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Global Impact of COVID-19 pandemic on Gastric Cancer Treatment: findings from a global cross-sectional multicentre study (GLEOHUG-GC) (2022)

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Type of publication:Conference abstract

Author(s):Herrera Kok J.H.; Viswanath Y.K.; Parmar C.; Bangash A.H.; Samaduv E.; Atici S.D.; Cheruvu C.V.; Abouelazayem M.; Yang W.; Galanis M.; Di Maggio F.; Isik A.; *Bandopyadaya S.; Mahawar K.

Citation:European Journal of Surgical Oncology; Feb 2022; vol. 48 (no. 2)

Abstract:Background: Gastric cancer (GC) is the 5th most common malignancy and remains one of the major causes of worldwide cancer-related deaths. COVID-19 pandemic has had a significant impact on the provision of cancer care. This study aims to overview the global standpoint of gastric cancer patients (GCP) during the first year of pandemic (PY1).
Material(s) and Method(s): The Upper Gastrointestinal Surgeons (TUGS), within its Global Level of Harm Project, designed an online cross-sectional survey to assess how GCP's management changed during PY1. The questionnaire included 33 questions about expertise, kind of health system, hospital organization and screening policies, personal protective equipment (PPE), change in patient's characteristics, preoperative, operative and postoperative management of GCP.Result(s): There were 209 answers from 178 centres (50 countries) around the world. Results of the survey showed: most hospitals (88,2%) had restricted areas for the management of COVID-19 patients; 53,6% of participants were redeployed; most frequent COVID-19 screening methods were PCR (78,8%) and chest CTscan (25,6%), and 55,9% thought there was a lack of PPE. Preoperative management: 43,2% decrease in the number of multidisciplinary teams (MDT) meetings; 28,4% increase in the number of cT2 or higher GCP; 34,7% increase in metastatic (M1) GCP; 26,8% increase in GCP receiving definitive palliative treatment; 23,7% increase in the number of frail patients; 50% increase in waiting list time (WLT); and 41,6% faced problems in the provision of oncological treatment. Operative management: 54,5% decrease in elective gastrectomies; 29,1% increase in the number of urgent/semi-urgent gastrectomies; 37% decrease in the number of minimally invasive gastrectomies (MIG); and 18,5% increase in the number of surgeries with palliative intent. Postoperative management: 16,5% increase in the overall complication rate (OCR); 12,6% increase in the number of Clavien-Dindo 3 or higher complications; 8% increase in the leak rate; increase in pulmonary infections (26,8%) and bowel obstruction (2,4%); 44,5% development of postoperative COVID-19 infection; 15,4% increase in 30-days mortality rate; 23,1% mortality due to COVID-19 infection; 17,6% increase in the need for adjuvant treatment. Most patients were postoperatively assessed either through a face to face consultation or a combination of face to face and remote consultation.
Conclusion(s): COVID-19 pandemic has affected GC management by decreased frequency of MDT's, higher clinical-stage migration and fuelled frailty. The pandemic increased WLT, the number of urgent and palliative surgeries, OCR, Clavien-Dindo 3 or higher complications, leak rate, and pulmonary infections. There was a noticeable high rate of postoperative COVID-19 infection and associated mortality. Further multicentric studies are warranted to affirm these findings.

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A study analysing the effect of wet wraps in patients of atopic dermatitis (2021)

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Type of publication:Journal article

Author(s):Kakroo S.N.; Beg M.A.; *Kakroo B.

Citation:Journal of Pakistan Association of Dermatologists. 31(4) (pp 588-594), 2021

Abstract:Objective We sought to evaluate the efficacy of wet wrap therapy treatment in patients with Atopic dermatitis. Methods Total 30 patients, (25 males and 5 females) were enrolled in this study with severe dermatitis [SCORAD] score >=50) were enrolled in this study. For disease severity SCORAD was used, for quality of life dermatology life quality index (DLQI) scores, visual analog scale (VAS) for pruritus and investigator's global assessment (IGA) was used. For evaluation of water content in the corneum, the capacitance was measured by Corneometer (Courage and Khazaka, Cologne, Germany), and TEWL was measured by Tewameter TM210 (Courage and Khazaka). The lipid amount of skin surface was assessed by Sebumeter (Courage and Khazaka). The patients underwent WWT (daily dose: 15 g Mometasone furoate cream+100g Vaseline ointment) twice daily for 2 h/session for 7 days. Results There was significant improvement in lesions, quality of life and itching. SCORAD was clearly decreased, epidermal water content was increased, and transepidermal water loss was decreased after wet-wrap dressing. Conclusion Wet wrap therapy (WWT) can relieve pruritus, reduce skin lesions, and improve quality of life.

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CORONA (COre ultRasOund of covid in iNtensive care and Acute medicine) study: National service evaluation of lung and heart ultrasound in intensive care patients with suspected or proven COVID-19 (2022)

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Type of publication:Journal article

Author(s):Parulekar P.; Powys-Lybbe J.; Aron J.; Knight T.; Lasserson D.; Smallwood N.; Rudge G.; *Miller A.; Peck M.

Citation:Journal of the Intensive Care Society; 2022 [epub ahead of print]

Abstract:Background: Combined Lung Ultrasound (LUS) and Focused UltraSound for Intensive Care heart (FUSIC Heart – formerly Focused Intensive Care Echocardiography, FICE) can aid diagnosis, risk stratification and management in COVID-19. However, data on its application and results are limited to small studies in varying countries and hospitals. This United Kingdom (UK) national service evaluation study assessed how combined LUS and FUSIC Heart were used in COVID-19 Intensive Care Unit (ICU) patients during the first wave of the pandemic. Method(s): Twelve trusts across the UK registered for this prospective study. LUS and FUSIC Heart data were obtained, using a standardised data set including scoring of abnormalities, between 1st February 2020 to 30th July 2020. The scans were performed by intensivists with FUSIC Lung and Heart competency as a minimum standard. Data was anonymised locally prior to transfer to a central database. Result(s): 372 studies were performed on 265 patients. There was a small but significant relationship between LUS score >8 and 30-day mortality (OR 1.8). Progression of score was associated with an increase in 30-day mortality (OR 1.2). 30-day mortality was increased in patients with right ventricular (RV) dysfunction (49.4% vs 29.2%). Severity of LUS score correlated with RV dysfunction (p < 0.05). Change in management occurred in 65% of patients following a combined scan. Conclusion(s): In COVID-19 patients, there is an association between lung ultrasound score severity, RV dysfunction and mortality identifiable by combined LUS and FUSIC Heart. The use of 12-point LUS scanning resulted in similar risk score to 6-point imaging in the majority of cases. Our findings suggest that serial combined LUS and FUSIC Heart on COVID-19 ICU patients may aid in clinical decision making and prognostication.

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Paediatric Injuries Pre And During COVID-19 Requiring an Operative Intervention: The District General Hospital Experience (2021)

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Type of publication:Conference abstract

Author(s):*Howard E.; *Arshad S.; *Kabariti R.; *Roach R.

Citation:British Journal of Surgery; Sep 2021; vol. 108, Supplement 6

Abstract:Aim: To assess the effect of lockdown and the following summer period on paediatric trauma patients who required an operative intervention in a district general hospital. Method(s): A single centre retrospective audit was performed on all paediatric patients <16 years requiring an operative intervention. Two study periods were assessed-pre-COVID (22/03/2019-30/09/2019) and during the COVID-19 pandemic and subsequent summer period (26/03/ 2020-26/09/2020). Data were collected on patient demographics, type of injury sustained, and intervention performed. Result(s): During the COVID-19 pandemic 119 operations were performed, compared to 238 operations performed before the pandemic. Distal radius fractures were the most common injury both during and before the pandemic. However, during the pandemic there was a higher incidence of both hand injuries and lower limb lacerations. The most common type of operation both before and during the pandemic was manipulation under anaesthetic, but there was an increased incidence of washouts performed during the pandemic. Conclusion(s): Despite extensive restructuring of services due to COVID-19, 119 operations were performed during the pandemic. However, this is 119 fewer operations than the same period of the previous year. The reduced rate of operations could be a consequence of increased parental supervision, and less outdoor activity during the pandemic period, but further research is necessary.

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Organising a surgical conference during the COVID-19 pandemic-is it 'virtually' the same? (2021)

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Type of publication:Conference abstract

Author(s):Hashmi Y.; Sahu M.A.; Hatt K.; Osman S.; Bhuiyan Z.A.; *Ahmed U.

Citation:British Journal of Surgery; Sep 2021; vol. 108, Supplement 6

Abstract:Introduction: Surgical conferences are invaluable events for healthcare professionals; they provide opportunities to engage with upcoming scientific discoveries, network professionally with peers as well as expand learning through lectures and workshops. For medical students, conferences provide an opportunity to expand understanding beyond the undergraduate curriculum in an interactive manner. COVID-19 has caused disruption to the organisation and attendance of in-person conferences (IPCs). Virtual conferences (VCs) offer a viable solution, allowing delegates to attend from the comfort of their own homes. Method(s): The aim of our study was to evaluate an organised VC and explore the perceived benefits and limitations of VCs compared to IPCs. A virtual one-day trauma & orthopaedics (T&O) conference was organised involving lectures, workshops, poster, and oral presentations. Anonymous questionnaire forms were distributed to delegates following the conference to assess the aims of our paper. Result(s): From 106 responses, 96.2% rated the conference as 'Excellent' or 'Good' with 92.5% stating that it increased their passion for T&O surgery. Based on a five-point Likert scale (5= strongly agree, 1= strongly disagree), mean score of agreement for preferring VCs to IPCs was 3.30(+/- 1.24). Key advantages of the VC were a lower cost (70.8%) and not having to travel (77.4%), whereas the main limitation was the inability to participate in hands-on workshops (84.9%). Conclusion(s): Despite the success of our VC, delegate feedback indicates a mixed response comparing VCs to IPCs. We share our findings to encourage similar events to be organised and for other specialties.

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Emotional Resilience and Bariatric Surgical Teams: a Priority in the Pandemic (2021)

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Type of publication:Conference abstract

Author(s):Graham Y.; Mahawar K.; Omar I.; *Riera M.; Bhasker A.; Wilson M.

Citation:British Journal of Surgery; Oct 2021; vol. 108, Supplement 7

Abstract:The infection control measures implemented as a result of COVID-19 led to a postponement of bariatric surgical procedures across many countries worldwide. Many bariatric surgical teams were in essence left without a profession, with many redeployed to other areas of clinical care and were not able to provide the levels of patient support given before COVID-19. As the pandemic continues, some restrictions have been lifted, with staff adjusting to new ways of working, incorporating challenging working conditions and dealing with continuing levels of stress. This article explores the concept of emotional labour, defined as 'inducing or suppressing feelings in order to perform one's work', and its application to multidisciplinary teams working within bariatric surgery, to offer insight into the mental health issues that may be affecting healthcare professionals working in this discipline.

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23-hour stay following total parathyroidectomy in renal patients (2021)

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Type of publication:Conference abstract

Author(s):*Neophytou C.; *Chang J.; *Howard E.; *Houghton A.

Citation:British Journal of Surgery; Oct 2021; vol. 108, Supplement 7

Abstract:Aim: Total parathyroidectomy in end-stage renal failure (ESRF), is an effective way to improve or stabilise calcium and parathormone levels and thus improve renal osteodystrophy. Previous BAEST guidelines were not in favour of true day-case neck surgery due to the risk of airway compromise from bleeding. Additionally, ESRF patients are at risk of profound hypocalcaemia after total parathyroidectomy. Patients undergoing total parathyroidectomy are prescribed Alfacalcidol 4mcg daily for 5 days prior to surgery. Following surgery under GA on a morning list, the potassium and calcium levels are checked in the afternoon. Calcium levels are then monitored daily for 3 days and subsequently when required. Oral Alfacalcidol is continued at the same dose until the nephrologists advise otherwise. Method(s): All ESRF patients undergoing total parathyroidectomy for secondary hyperparathyroidism were identified between 01/01/2005 and 31/12/2019 from a prospectively maintained electronic database. Demographics, biochemistry, length of stay (LoS) and outcomes were analysed. Result(s): There were 43 (30 male) total parathyroidectomies. The median age was 53 (range 14 – 78), and median LoS 1 day (range 0 -13). 26 patients (60%) were discharged within 23 hours (26% were day-case). Prolonged stay was due to calcium replacement (n=8) or dialysis (n=4) requirements. Pre- and post-operative calcium values over 2.49mmol/L were significantly related to 23-hour stay (p=0.010482 and p=0.000263 respectively). No 30-day re-admissions were observed Conclusion(s): Careful patient selection and adherence to a perioperative management protocol in total parathyroidectomy may enable early discharge within 23 hours. Preoperative calcium levels help predict this outcome.

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Fascial defect closure in laparoscopic incisional/ventral hernia: A systematic review and meta-analysis of published randomized, controlled trials (2021)

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Type of publication:Conference abstract

Author(s):Rehman S.; *Akhtar M.S.; Khan M.; Sains P.; Sajid M.S.

Citation:British Journal of Surgery; Oct 2021; vol. 108, Supplement 7

Abstract:Aims: Closure of fascial defect (CFD) during laparoscopic incisional/ ventral hernia repair (LIVHR) remains a controversial issue which requires further investigations to reach a solid conclusion. The objective of this study is to present a systematic review comparing the outcomes of randomized controlled trials evaluating the defect closure versus no-defect closure in patients undergoing LIVHR. Method(s): A systematic review of randomized, controlled trials reporting the fascial defect closure in patients undergoing LIVHR until January 2021 published in Embase, Medline, PubMed, PubMed Central and Cochrane databases was performed using the principles of metaanalysis. Result(s): A total of four RCTs involving 443 patients were included. In the random effects model analysis, using the statistical software Review Manager, defect closure during LIVHR showed no difference in hernia recurrence (risk ratio (RR), 0.89; 95% CI, 0.31, 2.57; z=0.21; P=0.84). In addition, the post-operative complications (RR, 0.69; 95% CI, 0.41, 1.16; z=1.41; P=0.16), duration of operation (Standardized mean difference (SMD), -0.04; 95% CI, -0.52, 0.43; z=0.18; P=0.86) and hospital stay (SMD, 0.27; 95% CI, -0.02, 0.56; z=1.80; P=0.07) were also statistically similar in both groups. CFD was associated with an increased post-operative pain score (SMD, 1.82; 95% CI, 0.61, 3.03; z=2.95; P=0.003). Conclusion(s): Fascial defect closure in patients undergoing LIVHR does not demonstrate any superiority over no-defect closure in terms of recurrence, post-operative morbidity, post-operative pain duration of operation and length of hospital stay.

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The post graduate virtual learning environment: An effective platform for the delivery of a surgical teaching programme in the West Midlands (2021)

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Type of publication:Conference abstract

Author(s):El-Sayed C.; *Ahmed U.; *Farquharson A.

Citation:British Journal of Surgery; Oct 2021; vol. 108, Supplement 7

Abstract:Aim: The Postgraduate Virtual Learning Environment (PGVLE) is a digital platform developed by HEEWM in response to the COVID-19 pandemic to deliver a virtual teaching programme to surgical trainees. The programme is delivered through the BigBlueButton; an integrated virtual classroom. All teaching sessions are recorded and archived to allow trainees to review content at their convenience. We performed a contemporaneous study to review the effectiveness and quality of the platform in delivering teaching and suggest its future role in the surgical curriculum. Method(s): Anonymised feedback was gathered of trainee's perspective of the platform experience, the quality of teaching and the archived content. All trainees were General Surgery higher trainees (HST) (ST3- ST8). The data from sequential teaching days was analysed. Result(s): Of 90 HST, on average 40 attended each monthly training day (consistent with pre-COVID attendance). 122 trainee responses were completed. 68% of respondents were between ST3-ST5. 91% rated the administration and delivery of the teaching sessions as excellent or very good. 16% of trainees watched the archived sessions after the teaching day of which 46% felt it met their educational expectations. Conclusion(s): The PGVLE is an effective platform for the delivery of a virtual surgical teaching programme. It met with high levels of trainee satisfaction in the context of the pandemic. The archived content provides advantages to consolidation of learning. It is thought that the PGVLE platform will become a key feature of the surgical training programme in a hybrid learning model, related to relevant curricula, in the future.

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Paediatric anaphylaxis 'EduCAKEtion' in 10-minutes: A multicentre initiative (2021)

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Type of publication:Conference abstract

Author(s):Dhesi A.; Mathias F.; Willets J.; Makwana N.; Halton F.; *Sohal I.; *Clarkson A.; *Brown K.

Citation:Clinical and Experimental Allergy; Dec 2021; vol. 51 (no. 12); p. 1664

Abstract:Objectives: Anaphylaxis is often over or undertreated with intramuscular adrenaline. Previous research in the Midlands has found that 32% of health professionals/medical students would administer intravenous adrenaline inappropriately. Our aim is to promote training in the recognition and management of anaphylaxis using an innovative technique. Method(s): We designed a 10-minute anaphylaxis education program composed of classifying symptom discs into type of reaction, management scenarios and adrenaline autoinjector (AAI) training. Small group sessions were designed to ensure social distancing in the COVID era, but also to allow hands-on training. Pre and post education scores were monitored. Following the session there was cake and debrief with participants to give the opportunity to answer any questions and provide feedback. Result(s): 131 health professionals were trained across three trusts (Sandwell and West Birmingham Hospitals NHS Trust, University Hospitals of North Midlands NHS Trust and Shrewsbury and Telford Hospitals NHS Trust) over a period of four months. 49% (64/131) were qualified nurses, 24% (32/131) doctors, 17% (22/131) healthcare assistants and 10% (13/131) other professionals. Experience of nurses ranged from 10% (7/71) being students to 14% (10/71) having worked over 30 years. 56% (18/32) doctors were ST3 level or below. Mean pre-education and scenario score was 18 and post score was 23 indicating a 28% improvement. Mean AAI training pre score was 4, post score was 8, indicating 100% improvement. The total mean pre score was 21 and post score 30, indicating a 43% improvement (p value <0.01). The maximum overall score possible was 32. Conclusion(s): This is a novel education method developed to be short, interactive and suitable for a wide variety of professionals. Feedback has included "concise and stimulating", "fun way of learning". It is being adapted to be delivered virtually for easier access but will also be reassessed to ensure retention of information.

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