bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP-364 The new normal in the post-pandemic world: Our experience of organising a three-part webinar series for the CST 2022 Applicants
Authors: Rahman Atiqur , Badawi Marwa , Swamad Mohamed , Ali Ramla , Vincent Elizabeth , Sharp Elizabeth 
Published: November 2022

Abstract

Introduction
In the time of COVID-19, the influx in the use of the online platform has been paramount. The surgical world is no exception with the first virtual selection process for Core Surgical Training (CST) 2021 applicants. We, the current core trainees from the Kent, Surrey and Sussex (KSS) deanery organised this three-part webinar series for CST 2022 applicants to aid our future colleagues.

Materials and Methods
The event poster was circulated among the surgical tutors, medical education department across the KSS region, all the foundation schools and to Foundation Trainees Surgical Societies (FTSS) across the UK. It was advertised on Facebook, Twitter, WhatsApp and Eventbrite. Google Workspace was used to manage registered participants and Microsoft Teams were used for the webinars.

Discussion
A total of 526 participants registered. 69.9% of them registered through social media whereas 16.4% and 9.8% through the medical education department and word of mouth respectively. The first part covering the CST program overview and self-assessment guidance was attended by 96 of them on 16 November 2021. The second part covering interview stations was attended by 29 participants on 14 December 2021. We received positive feedback from 42 and 8 participants following each webinar respectively. We currently have 88 participants registered for our mock interview sessions planned for late January 2022.

Conclusions
The virtual selection process is here to stay. Well-organised events like this will help the candidates prepare well for their interview as well as helping the current trainees with their teamwork, leadership and organisation skills.
EP-370 Contemporary clinical management strategies in lower gastrointestinal bleeding: A single-centre retrospective observational study
Authors: Julius Barbara , Chan Kin Yik , Jaffer Alisha , Liau Yun Hui , Tormey Shona 
Published: November 2022

Abstract

Aim
Significant heterogeneity exists in the recommendations for the diagnosis and management of acute lower gastrointestinal bleeding (LGIB). This study aims to demonstrate the contemporary management strategies adopted by a busy tertiary hospital.

Methods
We conducted a single-centre retrospective review of adults presenting to our institution with LGIB between January and March 2021. Demographic data, observations, laboratory results, endoscopy and radiology reports, operation notes and discharge summaries were collected for each patient via a retrospectively maintained registry.

Results
23 patients were included. Mean age was 66.6 years with a mean initial haemoglobin of 10.9 g/dL (Range 4.1–15.5g/dL). 17% of patients were in circulatory shock on presentation. 70% of patients presented with haematochezia. 47.8% of patients were on either an anticoagulant or anti-platelet agent at presentation. The transfusion index in this cohort was 30%. 26.1% of patients had a re-bleed during their admission. The diagnostic yield of cross-sectional imaging amongst 11 patients was 27.3% with no correlation with haemodynamic status or active bleeding. 47.8% of patients underwent endoscopy and 27% of patients who underwent an endoscopic procedure required endoscopic haemostasis. Flexible sigmoidoscopy was the commonest endoscopic modality (55%), followed by gastroscopy (27%) and colonoscopy (18%). No patients required surgical or radiological intervention. No cause of bleeding was identified in 26% of patients.

Conclusion
This study confirms the variation in diagnosis and management of LGIB. Despite access to onsite interventional radiology, endoscopy remained the predominant diagnostic and therapeutic modality. Routine cross-sectional imaging may not be justified given its suboptimal diagnostic yield.
EP-383 Correlation between delays to emergency laparotomy and outcomes at a large District General Hospital (DGH)
Authors: Patel Maitreyi , Thomas Joel Joy , Aguayo Xavier , Gutmann Daniel , Wain Mehmood 
Published: November 2022

Abstract

Aims
Significant morbidity and mortality are associated with emergency laparotomies. Delays to theatre inevitably increase the risk of sepsis, deterioration, failure to rescue and death. The aim of our study was to determine the outcomes associated with delays of non-vascular emergency laparotomies at a large DGH.

Methods
A retrospective review of a prospectively maintained database was performed of all patients who underwent general surgical emergency laparotomy over a 10 week period from 10th June 2021 to 25th September 2021. Outcomes of patients were compared between delayed and non delayed surgery as per NCEPOD classification.

Results
76 patients were included in the study, 46.05% were males. 15 (19.74%) patients had a delay to surgery. The most common indication for surgery was obstruction (63.16%), followed by perforation (27.63%). The patients requiring urgent surgery were least likely to arrive in theatre within the correct timeframe. 18.34% of patients experienced a delay if a decision is made for surgery during the day (0800–2000) compared to 30% at night (0000–0800). Severe complications, (Grade 3 and 4 on Clavien Dindo classification) occurred in 13% of those who had a delay to surgery, compared to 16% in those without delays. Total 30-day mortality was 9.2%. There was no significant difference in the outcomes of patients who had a delay and those who did not.

Conclusion
Delay in arrival to theatre was more amongst patients requiring urgent surgery. The time of day or week did not affect the time to theatre. Delay did not result in significant difference in outcomes.
EP-422 Operating in the outpatient department: the future of flexor tendon repair?
Authors: Rayner Anthony , Mohamed Ahmed , Mikhail Mark , Gardiner Matthew 
Published: November 2022

Abstract

Aims
Flexor tendon injuries are debilitating with rupture of repair leading to significant morbidity. The SARS-CoV-2 pandemic has led to a shift to out-of-theatre operating, with many flexor tendon repairs being performed on the same day as initial assessment in our outpatient department (OPD) procedure room. We aimed to compare the rupture rates before and after the start of the pandemic to assess the safety of this change in practice.

Methods
Patients who underwent repair of one or more flexor tendons were included from two six-month periods: July to December 2019 and April to September 2020. Patient records were reviewed to identify operation location, number of flexor tendons repaired per patient and rupture incidence. In the second period, patients whose operation was performed in theatre were excluded.

Results
28 patients were included for the initial period with a total of 49 flexor tendons injured. All repairs were performed in theatre and 3 ruptures were recorded (6%). 17 patients underwent flexor tendon repair during the second period. 11 patients were operated on in the OPD with a total of 16 flexor tendons injured. 1 rupture was recorded (6%).

Conclusions
The rupture rate of OPD operating is comparable to that of the traditional theatre pathway. OPD operating also allowed us to circumvent theatre waiting lists and thus avoid costly delays to patient care. This project demonstrates maintained safety for patients and offers a platform for further research to confirm OPD operating as a viable and sustainable alternative for future practice.
EP-490 Management of femoral non-union with post-traumatic bone defect using second-generation PRECICE® nail - A Case Report
Authors: Lu Victor , Zhang James , Krkovic Matija 
Published: November 2022

Abstract

Introduction
The management of post-traumatic bone defects with non-union remains a surgical challenge. Common limb length discrepancy (LLD) procedures involve Masquelet technique, vascularised bone grafts, distraction osteogenesis using external fixators, yet they pose a functional and economical challenge for patients, given high complication rates and need for revision surgery. Magnetically-driven PRECICE nails are self-lengthening internal devices activated via an external controller. We present one patient with post-traumatic femoral non-union with concomitant bone defect, using second-generation PRECICE nail.

Case
One 57 year-old gentlemen suffered open femoral fracture after a motorcycle accident. Having previously undergone open reduction internal fixation, he presented to us with atrophic non-union and bone defect, which were simultaneously treated with a second-generation PRECICE nail. Our treatment protocol was based on the strain theory, and involved initial distraction by ∼5mm at non-union site, at a rate of 1mm per day, to decrease strain on bone graft cells and promote callus formation. One week later, the non-union site was compressed to close the gap completely. After another four weeks, distraction using the PRECICE nail started, in increments of 0.25mm, four times a day, until the desired length was achieved. The patient achieved union and the initially planned limb lengthening regime was achieved with minimal complications.

Conclusions
By initially distracting the bone defect by ∼5mm, then compressing the gap, before distraction started, strain on bone graft cells was minimised, allowing robust callus and regenerate growth. Self-lengthening, magnetically-driven PRECICE nails can successfully restore union and manage limb length discrepancies with reasonable patient satisfaction and minimal complications.
EP-499 Is cleaner and greener NHS a pipe dream or a real possibility?
Authors: Bodapati Shruti , Gambhir Raghvinder Pal Singh , Kimura Shiori 
Published: November 2022

Abstract

Aim
In October 2020, the NHS committed to become the world's first carbon net-zero National Health Service by 2045. The aim of the study was to see what is Surgeon's role towards sustainability.

Methods
To review the Sustainable NHS with target of Net zero NHS proposal and analyse the changes being implemented at national and regional level. To assess how the surgical practice needs to contribute.

Results
Operating theatres contribute 30% of hospitals carbon footprint as the NHS contributes to nearly 5% of the country's carbon emissions. Exhaled anaesthetic gases are major contributors to the greenhouse effect and account for 5% of NHS foot print. Switch to more renewable sources of energy, to LED lights will offset some of that as will local products in the Supply chains.
In theatres abandoning the use of single use plastics and switching to reusable instruments, as well as water free hand washes will help. Blue-zone technologies’ that capture, reclaim and purify halogenated agents should become a standard practice. Record of daily theatre waste is not being recorded.
Optimal use of video technology for remote clinics and providing diagnostics and some interventions at non hospital sites will decrease patients need to travel and their carbon footprint.

Conclusions
There is need to accelerate awareness and encourage surgical care groups to change practice. Green sustainable theatres have to be standard in all new builds. Specialty specific, theatre waste analysis reports need to be presented in Monthly audits.

Reference
1. https://www.gov.uk/government/news/uk-health-services-make-landmark-pledge-to-achieve-net-zero
EP-503 An Audit of Day case surgery for Inguinal Hernia Repair
Authors: Gulnaz Nadia , Akram Farhan , Masala Ilaria , Dar G.Murtaza , Siddique Khurram 
Published: November 2022

Abstract

Aims
To compare the trust-wide performance with the standard by the British Association of Day Surgery in the management of inguinal hernias.

Methods
Electronic data of patients who underwent Inguinal Hernia Repairs in the trust from September 2019 to December 2019 was analyzed.

Results
A total of 122 male and 11 female patients had hernias repaired in this time period.18 were emergency while the rest of the cases were elective. The ages ranged from 19–91 with a mean age of 62. Of the 115 electives, 60% were performed as day-case. The mean length of stay was 1.7days (R 0–12).34 out of 46 (74%) patients who stayed inpatient were actually booked as day-case. 73% had no documented reason for their admission.4 patients were admitted for medical reasons 2 for post-operative surgical complications. Of patients pre-booked as inpatients,10 were quoted to have serious medical issues while 5 had no clear reason. The vast majority had open repairs while 26% of the 115 patients had laparoscopic repairs.

Conclusion
Our Performance was noted to be 30% lower than the BADS standard. There is a need of:
Development of inpatient surgery booking criteria and adherence.
Discussion with anesthetic colleagues to assist drive towards day-case surgery.
Clear documentation in the clinical letters to explain the reason for inpatient management and booking.
Perioperative notes need improvement.
EP-569 Case Report: An unusual case of prodigious Gigantomastia with macroprolactinemia and suspected autoimmune disease
Authors: Malik Mariam , Brookes Phil , Green Matthew J , Kasana Mohammad Iqbal 
Published: November 2022

Abstract
Macroprolactinemia is characterized by most authors, as a benign condition with no clinical implications. Gigantomastia is the progressive breast enlargement, usually bilateral. Due to its rare presentation, fewer numbers of cases have been reported and its association has yet to be fully established. It is usually presented during puberty and pregnancy and its association with hyperprolactinemia, macroprolactinemia, and autoimmune diseases are reported but in small numbers. Its management is improving the clinical symptoms and it varies from case to case. A 47 female premenopausal with sudden onset of massive enlargement of the bilateral breast without galactorrhea over 18 months. She also noticed joint pain and swelling with her breast enlargement. She was referred to the breast clinic for managing breast-related symptoms associated with gigantomastia like mastalgia, neck and back pain, postural issues, and recurrent breast skin eruptions. Her serum investigation showed a Prolactin level of 1708 mIU/L and was also referred to an endocrinologist to rule out prolactinoma. She underwent bilateral breast reduction and a total of 12 KG breast tissue from both breasts were removed and she is under further investigation for autoimmune diseases. The present report followed this patient from diagnosis, surgical intervention, and establishing its association to any other condition. Even though gigantomastia is an erratic condition and is a rare entity, its timely investigation and association to other clinical conditions like hyperprolactinemia or macroprolactinemia and arthritis are essential in the efficacious management of this condition. Gigantomastia outside the reproductive age group needs further research.
EP-570 Rare case of pre-pyloric perforation of stomach secondary to foreign body ingestion
Authors: Hopkisson Lucy , Pangeni Anang , Shrestha Ashish 
Published: November 2022

Abstract

Background
Gastrointestinal perforation remains a common cause of acute abdomen in clinical practice. However, pre-pyloric perforation secondary to ingested foreign body (FB) in the adult population is rare. Nearly 80–90% of ingested foreign bodies will pass through the GI system spontaneously with only 1% requiring surgery. We report a rare incidence of pre-pyloric perforation in a patient unaware of ingestion of any foreign body.

Case presentation
A 59 year old female with no medical history, presented to the ED department with severe epigastric pain, vomiting and fever. She had a peritonitic abdomen and corroborative inflammatory markers. An urgent computed tomography scan demonstrated a 7×5cm collection near the transverse colon and a linear streak of hyperdense material near the collection. Patient had no recollection of ingestion of FB. Diagnostic laparoscopy followed by laparotomy, revealed inflammation and necrotic adipose tissue between the transverse colon and stomach walling of a purulent cavity. A 2cm shard of glass was retrieved. Examination of the posterior wall of the stomach eventually located the site of perforation. Generous washout, debridement and suture repair with omental plug was performed. She made an uneventful recovery.

Conclusion
Sharp objects do not pass via the pylorus easily and can cause perforation in the proximal part of gastrointestinal tract. Any features of complication mandates exploration and examination of the posterior surface of the stomach is quintessential
EP-577 Seasonal Variation of Presentation of Perforated Peptic Ulcer Disease: An Overview of Patient Demographics, Management and Outcomes in Northern Ireland
Authors: Yawar Bakhat , Marzouk Ahmed , Ali Heba , Ghorab Tamer , Asim Ayeisha , Abousamra Mohammad , Asim Asim 
Published: November 2022

Abstract

Background
Perforated peptic ulcer disease is one of the most common causes of acute peritonitis. It carries significant mortality and morbidity. Several previous studies have reported a seasonal variation in presentation of patients with perforated ulcers. Here we present this study from a Northern Irish perspective on perforated peptic ulcers.

Methods
A retrospective cohort study was conducted on perforated peptic ulcer patients who presented to Altnagelvin Area Hospital emergency department between 2015 to 2020. Data on patient demographics, clinical presentation, investigations, management and outcomes were collected. Primary outcome was to investigate if seasonality was associated with incidence of perforated peptic ulcers. Followup data was also collected. Seasons were defined as per UK Met Office.

Results
A total of 50 patients presented with perforated PUD. Male:female ratio was approximately 3:2. Peaks were noted in spring and winter. April was the most common month for presentation followed by December. Smoking was the most common risk factor followed by alcohol abuse. 14 patients (28%) were either very frail or had contained perforations and were conservatively managed. 3 deaths were noted (6%). 13 patients (26%) required ICU admission at some stage in their management.

Conclusions
Slight seasonal variation was noted in presentation of perforated peptic ulcers in our study with more common incidence in winter and spring months. The month of April was noted to have the peak incidence of the disease in our study.
EP-585 An Evaluation of Plastic Surgery Post-Operative Follow Up Planning in Line With Local Guidelines
Authors: Khanna Rahul , Carhart Benjamin , Mwaura William 
Published: November 2022

Abstract

Aim
Post-operative follow up is an important aspect of surgical management plans. This audit evaluated whether the documentation of post operative follow up plans within plastic surgery operation notes, for three common operation categories, adhered to local guidelines.

Methods
This audit looked at one month's worth of follow up plans within a plastic surgery department in 2021. Specifically, the documentation within the operation note was audited for three operation categories: tendon repairs, K wire insertions and manipulations under anaesthetic (MUA). These operation notes were compared to local follow up guidelines and adherence was analysed. The results were presented within the department. Posters displaying the guidelines were created and placed in theatres, as well as circulated via WhatsApp. A second cycle was then undertaken.

Results
Each operation category guideline, consisted of various aspects of recommended follow up. Issues noted from the first cycle included an inaccuracy in the timing of follow up appointments. This was particularly evident in the MUA category where only 55% of cases having follow up appointments documented for the correct date. Following intervention, the K wire one week follow up appointment documentation improved from 40% to 67%.

Conclusions
Overall, an improvement in adherence to guidelines was observed during the second cycle following the intervention. The best impact was seen in the K-wire category, where all three aspects of that specific follow up guideline showed an increase in compliance. Publicising the follow up guidelines had a positive impact on the documentation of surgical follow up plans.
EP-624 Pioneering makeshift endosponge in the management of Post Low Anterior resection leak: Experience from a resource limited country
Authors: Rehman Abdul , Anwer Abdul Wahid , Mushtaq Usman , Khattak Shahid , Ali Syed Aamir 
Published: November 2022

Abstract
The aim of our study was to devise a method of salvaging anastomotic integrity in patients who develop leak post low anterior resection for rectal cancer. Although endopsonge is an established entity and has been in use for a while now as minimally invasive method but its availability is non existent in our region of the world.
We came up with a method based on the principle of endosponge to be used in patients who develop anastomotic leak. We used a Jackson Pratt drain to create a low cost and easily reproducible endosponge. We did regular washouts in the theater, endoscopy suite and in the ward. Until now we have managed 2 patients who developed defect in anastomotic integrity.
The results are very promising. Both patients have shown complete response in terms of complete resolution of pre sacral cavity and closure of the defect in the anastomotic integrity.
Although these are only 2 cases but this makeshift endosponges can prove to be a very important part of the armamentarium of a colorectal surgeon in areas of the world where endosponges are not available.
EP-625 An audit looking at whether consent has been gathered to upload patient details to the National Vascular Registry in Countess of Chester Hospital
Authors: Mewse Jacob , Iqbal Faisal 
Published: November 2022

Abstract

Aims
The National Vascular Registry (NVR) forms part of The Vascular Society and aims to improve the quality of care for patients with vascular disease by measuring the quality and outcomes of care for patients who undergo major vascular surgery.
Within the vascular department at Countess of Chester Hospital, patients had not consented for their information to be uploaded to the NVR but were still being uploaded post procedure.

Methods
A retrospective audit collected data from all vascular procedures performed in September 2021 in the Countess of Chester Hospital. For each procedure, we checked whether the data was uploaded to the NVR and where consent had been gathered from the patient to upload their data to the NVR.

Results
Of 57 procedures performed in September 2021:

Conclusion
Of 57 procedures, data was uploaded to the NVR 42.3% of the time and of these, consent from the patients was only gained 43.5% of the time.
With these results there is room for improvement within the department, firstly to consent patients to allow their data to be uploaded to the NVR and then to upload the data following procedures.