bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP-192 The effect of surgical case-based discussions in confidence levels in surgical intravenous fluid prescribing
Authors: Rees Chantal Olivia Blanch , George Jayan 
Published: November 2022

Abstract

Aims

Methods
FY1 doctors were surveyed throughout July 2021 and December 2021 across two sites. Eight questions used Likert scales (1 to 5: not at all confident to very confident) to assess surgical IV fluid prescribing. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results
44 FY1 doctors completed the initial questionnaire.
19 FY1 doctors completed the questionnaire post rotation. (8 attended teaching and 11 did not.)
Confidence levels in surgical intravenous (IV) fluid prescribing were greater in FY1 doctors who had received CBD across 7 of the 8 questions than in those who did not.
Confidence levels were similar between those who had received CBD or not in surgical IV fluid prescribing in diagnosing a chest infection (as opposed to fluid overload).

Conclusions
Confidence levels in surgical IV fluid prescribing were mostly higher in those FY1 doctors who received surgical CBD teaching. Further research is required for the use of CBD in its potential to improve FY1 doctor education.
EP-193 The effect of surgical case-based discussions in confidence levels managing general surgical patients
Authors: George Jayan , Rees Chantal Olivia Blanch 
Published: November 2022

Abstract

Aims

Methods
FY1 doctors were surveyed throughout July 2021 and December 2021 across two sites. Seven questions used Likert scales (1 to 5: not at all confident to very confident) to assess managing general surgical patients. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results
44 FY1 doctors completed the initial questionnaire.
19 FY1 doctors completed the questionnaire post rotation. (8 attended teaching and 11 did not.)
Confidence levels in managing the unwell general surgical patient and prescribing antiemetics was greater in FY1 doctors who had received CBD as opposed to those who did not.
Confidence levels were similar in managing gallstone disease, appendicitis, diverticulitis and prescribing analgesia for those who had received CBD and those that did not.

Conclusions
Confidence levels in managing general surgical patients were mostly higher in those FY1 doctors who received surgical CBD teaching. Further research is required for the use of CBD in its potential to improve FY1 education.
EP-194 The effect of surgical case-based discussions in confidence level in end of life patient management
Authors: George Jayan , Rees Chantal Olivia Blanch 
Published: November 2022

Abstract

Aims

Methods
FY1 doctors were surveyed throughout July 2021 and December 2021 across two sites. Six questions used Likert scales (1 to 5: not at all confident to very confident) to assess end of life management. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results
44 FY1 doctors completed the initial questionnaire.
19 FY1 doctors completed the questionnaire post rotation. (8 attended teaching and 11 did not.)
Confidence levels in end of life patient management were greater in FY1 doctors who had received CBD across 5 of the 6 questions as opposed to those who did not.
Confidence levels were similar for end of life patient management for prescribing oral morphine for breakthrough pain when a patient is on a Fentanyl patch, for those who had received CBD and those who did not.

Conclusions
Confidence levels in end of life care management were mostly higher in those FY1 doctors who received surgical CBD teaching. Further research is required for the use of CBD in its potential to improve FY1 doctor education.
EP-196 The effect of medical and surgical rotations in confidence in managing surgical patients
Authors: George Jayan , Rees Chantal Olivia Blanch 
Published: November 2022

Abstract

Aims

Methods
FY1 doctors were surveyed throughout July – August 2021 and December 2021 across two sites. Seven questions used Likert scales (1 to 5: not at all confident to very confident) to assess general surgical patient management. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results
44 FY1 doctors (27 Surgery, 17 Medicine) completed the initial questionnaire.
19 FY1 doctors (13 Surgery, 6 Medicine) completed the questionnaire post rotation.
Confidence levels were greater for FY1 doctors in surgery when managing the unwell general surgical patient and prescribing antiemetics.
Confidence levels in managing analgesia, diverticulitis, gallstone disease and appendicitis were similar for FY1 doctors in either group.

Conclusions
Confidence levels are similar post first rotation in managing surgical conditions between medical and surgical specialties. Confidence levels are higher for surgical FY1 doctors. Further research is required in this area to improve FY1 doctor education in managing surgical patients.
EP-198 Is Primary surgical treatment of anal carcinoma safe and cost-effective in low resource settings?
Authors: Weledji Elroy 
Published: November 2022

Abstract

Aims
The aim of the study is to debate if primary surgical treatment (abdominoperineal (AP) resection remains safe and effective in low resource settings especially when considering the cost, availability, protracted treatment and complications of radiotherapy+/- chemotherapy.

Methods
An electronic literature search were performed to identify original published studies on anal carcinoma and management.

Results
The oncological outcome of primary surgical treatment is equivalent to chemoradiotherapy. The arguments for surgery as primary treatment are (1) Surgery is the primary treatment modality for small perianal lesions that can be locally excised, (2) a 55% 5-yr survival after a potentially curable AP resection of early locally advanced cancer, (3) 50% relapse after complete remission using chemoradiation and many can be salvaged by AP resection. (4) Four situations may require surgery after primary chemoradiotherapy (a) residual tumour, (b) complications of treatment, (c) incontinence or fistula after tumour resolution, (d) subsequent tumour recurrence. (5) Only a generous biopsy will reveal if a residual ulcer contains residual disease for which a salvage AP resection may be the only option as further radiotherapy cannot be given. (6) Salvage AP resection carries a high morbidity. The main arguments against surgery as primary treatment are the increased tumour radiosensitivity in the undisturbed pelvis with well oxygenated tissues and less small bowel in the radiation field limiting toxicity, (2) radiation therapy will reduce local recurrence better than after surgery (3) 20% are incurable surgically at presentation.

Conclusions
Primary surgical treatment of anal cancer may remain safe and cost-effective in low resource settings
EP-210 Routine colonoscopy after acute diverticulitis – appraising an age-old practice
Authors: Elsaid Nada , Paxton Benjamin , Ismail Adam , Oshowo Ayo 
Published: November 2022

Abstract
The standard of care for patients with diverticulitis is to perform a colonoscopy following resolution of the acute episode, to exclude occult malignancy. But how often does malignancy masquerade as diverticulitis? Further, when deciding whether or not to investigate these patients, there does not appear to be a consensus for those who have had a previous colonoscopy confirming diverticulosis only. We examined this cohort to assess the outcomes of their endoscopic screening. Historically, tests, including barium studies, yielded a lower sensitivity but since the advent of CT colonography, the results are more accurate with the added benefit of reduced procedure-related morbidity and burden on the NHS. We consider whether routine endoscopic colonic evaluation post diverticulitis should, to all intents and purposes, become obsolete. A total of 34 patients (identified from a series of 457) were coded with a diagnosis of diverticulitis between September and December 2021. Of these, 21 underwent subsequent endoscopic evaluation post inflammatory episode. 0 patients had cancer. 2 patients had tubular adenomatous polyps, displaying low grade dysplasia. Interestingly, technical difficulty and/or poor patient tolerance meant that 4 of these patients underwent a flexible sigmoidoscopy only. 1 patient developed diverticulitis a month after their scope. 2 patients had repeat colonoscopies within 2 years, the indication being diverticulitis. The authors acknowledge that the sample used is small and robust conclusions could not be drawn thus far. Our aim is to evoke interest in the reader with this study serving as a precursor to a larger project that is underway.
EP-215 COVID-19: Influence on Stoma Outcomes & Post-Operative Mortality
Authors: Mactier Mhairi , Tallo Tracey , Robertson Isobel , MacDonald Angus 
Published: November 2022

Abstract

Introduction
The COVID-19 pandemic resulted in cessation of elective surgery and a shift towards emergency surgery, often non-curative with stoma formation. Our hospital stoma database scores surgical complications (retraction, prolapse, stenosis and hernia) and patient symptoms (leakage, soiling, skin changes and odour), recorded by the specialist nurse at varying post-operative points.

Aim
To compare stoma scores and post-operative mortality pre- and mid-pandemic.

Methods
The stoma database (Microsoft Access) was interrogated for two periods: 16/03/19–16/09/19 (pre-pandemic) and 16/03/20–16/09/20 (mid-pandemic). Mortality at 6 and 12 months was extracted from electronic patient records (Clinical Portal).

Results
Pre-pandemic, 28 patients underwent stoma formation. Median stoma score at post-operative day 3, day 10, 6 months and 12 months was 0(0–4), 0(0–4), 1(0–8) and 1(0–3) respectively. Post-operative mortality was 21% at 6 months and 36% at 12 months.
Mid-pandemic, 19 patients underwent stoma formation. Median stoma score at equivalent time intervals was 0(0–2), 1(0–8), 0(0–5) and 4 (n=1 patient score recorded). There was a relative paucity of data recorded mid-pandemic with a maximum of 9 patient scores recorded at any one time. Post-operative mortality was 16% at 6 months and 26% at 12 months.

Conclusions
While acute surgery during the pandemic does not appear to be associated with increased stoma complications and post-operative mortality was less during the pandemic, limited data recording makes true comparison of pre- and mid-pandemic stoma outcomes difficult. Assessing the impact of the COVID-19 pandemic on surgical outcomes may be limited by poor quality of data collected.
EP-221 Outcome of early cholecystectomy compared to percutaneous drainage of gallbladder and delayed cholecystectomy for patients with acute cholecystitis: systematic review and meta-analysis
Authors: Nassar Ahmed , Elshahat Ibrahim , Forsyth Katharine , Shaikh Shafaque , Ghazanfar Mudassar 
Published: November 2022

Abstract

Aim
Compare outcomes of ELC and PTGBD as an initial intervention for AC and to compare operative outcomes of ELC and delayed laparoscopic cholecystectomy (DLC).

Methods
English-language studies published until December 2020 were searched. Randomised controlled trials (RCTs) and observational studies compared EC and PTGBD with delayed cholecystectomy for patients presented with acute cholecystitis were considered. Main outcomes were mortality, conversion to open, complications and length of hospital stay.

Results
Out from 1347 records,14 studies were included. 205,361(94.7%) patients had EC and 11,565 (5.3%) patients had PTGBD as an initial intervention for AC. Risk of mortality was considerably higher in PTGBD compared to EC group; HR,95% CI: [3.68 (2.13, 6.38)]. In contrast, complication rate was significantly higher in EC group (47%) vs 8.7% in PTGBD group in patients admitted to ICU for sepsis related to AC; P-value=0.011. ELC group had more intra-operative blood loss than DLC group; MD (95%CI): 34.2 (4.15, 64.25) ml. There was no difference in mortality between the two groups; HR (95% CI): 1.30 [0.60, 2.83] Patients had ELC are at higher risk of post-operative complications compared to DLC; RR [95% CI]: 2.88 [1.78, 4.65]. Risk of bile leak or bile duct injury was six folds more in ELC; RR [95% CI]: 6.07 [1.67, 21.99].

Conclusion
ELC should be considered for all patients with acceptable surgical risk admitted with AC regardless its severity. PTGBD can be considered for patients admitted to the ICU for organ support. Future studies needed to assess the validity of this approach.
EP-245 A snapshot review of the use of prophylactic antibiotics for emergency gastrointestinal surgeries: a tertiary care centre experience
Authors: Nour Hussameldin Mohamed , Peristeri Dmitria V , Shafique Shehram , Khan Prof Mansoor , Singh Krishna K , Sajid Mr Muhammad S 
Published: November 2022

Abstract

Aim
The administration of recommended prophylactic antibiotics on time for emergency gastrointestinal surgery (GIS) is effective in reducing surgical site infections (SSI) and expediting post-operative recovery. This audit aims to assess the optimum use of prophylactic antibiotics in patients undergoing emergency GIS.

Methods
The data of all patients undergoing emergency GIS over a 1-month period was reviewed according to UH Sussex NHS trust (microguide) guidelines. The data was extracted, transferred and analysed using Microsoft Excel.

Results
Forty-one patients underwent emergency GIS during the study period. Emergency GIS procedures included laparoscopic appendicectomy (n=20), open colorectal resections (n=5), laparoscopic colorectal resections (n=3), perforated duodenal ulcer repair (n=2), inguinal hernia repair (n=2), diagnostic laparoscopy (n=2), defunctioning ileostomy (n=2) and other (n=5). Recommended antibiotics were administered in 17 (41.5%) patients and 29 (70.8%) patients were administered antibiotics at the correct time. Surgical site infections (SSI) were seen in 6 (14.5%) patients, of which 2 (11%) patients were in the recommended-antibiotics group and 4 (16.5%) in the non-recommended antibiotics group (p= 0.05). Two patients (2/29; 6.8%) contracted SSI in the group which received antibiotics on time. The major factor behind using non-recommended antibiotics and not administering antibiotics at the recommended time was the continuation of antibiotics commenced at the time of admission.

Conclusion
A significantly higher proportion of patients undergoing emergency GIS were not administered the recommended antibiotics. Moreover, almost one third of patients were not administered antibiotics on time. Use of non-recommended antibiotics results in higher incidence of SSI in patients undergoing emergency GIS.
EP-250 A closed-loop clinical audit on the impact of implementing the STAR Score at a tertiary level hospital in India: Where do we stand?
Authors: Sinha Akatya Vidushi , Kadam Sameer 
Published: November 2022

Abstract

Aim
To perform an audit to check Quality & Compliance of Surgical documentation using STAR Score at a tertiary hospital in India.

Method
A total of 90 case files were studied and assessed in detail from all surgical departments. The audit was done for a period of 1 month at a tertiary hospital in India. The “STAR: Surgical tool for auditing records” tool was used to collect data accordingly. The results were compared with standard guidelines and further analyzed. A series of departmental training and implementation meetings were carried out. After 2 weeks, a re-audit was performed.

Result
The overall compliance score of the hospital was found to be 74%. While the departments of General surgery and orthopaedics showed a higher rate of compliance, each constituting 82%, Neurosurgery showed the least compliance of 62%. It was also seen that the maximum percentage of missing information constituted of anaesthetic records and subsequent entries. After the re-audit, a considerable improvement was observed, with the compliance rate improving to 90% in all departments.

Conclusion
We believe that compliance and implementation of the STAR Score is mandatory, as it can significantly improve the quality of documentation and can be implemented universally.
EP-254 Do not forget about bowel ischemia: a thematic review at Bedford Hospital
Authors: Muscara Francesca , Mwendauya Abigail , Kattaria Khaled , Soriano Jose , Bevan Katharine 
Published: November 2022

Abstract

Introduction
Bowel ischaemia (BI) is a life-threatening emergency with a mortality rate of 60–80%, which requires early diagnosis and surgical intervention. Clinical presentation is nonspecific, being characterised by initial discrepancy between severe abdominal pain and minimal clinical findings, abdominal CT has poor sensitivity and specificity. BI remains a diagnostic challenge for clinicians and often is an autopsy finding (1–1.5% of all adults’ autopsy). We conducted a thematic review to identify major issues which led to fail to recognise BI.

Methods
Data was collected retrospectively from NELA database on 626 patients who underwent emergency laparotomy, between 2013–2021 at Bedford Hospital, including preoperative clinical-radiological data, operation details, postoperative complications according to Clavien-Dindo (CD) classification and mortality.

Results
A total of 68 (10.8%) patients had BI as intra-operative finding, average age 71.3 (37–99), 35 (51.4%) female and 33 (48.5%) male. 25 (36.7%) had BI as indication for emergency laparotomy. 65 (95.5%) presented as emergency versus 3 (0.5%) as elective admission. The average waiting time for surgery was 8.9 hours. 53 (77.9%) patients received CT AP (46 triple phase, 4 angiogram, 3 without contrast), presence of BI was highlighted in 11 (21.1%) cases. In 14 (20.5%) patients a stoma was fashioned during laparotomy. 28 (41.2%) complications were recorded, of which 8 (28.5%) CD grade I, 5 (17.8%) CD grade 3b and 13 (46.4%).

Conclusions
Our results showed a mortality rate of 19.1% at 30 days postoperatively. We recommend strong clinical suspicion and aggressive approach should be adopted to improve the clinical outcome of BI.
EP-269 An Audit of Carbon Emissions Generated by Virtual and In-Person Clinic Appointments During The COVID-19 Pandemic
Authors: McKay Ellen , Singh-Ranger Gupreet , Schimp-Manuel Krystal 
Published: November 2022

Abstract

Background/Introduction
Virtual appointments have been considered in our department for many years, as a strategy to lower carbon emissions. The advent of COVID-19 prompted urgent implementation as in person appointments were limited.
We performed a prospective audit to assess the effectiveness of this approach in lowering carbon footprint.

Method
Audit study of all surgical clinic appointments from 18/03/20–31/03/21at the Upper River Valley Hospital, New Brunswick. Mileage calculated based on a round trip from patient postcode to hospital address.
CO2 / CO2 equivalents (CO2-e) emitted calculated from previously published data - mobile phone CO2-e; 0.0092751142 g/minute, laptop; 0.269216134 g/minute, standard car emissions 128.002 g/km.
Results were analysed statistically.

Results

Discussion
Implementation of virtual appointments significantly lowered the carbon footprint of our surgery clinic.
This has the potential to be a positive development in the efforts against climate change. Factors such as quality assurance, patient and physician satisfaction need to be determined however.
EP-271 Assessing the Impact of Implementing the STAR Score at a Tertiary Level Hospital in India: A Closed-loop Clinical Audit
Authors: Sinha Akatya Vidushi , Kadam Sameer 
Published: November 2022

Abstract

Aim
To perform an audit to check Quality & Compliance of Surgical documentation using STAR Score in the general surgery department of a tertiary hospital in India.

Method
A total of 20 case files were studied and assessed in detail from the general surgery department. The audit was done for a period of 1 month at a tertiary hospital in India. The “STAR: Surgical tool for auditing records” tool was used to collect data accordingly. The results were compared with standard guidelines and further analyzed. Interventions were carried out by a series of departmental training and meetings. After 2 weeks, a re-audit was performed.

Result
The overall compliance score of the general surgery department was seen to be 82% in the first cycle. While the initial clerking constituted 21% compliance, operative records, and discharge summaries, showed compliance of 33% and 22% respectively. Consent and Anesthetic records showed the least compliance of 7% and 14%. The highest compliance was seen in subsequent entries, constituting 35%. In the second cycle, a significant change was reported as the overall compliance score increased to 95%. All sections showed a statistically significant increase. Consent and anesthetic records demonstrated an increase of 75% and 70% compliance, respectively.

Conclusion
We believe that compliance and implementation of the STAR Score is mandatory, as it can significantly improve the quality of documentation and can be implemented universally.
EP-273 Magnetic nanoparticle administration to a model of penetrating neurotrauma in vitro
Authors: Basit Raja Haseeb , Wiseman Jessica , Chari Divya Maitreyi 
Published: November 2022

Abstract

Introduction/Aims
Functional recovery in penetrating traumatic brain injury (pTBI) is hampered due to the lack of clinically approved regenerative therapies. Although a surgical emergency, pTBI management is largely supportive, with no targeted neuroregenerative therapies. Reactive gliotic and neuroinflammatory responses with a lack of spontaneous axonal regeneration represent a major barrier to repair. Emergent nanotechnologies including magnetic nanoparticles (MNPs) show promise to attenuate such responses through immunomodulation, with potential of delivery of neurotherapeutic molecules to lesion sites during surgical intervention. However, there is a lack of high throughput, neuropathomimetic, models for nano/biomaterial testing in experimental neurology. Our group recently showed glial cell interactions with a surgical biomaterial scaffold (DuraGen PlusTM) in a novel in vitro model of pTBI.

Methods
Mice cerebral cortices were extracted and cultured 8–10 days in vitro (DIV) using previous methodology (Basit et al, Mat Sci Eng C, 2021) with a modified chemical medium. At 8 DIV, a sterile pipette was used for transection of the culture simulating penetrating injury in vitro with injection of carboxymethyl dextran-coated magnetic nanoparticles and polyethylene glycol-coated magnetic nanoparticles into the lesion site. MNP-neural cell responses were evaluated using immunocytochemistry methods.

Results
Our model demonstrates hallmark reactive gliotic responses, immune cell infiltration and axonal transection in injury sites. We demonstrate preferential and competitive microglial uptake of delivered MNPs versus other neural cell types (p&lt;0.05, n=5).

Conclusion
The model is adaptable to study neural cell responses to range of materials, offering high versatility for testing promising surgical neuromaterial based therapeutic interventions in experimental clinically relevant research.