384 Local Closed Loop Audit: COVID-19 Screening Before Endoscopic Ultrasound

Aim

Endoscopic Ultrasound (EUS) is one of the important diagnostic tests in patients with probable hepatobiliary or lung diseases. As it is an airborne procedure and due to the current COVID-19 pandemic, British Society of Gastroenterology and NICE guidelines have stated that patients who are undergoing EUS must be tested for COVID-19 within 3 days before the procedure. EUS must be considered deferring if the patient tests positive. The aim of this audit is to increase the proportion of patients being swabbed within 3 days/72 hours of the procedure to > 90% by the end of 2021.

Method

A list of patients who underwent elective EUS in January (initial audit) and mid-May to mid-June (re-audit) were collected using Endosoft software. Afterwards, electronic patient record system was checked for the date of the COVID-19 swab and its results. This data was then recorded in a password-protected Excel spreadsheet and the proportion of the patients meeting the standard was calculated.

Results

The results of the initial audit indicated that although 95.7% of swabs were done within 3 days of the procedure, only 40.9% were done within 72 hours. These results were discussed at a mortality and morbidity meeting, and recommendations were. Hence, in the re-audit, 98.4% of the swabs were done within 3 days of the procedure and the percentage of swabs being done within 72 hours increased to 95.2%.

Conclusions

The target of increasing the proportion of patients being swabbed within 3 days/72 hours of the EUS procedure to > 90% was met in mid-2021.

367 Comparing Mortality Rates in Patients with Gastric Cancer in a Single Tertiary Centre: What Can We Learn from the Numbers?

Aim

Over 6500 of primary gastric cancer diagnoses are made each year in the United Kingdom. Depending on the suitability of a surgical intervention and the patient’s choice, the treatment plans for such patients can be generally divided into curative, palliative, and no treatment. Recently, a tertiary Upper Gastrointestinal (UGI) Department has noticed an increase in mortality rates after a curative intervention and therefore, the aim of this study is to compare mortality rates in the three aforementioned subgroups with respect to the TNM staging in this tertiary centre.

Method

Patients who were discussed at an UGI disciplinary team meeting between 1st January 2013 and 31st December 2020 were identified. Among them, patients with a primary gastric cancer were selected and patients with metastatic gastric cancer at the time of diagnosis were excluded. In addition, patients without histological staging were excluded as well.

Results

279 patients with primary gastric cancer were included in this study. Patients who received palliative treatment have higher mortality rates in all T stages apart from T1 where the 90 days mortality rate was 16.67% and 0% for curative and palliative treatment respectively.

Conclusions

As it has been shown that the majority of patients who received palliative treatment has higher mortality rates, clinicians should continue to consider curative surgical resection in patients who are suitable. In addition, other precautions including consideration of dual consultant operation in patients with borderline respectability or patients with borderline fitness for surgery need to be taken to reduce the mortality rates further.

279 Preparing Foundation Trainees for Surgical On-Calls

Aim

Foundation trainee feedback has highlighted low levels of confidence with the prospect of surgical on-calls. Key areas of concern are assessing and managing the acute surgical patient, identifying which patients need an operation and having the technical skills to competently assist in theatre. This lack of confidence prevents trainees engaging in an educational and rewarding rotation. We have designed and facilitated a day of robust workshops, addressing these key educational needs.

Method

Pre and post course questionnaires assessed the efficacy of teaching. Lectures on the assessment and management of acute surgical patients in general surgery, urology and trauma and orthopaedics were delivered by core surgical trainees. A named consultant oversaw quality assurance. Addressing the technical skills development need, an afternoon of surgical skills workshops covered, suturing, knot tying, laparoscopic principles, and theatre etiquette. Small groups of trainees rotated through each workshop, delivered by senior specialty trainee registrars, to ensure high fidelity training

Results

Trainees rated themselves in key areas pre and post course on a scale from 1-5. Pre course, 66% of trainees scored 3+ in “confidence in managing a surgical patient on-call”. This rose to 100% post course. Similarly; “Confidence in decision making regarding whether a patient should proceed to theatre” increased from 37.5% to 93.7%. “Suturing skills” improved from 37.5% to 100%.

Conclusions

All trainees that attended the course displayed marked improvement in their confidence and competence. We feel this course or similar should be incorporated into the foundation teaching program locally and has scope to be expanded regionally.

Marijuana 'bong' smoking and tuberculosis

The incidence of tuberculosis in the non-indigenous Australian population is low. However, in this paper we report on three cases of cavitating disease, which seem to be associated with a common illicit drug habit namely smoking marijuana using a makeshift pipe or bong. There was a total of 34 positive contacts of these cases and among the contacts sharing a bong with an index case was associated with a sixfold risk of transmission (odds ratio 6.5, confidence interval 1.4-30.4, P = 0.016). When cavitating tuberculosis is detected in a young non-indigenous native born Australian, marijuana use should be considered as a possible risk factor.

Impact of odor from industrial hog operations on daily living activities

Intensive industrial animal production systems worldwide require confinement of large numbers of animals in small spaces and concentration of enormous quantities of waste. Industrial hog operations, in particular, have raised public concerns about their adverse impact on public health and sustainable development. Using a community-based participatory research approach and qualitative interviews, we explored people's perception of the impact of odor from these industries on daily living activities as they relate to the beneficial use of property and enjoyment of life. Our research indicates that hog odor limits several leisure time activities and social interactions which could have adverse public health consequences. The results of this study can assist the communities and other stakeholders in public policy development that addresses these concerns.

Risk factors for agricultural injury: a case-control analysis of Iowa farmers in the Agricultural Health Study

The purpose of this case-control study nested in the Agricultural Health Study was to assess risk factors for agricultural injury among a large group of Iowa farmers. A questionnaire sent to 6,999 farmers identified 431 cases who had a farm work-related injury requiring medical advice/treatment in the previous year and 473 controls who had no injury in the previous year. We assessed several potential risk factors for injury. A multiple logistic regression analysis showed significant associations between farm work-related injury and weekly farming work hours (> or = 50 hours/week) (OR = 1.65; 95% CI = 1.23-2.21), the presence of large livestock (OR = 1.77; 95% CI = 1.24-2.51), education beyond high school (OR = 1.61; 95% CI = 1.21-2.12), regular medication use (OR = 1.44; 95% CI = 1.04-1.96), wearing a hearing aid (OR = 2.36; 95% CI = 1.07-5.20), and younger age. These results confirm the importance of risk factors identified in previous analytic studies and suggest directions for future research in preventive intervention strategies to reduce farm work-related injuries.

[Patients surgically treated for aortic coarctation]

The aim of this study was to evaluate the results of surgical treatment of coarctation of the aorta. All patient files on patients operated at Haukeland Hospital, Bergen, Norway, in the period 1975-95 (n = 102) were surveyed. We sent a questionnaire to all patients alive in 1996 (n = 84), and 82 (98%) responded. Six patients (6%) died within 30 days of surgery, and 12 (12%) died later. These mortality numbers were smaller among patients operated in the period 1988-95. Among patients with associated heart defects (n = 28) the numbers were 14% and 25%, respectively. Four patients required reoperation and three patients balloon dilatation. Six of these patients were operated in the period 1975-87. Among the 82 patients that responded to the questionnaire, clinical follow-up by a cardiologist had been discontinued in 35 cases. 31 patients (38%) were not satisfied with the follow-up. Many patients reported muscle fatigue in the legs (30%), reduced exercise performance (29%), headache (26%), general fatigue (22%), and leg pain (17%). 38% did not report any symptoms. Our results are in accordance with previously reported studies, and the mortality numbers were reduced in the second period. The number of recurrences was also reduced in this period. The symptoms reported by many patients may be caused by recoarctation or an abnormal blood pressure. This group of patients should, therefore, be monitored systematically for abnormal blood pressure, recoarctation and aortic valve disease.

Scanning electron microscopy of cyclosporine-induced gingival overgrowth

Overgrown human gingival specimens were examined histologically and by scanning electron microscopy (SEM) to study structural changes caused by cyclosporine. The biopsy specimens were from organ transplant recipients receiving cyclosporine to suppress the rejection of the transplanted organ. The epithelium of the overgrown gingiva was thickened, acanthotic and parakeratotic. Retepegs were anastomosing and extending into connective tissue. The SEM examination of the outer surface of the attached gingival showed loss of cellular attachments and cells were exfoliating. The normal honeycomb structure formed by interconnecting microvilli surrounding the pits was distorted. Outer gingival cell surface showed numerous round, ovoid and dome-like structures instead of parallel, reticular or fingerprint-like microridges. It was concluded that cyclosporine not only caused hyperplasia but also changed the structure of the outer epithelial cell surface.

The farm family perception of occupational health: a multistate survey of knowledge, attitudes, behaviors, and ideas

It is vitally important to integrate the views and concerns of the farm family into the process of policy development. If the input is not there, policy planners could implement programs that are philosophically separated from the farm families' concerns and attitudes. This would destroy credibility and future farmer support of any new program development. From May of 1988 to April of 1989, a phone and mail survey of approximately 1,500 farmers and spouses was conducted to assess knowledge, attitudes, and behaviors regarding agricultural safety and health. The survey was conducted in Iowa, New York, South Carolina, and Washington state. Preliminary results from Iowa and New York indicated that: 1) farmers value highly, and are concerned with, occupational health and safety issues; 2) farmers report that their major concerns include stress, trauma and respiratory problems; 3) farmers would like access to an occupational health and safety service; and 4) any new farm health and safety programs must include farmer input to ensure practicality, applicability, and acceptance.