bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP-609 Doctor-led Straight to Test Service: Streamlining the Colorectal 2ww referral pathway
Authors: Nunn Rebecca , Hassan Adil , Allgrove Carol , Vivekanandan Shanmugam , Vijay Vardhini 
Published: November 2022

Abstract

Aims
Since its introduction in 2000, the Two-week wait referral pathway (2ww) has become entrenched in NHS practice to fast-track the investigation, diagnosis and management of suspected cancer. Straight-to-test (STT) routes further expedite this process: staff screen referrals and offer a diagnostic test within 2 weeks where appropriate. Our Trust has provided a doctor-led STT service for the Colorectal Department since January 2021. We hypothesize that physician-led strict scrutiny of referral proformas, with incomplete forms being returned to GPs, has led to improved compliance with the referral process.

Methods
A prospectively maintained database consisting of 2ww Colorectal referrals from primary care was analysed over a 12-month period (January 2021- December 2021). Agreed key referral criteria required to make an STT decision were identified as ‘complete’ or ‘incomplete’. Incomplete referrals were returned to GPs, with a request for complete information (usually provided within a median period of 2 weeks).

Results
There were 1112 referrals during January-April 2021, 1140 during May-August 2021 and 1158 during September-December 2021. The proportion of referrals containing incomplete datasets fell from 28% (January-April 2021) to 17% in the latter two 4-monthly time intervals.

Conclusions
Our data is promising- the proportion of incomplete referrals has reduced since the introduction of our doctor-led STT triage service. These figures may reflect a positive change in the referral practises of local GPs. Submission of complete referral forms improves communication between primary and secondary care, enabling our doctors to make timely informed decisions about STT pathways.
EP-617 Early vs delayed laparoscopic cholecystectomy for acute cholecystitis: A systemic review
Authors: Gibson Jamil , Allen Neill , Viswanath Yks 
Published: November 2022

Abstract

Background
Gallstones are present in approximately 10% to 15% of the adult western population with 1% to 4% of patients becoming symptomatic each year. Laparoscopic cholecystectomy for acute cholecystitis is usually performed after the acute cholecystitis episode settles because of the perceived fear of higher morbidity and of need for conversion from laparoscopic to open cholecystectomy. However, delaying surgery may expose the individual to gallstone-related complications.

Aims & objectives
To compare early laparoscopic cholecystectomy, defined as less than seven days of clinical presentation with acute cholecystitis, versus delayed laparoscopic cholecystectomy more than six weeks after index admission and conservative treatment for acute cholecystitis.

Search Criteria
Clinical databases were searched for suitable studies. Randomised and non-randomised clinical trials comparing early versus delayed laparoscopic cholecystectomy in participants with acute cholecystitis published after 1994 were included.

Results
16 studies were identified for this review and the outcomes measured were operation time, conversion to open surgery, postoperative complication, post operative pain and analgesia use, length of hospital stay, and duration of antibiotic therapy. For all but one of the criteria it has been found that early and delayed laparoscopic surgery were equivalent for these end points. The endpoint antibiotic duration post-surgery still remains an area of contention.

Conclusion
Early and delayed cholecystectomy for the treatment of uncomplicated acute cholecystitis is both safe and feasible. Early laparoscopic cholecystectomy is preferred over delayed laparoscopic cholecystectomy mainly because of decreased length of hospital stay in the early laparoscopic cholecystectomy group. This is a clear advantage.
EP-623 Can we count on serum hyperbilirubinemia to predict acute complicated appendicitis?
Authors: Jaskani Sadia , Al-Hamid Zaid 
Published: November 2022

Abstract

Introduction and Aims
Acute appendicitis (AA) is usually a clinical diagnosis and surgical intervention is typically a preferred choice to avoid potentially lethal complications. The aim of this study was to evaluate hyperbilirubinemia as a predictor of complicated acute appendicitis (CA).

Material and Methods
A retrospective analysis of patients who underwent surgery for AA in a district general hospital in the UK from Jan 2018 to April 2019. It includes White cell count (WCC), C- reactive proteins (CRP), and liver function tests (LFTs).

Results
A total of 236 (Median age = xx, IQR , F: M = 1:1.4). The frequency of normal, uncomplicated, and complicated appendicitis was 25(10.6%), 161 (68.2%), and 50 (21.2%), respectively. There were significant differences in the rate of negative appendicectomy in females (9.3% F vs 1.3% M, p-VALUE=0.0001). The bilirubin levels mirrored the CRP levels and showed statistically significant difference in patients with normal versus uncomplicated/complicated appendicitis (Bilirubin = 8.36 in normal versus 12.39 in uncomplicated and 16.44 in complicated appendicitis, p value=0.0001; CRP= 34.09 in normal versus 44.38 in uncomplicated and 114.34 in complicated appendicitis, p value=0.0001). The Neutrophil count showed increased differences between normal and uncomplicated/complicated appendicitis (Neutrophil 8.4 vs 11.2, p-value0.016; WCC 11.8 vs 14.1, p-value=0.003).
In the negative appendicectomy group, 17/25 had preoperative imaging. In 7/25 (28%) imaging was suspicious of appendicitis, 10/25 (40%) had normal findings and 8/25 patients did not have any prior imaging.

Conclusion
SB had low sensitivity and high specificity as compared to CRP and WCC for AA.
EP-631 Left Ovarian Teratoma Containing Follicular Thyroid Carcinoma: A case Report
Authors: Rezkallah Emad , Elsaify Wael 
Published: November 2022

Abstract

Introduction
A mature cystic teratoma of the ovary is composed of well-differentiated derivatives of the three germ layers, the ectoderm, the mesoderm and the endoderm. About 20% of ovarian teratomas contain thyroid tissues. When thyroid tissue comprises more than 50% of the ovarian teratoma, it is termed; struma ovarii. Patients are usually asymptomatic or predominantly presented with a pelvic mass in 45% of cases or abdominal pain.
We represent a rare case of stuma ovarii containing follicular thyroid carcinoma.

Case presentation
A 56 years old patient presented with a left ovarian mass. The patient had no history of any thyroid abnormalities and no family history of thyroid malignancy. The patient underwent total hysterectomy (TH) and bilateral salpingo-oophrectomy (BSO). Mature cystic teratoma of the left ovary containing highly differentiated follicular carcinoma with omental deposits was discovered.
The case was referred for thyroid MDT for discussion of further management. Thyroid US and CT scans showed slightly small thyroid containing multiple hypoechoic nodules with no evidence of distant metastasis.

Management
The patient had total thyroidectomy and the final histopathology reported incidental multifocal papillary microcarcinomas of follicular variant; stage pT1a. Post-operatively the patient had Radio-iodine ablation. TSH suppression with thyroxin was initiated. The patient had regular radiological and thyroglobulin checks and no recurrence was detected on 5 years of follow-up.

Conclusion
The treatment for malignant struma ovarii depends on the tumor stage. The initial surgery includes TH and BSO with omentectomy. The adjuvant treatment includes thyroxine, total thyroidectomy with RAI ablation. Long-term follow-up is recommended.
EP-641 ‘Feel Good Factor’: Positive recognition impacted staff morale, encouraged juniors and led to the overall departmental development during the COVID-19 pandemic
Authors: Zarsadias Prizzi , Burford Charlotte , Rai Sujata , Vigneswaran Natali , Shah Ankur 
Published: November 2022

Abstract

Aims
Low doctor morale and mental well-being is associated with poor patient care, especially during the COVID-19 pandemic. We report on a local initiative, Feel Good Factor (FGF), and its impact on doctors and the department.

Methods
FGF is a monthly presentation at the departmental meeting implemented at WHH, started in December 2019; where kind acts are applauded. A 10-item questionnaire was distributed to doctors working in two Surgery Departments (WHH and QEQM) in May 2021. Questionnaires collected demographic data, awareness of both positive/negative events and mental well-being using Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). Data was collected on audits, QIP's, sickness due to mental health, junior progression and publications.

Results
48 doctors responded (58.3% QEQM). There was no significant difference in overall WEMWBS score. Doctors in the WHH department were more decisive (70% vs 25%, p = 0.043); positive incident reporting was higher at WHH (25.0% vs 0.0%, p = 0.025). A trust-wide record number of 45 audits, 22 publications, 6 national studies and 11 juniors progressed in 2020. Patient clinical marker of NELA mortality was one of the least. There was no sickness leave due to mental health. FGF was also shortlisted for the annual BMJ awards.

Conclusion
FGF is associated with increased awareness of positive events. Improved doctor morale led to widespread participation in projects and departmental output leading to national recognition. Initiatives such as FGF should be encouraged and advertised to other departments, to improve the hospital rating.
EP-642 Case Report: Using the Novel Flamingo Device for Endoscopic Treatment of Buried Bumper Syndrome in high risk patients
Authors: Asnani Kusum , Fernandes Roland 
Published: November 2022

Abstract

Aim
Buried Bumper Syndrome is a rare, major late complication of percutaneous endoscopic gastrostomy (PEG) occurring in 1% of cases. It occurs when the internal bumper of the PEG tube erodes into the gastric wall. This lead to a loss of patency, leakage and inability to change the tube endoscopically. Until recently, the treatment was surgical removal under general anaesthesia. However, patients with BBS are likely to have significant co-morbidities thus deeming the procedure high risk.

Method
We present a case report demonstrating successful treatment of BBS completed endoscopically using the Flamingo device with a good patient outcome. The Flamingo device is a new endoscopic tool that acts like a sphincterotome. Appropriate consent was taken from the patient. This was performed on a 56 year old patient suffering from multiple sclerosis causing dysphagia for which a PEG tube was inserted in 2018 for nutrition. Over time, his care home noticed significant leakage from the site. At gastroscopy, he was diagnosed with BBS. Due to his risk for surgical intervention, the Flamingo device was trialled to remove the buried bumper and allow insertion of a new PEG.

Results
As demonstrated in the photos, the mucosa was successfully cut allowing the buried bumper PEG to be retrieved. A new PEG was inserted without complication. The patient was discharged the following day and no complications have arisen 3 months later.

Conclusion
The Flamingo device has proven to be a safe and minimally-invasive method to treat BBS endoscopically in this patient.
EP-653 Diagnosing Acute Appendicitis using Machine Learning: A Systematic Review
Authors: Chan Anthony , Yau Christopher 
Published: November 2022

Abstract

Introduction
Acute appendicitis is a surgical emergency that usually presents in the younger population. The mortality risk for uncomplicated acute appendicitis is less than 0.1%, but this rises to 0.6% should gangrene or a perforation develop during its disease course. The clinical diagnosis of acute appendicitis remains challenging, with systems such as the Alvarado score not specific enough to exclude a diagnosis. The aim of this study is to review the literature on the use and effectiveness of machine learning (ML) in the clinical diagnosis of acute appendicitis, with a particular focus on the parameters used to train the ML models.

Methods
A systematic review was conducted using PubMed and OvidSP using search terms ‘appendicitis’, ‘artificial intelligence’ and ‘machine learning’.

Results
There were 255 articles identified, which after excluding duplicates and screening, 14 articles were reviewed in detail and 6 articles included in the final review. Parameters used to train ML machines included patient demographics such as age and gender, clinical assessment such as temperature, presenting symptoms and examination findings, and biochemical and haematological results such as white cell count and C-Reactive Protein.

Discussion
The parameters used to train ML models are based on limited clinical and biochemical components from established scoring systems such as the Alvarardo score. Despite this limitation, ML models were generally better in predicting acute appendicitis in terms of sensitivity and specificity and positive- and negative-predictive values. Future ML models should use more contemporary markers to further improve diagnostic accuracy.
EP-682 Management of Superficial Abscesses: Scope for Day Case Surgery
Authors: Ahmed Ayesha , Olugbemi Jola , Prihartadi Aliya , Ridgway Lucy , Sebastian Boby 
Published: November 2022

Abstract

Background
Superficial abscesses form a large part of surgical emergencies in many units and are considered a low priority emergency often leading to delayed definitive treatment.

Aims and objectives
The aim of this study was to investigate the efficiency of emergency treatment of superficial abscesses and to identify areas for service improvement. A set criterion for ambulatory care was made: Apyrexial on admission, White Cell Count of less than 13.5×10*9/L, CRP less than 100mg/L, no significant co-morbidities and no other medical concerns for admission. Patients who meet this criteria should be sent home to present for planned procedures the next morning.

Methodology
Retrospective audit of care provided to patients who required drainage of superficial abscess under general anaesthesia over a six-month period.

Results
76 patients were included in the study. 39% of the patients had their abscesses drained on the day of presentation with another 50% waited till the next day for procedure while the remaining 11% waited for 2 or more days. The time interval between admission and surgery ranged from 2 hours to 94 hours (mean ± SD 19 ± 16.25. The length of admission ranged from 7 to 167 hours (mean ± 43 hours). Of the 130 overnight beds used by the 76 patients, 53 nights were spent awaiting surgery and 77 following surgery and awaiting discharge.

Conclusion
Out of 76 patients, 40 patients fulfilled the inclusion criteria of ambulatory abscess pathway and could have been discharged the same day for next day surgery.
BJS Prize 1 Postoperative electrical muscle stimulation attenuates loss of muscle mass and function following major abdominal surgery: A split body randomised control trial
Authors: Hardy Edward , Hatt Jacob , Doleman Brett , Phillips Beth , Lund Jon 
Published: November 2022

Abstract

Aims
Significant loss of muscle mass and function occurs after major abdominal surgery. Neuromuscular electrical stimulation (NMES) has been shown to reduce muscle atrophy in some patient groups, but evidence in postoperative patients is limited. This study assesses the efficacy of NMES in attenuating muscle atrophy following major abdominal surgery.

Methods
Fifteen patients undergoing open colorectal resection were recruited to a split body randomised control trial and their lower limbs randomised to control (CON) or NMES (STIM). The STIM limb underwent 15 minutes of quadriceps NMES twice daily on postoperative day (POD) 1 to 4. Ultrasound measurement of Vastus Lateralis (VL) cross sectional area (CSA) and muscle thickness (MT) was made preoperatively and on POD 5, as was dynamometer measurement of knee extensor strength (KES). All outcomes were analysed using linear mixed model techniques. The study was approved by NHS research ethics committee (ref 20/EM/069).

Results
NMES significantly reduced the loss of CSA (-2.52% vs -9.16%, p&lt;0.001), MT (-2.76% vs -8.145, p=0.001) and KES (-10.35% vs -19.69%, p=0.03). No adverse events occurred, and patients reported that NMES caused minimal or no discomfort.

Conclusions
NMES reduces loss of muscle mass and function following major abdominal surgery and may be an important tool in aiding recovery to normal activity levels. This will be especially important in preventing postoperative loss of independence in the increasingly physiologically frail patients undergoing major abdominal surgery. Further studies should establish the efficacy of bilateral whole-leg NMES for improving patient-centred outcomes.
BJS Prize 3 PPE-induced systemic hypercapnic-hypoxaemia: translational implications for impaired cognitive-clinical-functional performance
Authors: Luton Oliver , Stacey Benjamin , Mellor Katie , Egan Richard , Bailey Damian , Lewis Wyn 
Published: November 2022

Abstract

Background
Personal Protective Equipment (PPE) has been reported to adversely influence pulmonary gas exchange, resulting in systemic hypercapnic-hypoxaemia and cerebral hyperperfusion-induced cephalalgia. This study aimed to determine to what extent these changes impact functional cognition and manual dexterity given their relevance to surgical performance.

Method
Thirty-one surgical trainees (20 male, 11 female, aged 29 yr. (29.2 ± 2) participated in a randomised single-blind repeated measures crossover trial, completing one-hour of standardised laparoscopic simulation tasks, on two separate occasions (same day), once in Standard Operating Attire (SOA), and once in full PPE (including FFP3 mask). Global Cerebral Blood Flow (gCBF) was determined using duplex arterial ultrasound. Cognition and manual dexterity were assessed by timed Grooved Pegboard and a novel measure of laparoscopic bead placement.

Results
Following one-hour of simulation, PPE (compared with SOA) increased heart rate (93 ± 13 b/min vs. 79 ± 13 b/min, p=0.001), decreased peripheral O2 saturation (96.9% ±1% vs. 97.9% ±1%, p=0.001), increased gCBF (Δ+7 ± 8 mL/min/100g vs. + 1 ± 11 mL/min/100g, p=0.016; reflecting hypercapnic-hypoxic cerebral vasodilatation) and skin temperature increased by 0.6°C (p=0.001). Cephalalgia was reported by 21 (67.7%) participants wearing PPE vs. 13 (41.9%) wearing SOA (p=0.001). Dominant hand pegboard and laparoscopic bead performance were both impaired by PPE: 71.1s (±12) vs. 61.4s (±12), p=0.001; 270.7s (±135) vs. 192.5s (±67), p=0.001 respectively.

Conclusion
Collectively, these findings are the first to demonstrate that PPE-induced systemic hypercapnic-hypoxaemia is associated with important impaired cognitive-clinical-functional performance that may have a cerebrovascular basis.
Moynihan Prize 1 Antibiotic management of acute appendicitis avoids surgery in over 70% of adults: one-year follow-up from a prospective, multicentre, observational study
Authors: Javanmard-Emamghissi Hannah , Doleman Brett , Hollyman Marianne , Lund Jon N , Moug Susan , Tierney Gillian M 
Published: November 2022

Abstract

Background
Surgeons are sometimes reluctant to manage uncomplicated appendicitis non-operatively. Reasons cited are unknown rates of recurrent appendicitis and the risk of missed appendiceal malignancy. The aim of this study was to address these uncertainties and determine the long-term efficacy of antibiotic versus operative management of appendicitis.

Method
One-year follow-up of patients enrolled in the multicentre observational COVID:HAREM cohort study during March-June 2020 was undertaken. Patients were diagnosed with appendicitis either clinically or radiologically; initial operative or non-operative management was determined on a case-by-case basis by the responsible surgeon. Outcomes were the one-year appendicectomy rate, resected appendix histology and predictors of antibiotic failure.

Results
A total of 625 patients who underwent non-operative management were identified from 49 of the original 97 hospital sites. The overall appendicectomy rate at one-year in the initial non-operative group was 29% (180/625), with a median time to appendicectomy of 29 days [IQR 2-124]. Elective appendicectomy accounted for 17% (31/180) of operations with normal histology found in 39% (12/31). The overall normal histology rate was 11% (19/167). There were 7/167 malignancies and 3/167 neuroendocrine tumours identified at delayed operation. The presence of a faecolith (HR 1.72; 95% CI 1.18–2.51) and CRP&gt;300 versus &lt;50 (HR 3.05; 95% CI 1.6–5.81) were independent risk factors for failure of antibiotic-management (n=441).

Conclusion
The success rate of non-operative appendicitis management was 71% at one-year. Appendicitis recurrence was associated with the presence of a faecolith, malignancy and significantly raised CRP. These factors should be considered when counselling patients on non-operative management.
Moynihan Prize 3 Financial implications of gallstone-related complications whilst awaiting elective cholecystectomy: a single institution experience of 900 patients.
Authors: Burford Charlotte , Ainger Ellen , Syed Tayyaba , Tanwar Astha , Efiannayi Antonia , Shah Ankur , Chan Annabel 
Published: November 2022

Abstract

Aims
Over 65,000 cholecystectomies are performed each year in the United Kingdom with increasing waiting-list times due to the COVID-19 pandemic. This study set out to understand the cost to the NHS of complications experienced whilst awaiting cholecystectomy.

Methods
A retrospective cohort study was carried out for all patients who had been awaiting elective cholecystectomy for more than 20 weeks on the 17th September 2021 at a large NHS Foundation Trust. Demographic data was collected at the time of listing. Re-admission data was collected from patient notes. It included clinical history, blood results and imaging investigations. Associated costs were calculated.

Results
900 patients included in the study (median age 56 years, 71.7% female). 138 patients (15.3%) re-presented to hospital whilst on the waiting list with complications of gallstone disease. Of these, 51 had more than one presentation to hospital with 18 patients having more than three presentations. This was equivalent to 625 days in hospital, with only 79 same day discharges, and multiple investigations were performed (ultrasound scan = 79; CT scan = 31, MRCP = 47, ERCP = 21). This was estimated to have cost a minimum of £364,917. Assuming an average time for an elective cholecystectomy of 90 mins at a cost of £1,200 per hour, 202 additional cholecystectomies could have been performed.

Conclusion
This study highlights the enormous potential to reduce patient suffering by increasing the number of elective cholecystectomy lists, and at no overall additional cost to the trust.