bluuebunny/crossref_metadata_2025_split huggingface dataset:
WE8.3 Pandemic Priorities: The Impact of COVID 19 Pandemic on Ethical Leadership in the Healthcare Profession
Authors: Wright Holly , Musbahi Aya 
Published: November 2022

Abstract
Leadership priorities within the healthcare setting have been brought into sharp focus by the Covid 19 pandemic, coinciding with the Black Lives Matter movement, Me Too movement, PPE shortages and staffing crises. Appropriately championing the rights of such staff is imperative. The pandemic necessitates a period of rigorous self-analysis, recognising past failures, oversights and discriminations. Utilising a modified ethical leadership questionnaire, comparing pre- and post-pandemic views of healthcare leaders on their own ethical leadership values, this study demonstrates a novel research into the effects of the pandemic on this topic. Our study has found significant changes in attitudes of healthcare leaders with regards to the ethics of justice; fewer leaders were likely to hold formal investigations and more leaders would follow unwritten rules relating to an ethical dilemma. They also would pay more attention to individuals. In addition, in terms of critique, leaders were more likely post-pandemic to speak out against injustice and unfair practices although whether this is due to the pandemic solely, or social movements such as Black Lives Matter and Me Too is yet unknown.
WE8.4 Acute Pancreatitis during COVID-19 Pandemic: An Overview of Patient Demographics, Disease Severity, Management and Outcomes in Western Health and Social Care Trust (Altnagelvin Area Hospital)
Authors: Yawar Bakhat , Marzouk Ahmed , Ali Heba , Asim Ayeisha , Ghorab Tamer , Bahli Zahid , Asim Asim 
Published: November 2022

Abstract

Background
Acute pancreatitis is a common disease requiring admissions under surgical and critical care units. The two most common causes are alcohol and gallstones. COVID-19 pandemic had a significant impact on service delivery and patient management throughout all surgical specialties. In this study, primary aim was to ascertain incidence of COVID-19 in acute pancreatitis patients.

Methods
A retrospective observational review of all patients admitted under General Surgical team from March 2020 till September 2020 was performed. Information regarding demographics, severity of acute pancreatitis (using Glasgow score, Atlanta classification and CT severity index score), ICU admission and organ support, treatment modalities and follow-up data for outcomes was collected.

Results
Forty four (44) patients were admitted with acute pancreatitis. Only one patient (2.3%) was diagnosed with COVID-19 at time of pancreatitis. Aetiology of pancreatitis was found comparable to aetiology reported by large scale studies (2). Mortality was 7% (3 patients). Five patients (11%) needed ICU admission due to organ dysfunction. Three patients (7%) developed ARDS.

Conclusions
The overall incidence of COVID-19 in pancreatitis in our population of study was low. Therefore, results were compared to patients who were COVID-19 negative in COVID-PAN study. Patients with acute pancreatitis in our target population were mostly elderly, about one in five had moderate to severe or severe pancreatitis and in 16.3% the aetiology could not be identified. As has been observed in other centres globally, urgent for gallstone pancreatitis faced significant delays with no patients being offered index cholecystectomy and only 4/19 patients having undergone interval cholecystectomy.
WE8.5 Can self-estimated BMI be used for pre-operative planning in elective general surgery?
Authors: Burford Charlotte , Ainger Ellen , Chowdhury Ashim , Fernandes Roland 
Published: November 2022

Abstract

Aims
Telemedicine is being increasingly used in outpatient settings following the COVID-19 pandemic. This study aimed to determine if self-estimated body mass index (BMI), from telephone consultation, was accurate and useful for planning prior to elective general surgery.

Methods
Age, gender and estimated BMI were collected from consecutive patients attending a pre-operative telephone clinic under a single surgeon at a district general hospital in the South of England between April and October 2021. Actual BMI was measured on the day of surgery and compared.

Results
124 patients were included (median age 59 years, 49.2% male). BMI was accurately estimated by 38, under-estimated by 33 and over-estimated by 53 participants. Overall, there was a significant difference in the pre-operative and post-operative BMI (p = 0.003). This was significant for females (median change 0.1, IQR 0.0–0.7, p = 0.002) but not for males (median change 0.0, IQR -0.1, 0.2, p = 0.479). Those with an actual BMI &gt;29.9 had a significantly higher median change (0.2 (0.0, 1.1) compared to those with BMI ≤29.9 (0.0 (-0.2, 0.1); p &lt;0.001). Only 2 patients could have required a change in surgeon on the day of the procedure (p = 0.500).

Conclusions
Self-estimated BMI is a suitable method for assessing patients for planning in elective general surgical procedures, particularly for males. However, it is important to be aware of those with higher BMIs, particularly females, who may underestimate their BMI.
WE8.6 Paediatric inflammatory multisystem syndrome presenting as acute appendicitis: a case report and literature review
Authors: Catana Sabina , Burford Charlotte , Pangemi Anang , Shrestha Ashish 
Published: November 2022

Abstract

Aims
Paediatric inflammatory multisystem syndrome– temporally associated with SARS-CoV-2 (PIMS-TS) is a novel hyperinflammatory condition that most commonly presents with an acute abdomen. Here we present a case of PIMS-TS mimicking appendicitis and a review of the literature with a proposed protocol for managing abdominal pain in patients with recent SARS-CoV-2 infection.

Results
An 8-year old girl presented with suspected appendicitis. She underwent a day case open appendicectomy with normal appendix confirmed on histology. Unfortunately, she re-presented the following day with persistently high fever and was investigated for post-appendicectomy complication. She was started on intravenous antibiotics. MRI of abdomen and pelvis showed no collection but evidence of lymphadenopathy. On post-operative day four she was transferred to the tertiary centre PICU for specialist management of suspected severe PIMS-TS.
Common abdominal radiological findings in PIMS-TS include ascites, bowel wall thickening and mesenteric inflammation. In addition, CRP and ferritin have been found to be significantly higher in PIMS-TS. White cells may be raised with neutrophilia and lymphopaenia. In addition, highly deranged inflammatory markers in the context of a normal abdominal imaging are more consistent with PIMS-TS than appendicitis. We propose anyone with these findings is considered as having PIMS-TS and requires urgent imaging including combined senior surgical and paediatrician review.

Conclusion
PIMS-TS may present mimicking acute appendicitis and given the severe cardiac compromise that can develop in patients with PIMS-TS is it important to avoid unnecessary general anaesthetic and abdominal surgery where possible. Our proposed protocol could help reduce unnecessary abdominal surgery in these patients.
WE8.7 Are Virtual Clinics for General Surgery Here to Stay? – A Single Centre Analysis
Authors: Leigh Charlotte , Deb Rita , Sheth Hemant , Raje Durgesh , Pore Naresh , Soggiu Fiammetta 
Published: November 2022

Abstract

Aim
Virtual clinics were rapidly established during the COVID-19 pandemic to maintain outpatient surgical care.
To evaluate their use, we analysed telephone clinic outcomes and their compliance with the NHS Referral to Treatment (RTT) guidelines.

Method
Data was collected for patients booked into Upper GI Surgery clinics between September – December 2020 (n = 622). This included details of referral, appointments (first to most recent), patient attendance, and clinic outcomes (active monitoring, offered surgery, discharge, other). We compared first appointment management decisions between telephone and face-to-face clinics.

Results
317 patients had their first appointment via telephone; 179 patients were seen initially face-to-face.
For first appointments, non-attendance rate was 9.8% (31/317) in telephone clinics versus 3.9% (7/181) in face-to-face clinics.
At first appointment, 8.5% (27/317) of patients consulted via telephone were offered surgery compared to 20.1% (36/179) seen face-to-face.
22.4% (71/317) of telephone clinic patients were started on active monitoring at first appointment, compared to 31.3% (56/179) of patients assessed face-to-face.
31.3% (155/496) of all patients analysed were compliant with RTT guidelines – 57.4% initiated on active monitoring; 11.6% underwent surgery.

Conclusion
Patients are less likely to be listed for surgery after their first assessment if this was via telephone appointment compared to face-to-face. Delays in physical examination, and clinician and/or patient hesitancy may contribute to this; higher non-attendance rates would further postpone outcomes. However, telemedicine does allow effective active monitoring.
To better evaluate telemedicine's efficacy in sustaining timely patient care, comparison of compliance with the RTT guidelines for cases managed solely face-to-face pre-COVID-19 is warranted.
WE8.9 Do Telephone Clinics Lead to Greater Patient Satisfaction in General Surgical Outpatients?
Authors: McCance Angus , Ainger Ellen , Black Rebecca , Fernandes Roland 
Published: November 2022

Abstract

Aims
To limit exposure risk in view of the current COVID-19 pandemic, telephone clinics have become the mainstay of outpatient assessment. Although there is data from primary care, there is little evidence for the suitability of telemedicine within General Surgery. The lack of clinical examination can be dissatisfying for both patient and surgeon. The aim of this study was to explore patient satisfaction from telephone clinics in a General Surgery setting.

Methods
Data was collected prospectively from general surgery clinic appointments by a single surgeon in a District General Hospital from September 2021. Demographic data was obtained in addition to a short questionnaire at the end of their consultation. Patients were asked to score their experience out of 5 (5 being most favourable) and their preference in comparison to face to face appointments.

Results
156 patients were included in the study, of which 95% of patients were contactable. 98% of patients gave the experience a satisfaction score of 3 or more out of 5. The median satisfaction score was 5. 97% expressed a preference over a Face-to-Face appointment. 7% of patients required a further Face-to-Face consultation and this group were more likely to have a lower patient satisfaction score.

Conclusion
Telephone clinics within general surgery achieve excellent satisfaction for the majority of patients. The patient experience could be further optimised by careful selection of patient suitability for the service. The data provides supportive evidence to the NHS Long Term Plan to reduce Face-to Face outpatient appointments by one third before 2024.
WE8.11 How has the management of acute biliary pathology changed as a result of the SARS CoV2 pandemic?
Authors: Mukherjee Arnab , Robertson Sarah , Carden Claire 
Published: November 2022

Abstract

Aims
Gallbladder pathology is a common cause of emergency admission under general surgery - however management had to be drastically changed given the unexpected pressures of the SARS-CoV-2 pandemic. This study aimed to compare management strategies in patients presenting with biliary pathology pre and intra-SARS-CoV-2 pandemic in one NHS trust.

Methods
A database of patients admitted to the acute surgical admissions ward in the months of November 2019 and 2021 was accessed, patients with biliary presentations were isolated and information about these admissions analysed.

Results
In 2019 4 of 57 (8.7%) of patients admitted with biliary pathology had a laparoscopic cholecystectomy during that acute admission, compared to 8 of 65 (12.3%) in 2021. For all interventions (including ERCP and cholecystostomy) these values were 14 of 57 (25%) in 2019 and 24 of 65 (37%) in 2021. Of 54 patients in 2019 who did not have laparoscopic cholecystectomy on index admission, 9 were readmitted (16.7%).
The median duration of admission for all biliary patients on index admission was 4 days in 2019 compared to 5.9 days in 2021.

Conclusions
SARS CoV2 has precipitated a change in management of acute biliary patients. There is now an increased rate of intervention during the index admission and subsequent increase in admission duration. This is seen as an improvement in the pathway for patients in the long term, reducing the burden on the elective waiting list and reducing re-admission which will offset the modest increase in length of stay on the index admission.
WE8.12 Improvement of the Laparoscopic Cholecystectomy Service at a District General Hospital During the COVID-19 Pandemic
Authors: Patel Shivam , Dickson-Lowe Richard , Qureshi Nabeel , Lascelles Simon 
Published: November 2022

Abstract

Background
British Association of Day Surgery and Royal College of Anaesthetists guidelines specify that 75% of elective surgery should be done as a day-case. Our Trust reported a laparoscopic cholecystectomy day-case rate of 25% pre-pandemic. Following the first wave of the pandemic our waiting list increased significantly. Therefore, to address this, we aimed to improve the day-case rate by developing the booking pathway, such as introducing the Cholecystectomy As A Day-case (CAAD) score.

Methods
Retrospective data for laparoscopic cholecystectomy were reviewed between 19th March and 9th July 2021. Specific documents reviewed were the operation booking forms, hospital-specific ‘boarding cards’ for booking and CAAD score completion, and a day-case rate was calculated.

Results
A total of 86 procedures were performed. There was an overall day-case rate of 54.7%. Of those booked to be day-cases (n=39), 61.5% remained day-case post-operatively and 28.2% were discharged the next day. Of the patients that were not discharged the same day (n=39), 18 cases had no documented reason for the additional stay. Incomplete booking forms (n=42) demonstrated a day-case rate of 50% versus 60.5% with complete forms (n=38).

Conclusions
Overall, the day-case rate has improved. We believe this is from adhering to the boarding card and introduction of the CAAD score to guide appropriate booking. However, for further improvement we are going to revise the booking form and create a Standard Operating Procedure (SOP) for the booking of these operations. Together with CAAD scoring, this should improve day-case rates further to reach the nationally accepted standard.
WE8.13 Hospital consultant remote consultations during COVID 19 - experiences at a large NHS trust
Authors: Ahmed Humairaa , Oni Georgette 
Published: November 2022

Abstract

Aim
COVID-19 has intensified the need for the NHS to almost overnight utilise remote consulting technology, with clinicians under increasing pressure to provide virtual services preferentially, in line with the NHS digital ideals. This study explores the clinician experience of virtual working during the pandemic in a large acute NHS Teaching Trust, and to identify the facilitators and barriers to remote consultations (RC).

Method
A multi-format online questionnaire was constructed and emailed to all 816 consultants across the trust. The survey was open for one month and during that time two reminders were sent. The data was tabulated and analysed using Microsoft excel.

Results
270 consultants responded to the questionnaire, giving a response rate of 33%, with 208 (77%) performing RCs. 92.8% of these (N=193) have increased the number of RC during the pandemic. 45.9% did not have their own office (N=124), with over half of those (N=63) sharing an office with 3 or more people. The majority of remote consultations were over telephone (82%) with only 54.4% feeling they had the right equipment for video consultations. The biggest barriers were patient related issues (technical, poor environment or not available at scheduled time).

Conclusion
The main challenges facing consultants, in the provision of virtual services were: lack of appropriate hardware, an absence of a suitable environment, the prevalence of technical complications, and difficulties experienced by their patients. It is therefore, important to recognise, both at an organisational level, and nationally, that virtual consultations may play a role in the worsening of health inequalities.
TH1.3 Initial experience - Magseed for impalpable breast lesion localisation
Authors: Harris Grant , Saafan Tamer , Quigley Katie , Bristow Gary , Townend Alice , Youssef Magdi 
Published: November 2022

Abstract

Aims
Impalpable breast lesions can be localised intraoperatively with Magseed and the Sentimag probe. Advantages over traditional wire localisation include reduced displacement, flexible insertion timescales, reduced patient anxiety and no requirement for radiation governance compared with radio-iodine seeds. We assess outcomes following introduction of Magseed localisation for impalpable breast lesions.

Methods
The first consecutive Magseeds inserted into breast lesions were identified from radiology records in a UK non-screening breast unit from July 2020 to March 2021. Indication for seed, intra-operative complications, margin involvement and re-excision rates were ascertained from electronic patient records. Caldicott / audit department approval was obtained.

Results
63 Magseeds were inserted in 59 patients. Indications for seed localisation were invasive disease 81% (51/63), DCIS 8% (5/63) and B3 lesions 11% (7/63). 21% (10/47) of patients with invasive disease had received neoadjuvant chemotherapy. The median seed insertion to surgery time was 13 days. All patients underwent standard wide local excision or therapeutic mammoplasty. The lesion localisation rate and seed retrieval rate was 100%, however 2 magseeds (3%) were displaced during dissection. The margin re-excision rate was 15.3% (8/52) in patients with invasive and preinvasive disease. The upgrade rate for B3 lesions was 16.6% (1/6).

Conclusions
Magseed can be used to accurately localise impalpable breast lesions with acceptable margin re-excision rates. These findings during the learning curve would imply that this technique is easy to adopt. Insertion of seeds within 2 weeks of the operation is feasible and should improve radiologist's efficiency by avoiding on the day wire insertion.
TH1.4 Indication for clinical biopsy in symptomatic breast disease- A closed loop audit
Authors: Ning Lee Rachel Xue , John Avinesh , Fabelurin Christiana , Zheng Chia Zoe Ying , Goyal Amit 
Published: November 2022

Abstract

Aims
Royal College of Radiologists states core biopsy is indicated where imaging is normal, but clinical assessment is P3 and above. However, many clinicians opt for clinical biopsy following normal imaging results despite clinical assessment under P3. We recommended: reserving clinical biopsies following normal imaging for women &gt;50 year; performing ultrasound and mammogram in women &lt;40 years with clinically (P3-P5) or ultrasonically (U3-U5) findings. Here we look at the impact of our recommendations on clinical practice and patient diagnosis.

Methods
All patients who had clinical biopsies were analysed within a six-month time period in 2019 and 2020. 43 patients were included in 2019. 78 patients were identified in 2020. 14 were excluded as they had history of breast malignancy, or a biopsy diagnosis of non-breast malignancy.

Results
64 patients were included in our analysis. Improvements in the 2020 audit cycle compared to 2019 included: Lesser women &lt;40 years with P3/U3 not getting MMG prior to clinical breast biopsy (15.4% compared to 80.0%); higher rates of both MMG and targeted US were performed in women 340 years with score 3U3 (86.8% compared to 41.9%). Only 6 (9.4%) patients returned with malignant biopsy results. No patients (compared to 1) who underwent clinical biopsy for symptomatic breast disease following normal imaging showed malignant biopsy results.

Conclusion
Our findings indicate a low test positivity rate for clinical biopsies performed following normal imaging. Being prudent and selective in the type of patients clinical biopsies are carried out have a positive impact on clinical practice and patient diagnosis.
TH1.5 A Novel Method Breast Lesions Localisation: Using Scout System
Authors: Lefroy Rebecca , Kaur Jaspreet , Karategos Athanasios , Bowen Natasha , Tapan Sircar , Raghavan Vidya 
Published: November 2022

Abstract

Aims
The advent of screening along with increased patient awareness means that approximately 30–50% of breast lesions are impalpable at diagnosis. SAVI SCOUT is a reflector guided system using an implanted device within the breast to guide excision. A probe is then used, in a similar fashion to sentinel node localisation, to target and excise the lesion. As it lacks an external component, it can be placed days prior to surgery, one of a number of advantages it has over our current standard; wire guided excision.

Methods
Our unit aimed to review the implementation of the SAVI SCOUT system into our practice, looking at the excision and re-excision rates as well as evaluating the advantages or drawbacks we found during our learning curve with this device.

Results
18 patients underwent 19 SCOUT guided excisions, over a nine month period. Average age was 62 (range 50–81) and modal length of hospital stay was 0 days (range 0–1). All 18 patients were female and 79% (n-15) underwent wide local excision with 21% (n-4) undergoing quadrantectomy with mammoplasty. 100% of patients (n-19) had the lesion successfully removed. 10% (n-2) of patient underwent re-excision due to close or positive margins.

Conclusion
Our study has small numbers so far but represents successful use of this technology with good outcomes. We have also found its use acceptable to both surgeons and radiographers. In our experience we have found that diathermy can prevent the reflector from sending or receiving signals if used too close to the device.
TH1.7 Patterns of care of male breast cancer in clinical practice: A five-year single institution experience
Authors: Troy Amanda , Jaffer Alisha , Julius Barbara , Tormey Shona 
Published: November 2022

Abstract

Aims
Only 1% of all diagnosed breast cancers are in male patients. Overwhelmingly, current literature addresses breast cancer in female patients. This study aims to analyse the investigation and management of male breast cancers in a busy Symptomatic Breast Unit.

Methods
We conducted a single-centre review of male breast cancers diagnosed in our institution between January 2016 and December 2020. Initial presenting symptoms, imaging findings, histology and follow-up data were collected via a prospectively maintained database.

Results
The most common presenting symptom was a palpable breast lump (69%). Other symptoms included nipple bleeding/discharge (15%) and skin ulceration (8%). 62% of cases were located centrally behind, or involved, the nipple. The most common pathology was invasive ductal carcinoma (77%). One patient was diagnosed with invasive papillary carcinoma, while two patients were diagnosed with different cancers (spindle cell sarcoma and metastasis of medullary carcinoma of the thyroid). 77% of patients were managed operatively, with all undergoing a simple mastectomy. A sentinel lymph node biopsy or axillary clearance was performed in 62% and 8% of cases respectively. Several patients underwent adjuvant radiotherapy (62%) and chemotherapy (54%). 77% of patients were ER/PR positive, with 15% HER2+ positive. 100% of these patients received appropriate endocrine therapy.

Conclusions
Although female breast cancer commonly presents in the upper outer quadrant of the breast this study found that more male breast cancers occur centrally and involved the nipple. As breast cancer in male patients is rare, larger cohorts are required to confirm the findings of this study.