surveyed the core trainee group regarding their on-call working pattern, training opportunities when on-call and where most time was spent. We implemented a change of working to utilise the new expanded EST, reducing the CST (and patient) time in ED. We re-surveyed the group after intervention.

Results
Results showed a reduction in the amount of time CSTs were spending with patients in the emergency department, easing the pressure on ED. Results showed support for the decision making on-call was greatly improved and the workload eased, allowing for improved educational opportunities for the trainee.

Conclusion
We have shown that the expansion of the EST and ambulatory service, when properly utilised by the surgical team, improves the training opportunities available to junior trainees, whilst also improving the delivery of General Surgery acute services by reducing the surgical patient pressure on our already stretched emergency department. We plan to continue the expansion of our EST and new model of delivery of CST on-call services.