bluuebunny/crossref_metadata_2025_split huggingface dataset:
TU4.11 Colonic Polyps Surveillance and outcomes - are we using a magnifying glass?
Authors: Jayasankar Balaji , Balasubramaniam Dinesh , Abdelsaid Kirolos , Frowde Kyle , Galloway Emily , Leeves Laura 
Published: November 2022

Abstract

Introduction
Colonoscopic polypectomy is a well established screening and surveillance modality for malignant colorectal polyps. Following a detection of a malignant polyp patients are either put on endoscopic surveillance or planned for a surgical procedure. We studied the outcome of colonoscopic excision of malignant polyps and their outcomes.

Methods
We performed a retrospective analysis of patients over a period of 5 years who underwent colonoscopy and resection of malignant polyps. Size of polyp, follow up with tumour markers, CT scan and biopsy were considered individually for pedunculate and sessile polyps. The main outcome was to look at the percentage of patients who underwent surgical resection, the percentage of patients who were managed conservatively and the percentage of recurrence post excision. We also identified 5 year outcome of completely removed malignant polyps in accordance with the Maastricht guidelines.

Results
The study was a retrospective analysis of 46 patients from 2015 who underwent colonscopic resection of malignant polyps. The male:female ratio of 1.4:1. 9% (4/44) of the patients went on to have a surgical resection of the malignant part and another 9% (4/44) had a trans-anal procedure for resection; 82% (36/44) were managed successfully by conservative follow up with colonoscopy, radiology and tumour markers.

Conclusions
Colonoscopic polyp resection may prove to be beneficial by avoiding a major resection. A reduction in the frequency and the battery of surveillance may be considered looking at the number of recurrence and surgical intervention.
TU5.2 Lifting the LiDCO on Haemodynamic Monitoring. Which would you PiCCO?
Authors: Afify Sarah Jane , Thida Nge Nge 
Published: November 2022

Abstract

Aims
Surgical patients in the intensive care unit (ICU) are frequently critically unwell with varied abnormal physiology1. The use of haemodynamic monitors in such cases is invaluable in permitting early intervention of complications such as multi-organ failure (MOF), yet is often overlooked1.
A Trust-wide study was performed utilising guidelines outlining criteria for haemodynamic monitor instigation2.

Methods
We retrospectively reviewed the records of 20 surgical patients to determine whether standards were achieved. Concurrently, we conducted a survey of junior doctors in order to establish knowledge and identify areas for improvement.

Results
20% of patients were new admissions with sepsis and MOF. 10% had inotropic requirements in accordance to Trust guidance. 35% required fluid bolus &gt;2l within 12 hours of ICU stay; 40% did not and there was no documentation for 25% of patients. 85% were within the 1st 48 hours post-operatively. Only 4 patients received haemodynamic monitoring, LiDCO and PiCCO monitors being used equally.
12 responses were received from our survey of junior doctors. 66.7% were familiar with different haemodynamic monitor types. 58.3% stated they would be confident knowing when to initiate usage. 83.3% added they would be able to use these monitors independently. Only 2 individuals had read the Trust guidelines on haemodynamic monitoring. All participants stated they would benefit from teaching on this subject.

Conclusions
Our study showed Trust guidance for haemodynamic monitor instigation was not being adhered to optimally. Increased awareness via education programmes would be beneficial, ensuring more favourable outcomes for patients- surgical or otherwise.
TU5.3 Surgical Simulation – Does it improve the undergraduate surgical experience?
Authors: Irvine Laura , Bruce Nikki 
Published: November 2022

Abstract

Aims
Many final year undergraduate students rotating through surgery in our DGH have had their clinical experience adversely affected by COVID due to missed or cancelled patient contact, absence, or cancelled placements earlier in the curriculum. We sought to improve the experience by designing a new simulation programme of acute surgical presentations to become embedded in the teaching schedule and to audit the feedback from this and make improvements.

Methods
We held a small focus group with FYs and medical students to identify surgical presentations that they would benefit from practice on. We wrote a package of simulated cases including “unwell pancreatitis”, “wound dehiscence” and “post op pyrexia”. All scenarios had the aim of encouraging A-E assessment by the student pitched at incoming-FY1 level, and available equipment in the SIM lab includes SIM man, real-time obs, and general ward equipment. Scenarios were written to include multidisciplinary input from nursing, anaesthetic and surgical colleagues and include flexible options depending on student performance. The hospital resus officer helped to run the scenarios.

Results
The scenarios were run with 4 consecutive blocks of students. All feedback was positive with all students grading feedback as “very good” or “excellent”. Other feedback included “more scenarios” and “helps prepare for FY1”. Small improvements were made to the written documentation through PDSA cycles over the 4 blocks and are now embedded in the curriculum.

Conclusions
Availability of surgical simulation helped students to become more confident in A-E assessment of unwell surgical patients despite loss of patient interactions due to COVID.
TU5.6 Teaching to transform surgical culture: An educational programme and thematic analysis in a general surgery department
Authors: Dave Madhav , Mobarak Shahd , Tarazi Munir , Macutkiewicz Christian 
Published: November 2022

Abstract

Introduction
General surgery departments are busy, meaning educational opportunities may be sporadic. Clinical priorities can sometimes supersede teaching and trainees may feel alienated at the periphery of the working community. In this study, we demonstrate how a reflective, multidisciplinary general surgery teaching programme was established and use this to assess the impact of structured teaching on surgical doctors of all grades in the department.

Methods
Twelve semi-structured telephone interviews were conducted with participants of varying grades. Transcripts were analysed using a grounded theory thematic analysis, revealing four themes: the value of teaching; learning as a community; barriers to successful training; and culture of surgery.

Discussion
Teaching helped juniors construct healthy narratives around general surgery and encouraged a process of professional identity formation. Pairing junior and senior colleagues allowed both to develop their skills, and reflective learning revealed new learning opportunities. Transparency across the ‘community of practice’ was achieved and the programme helped juniors overcome negative stereotypes of intimidation embedded in the hidden surgical curriculum.

Conclusion
Reflective, multidisciplinary learning can challenge the hidden curriculum and encourage team cohesion. A commitment to critical reflective teaching will be vital in cultivating surgeons of the future.
NB: submitted to previous ASGBI congress 2020 but later withdrawn due to COVID-19 and congress being cancelled. We wish to re-present our work.
TU5.8 Audit on Adherence to NICE Guidelines for VTE Prophylaxis in Patients Undergoing Surgery for Appendicitis
Authors: Devarakonda Sreekar , Shuttleworth Paul , Clark Edwin 
Published: November 2022

Abstract

Background and Aims
According to the Nice Guidelines (NG89), for any person (over 16 years) undergoing abdominal surgery, pharmacological VTE prophylaxis must be added for a minimum of 7 days (if the risk of VTE outweighs the risk of bleeding). Also, mechanical VTE prophylaxis must commence on admission. We wanted to audit our adherence to these guidelines in the patients undergoing surgery for appendicitis.

Methods
A review of the electronic pharmacy records of the patients (over 16 years) who underwent surgery for appendicitis (proven with a CT scan or diagnosed intra-operatively) was performed from October to December 2021. We used the Department of Health VTE risk assessment form, and only the patients whose risk of VTE outweighed the bleeding risk were included.

Results
Of the 23 patients, 22 (95.6%) underwent laparoscopic appendicectomy and, open appendicectomy was done in 1 (4.4%) patient. 11 (47.8%) patients were females, and 12 (52.2%) were males. The mean age was 38.3 (±16) years, and the mean duration of hospital stay was 2.8 (±1.6) days. VTE risk assessment form was completed only for 12 (52.2%) patients. During the hospital stay, 15 of 23 (65.2%) patients received TEDS, and 18 (78.2%) patients received Enoxaparin. 4 (17.4%) patients did not receive any form of VTE prophylaxis. None of these patients was prescribed seven days of pharmacological prophylaxis.

Conclusions
VTE prophylaxis prescription in patients with short hospital stays is often missed. We must explore the necessary interventions to ensure that patients are given seven days of VTE prophylaxis and regularly audit this practice.
TU5.10 Development of a Novel Near-peer Surgical Simulation-based Teaching Programme for Intern Doctors
Authors: Ferriter Bridgid , Julius Barbara , Burke Sinead , Slattery Natasha , Tormey Shona , Merrigan Anne 
Published: November 2022

Abstract

Background
Trends in healthcare have caused a shift in training towards more competency based programmes. The COVID-19 pandemic has reduced time available for direct exposure and clinical learning, necessitating incorporation of simulation in training. The objectives of this study were to develop, pilot and evaluate a four week simulation based surgical teaching programme.

Methods
Interns pursuing a career in surgery joined a near-peer surgical training programme delivered by NCHDs. A survey established a baseline competency. Four skills workshops were delivered. Outcomes were measured using data from pre and post course surveys as well as a surgical skills competition.

Results
Of the 12 trainees, 71% had scrubbed in theatre before. 50% were already confident to scrub independently, increased to 75% post training. 28% were confident gowning/gloving, increased to 75% post training. 28% were confident to place a simple suture in theatre, this did not increase despite training. 42% were confident performing an instrument tie, increased to 75% post training. 14% were confident hand tying knots, this increased to 62%. 14% of participants were comfortable performing excisional biopsy in theatre, increased to 62% post training. Preparation and administration of local anaestetic could be performed confidently by 14% before training, this increased to 87%.
On completion, a surgical skills competition showed that 100% were able to satisfactorily perform basic skills.

Conclusions
Near-peer delivery of surgical training has enhanced the basic surgical skills of interns. Similar programmes in other sites would ensure that interns have the skills required to safely care for surgical patients.
TU6.1 Tackling the training deficit due to COVID-19 disruptions
Authors: Bodapati Shruti , Gambhir Raghvinder Pal Singh , Kimura Shiori 
Published: November 2022

Abstract

Aim
Surgical training has been severely affected by stop, start and stop of elective surgical activity during the COVID pandemic. The aim of this study was to analyze the effectiveness of strategies put in place to tackle them.

Methodology
We looked at the four UK Statutory Education Bodies (SEBs) published guidance and trainee led resources to see what measures were put in place to mitigate the severe disruptions in surgical training due to COVID-19 pandemic.

Results
Across the world, training programmes have been affected and craft specialities have fared the worst. Lesser operative experience and redeployment to non-surgical critical areas being the top 2 causes.
A Post Graduate Medical Education (PGME) Recovery Programme was established in April 2021 to reset, recover and reform PGME with one to one trainee recovery discussions. Simulations and virtual CME sessions are being put in place to help mitigate the deficiencies in the current training programmes. These measure may be suitable for Medical specialities, but Surgical specialities need hands on training on human cadavers in lieu to catch up and prevent extension of period of training.

Conclusion
The COVID 19 pandemic has not only affected the physical and mental well-being of trainees but has also restricted training opportunities, professional development and severely dented trainee confidence. The plans put in place are not good enough for surgical trainees who need hands on experience. Increased didactic teaching around cadaveric training programs is the quickest way of overcoming this deficit.

References
1. https://www.hee.nhs.uk/covid-19/training-recovery-support; 2. https://www.hee.nhs.uk/covid-19/covid-19-training-recovery-programme
TU6.5 Motivation in the Surgical Workforce
Authors: Marlow Neale 
Published: November 2022

Abstract

Aims
To investigate the motivational spectrum amongst those choosing to work in the theatre environment according to Deci and Ryan's Organismic Integration Theory.

Methods
The Survey of Current Regulation of Behaviour In Theatres (SCRUB-IT) was adapted from the Behavioural Regulation in Exercise Questionnaire (BREQ-3) and administered to theatre staff at a UK university hospital in April 2019.

Results
48 staff members (surgical consultant n=6, surgical trainee n=9, nurse n=24, healthcare assistant n=9, male(%) 15(31.3), mean age 34 (27–59) years) completed the survey. Respondents had been working in theatres for an average of 11 (2–39) years.
The degree of self-motivation to work in the theatre environment was higher in the surgeon group (p=0.037) but there was no significant difference by age (p=0.119) or duration of theatre experience (p=0.227).

Conclusion
Theatre staff demonstrated a high degree of self-motivation and explanations are likely multifactorial (personal fulfilment, sense of duty, team dynamics, technical challenge) although the Hawthorne effect may bias results. These data could inform targeted recruitment and retainment of staff, whilst further work could compare findings with other medical specialties.
TU6.6 The value of immersive endoscopy training for the surgical trainee
Authors: Massie Eleanor , Hughes Rebecca , Vella Mark , Moug Susan , Mackie Helen , Renwick Andrew 
Published: November 2022

Abstract

Aims
Achieving endoscopic targets for CCT is problematic for General Surgery trainees. COVID-19 has negatively impacted all aspects of surgical training. Nationally, only 19% of colorectal trainees report completing 300 colonoscopies by CCT. We report on an immersive endoscopy training programme to achieve CCT targets.

Methods
To confirm reduced access to endoscopy, local General Surgery trainees (n=95) were invited to complete our survey assessing their endoscopic experience during their training to date. We compared the results to outcomes from a new 6-month immersive endoscopy programme. 2 out-of-programme (OOP) trainees; one had no endoscopy experience (completed core training; OOP 1); one had attempted 70 colonoscopies and 130 UGI endoscopies (ST4; OOP2).

Results
42 trainees completed the survey (44% response rate), ranging from ST2-ST8 (74% ST2-ST6, 14% ST7/ST8, 12% OOP). UGI endoscopies attempted by all trainees: mean 119 (range 10–306). 55% had attended or secured a place on the JAG UGI endoscopy course. Colonoscopies attempted by all trainees: mean 67 (range 2–233). 45% having attended or secured a place on the JAG colonoscopy course. 29% of trainees anticipated not reaching target CCT endoscopy numbers. In comparison, in 6 months; OOP1 attempted 49 OGD, 199 colonoscopies with a place secured on colonoscopy course. OOP2 attempted 109 OGD and 216 colonoscopies with both courses completed.

Conclusion
Shortcomings in endoscopic training and courses, particularly for colonoscopy, have been confirmed. Implementation of immersion endoscopy training can achieve CCT target numbers and competency within a short time, irrespective of previous experience.
TU7.2 Preoperative Indications for Coagulation Screening in the Elective Setting- A Single Centre Review
Authors: Ross Amy , Armstrong Lará 
Published: November 2022

Abstract

Aim
NICE Guidelines 2016 state that coagulation screens should be carried out in all patients with chronic liver disease, anticoagulation use or those with an ASA 3 or 4. We aimed to review coagulation screening in elective patients according to current guidelines.

Methods
A single centre, retrospective review was carried out over a 3 month period, of patients undergoing elective procedures in a district general hospital. Data was retrieved from an institutional data base, with follow up information reviewed in an up to date electronic data base.

Results
64 patients were included with a median age 41 years (range 19–85) and 56.3% male. Nineteen patients had an ASA of 3 or 4, however only one of these patients underwent a pre-operative coagulation screen. Four patients were taking anticoagulation medication prior to their procedure, however only one patient underwent pre-operative screening. Neither of these patient groups experienced any intra or post- operative bleeding. 3.1% of patients within the cohort experienced bleeding, all without pre-operative coagulation screening. Overall, screening was indication in 39.1% of patients, but was only performed in 3.1%.

Conclusion
Whilst a small number of patients within this study had bleeding related complications, it is evident that recommendations for patients with ASA 3 and 4 or those on anticoagulation therapy are not being met. Teaching and education on these guidelines will be provided and a further audit cycle completed.
TU7.3 Laparoscopic Cholecystectomy for Ultrasound Proven Gallbladder Polyps – An Unsound Indication?
Authors: Bezzaa Sabrina , Clements Caterina , Patel Puja , Kumapley Leonora , Burney Kashif , Nehra Dhiren 
Published: November 2022

Abstract

Aim
Current European guidelines recommend cholecystectomy for ultrasound proven gallbladder polyps based on size. Over-diagnosis of gallbladder polyps by conventional transabdominal ultrasound may lead to unnecessary surgery. The aim of this study is to correlate the ultrasound findings of gallbladder ‘polyps’ with histology of the removed gallbladder specimens.

Methods
Data from transabdominal ultrasound reports was collected over a 5-year period and cross-referenced with the histology from patients undergoing a laparoscopic cholecystectomy over the same time-period.

Results
60 patients who underwent laparoscopic cholecystectomy with ultrasound proven gallbladder polyps were identified. The age range was 19–79 years. There were 36 females and 24 males.
On imaging 30 patients (50%) had a solitary polyp (size range 2–24mm) and 30 (50%) had multiple polyps (largest polyp size range 4–13mm).
The indication for cholecystectomy was gallbladder polyps with or without gallstone disease in 32 patients (53%) and gallbladder or gallstone disease with incidental polyps in 28 patients (47%).
Only 2/60 (3.3%) patients had adenomatous polyps on histology (9mm and 9.7mm on ultrasound), whilst 18/60 (30%) had pseudopolyps and in the remaining 40 specimens, no lesion of polypoidal type was found. No specimens had evidence of dysplasia or malignancy.

Conclusion
We propose that an ultrasound abdomen is an inadequate imaging modality alone to diagnose gallbladder polyps and that patients require further imaging or MDT discussion as adjuncts to decision making for those referred for consideration of cholecystectomy.
TU7.4 Service Evaluation Audit of Virtual Outpatient Clinics in the Post-COVID-19 era
Authors: Caine Matthew , Wickstone Lydia , Rogers Charlotte , Macutkiewicz Christian , Chan Anthony 
Published: November 2022

Abstract

Introduction
The COVID-19 pandemic has significantly changed outpatient clinic services which now involve virtual (telephone/video) rather than face-to-face consultations. For both new clinic patients or follow-up patients after a recent emergency admission, these changes may impact on their perceptions and confidence in the outpatient service. The aim of this service provision audit is to ascertain both patient satisfaction and confidence in virtual consultations in our unit.

Methods
A retrospective evaluation of all General Surgery virtual clinic appointments between January and March 2021 was undertaken. Patients were contacted for feedback about their surgical consultation based on questions from the National Health Service Outpatient Department Survey (2011).

Results
In total, 151 patients were contacted. Overall satisfaction regarding telephone consultations was significantly higher when compared to survey results of face-to-face appointments in the pre-COVID era. The majority of patients were confident (51%) or confident to some extent (27%) of being listed for surgery without further examination. Only 8% of patients were not confident at the way surgery was explained and 10% were not confident of the risks of surgery. Finally, more than a third were not happy to be discharged from clinic following a telephone consultation.

Conclusion
Follow-up appointments are an integral part of the patient journey following an emergency admission. The COVID-19 recovery phase has necessitated a service reconfiguration towards virtual appointments. We show that patients were satisfied with virtual consultations, although further quality improvement should be undertaken to ensure outpatient discharge is satisfactory for all patients following an emergency admission.
TU7.5 Prostate cancer pick up rate in pure LIKERT 3 lesions on MRI prostate? A retrospective review of 157 cases in a district general hospital
Authors: Chiran Jaginkere , Farooq Abid , Anwar Baseerat , Billington Paul , Abuismaeil Muhammad 
Published: November 2022

Abstract

Introduction
LIKERT 4 and 5 lesions picked up on MRI prostate have a high chance of picking up high grade high volume prostate cancer so they under biopsy. It is quite challenging to decide whether to biopsy pure LIKERT 3 lesions. In our retrospective review of 500 prostate MRI scan we looked for correlation between pure LIKERT 3 lesions and the risk of finding prostate cancer after biopsy.

Materials and Methods
Pre-biopsy Multi parametric MRI prostate was done in 500 cases and reported by two consultant radiologists. 157 mp Prostate MRIs showed one or more pure LIKERT 3 lesions . All 157 cases underwent targeted and saturation biopsies. 91 biopsies (57.96%) out of 157 were benign. 66 biopsies (42%) out of 157 showed prostate cancer. Gleeson score is shown in the table below

Conclusion
157 cases with pure LIKERT 3 lesions on MRI prostate 58% were benign. 42% who had positive biopsies low and intermediate risk i.e. Gleeson 6 or 7 (95.4%) prostate cancer was found. High grade prostate cancer i.e. Gleeson 8 and 9 was seen in 3%. Patients with pure LIKERT 3 lesion on mp MRI prostate should be counselled about the risks of finding prostate cancer, likely grade to help them make an informed decision about PSA monitoring only or undergo prostate biopsies.