bluuebunny/crossref_metadata_2025_split huggingface dataset:
OGBN P14 The development, introduction and outcomes of an electronic, patient record-based, Morbidity and Mortality (M&M) reporting system
Authors: Couper Graeme 
Published: December 2022

Abstract

Background
Recording of patient complications and outcomes has suffered from the lack of a standardised reporting system. The aim of this project was to develop and introduce within our health board a generic M&M reporting tool for all surgical and medical specialities which would allow agreed outcomes and actions, following open discussion at M&M meetings, to be documented in the electronic patient record (EPR).

Methods
TrakCare® (Intersystems) is the electronic patient management system used within our region to record and store information for patient consultations, investigations and treatments. The criteria felt essential were for a reporting system that was suited to all disciplines, accessible to all levels of staff, interlinked between specialities and allowed analysis and reporting of outcomes. Access to all aspects of the EPR including results and imaging should be available during the M&M meeting to facilitate informed discussion. Agreement was reached on the required drop down menus which included patient details, background/event timeline, death certification, end-of-life care, clinical governance, lessons learned and actions and outcomes. ICD-10 codes were used for diagnosis and OPCS-4 coding for procedures. A complication list was developed with word recognition of either the organ system or the complication. Complications were graded according to the Clavien-Dindo classification. All entered data was analysed using Business Intelligence.

Results
The development process lasted 9 months with the input of the author and programmers from the TrakCare® team. The system was first introduced in September 2017 within the general surgical unit. 1855 patients have been discussed at the general surgical M&M meetings using the system. Since introduction, an additional 37 specialities have adopted the electronic M&M reporting tool. To date 4859 patients in total have been discussed. The introduction of the system has resulted in additional improvements to the M&M process including the requirement for a designated chairperson, a meeting attendance record and documentation of actions and outcomes from meetings. Automatically generated reports show all outstanding actions and recommendations identified at M&M meetings to ensure that the full process is completed.

Conclusions
The widespread adoption of a standardised M&M reporting tool clearly shows the willingness of care providers to engage in open discussion and learning from M&M meetings. The introduction of a standardised electronic reporting tool has led to additional improvements in the M&M process.
OGBN P15 Covid-19's impact on delays to elective Cholecystectomy
Authors: Picton Charles , Galloway Simon 
Published: December 2022

Abstract

Background
Patients waiting for elective cholecystectomy for symptomatic gallstone disease may need admission with biliary symptoms or complications whilst on the waiting list. The longer the length from listing to procedure the higher the risk of symptoms and possible admission with complications. Many elective operations were cancelled or delayed during the pandemic leading to increased waiting times. The trust noticed a significant number of patients presenting to hospital who were already listed for surgery. This study looks at emergency admission data of 100 patients awaiting elective cholecystectomy.

Methods
Hospital admission data on 100 successive patients from the cholecystectomy waiting list were analysed from Dec 2021-January 2022. Data was collected on when were they added to the list and whether they had presented to hospital in the waiting period before cholecystectomy. Of those that were admitted, reasons for admission, demographics of people who needed admission and length of stay in hospital were recorded.

Results
Of the 100 patients many had been waiting more than a year with Covid 19 a predominant delaying factor (cholecystectomy is a P3 or P4 procedure and many elective procedures were cancelled or delayed during the pandemic). This cohort of patients had 32 separate presentations to hospital while on the waiting list (some patients presenting multiple times). 9 patients required emergency hospital admission for clinical reasons such as pancreatitis and cholecystitis. This totaled 67 bed days for the admitting hospital, some data was unavailable due to admissions to other hospitals.

Conclusions
NICE guidelines recommend laparoscopic cholecystectomy within 1 week for patients presenting with acute gallstone disease. Early elective cholecystectomy is recommended for patients with symptomatic gallstones. Delays in elective cholecystectomy operations during Covid 19 have caused delays to definitive treatment and led to excess bed usage during the treatment pathway with the associated financial costs and patient morbidity.
EGS P10 The Effect of COVID-19 on the Management of Upper Gastro-intestinal Cancers at a London NHS Trust
Authors: Osilli Dixon , Horsley Varnika , Mukherjee Samrat , Amalesh Thangadorai , Mukherjee Dipankar 
Published: December 2022

Abstract

Background
The advent of the COVID-19 pandemic in 2020 led to staff redeployment and prioritization of urgent care services. Cancer services were impacted by staff and resource diversion. Cancer diagnoses fell by 33% due to reduction in surveillance, diagnosis, and screening. Upper gastro-intestinal cancers (UGI) include cancers of the esophagus, stomach, small intestine, pancreas, liver, and gall bladder. These cancers progress insidiously, present at late stages and are challenging to treat. Delayed diagnosis significantly reduces the scope of treatment options available and therefore impacts the prognosis of the patient. A Public Health England Report in 2021 showed a reduction in tumor resection surgeries in UGI cancers between March to May 2020 and December to February 2021. The backlog of surgical cancer management is ongoing as the pandemic evolves and NHS service provisions adapt. It is important to understand the effects of COVID-19 on diagnosis, staging and treatment of UGI cancers in order to improve service provision in the ensuing years.

Methods
This was a cross-sectional study conducted at Barking, Havering and Redbridge NHS Trust from January to June 2019, 2020 and 2021. Data for 316 study participants was sourced from the Somerset Cancer Database and supplemented with data from electronic patient care records. Six months of data was compared in 2019 (pre-pandemic), 2020 (mid-pandemic including the first lockdown) and 2021. The data was analysed as raw proportions and percentages.

Results
The number of UGI cancers diagnosed was lowest in 2020 during the height of the pandemic compared to 2019 and 2021. The most common cancer in all three years was pancreatic. Pancreatic cancer was also the most common emergency cancer presentation. The highest proportion of stage IV cancers presented in 2021 (67%). The proportion of cases that resulted in palliative care management increased from 2019 to 2021 (67% and 70% respectively). 53% of all patients came from neighbourhoods that fell within 50% of the most deprived areas nationally.

Conclusions
The COVID-19 pandemic has had variable impacts on the presentation and management of UGI cancers at the BHRUT NHS Trust. This study exhibits local trends and percentages following suit from Public Health England's National Cancer Registration and Analysis Service data for trend-based discussion. Further research within London NHS Trusts is encouraged to understand the full impact of COVID-19 on surgical cancer services in the NHS.
EGS P15 Role of electronic consent in emergency surgery – A QIP in a high volume surgical emergency unit at a tertiary hospital
Authors: Sharmin Afroza , Loyala Vishani , Shams Ola , Bond-Smith Giles 
Published: December 2022

Abstract

Background
The Royal College of Surgeons of England discusses the significance of maintaining a written record of consent in addition to completing the consent form under section 4.10 of the supported decision-making guide to good practice - “any written information given to the patient should also be recorded and copies should be included in the patient's notes”. Studies show high error rates (27–50%) with handwritten consent forms due to poor legibility, incomplete/ inaccurate information, increased variability, and risk of misplacement. The consequences of these errors can lead to poor patient experience as well as unfavourable outcomes at the operational and institutional levels. Missing or incomplete consent is also the most common reason for first case delay (average 1–75mins). This prompted the QIP and generation of a standard template for the common emergency general surgery procedures in a high-volume Surgical Emergency Unit (SEU) at the John Radcliffe Hospital.

Methods
Procedure-specific Electronic Surgical Consent (eSConsent) template for common emergency general surgery operations was added to the online database to easily be added to the electronic patient record. The format, as outlined below, was designed to allow even junior surgical trainees to adapt and perform the consent process early on in their placement-

Results
The consent for all the emergency general surgery cases in a given week was reviewed and the compliance to maintaining eSConsent was audited. The first cycle between 20th-26th September 2021 showed compliance of only 18% (9 out of 49 operations). After discussing the audit findings with the members of the surgical team involved in the consenting process in the local meeting and implementing eSConsent, the compliance increased to 83.7% (36 of 43 cases) in the following week, 78% (33 of 43 cases) between 12th-18th November 2021 and 73% (28/38 operations) in the beginning of March 2022.

Conclusions
A consent form is a medicolegal document. Health care systems have taken advantage of technology to facilitate accuracy and robust monitoring. The emergency surgical consent process can benefit from this to avoid delays, errors and litigation. This transition is justifiable from our results and easily translated to practice particularly by using simple technology demonstrated in our QIP. Challenges including trainee changeover and new recruitments will expectedly affect the compliance of eSConsent but a proper induction to ensure adequate staff education will help overcome this. Weekly data capture has been adopted in our department as a surveillance protocol to ensure adherence and to standardize our practice.
EGS P19 A new normal or the calm before the storm?
Authors: Olivier James , Walsh Adam , Old Oliver 
Published: December 2022

Abstract

Background
One of the highest risk factors for morbidity and mortality for general surgery patients is having their surgery in the emergent rather than elective setting. Patients are presenting older, with often complex pathology on a background of multiple medical comorbidities and sometimes extensive surgical history.
NELA (national emergency laparotomy audit) and similar projects have looked at assessing and improving upon the management of such cases. These have produced valuable data and improvement in outcomes but there remains a lack of information around the acuity of surgery and the provision of services in response to demand. This study sought to assess the number of NELA cases in hospitals around the UK and compare this to historical data pre-pandemic.

Methods
Acute trusts admitting adults under general surgery in England were identified from the online NHS Service Directory. This list was cross referenced with the National Emergency Laparotomy Audit (NELA) list of participating hospitals to check for completeness. This generated 123 acute trusts in England. Contact details for each trust's Freedom of Information (FOI) department was identified from publicly available data on each trust's website. Questions were submitted to the FOI via email for 112 trusts, and online form submission for 11 trusts. Responses were collected for 8 weeks from the date of submission and analysed in Microsoft Excel. Trusts were asked to provide the number of general surgery admissions, inpatient bed numbers and NELA numbers. These were cross-referenced with publicly available data from NHS and NELA websites. Comparisons were made to similar data from 2014.

Results
101 out of 124 trusts responded within the 8-week timeframe. 14,497 NELA cases were recorded from the national total of 21,846 stated in the NELA Year 7 report (66.36%). The mean number of beds reported per NELA case was 5.76 (+/- 1.46 CI 95%), with histogram peaking between 3 and 5 beds with a right skew distribution. The mean number of admissions per NELA case was 30.81 (+/- 3.29 CI 95%), with histogram data peaking between 21 and 26 admissions with right skew distribution.
A comparison with data from 2014 can be seen below (table 1).

Conclusions
The Covid-19 pandemic had significant and widespread effects on the provision of services but also to demand. We now know that presentations to hospital reduced as did subsequent inpatient admissions. Our study shows that the number of NELA cases decreased across England and this was independent of hospital size. The largest decrease was seen in quartile 2 followed by quartile 3 representing mid-sized hospitals. Whilst not certain it is likely that this decrease was secondary to the pandemic rather than any change in practices. The results from this study can be used to help hospitals and departments plan their provision of services and training.
EGS P22 Management of acute cholecystitis during the Covid-19 pandemic - A complete cycle
Authors: Islam Muhammad , Tan Jay Roe , Oldfield Frances , English Louise , Tandon Ashutosh , Al-Rashedy Mohammed 
Published: December 2022

Abstract

Background
Acute cholecystitis is a common surgical emergency. NICE guidelines recommend early laparoscopic cholecystectomy should be performed within 1 week of diagnosis. Emergency and elective surgical provision was affected during the first wave of the covid pandemic due to high postoperative mortality and pulmonary complications. The objectives of this audit were to assess and improve the local management of acute cholecystitis during the Covid-19 pandemic.

Methods
A retrospective review of all patients who presented with acute cholecystitis over 2 months was performed in April 2020. Several interventions were introduced following the first cycle to improve our adherence with NICE guidelines, including ‘green elective surgical pathway’, clinical priority coding for elective surgeries, a hot gallbladder pathway, and a dedicated weekend and evening list. A re-audit was performed over 2 months in July 2020. These findings were presented at the departmental meeting.

Results
34 patients were reviewed in the first audit and 37 in the re-audit. A higher number of patients with acute cholecystitis in cycle 2 had admission covid swabs (97.3% vs 64.7%) and interval covid swabs (54.1% vs 0%) compared to cycle 1. One patient was tested positive for Covid-19 in cycle 2 and was listed for elective operation. Cycle 2 revealed a higher rate of hot gallbladder (from 8.8% to 10.8%) and a shorter median length from admission to operation (from 4 to 1.5 days). A higher rate of patients was readmitted due to complications of cholecystitis in cycle 2 (29.7% vs 20.6%) compared to cycle 1.

Conclusions
The overall performance is still behind the NICE guideline recommendation. We have identified factors such as pressure on theatre facilities and resources and cancer fast-track priority surgeries during the Covid-19 pandemic. Ongoing audit and optimisation of the hot gallbladder pathway, elective surgical pathway, extra lists, and clinical priority of operations are important to improve the quality of care for patients with acute cholecystitis.
EGS P23 Boerhaave syndrome: provision of emergency services during the COVID era
Authors: Hawkins Rosalyn , Phillips Benedict , Amalesh Thangadorai , Mukherjee Dipankar , Mukherjee Samrat 
Published: December 2022

Abstract

Background
The provision of emergency surgery was significantly impacted during the COVID-19 pandemic. This was due to limited intensive care beds and the risk of catching COVID-19 in the post-operative period. The aim of this study was to determine whether outcomes for patients with Boerhaave syndrome were negatively affected by service constraints during the COVID-19 pandemic.

Methods
Single centre case control study of patients with Boerhaave syndrome before and during the COVID pandemic. Univariate and multivariate analyses was employed to determine whether patient outcomes following Boerhaave syndrome were influenced by the COVID pandemic (defined here as 2020–2022) compared to a pre-pandemic period (2013–2019).

Results
During the COVID pandemic, 7 patients presented with Boerhaave syndrome, although none of these patients tested positively for COVID-19. Patient characteristics and outcome data of these patients were compared to a group of 14 patients with Boerhaave syndrome during a pre-pandemic period. The median age of patients presenting with Boerhaave syndrome was statistically significantly lower during the pandemic compared to those presenting before the pandemic (28 years versus 60 years, p=0.04). There was no significant difference in the treatment approach between the two groups, with non-operative and operative measures being employed in both groups equally (p=0.66), suggesting that the pandemic did not influence treatment decision. There was no difference in the use of endoscopic stenting between the groups (p=0.25). 30-day mortality was equal between patients admitted during the pandemic and those admitted before the pandemic (p=0.13).

Conclusions
This study demonstrated that the median age of patients presenting with Boerhaave syndrome during the pandemic was significantly lower than it was historically. This may have reflected shifts in behaviour and lifestyle during the pandemic. Never-the-less, the impact on services during the pandemic did not appear to influence treatment choice, and 30-day mortality remained the same for both patient groups. This may have reflected provision of COVID-secure pathways and locations.
EGS P27 Evaluating the use of gastrografin for the management of small bowel obstruction at Harrogate District Foundation Trust
Authors: Tahir Wasif , Al-Ramadhani Hasan , Ding Wayne , McNaught Clare 
Published: December 2022

Abstract

Background
Small bowel obstruction (SBO) is associated with significant morbidity and mortality (90 day mortality: 13%). Common causes include: adhesions, hernias or tumours. Conservative management includes nil per oral, intravenous hydration and naso-gastric decompression. If conservative management fails (&gt;72 hours) patients usually require surgery.
Recent national and international guidelines (ASGBI, Bologna, etc.) however advocate early use of gastrografin for the management of SBO.
The aim of the audit is therefore to review current HDFT practice of gastrografin use for the management of small bowel obstruction.

Methods
Retrospective data collection between April 2020- January 2022. All patients who underwent surgery for SBO were included. Exclusion: ischaemic or strangulated bowel, large bowel obstruction.

Results
A total of 50 patients were included in the analysis (25 male: 25 female) with a mean age of 73 years. 46% of the patients had undergone previous abdominal surgery. Cardiovascular conditions were the commonest pre-operative co-morbidity (32% had cardiac co-morbidities on presentation).
Adhesions were the commonest cause of SBO (64%). Gastrografin was only administered in 12% of patients prior to surgery. Majority of the patients underwent laparotomy (92%) with 58% requiring bowel resection during surgery (27% of these required a stoma).
52% of the patients undergoing surgery were admitted to ICU post-operatively with a mean stay of 4 days. The mean length of hospital stay was 19 days. The 30 and 90 day post-operative complication rate was 52% and 6%, respectively. Commonest post-operative complication was related to surgery (44% either developed wound infection, ileus, collections, leak, obstruction, etc.).

Conclusions
Emergency laparotomy for SBO is associated with significant morbidity and hospital stay. Use of Gastrografin for diagnostic/ therapeutic effect is suboptimal in HDFT and requires further work.
HPB P01 Volatile Organic Compounds for the Detection of Hepatocellular Carcinoma – a Scoping Review
Authors: Psica Alicja , Metwaly Sayed , Sogaolu Opeyemi , Ahmed Irfan , Delibegović Mirela , Bekheit Mohamed 
Published: December 2022

Abstract

Background
Hepatocellular carcinoma (HCC) is an increasingly common disease and is classified as one of the most common cancers leading to mortality worldwide. Only a small percentage of patients with this disease are eligible to curative treatment. Quite often the main reason is the late diagnosis of the disease. In the last decade, a Nobel prize awarded discovery of the volatile organic compounds in the breath opened the frontiers for new diagnostic tools and methods for several diseases. Cancer is one of the target diseases that appears to have unique biomarkers in the breath of the affected individuals. This have been found true in colorectal, breast, lung cancers. This systematic review aims to answer the question if markers specific to hepatocellular carcinoma exist in exhaled breath and what is the current knowledge regarding its detection.

Methods
A systematic search was conducted by two reviewers and the Royal College of Surgeons of Edinburgh librarian using the Embase, Medline, PubMed and Web od Science databases. Search strategy included all studied published until the 24th of March 2021 containing combination of keywords (Hepatocellular carcinoma, hepatocellular neoplasm, hepatocellular cancer, hepatocellular tumor, hepatocellular tumour, HCC, liver cancer, liver carcinoma, liver neoplasm, liver tumor, liver tumour AND volatile organic compound, VOC, volatilome, volatilomics, metabolome, metabolomics, breath analysis).

Results
The search yielded 6 publications using PRISMA pathway. Two of the studies described in vitro experiments and four were conducted on a small number of groups of patients. Overall, in the in vitro studies 42 headspace gases were analysed. Clinical studies included 164 patients with HCC and as control groups - 110 patients with cirrhosis and 130 healthy individuals.
Multiple VOCs were found in the studies. Following their identification in PubChem library, a pathway analysis was performed using the Kyoto Encyclopaedia of Genes and Genomes (KEGG). Only three VOCs were annotated in the KEGG maps and out of those, two could be traced back to their biological pathways. These are acetaldehyde and ethanol which participate in glycolysis and gluconeogenesis (Figure 1).

Conclusions
At present time there are no specific volatile biomarker in exhaled breath characterising hepatocellular carcinoma. Data on extracted studies emphasised lack of unified methodology. This review, however, highlighted metabolic pathway which might be the source of VOCs produced by cancerous hepatocytes. Large population studies are required to verify this finding.