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1.
Colorectal Disease ; 24(Supplement 3):254, 2022.
Article in English | EMBASE | ID: covidwho-2078408

ABSTRACT

Aim: To adapt the theory of the Manchester model in a novel cancer service pilot across 3 tumour groups, colorectal, head and neck and lung cancer. Method(s): An adaptive methodology Multimodal adaption by combining evidence from literature, in context of practice within COVID-19 and across 3 tumour sites to create a valid and reproducible methodology, a prehabilitation working group of clinicians and cancer leads as well health development team. A pilot was developed and content adapted given the mixed tumour group and multimodal delivery. The multimodal prehabilitation pilot live March 2021, with a 12 month cycle with monthly working group meetings and in real time modifications as well as data collation and interrogation as part of service delivery and evaluation. Result(s): Many identified challenges common across tumour groups, some relating specifically to the delivering and capture of outcome data, in the context and restrictions of covid-19 and within pilot testing phase difficulties identified and resolved. During the pilot phase, delivery and capture difficulties were identified and resolved. Key stakeholder engagement was variable and limited by knowledge and application of prescriptive measures for patient outcome. With additional support and 'booster' sessions engagement and data capture improved with more appropriate patient screening and counselling and engagement within the programme. Conclusion(s): A adaptive methodology delivery prehabilitation in cancer care, designing an equitable service was developed. A pragmatic and and tangible approach has generated important insights to overcome challenges, enhance outcome content and usability to deliver success with an iterative and organised framework . The adaptation of the Greater Manchester Model has developed an novel resource in Northern Irelands cancer care to deliver equitable cancer service and improved patient outcomes across several health outcome domains.

2.
Colorectal Disease ; 24(Supplement 3):254, 2022.
Article in English | EMBASE | ID: covidwho-2078407

ABSTRACT

Aim: Re-establishing Colorectal elective surgery within COVID-19 recovery has been challenging.The publication of updated Enhanced Recovery After Surgery guidelines following colorectal resection (2018), builds on a surgical continuum of evidence-based domains for perioperative optimisation.Aiming to evaluate adherence to ERAS guidelines promoting awareness and use through educational sessions for improved patient outcomes. Method(s): An audit of 24 patients were compared against ERAS recommendations with complete data sets of 14 (December 2021 -February 2022).Compliance against 24 domains encompassing pre, intra and post-operative care were assessed.An ERAS multidisciplinary focus group of clinicians and nursing staff highlighted key areas to increase adherence to ERAS recommendations.A didactic teaching intervention was introduced.Pre and post intervention questionnaire explored ERAS baseline knowledge, confidence and barriers to implementation. Result(s): Eleven of 24 ERAS domains were completed after the initial audit. Following intervention compliance increased to 19 domains. Average inpatient stay was 11 days with 64% of patients undergoing a laparoscopic resection. Response rate for pre and post intervention questionnaire was 75%.Median self-reported knowledge increased from 2.8 to 4.3 out of 5 post-intervention. Eighty one percent of junior doctors reported high importance of ERAS in elective patient journey but challenge of time constraints, lack of awareness and communication were barriers to its implementation.At 3 months post intervention, 80% of doctors reported a positive impact on both their confidence and management of ERAS patients. Conclusion(s): By embracing an evidence-based ERAS approach through integrated multidisciplinary working utilising educational sessions to increase stakeholder confidence and knowledge, we can deliver standardised, equitable and optimised patient care.

3.
British Journal of Surgery ; 109(SUPPL 1):i40, 2022.
Article in English | EMBASE | ID: covidwho-1769172

ABSTRACT

Aim: We evaluated time to definitive treatment of Gallstone Pancreatitis (GSP) against the BSG guidelines during the first wave of COVID-19, comparing it to data of the same time period the previous year. Did the first wave of Covid-19 impact on time to intervention for patients diagnosed with GSP? Method: Data were obtained retrospectively for 40 patients identified via the hospital coding department that presented with GSP between March 2019 - June 2019 and March 2020 - June 2020. Patient demographics, length of stay, time to intervention and re-admission awaiting intervention were recorded. Results: Twenty-three patients were admitted during the non-COVID period. 30% (n=7) of the non-COVID cohort had definitive management of GSP during index admission or within 2 weeks. Seventeen patients were admitted during the first wave of Covid-19. 64.7% (n=11) of the COVID-19 cohort had definitive management of GSP during the index admission or within 2 weeks. Conclusions: Prior to COVID-19, we were not meeting guidelines for definitive management on index admission / within 2 weeks. During the first wave of COVID-19, more patients received definitive management of GSP during index admission / within 2 weeks than during the non-COVID period. A higher percentage of patients received surgical management within 2 weeks than in the non-COVID cohort. Those that did not receive management within 2 weeks, waited longer for intervention and had higher rates of re-admission than the non-COVID cohort. Despite anticipated future waves of COVID-19, prioritisation of urgent OP services is essential for those diagnosed with GSP to help reduce re-admission rates whilst awaiting intervention.

4.
Colorectal Disease ; 24(SUPPL 1):92, 2022.
Article in English | EMBASE | ID: covidwho-1745950

ABSTRACT

Purpose/Background: With the introduction of COVID-19 we are facingone of the greatest healthcare challenges in modern times, with disruption and cessation of established services. Colorectal cancer patients are included as the secondary casualties of this pandemic. Quantitative Faecal Immunochemical Testing (qFIT) has been established as a screening method in asymptomatic patients. We aim to assess its utility as a triage tool in symptomatic patients with suspected colorectal cancer, to allow service provision and prioritisation of limited investigations in the COVID-10 era. Methods/Interventions: At the commencement of the COVID-19 pandemic a database was established to include patients awaiting red flag outpatient consultation or colonic investigations and new red flag referrals from March to June 2020. Patients were supplied with qFIT kits and returned results categorised into 3 priority groups according to the qFIT value. Group 1 > 150μg Hb/g, Group 2 ≥ 10 to ≤150 μg Hb/g and Group 3 < 10 μg Hb/g. Subsequent colonic evaluation was offered by colonoscopy or cross-sectional imaging with urgency determined by qFIT priority group. When identified colorectal cancer, inflammatory bowel disease or high-risk polyps were recorded as “significant colorectal pathology.” Results/Outcomes: Three hundred and seventeen patients were identified with data analysed on 290 patients. Colorectal malignancy was identified in 17 patients;94% of these patients were in Group 1. A qFIT result >150 μg Hb/g a sensitivity and specificity for colorectal cancer of 94.12% (95% CI 71.31% to 99.85%) and 91.21% (95% CI 87.20% to 94.29%) respectively. No malignancy was detected in Priority Group 3;negative predictive value of 100% (95% CI 98.06% to 100%). Conclusion/Discussion: The urgency of colorectal investigation in symptomatic suspect lower GI cancer patients can be determined using qFIT as a triage tool to ensure patients timely access to investigation. This is based on prioritisation group and therefore mitigate missed and delayed cancer diagnosis.

5.
Irish Journal of Medical Science ; 190(SUPPL 6):S252-S252, 2021.
Article in English | Web of Science | ID: covidwho-1609880
6.
British Journal of Surgery ; 108(SUPPL 7):vii105, 2021.
Article in English | EMBASE | ID: covidwho-1585087

ABSTRACT

Introduction: During the COVID-19 pandemic there has been a reduction in trainee hands-on learning opportunities due to curtailment of elective workload. Our study aims to assess the impact of non-consultant led operating on theatre list efficiency. Methods: Prospective data collection over an eight week period of consecutive elective day case hernia lists at a newly established regional centre of excellence for day surgery. Specifically recording of key time points in surgical cases including time ready, knife to skin, last suture and exit theatre. This was achieved using the Theatre Management System (TMS). Results: 46 patients underwent open unilateral elective inguinal hernia repair. 54% (N=25) of cases were trainee led. Median trainee time was 53 minutes, vs 51 minutes for consultant led procedures;no significant difference (p>0.05). Conclusion: Day case elective hernia lists can be efficient training opportunities for general surgical trainees. Our results demonstrate that trainee-led operating in this setting have not resulted in significantly increased surgical time or operative theatre inefficiency. It is widely acknowledged there is benefit to training in performing the same technical skill within a short time frame.

8.
British Journal of Surgery ; 108:1, 2021.
Article in English | Web of Science | ID: covidwho-1537536
9.
Colorectal Disease ; 23(SUPPL 1):69, 2021.
Article in English | EMBASE | ID: covidwho-1457683

ABSTRACT

Aim: The COVID-19 pandemic is an evolving healthcare challenge causing secondary disruption of cancer services. Quantitative Faecal Immunochemical Testing (qFIT) has been established as a screening method in asymptomatic patients. We aim to assess its utility as a triage tool to prioritise investigations in symptomatic patients with suspected colorectal cancer. Methods: At the commencement of the COVID-19 pandemic a database was established to include patients awaiting red flag outpatient consultation or colonic investigations and new red flag referrals from March to June 2020. Patients were supplied with qFIT kits and returned results categorised into 3 priority groups according to the qFIT value. Group 1 >150μg Hb/g, Group 2 ≥10 to ≤150μg Hb/g and Group 3 <10μg Hb/g. Subsequent colonic evaluation was offered by colonoscopy or cross-sectional imaging with urgency determined by qFIT priority group. When identified colorectal cancer, inflammatory bowel disease or high-risk polyps were recorded as “significant colorectal pathology.” Results: Three hundred and seventeen patients were identified with data analysed on 290 patients. Colorectal malignancy was identified in 17 patients;94% of these patients were in Group 1. A qFIT result >150 μg Hb/g a sensitivity and specificity for colorectal cancer of 94.12% (95% CI 71.31% to 99.85%) and 91.21% (95% CI 87.20% to 94.29%) respectively. No malignancy was detected in Priority Group 3;negative predictive value of 100% (95% CI 98.06% to 100%). Conclusion: In symptomatic, suspect lower GI cancer patients qFIT is useful in prioritising patients and can be used to determine the urgency of colorectal investigations.

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