bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP-88 Plastic Surgery Venous Thromboprophylaxis for abdominal and thigh based free flap breast reconstruction surgery
Authors: Bahadori Darab , Eiben Inez , Eiben Paola 
Published: November 2022

Abstract

Aims
Correct Venous Thromboprophylaxis (VTE) assessment and prescription is at basis of patient safety when considering patient hospital admission. Current local Guy's and St Thomas Hospital guidelines are in keeping with National Institute for Health and Care Excellence (NICE) guidelines recommending all patients to be assessed and prescribed VTE prophylaxis within 24 hours of admission. There are no specific local or national guidelines however that would recommend VTE prophylaxis specific to free flap breast reconstruction surgery.
We assessed therefore adherence to VTE prophylaxis guidelines for patients undergoing abdominal and thigh based free flap breast reconstruction surgery. Patient outcomes were reviewed and VTE prophylaxis proforma was recommended.

Methods
Patients who underwent abdominal or thigh based free flap breast reconstruction surgery between October 2017 and February 2019 were identified. Data was collected retrospectively and analysed via SPSS Statistics (IBM, USA).

Results
51 patients were included in the first audit cycle; 50 patients in the re-audit. Overall improvement and 100% of patients received LMWH on admission. The timings of correct prescription versus actual administration of LMWH decreased however from 71% to 49%.

Discussion
There is good adherence to assessment and administration of VTE prophylaxis across the patients. Unfortunately the prescription of VTE prophylaxis itself is mostly incorrect. It is therefore with gratitude to the ward staff VTE is administered correctly. Further improvements in the communication therefore between theatre, ward and surgical staff and implementation of VTE prophylaxis proforma need to be considered.
EP-127 Filling in the Knowledge Gap: Designing the General Surgery/ Orthopaedic Clinical Handbook for NHS Dumfries & Galloway
Authors: Hemadasa Niroshini A , Isles Chris , Apollos Jeyakumar , Sami Sharukh 
Published: November 2022

Abstract

Introduction
The NHS Dumfries & Galloway Clinical Handbook was developed to provide readily accessible and practical guidance when assessing and managing a wide variety of medical conditions for junior doctors. We summarise the relevant NICE and SIGN guidelines and link to other relevant handbooks. Until now the content has been purely medical.

Aim
To expand the Clinical handbook to include topics in General Surgery and Orthopaedics that would be useful for junior doctors.

Methods

Results
Initial survey sent to 15 junior doctors showed everyone stating it would be very useful to have a general surgery and orthopaedics section in the handbook with 80% stating they used the handbook all the time. Free text questions included asking useful topics to be included in the handbook with answers including management of common surgical emergencies/ presentations, analgesia and laxatives, anticoagulation. The handbook was written and published online and can be accessed via https://www.nhsdghandbook.co.uk

Conclusions
The handbook was well received by the junior doctors. A survey has been sent out to junior doctors for feedback and number of online visitors to the site will be collected and reviewed. The handbook will be updated to include more topics.
EP-169 Management dilemma in an unusual presentation of acalculous acute cholecystitis
Authors: Bose Sayantan , Alasmar Mohamed , Doran Helen 
Published: November 2022

Abstract
Acute acalculous cholecystitis is a recognised but seldom encountered entity except in immunocompromised and critically ill patients. Epstein-Barr virus infection, on the other hand, is a common viral illness throughout the world, mostly in the younger age groups. However acute cholecystitis due to EBV infection is very rare to occur and can be difficult to diagnose. Here we present a case of a middle aged adult who presented with upper abdominal pain and non-specific viral illness-like symptoms. LFTs were of a mixed picture and she had marginally raised inflammatory markers. Standard imaging studies excluded gallstones but she had thickened gallbladder wall with pericholecystic oedema and some fat stranding, but normal intra hepatic biliary tree and CBD. Strikingly there were sizable lymph nodes in abdomen and thorax. Suspecting viral aetiology, a viral screen was performed which gave a positive EBV result. However on daily clinical examination she kept on worsening symptomatically and a decision to operate was made following discussion with gastroenterologists and the patient. To note, EBV result was delayed and arrived after she had the operation. This case gives an example of a rare surgical case which may create a diagnostic dilemma amongst clinicians. Whilst understanding that management of acalculous cholecystitis is usually conservative, but in a clinically deteriorating young patient like this there may be a case for cholecystectomy or cholecystostomy. Here the learning point should be to think of other possible diagnoses and consider viral aetiologies earlier which may avoid a procedure on a patient.
EP-191 The effect of surgical case-based discussions in confidence levels in acute kidney injury 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 managing AKI. 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 AKI were greater in FY1 doctors who had received CBD for recalling the common classes of drugs that cause AKI, explaining the significance of lactate and bicarbonate and managing the surgical patient with AKI, as opposed to those who did not.
Confidence levels for managing AKI, categorising the causes of AKI and assessing a patient's fluid status, were similar between those who had received CBD and those who did not.

Conclusions
Confidence levels in managing AKI 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-213 An Audit on the Initial Management of Acute Cholecystitis: A Single Centre Experience
Authors: Stoll Sarah , Doherty Rachel , Sedighi Tina , Davidson Christopher , Modi Hemel 
Published: November 2022

Abstract

Aim
Acute cholecystitis (AC) accounts for up to one third of emergency surgical admissions. The initial management of AC includes fluid resuscitation and appropriate antibiotic therapy. The aim of this study is to audit compliance with local microbiology guidelines for the treatment of AC and to develop interventions that improve compliance rates.

Method
All patients admitted from September to December 2020 with radiologically confirmed AC were included in an initial prospective audit (n=39 patients). Antibiotic prescriptions, patient demographics, presence of fever (&gt;38°C), inflammatory markers and liver function tests were recorded. The results were disseminated, educational material produced, and antibiotic “champions” appointed to improve adherence to antibiotic guidelines. A prospective re-audit was conducted from May to June 2021 to establish the effectiveness of the interventions (n=49 patients). Compliance rates before and after the interventions were compared using a Chi-squared test. Binomial logistic regression was carried out to establish whether any patient demographic or clinical parameters were independent predictors of prescribing behaviour.

Results
Compliance to antibiotic guidelines for AC significantly improved following the interventions (12.8% vs 57.1%; p&lt;0.001). Age, gender, temperature, inflammatory markers and liver function tests were comparable in both groups and were not found to be independent predictors of non-compliant antibiotic prescription.

Conclusions
Adherence to antibiotic guidelines for AC can be improved with educational interventions and the appointment of individuals responsible for ensuring correct prescribing behaviour. Interestingly, patient demographics, signs of sepsis or liver function did not influence prescribing behaviour, suggesting that divergence from antibiotic guidelines may be due to ingrained prescribing dogma.
EP-216 Case Report: A Fishy Case of Flexor Tendon Injury
Authors: Mactier Mhairi , Davies Kerry , Gilmour Adam 
Published: November 2022

Abstract

Introduction
We describe the first documented case of a flexor pollicis longus (FPL) tendon injury occurring secondary to a fish bite.

Case Report
A 52-year-old right hand dominant male was referred with inability to flex his right thumb following a pike bite whilst fishing in a nearby Loch. Clinical examination revealed superficial abrasions to his right thumb with two deeper puncture wounds over the volar pulp. He had no active flexion of the interphalangeal joint. Radiographs showed no fracture/foreign body. Given deep animal bite, intravenous antibiotics and operative exploration were indicated. Intraoperative findings revealed 100% division of the FPL tendon (zone II); this was repaired using a modified Strickland method. The patient completed 48 hours intravenous antibiotics and was discharged with physiotherapy-led follow up.

Discussion
Animal bites are a common presentation to the Emergency Department however non-domesticated animals account for &lt;5% cases. We are not familiar with managing marine animal bites and the literature is lacking. Only 2 cases of sting-ray injuries have been described, both of which were associated with delayed presentation and poor functional outcome. Aquatic injuries also contain unique bacterial flora including Vibrio, Aeromonas and Pseudomonas which merits consideration.

Conclusion
This case highlights the importance of managing innocuous wounds with caution in case of underlying structural damage. Unusual animal bites should be closely monitored with low index for surgical exploration to avoid delayed complications. Discussion with microbiology specialists should also be considered.
EP-238 Challenges of delivering a tertiary breast cancer service during the COVID-19 pandemic
Authors: Mehta Anjali , Whisker Lisa , Oni Georgette 
Published: November 2022

Abstract

Introduction
Delivering a breast service during the COVID-19 pandemic has been challenging. At our tertiary referral centre, we have had to coordinate care across multiple sites in order to maintain provision of services. This study looks at how this was achieved at the Nottingham Breast Institute (NBI) by a team of 6 Consultant Surgeons.

Methods
This was a retrospective review of a prospective data base (managed by one Consultant Oncoplastic surgeon) of all patients treated at the NBI over a period of 18 months, at the start the pandemic from March 2020 to October 2021. Data collected included patient demographics, hospital site, and type of surgery.

Results
Over the 18 months 1191 patients were operated on. The average age was 57.8 years (range 17 to 86); as expected the commonest indication was cancer (93.1%). 11.3% of those patients (125/1109) received neoadjuvant chemotherapy. Of these 37.4% of patients (N=446) were operated on at our usual operative base site (NBI). 49.5% and the majority of cases (N=589) were performed across two independent hospitals and a smaller proportion (12.9%) was conducted at a fourth hospital which offered 23 hour stay facilities.

Conclusions
Despite the challenges of securing operative capacity, thus far, we have been able to deliver over 1000 breast cancer surgeries during the COVID-19 pandemic. This is due in part to multisite working, surgeon flexibility, and oversight of all the patient pathways collated on one database by a dedicated surgeon.
EP-244 A “missed” nasal button battery in a child during the COVID-19 pandemic
Authors: Anastasiadou Sofia , Chan Jacqueline , Janjua Ah 
Published: November 2022

Abstract
A 5-year-old boy was referred acutely to the on-call ENT doctor following multiple remote consultations with his general practitioner with 2 months history of worsening left-sided foul-smelling nasal discharge and bleeding. He underwent examination under anaesthesia and removal of nasal foreign body which was subsequently identified as a button battery (intra-operative as well as imaging pictures included). This case highlights the challenges posed to clinicians during the COVID-19 pandemic but also serves as a reminder to keep a high index of suspicion and low threshold for clinical examination in suspected cases of nasal foreign body. It also highlights that since COVID19 omicron variant has emerged it is more than significant to evaluate cases that are assessed remotely with increased care to avoid any further misses or mistakes.
EP-257 A case report of Furuncular myiasis affecting the glans penis of a young boy caused by the larvae of Cordylobia anthropophaga (The Tumbu Fly)
Authors: Jesuyajolu Damilola , Jesuyajolu Paul 
Published: November 2022

Abstract

Introduction
Cutaneous myiasis is endemic in West Africa, and it is most commonly caused by the larvae of Cordylobia anthropophagia. In English literature, recorded cases of this cutaneous myiasis affecting the glans penis are rare. This rarity calls for a need to consider this as a differential when looking at furuncular lesions of the glans penis. This awareness is important for practitioners who may come across this case.
We report a case of furuncular myiasis of the glans penis due to the larvae of C.anthropophaga of an 11-year-old boy living in Lagos, Nigeria.

Case presentation
We present an 11-year old boy who presented to the surgical emergency department with a lesion on his glans penis, initially thought to be a boil. Upon examination, the lesion contained a single larva of C.anthropophaga. After sedation of the patient, It was extracted in the mini-theatre with a non-toothed forceps and dressed, and the area healed well.

Discussion
Although endemic, furuncular myiasis of the glans penis is a very rare condition, likely related to the living circumstance of the patient. An awareness of the clinical features is important to prevent misdiagnoses of foruncular lesions that occur on the glans penis, especially in people with identified risk factors.
Health education and promotion of good hygiene are important in reducing the incidence of Cordylobia anthropophagia infestation in endemic regions as well as among frequent travelers to and from endemic areas.

Keywords
myiasis, cutaneous myiasis, Cordylobia anthropophagia, glans penis, Tumbu fly
EP-306 Management of acute sigmoid diverticulitis in a district general hospital – a retrospective audit
Authors: Egbe Azelle 
Published: November 2022

Abstract

Aim
Acute sigmoid diverticulitis is one of the most common emergency general surgery conditions. Guidelines from the European Society of Coloproctology published in 2020 outline best practice in management, including a move away from routine antibiotic therapy. This audit aims to assess compliance with these guidelines.

Methods
Electronic records of all patients admitted under the emergency general surgery team with acute sigmoid diverticulitis in 2021 were analysed to obtain information on management. These data were compared against the 2020 guidelines to assess compliance.

Results
99 patients were admitted with acute sigmoid diverticulitis in 2021. 97% of patients underwent an abdominal CT scan and 100% received IV antibiotics.
65% of cases were classified as uncomplicated and 35% were classified as complicated (i.e. abscess formation or perforation).
The mean length of stay for all patients was 5.7 days. The length of stay for patients with uncomplicated diverticulitis was 3.7 days compared to 9.3 days for complicated diverticulitis. 10% of patients underwent surgical intervention and no patients underwent radiological intervention.
Only 57% of patients were referred for an outpatient lower GI endoscopy.

Conclusion
These results raise three main insights for further consideration. Firstly, it appears that the evidence against routine antibiotic therapy for acute diverticulitis is not yet being reflected in clinical practice. Secondly, patients admitted with uncomplicated diverticulitis have a relatively short length of stay, indicating a role for ambulatory management of this common condition. Lastly, referral rates for outpatient endoscopy must be improved to ensure that patients with an underlying malignant lesion can be identified.
EP-319 Evaluating the outcomes of patients treated with surgical vs IR cholecystostomy during the COVID-19 pandemic
Authors: Gunn Christopher , Alam Imran 
Published: November 2022

Abstract

Aims
We evaluated the outcomes of patients treated with laparoscopic cholecystostomy versus percutaneous (IR) cholecystostomy during the COVID-19 pandemic.

Methods
Electronic records of patients undergoing cholecystostomy during the COVID-19 peak in 2020 were analysed. Our primary outcomes were the number of readmissions and subsequent completion of laparoscopic cholecystectomy.

Results
6 patients underwent laparoscopic cholecystostomy between January and December. 3 were performed following failure of cholecystectomy, 2 were unfit for cholecystectomy and one underwent surgery due to lack of radiologist availability. 9 IR cholecystostomies occured between March and July. 4 were unfit surgical candidates, 5 were due to COVID related restrictions on operating. 6 readmissions came from the surgical cohort, 4 for infection compared to 3 from the IR cohort with only 1 for infection. Notably, of the 4 IR-drained patients deemed unfit, only one had a subsequent gallbladder related admission. 3 surgical patients underwent definitive surgery, 2 subtotal and 1 total cholecystectomy with a mean time to definitive treatment of 27.5 weeks. 4 IR patients underwent surgery with 1 abandoned, 1 subtotal and 2 total cholecystectomies with a mean time to definitive management of 20.25 weeks.

Conclusions
IR cholecystostomy showed reduced readmission rates compared to laparoscopic cholecystostomy, especially related to infection with rates of 11% and 66%, respectively. More patients underwent total laparoscopic cholecystectomy following IR drainage. However, adhesion formation proved troublesome in both methods. IR cholecystostomy showed a reduced time to definitive surgery. Finally, most high-risk patients undergoing IR cholecystostomy had no further gallbladder related admissions therefore proving its utility in such groups.
EP-341 Haemorrhagic Cholecystitis with cystic artery pseudo-aneurysm
Authors: Nessa Ashrafun , Milburn James , Ramsay George 
Published: November 2022

Abstract

Introduction
Haemorrhagic cholecystitis and cystic artery pseudo-aneurysm (CAP) are two very uncommon causes of right upper abdominal pain. However, the development of haemorrhagic cholecystitis induced by ruptured cystic artery pseudo-aneurysm and haemobilia are extremely rarely documented with few occurrences documented in the literature.

Case presentation
A 80year-old frail patient was admitted with RUQ pain, deranged LFTs and melaena. She had known gall stones, hypertension, chronic kidney disease and fibromyalgia. She demonstrated localized tenderness in the right abdomen and bloods showed a significant drop in haemoglobin which required blood transfusion. Abdominal ultrasound showed cholecystitis and MRCP showed CBD dilatation with no choledocholithiasis. She was found to have haemorrhagic cholecystitis and CAP along with a cholecysto-colonic fistula on triple phase liver CT. The patient underwent urgent embolization of the CAP and remained clinically stable. She was discharged home with a plan of further review before consideration for cholecystectomy.

Clinical discussion
Haemorrhagic cholecystitis and CAP are rare. Clinical suspicion is warranted to diagnose the case – the combination of features of cholecystitis with acute anaemia should raise the suspicion. Diagnosis is made primarily by pathognomonic findings on appropriate phase of CT and US imaging. Prompt diagnosis and management is essential in preventing mortality and/or significant morbidity.

Conclusion
A rare consequence of intra-biliary bleeding due to ruptured CAP leading to haemorrhagic cholecystitis is a potential differential diagnosis in patients presenting with right upper abdominal pain and haemoglobin drop. Close liaison with radiologist is warranted to organise appropriate investigation for diagnosis and successfully manage the condition.
EP-343 Compliance of Prescription of Intravenous Maintenance Fluids in Acute Surgical Patients According to NICE Guidelines
Authors: Morsy Hesham , Li Michael , Davidson Chris , Gu Kat , Ali Maryam , Hollingshead James , Patel Dharti 
Published: November 2022

Abstract

Aim
Assess compliance of prescription of for intravenous maintenance fluids in accordance with NICE Guidelines in the acute surgical admissions population.

Method
Total of 158 patients were included. We collected data prospectively for surgical patients admitted between 25/02/21–18/03/21 (first cycle) & 12/09/2021–4/10/2021 (2nd cycle). Maximum of 5 patients daily randomly selected. Data collected in wards after clerking on Day 1 of admission. Surgical Proforma was used to identify feeding plan for patients. Drug charts used to assess volume and types of intravenous fluids prescribed. Admissions by audit authors were excluded to prevent selection bias.

Intervention
Posters in Emergency Assessment Unit and Wards, Teaching to junior doctors, Regular reminder messages to on-call teams.

Results
Prescription of Intravenous Maintenance Fluids in Acute Surgical Patients in compliance with NICE guidelines for IV Fluid maintenance rose from 6% to 22% between cycle 1 and 2, respectively. In non-compliant prescriptions, the issue was due to excess volume (73%), sodium and chloride (88%) as well as inadequate potassium (75%) and glucose (40%).

Conclusions
Most acute surgical admissions require maintenance fluids. Some patients did not have their weight recorded which is necessary for correct calculation of fluid requirements. Some patients were prescribed maintenance fluids although they were not indicated. Most patients received an excessive fluid volume, sodium & chloride. Most patients received inadequate potassium & glucose. Ward based nursing staff are reluctant to give maintenance fluids containing potassium. More teaching and awareness on correct prescription of maintenance fluids is needed.