Princess Royal University Hospital Research Articles

Hybrid Technique for Abdominal Wall Hernia Repair: Description and Early Results.

Objective Ventral hernia repair is a widely practiced surgical procedure worldwide. The objective of this paper is to evaluate and analyze the results of a hybrid approach for treating ventral hernias. Methods All patients with clinically and radiologically proven ventral hernia underwent hybrid laparoscopic ventral hernia repair at Princess Royal University Hospital, London, United Kingdom using a retrospective approach with the same surgical team. Large defects >10 cm, inguinal hernia, para-stomal hernia, incarcerated patients, and spigelian hernia were excluded. We utilized the laparoscopic approach for the dissection and isolation of the sac and used the port site for the delivery of mesh into the abdominal cavity. Results Our study comprises 67 patients, with 39 males (58.2%) and 28 females (41.8%). The median age in our study group was 41 years (range: 18-65 years). The median BMI was 38 kg/m2 (range: 24-52 kg/m2). The majority of the cases were umbilical or paraumbilical hernias (n = 46). The median defect size in our study was 5.4 cm (range: 2-10 cm). The median operative time was 67 minutes. We have not encountered any recurrences in this group. Conclusion This hybrid approach combines the advantages of both the open and laparoscopic approaches.

The impact of socioeconomic deprivation on the prevalence of gestational diabetes: An observational study

Background Approximately 3.5% of pregnancies in the United Kingdom are complicated by gestational diabetes mellitus (GDM). Risk factors for this mirror those contributing to type 2 diabetes (T2DM). Though socioeconomic status (SES) is presumed to contribute to GDM, evidence in the United Kingdom is limited. In this unique study, we explored the impact of SES on GDM prevalence in a London suburb population. Materials and Methods Four thousand one hundred and sixty-three pregnant women who booked between July 2018 and March 2020 at Princess Royal University Hospital were retrospectively analyzed. Associations between GDM prevalence and SES trends (using multiple deprivation deciles (MDD)), and body mass index (BMI), age, ethnicity, screening uptake, birth-weights and birth outcomes, were analyzed. Results Patients with BMI >30 kg/m2, older than 35 years, and non-Caucasian ethnicity have an increased risk of developing GDM ( p < 0.0001, p < 0.0001, p < 0.0001, respectively). No association existed between MDD and GDM prevalence ( p-values over 0.05). Patients with risk factors for GDM were highest in the deprived areas p < 0.0001. MDD 1–4 (most deprived) had the highest percentage of missed screening (15% of patients with risk factors missed screening), compared to 8% in the least deprived group ( p < 0.0001). Discussion Our data surprisingly suggest that low SES did not increase the incidence of GDM, despite a higher proportion of women with risk factors for GDM living in the most deprived postcodes. However this unclear finding may be due to low screening uptake of deprived populations, and therefore lack of GDM diagnosis, or indicate that GDM is a result of a different aetiology to T2DM. Further research is needed to explore if access to screening services, lack of health education or other health inequalities were responsible for the high proportion of missed screening opportunities in deprived areas.

Percutaneous Cholecystostomy to Manage a Hot Gallbladder: A Single Center Experience.

Objective A percutaneous cholecystostomy (PC) is a suitable option for treating acutely inflamed gallbladders. Its use has been postulated before for treating acute cholecystitis (AC), especially in elderly populations. The primary aim of our study is to analyze and present the positive results of PC as a bridge to laparoscopic cholecystectomy. Methods All patients who underwent PC at our hospital, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London, GBR, from October 2020were reviewed using a retrospective approach. Results Our study comprises 123 patients, with 72 females (58.5%) and 51 males (41.4%). In our study, many patients had significant comorbidities, and some of them were categorized as high-risk due to their frailty and medical conditions. The majority of the patients were in American Society of Anaesthesiologists' (ASA) groups II and III (45, 61), respectively. Though hospital stays can depend on variable factors, in our experience, the mean hospital length ofstay was 12.7 days. In our study, 119 patients (96.8%) had the procedure through the interventional radiological approach, while only four patients had it through the laparoscopic approach. The transhepatic route for drainage was more commonly practiced at our center and was used in 108 patients. At the time of writing this article, 54 patients have already had a laparoscopic cholecystectomy (LC) done as an interval procedure after surpassing the acute attack of cholecystitis, while 42 patients are still awaiting their surgical procedure. Conclusion Our results show that PC is a viable option, especially in cases of AC that are not responding to conservative treatments. Our study has shown low complications and conversion rates after PC. We believe PC is a safe and effective tool for managing severe and refractory cases of AC.

Implementation of an electronic porter requesting tool for inpatient radiographs at the Princess Royal University Hospital

Background: Before the quality improvement project, the Princess Royal University Hospital (PRUH) utilised a paper-based porter requesting system, which was associated with multiple patient transport incidents. To address these incidents, the hospital needs to keep an auditable record of portering activities (unavailable due to data retention by the external portering company).

TP10.2.9The effect of COVID-19 on Breast clinic follow ups – a change in future practice?

AimsPrior to March 2020, at Princess Royal University Hospital (PRUH), Kings College NHS Foundation Trust, almost daily face to face benign/malignant breast clinic follow ups occurred. On March 23rd 2020 the UK went into official COVID-19 pandemic lockdown. The effect on elective follow up practice was swift with cancellation, triaging and replacement of face-to-face by telephonic/virtual consultations.We compared the change of follow up pattern, pre and post COVID-19. Could this effect the future of consultations at PRUH?MethodsA comparison of all patients attending PRUH breast unit outpatients in January 2020 (preCOVID-19) for follow up, with those attending in April 2020 (postCOVID-19).Data collection from clinic lists and electronic patient records, with Excel version 16 analysis.Results343 patient follow up consultations 01/2020. 53 patient follow up consultations 04/2020.Malignant cases: January 65%, April 60%Benign/B3 cases: January 35%, April 20%TP10.2.9 Table5 year surveillanceBenign f/upPost-Biopsy ResultsPost-InvestigationPost-OperativePre-Operative PlanningPrimary EndocrineResultsResultsf/upPre COVID-01/2020134(39%)15(4%)26(8%)79(23%)68(20%)16(5%)5(1%)Post COVID-04/20205(9%)7(13%)14(26%)15(28%11(21%)2(3%)0(0%)Summary follow up types.ConclusionsImpact of COVID has been widespread in our practice. Our results show a significant reduction in face-to-face appointments, to allow social distancing. Further evaluation of this model will show its sustainability. Patient satisfaction will have to be assessed, with a view to a full move to video/telephone consultation where indicated.

EP.TH.177Safety profile of SurgiMend Acellular Dermal Matrix and Mentor implant assisted immediate breast reconstruction – Our experience at the Princess Royal University Hospital

Abstract Background ADM (Acellular Dermal Matrix) assisted implant-based immediate breast reconstruction (IBR) is a common technique worldwide. Various ADMs are available manufactured from different sources. The Surgimend ADM (fetal bovine dermis) is fenestrated and rich in type I/III collagen; it is claimed to reduce fluid accumulation and promote healing. Methods Retrospective observational analysis exploring safety profile using combination of SurgiMend MacroPorous (MP)/SurgiMend PRS and Mentor CPG/Mentor Siltex implants between January 2018 to December 2019. Patients with unilateral/bilateral IBR following Nipple sparing (NSM) or Skin sparing mastectomy (SSM) were included. The primary outcome was minor complications (seroma (>100ml on USS), hematoma, wound infection and infected seromas). Secondary outcome was major complications (flap necrosis, capsular contracture, implant explantation and Red Breast Syndrome). Results Six (16.2%) bilateral and 31 (83.8%) unilateral IBR were performed in 37 patients. Mean age was 53.78 years. No major complications were recorded. Conclusions The Surgimend ADM and Mentor implant combination demonstrate a good safety profile. Higher rates of seroma in this study could be explained by overdiagnosis and treatment at our unit, which in turn might imply as a result that no major complications were detected and no implant loss.

533 Diverticular Disease and Diet: Are We Doing Enough?

Abstract Introduction Diverticular disease (DD) is a major burden on healthcare systems globally, especially in the western world. DD accounts for the second most common indication for elective colorectal resections, with each resection costing the NHS a minimum of £5000. Since dietary advice is an integral part of the management of DD, we aim to investigate the proportion of patients that receive documented dietary advice or guidance on their stay in hospital. Method A list of all admissions related to DD from June to November 2019 was obtained from the HIPE Department in Princess Royal University Hospital. Our Electronic patient record system was used to extract information regarding patient demographics, length of stay in hospital and the presence of documented evidence that dietary advice was given to patients. Results A total of 57 patients were admitted due to DD over a six-month period in 2019. 41 were female and 16 were male. They had a mean age of 67.1 and an average length of stay of 6.3 days. 12 of the 57 (21%) had some form of surgery either as an emergency or electively after discharge. Only 15 (26%) received dietary advice of which only 9 were referred to a dietician. Conclusions DD is a major contributor to surgical admissions requiring both elective and emergency surgery. It is largely a preventable disease; hence health care staff should take more initiative to highlight the importance of lifestyle modification to patients whenever the opportunity arises, with the target to benefit public health and free healthcare resources.

Heart failure-the experience of living with end-stage heart failure and accessing care across settings.

Heart failure is a complex clinical syndrome affecting an increasing number of the ageing population. Patients and carers require increasing input from specialist palliative care services to both manage symptoms and access support in the last year of life. An integrated clinical service between the local cardiology team at Princess Royal University Hospital and the palliative care team at St. Christopher's Hospice was piloted for patients with end-stage heart failure in Bromley in Kent, UK. This study explored views of patients and carers who participated in the integrated pilot service. A qualitative study was conducted in which a convenience sample of patients and carers were invited to participate in focus groups: two bereaved carer groups (n=2, n=2); one patient group (n=4), held between 14th December 2018 and 18th January 2019. Participants were asked to describe their experiences of care received facilitated by a topic guide. Interviews were recorded, transcribed and coded using thematic analysis to identify common themes. Four patients (2:2 M:F) aged between 70 to 87 years and four female carers whom had cared for patients aged between 70 to 96 years who were since deceased, participated in this study. Overall, the service was positively received, and responses were mapped into four key areas; being diagnosed and living with heart failure, referral to palliative care, key helpful components of the care received and finally, unhelpful components of the new service in terms of care. Common themes emerged including understanding of heart failure and its trajectory, communication around palliative care, having a 'broker' for the system, recognition of carer's needs, service responsiveness, and feeling 'in control'. This qualitative study highlighted important considerations when developing an integrated heart failure and palliative care service. Education about heart failure for patients and carers, but also the integrated multidisciplinary team is crucial to improving detection of deterioration and facilitating communication around Advance Care Planning. The value of the 'expert-carer' should also be promoted and supported in chronic conditions. We recommend a focus on development of integrated services that enable joined-up care or single point of contact for patients and carers.

The myth of pre-operative isolation during the COVID-19 pandemic.

The SARS-CoV-2 (COVID-19) pandemic called for the restructuring of National Health Service (NHS) surgical departments across the country. Initial guidance advised that patients undergoing elective surgery isolate for 14 days prior to their operation. As we learnt more about COVID-19 and its incubation period, at the Princess Royal University Hospital this guidance has been decreased to 72 h. We collected retrospective data for two patient cohorts that underwent elective surgery in June and September 2020, isolating for 14 days and 72 h, respectively. We followed-up these patients with several questions allowing us to categorise the cohorts into three groups based on their compliance with isolation measures and also to assess their satisfaction with the isolation process. Our data shows that only 16% of the June cohort and 53% of the September cohort isolated in accordance with the guidelines whilst patient satisfaction was 16% and 64% respectively. These results highlight a suboptimal compliance to pre-operative guidelines as well as an adverse effect on patient mental health and raise the issue of both patient and NHS staff safety. With the possibility of a COVID-19 second wave and for future pandemics, a clear evidence-based plan for pre-operative isolation is vital. Furthermore, consideration of patient adherence and satisfaction is key in deciding which guideline will be most effective.

40 Improving Urinary Catheter Documentation and Care in Geriatric Wards

Abstract Introduction NICE guidelines state that urinary catheter insertion, changes and care should be documented. Duration of catheterization is directly linked to the risk of developing a catheter-associated UTI. Furthermore, Public Health England has announced a national aim to reduce the incidence of Gram-negative bacteraemia by 50% by March 2021, and targeting catheters is one of the first steps. Local problem These issues are relevant to the elderly population at Princess Royal University Hospital, where documentation surrounding catheters was found to be inadequate. Despite there being an Electronic Patient Record (EPR) order for catheter insertion and monitoring available, this was not being used. Our primary aim was for all patients to have this order. We also hoped to reduce the weekly rate of catheter days (catheter days per 100 bed days), and improve documentation in clinical notes. Methods We focused on two medical wards and sampled all patients admitted over a period of 4 months who had a catheter at the time of data collection. We identified catheterized patients and whether they had an EPR catheter order on a daily basis. Additional parameters such as indication, insertion date, inserter, and documentation standards were extracted from EPR on a weekly basis. Patients were kept “live” and contributing to catheter day calculations until they were no longer on the ward or if the catheter was removed. Interventions We implemented changes over 2 PDSA cycles. Interventions included the addition of catheter columns to boards and education sessions for doctors and nurses (cycle 1), as well as catheter posters, alert cards, and circulation of emails with guidance to doctors and nursing staff (cycle 2). Results A total of 87 patients were analysed during the project. There was an increase in EPR orders being used, with the 100% target being reached on the final data collection point, and with data showing a significant shift above baseline. Furthermore, there was a decrease in the weekly rate of catheter days, but changes were difficult to sustain. We also saw a general improvement in documentation standards. Conclusion By improving documentation and reducing unnecessary catheterization, we hope to have reduced the overall risk of infection whilst improving patient comfort and experience. Lessons may be transferrable to other trusts.

Prakash S Sinha

Prakash S Sinha was a general surgeon with a specialist interest in endocrine, breast, and oncoplastic surgery, and the medical director of the Princess Royal University Hospital, part of the...

528 Poster - Impact of COVID-19 on Breast clinic follow ups – a new way forward?

Background: The global pandemic of coronavirus disease 2019 (COVID-19), caused considerable change to working practices in breast units across the UK. Prior to March 2020, at the Princess Royal University Hospital (PRUH), Kings College NHS Trust, Kent, almost daily face to face breast clinic follow ups occurred. This consisted of patients with both benign and malignant conditions. It encompassed post investigation/operative results, pre-operative planning, benign follow ups and 5 year surveillance patients. On March 23rd 2020 the UK went into official lockdown. The effect on breast elective follow up practice was swift. There was a move to cancellation and triaging of the majority of our follow ups, with replacement of face to face with telephonic or virtual consultations. The aim of this study was to review the change of the follow up pattern, comparing pre and post COVID-19 setup, could this effect the future of follow up consultations at PRUH? Material and methods: A comparison of all patients attending PRUH breast unit outpatients in January 2020 (pre COVID-19) for follow up and with those attending in April 2020 (post COVID-19). Categories analysed included numbers of patient attendances, patient demographics, type of follow up, and original diagnosis. All data was collected from clinic lists and electronic patient record notes and analysed using Excel version 16 (365). Results: 368 patient follow ups were booked into clinic in Jan 2020 with 25 not attending (DNA’s), overall 343 attendances. 59 patient follow ups were booked in April 2020 with 6 DNA’s, overall 53 attendances. The mean age in January was 57 and in April 51. Sex distribution in January F:M 336:7 (98%:2%) was similar to that in April F:M 51:2. In January 65% of cases were malignant and 60% in April. Benign/B3 diagnosis were 35% in January and 20% in April.Tabled 15 year surveillanceBenign f/upPost Biopsy ResultsPost Investigation ResultsPost Operative ResultsPre Operative PlanningPrimary Endocrine f/upPre COVID – April 2020134(39%)15(4%)26(8%)79(23%)68(20%)16(5%)5(1%)Post COVID – April 20205(9%)7(13%)14(26%)15(28%)11(21%)2(3%)0(0%) Open table in a new tab Summary of follow up types Conclusions: Impacts of COVID have been widespread in our practice. Our results show a significant reduction in face to face appointments. Further evaluation of this model will show if this is sustainable. Patient satisfaction will also have to be taken into account and assessed. Implementation of 5 year post cancer treatment surveillance without a clinical follow up (open access follow up) is becoming a standard practice in many breast units. Social distancing in the waiting areas has been one of the limiting factors for face to face consultations. Options of video/telephone consultations are a possibility, although clinical review is sometimes necessary. No conflict of interest.

Comparative Analysis of Dorsal Nerve Relocation versus Dorsal Neurectomy in the Surgical Management of Morton's Neuroma

This clinical study compares the use of dorsal nerve relocation (DNR; also known as dorsal nerve transfer) and dorsal neurectomy (DN) in the surgical management of Morton's neuroma within the surgical directorate of an NHS Hospital Trust (Princess Royal University Hospital) in the South East of England between 2002 and 2009. Approaches to the surgical management of Morton's neuroma are dependent on the views of individual surgeons, rather than empirical evidence and varied considerably, so this study was essentially all about checking whether best practice is being followed and making improvements. Data were collected using an in-depth review of patients' case notes and patient questionnaires. In total, there were 47 cases (51 web spaces), 25 (28 web spaces) in the DNR group, and 22 (23 web spaces) in the DN group. The key indication for surgery in all cases reviewed was failure of the condition to improve using conservative methods. The mean follow-up duration was 36 months (12-89) in the DNR group and 41 months (12 69) in the DN group. Coughlin's criterion was used to analyze individual records. The results suggest that DNR is more effective (92%) than DN in the surgical management of Morton's neuroma (82%). Key advantages of DNR include earlier return to wearing routine footwear, earlier return to normal routine/work, and better resolution of sensory symptoms in the toes. Although DNR is a slightly longer procedure than DN, minor difficulties were encountered relating to nerve mobilization because of overlying prominent veins or multiple nerve branches rather than a single nerve. DNR avoids the risk of a stump neuroma formation. Our results, although supporting the literature, are not statistically significant. There are no direct comparative studies between DNR and DN in the literature, and therefore potential for more studies in the form of prospective randomized trials to establish a robust evidential basis for the surgical management of Morton's neuroma are needed.

Improving the documentation quality of point-of-care ultrasound scans in the emergency department

A point-of-care ultrasound scan (POCUS) is a core element of the Royal College of Emergency Medicine (RCEM) specialty training curriculum. However, POCUS documentation quality can be poor, especially in the...

Introducing a formal night-to-morning handover on the acute medical unit Princess Royal University Hospital (PRUH)

Handover allows responsibility for immediate and continued care to be transferred between healthcare professionals. The National Confidential Enquiry into Patient Outcome and Death and the Royal College of Physicians identified handover as a high-risk step of the patient pathway.1 Thus, lack of handover such as that at Princess Royal University Hospital (PRUH) is a major preventable cause of patient harm and critical to patient safety. The aim was to develop a formal, structured AMU night-to-morning handover, to enable safe recognition and handover of unstable and unwell patients, and to highlight priority tasks and specialty referrals. A qualitative questionnaire was …

Multifactorial assessment in patients presenting with fall

Fall is the commonest cause of death from injury in the population aged over 65, and many falls result in fractures and head injuries. The aims of this study are: All patients who presented with fall from 1 May 2017 to 14 May 2017 to the Princess Royal University Hospital were included in the

Abstract WP229: Randomised Clinical Trial of Early Prolonged Ambulatory Cardiac monitoring After Stroke (EPACS): Interim Analysis

Introduction: Cardioembolism in paroxysmal atrial fibrillation (PAF) is a preventable cause of ischaemic stroke or transient ischaemic attack (TIA), but the transient nature of PAF means that a short-duration Holter monitor misses a significant proportion of cases. Systems for recording beyond 3-7 days have significant limitations: event-triggered loop recorders are cumbersome while implanted loop recorders require a minor surgical procedure. There is a need for a patient-friendly long-duration cardiac monitoring system for stroke patients which can be performed without significant delay from the index event and with superior yield to Holter ECG’s. Methods: We conducted a pragmatic randomised controlled trial of cardiac monitoring after an ischaemic stroke or TIA to increase detection of paroxysmal atrial fibrillation (recruited within 72 hours of index event) using a wearable water-proof adhesive cardiac monitoring patch (Zio® Patch, iRhythm Technologies) that can be fitted immediately by the clinician early after the index event for up to 14 days or a standard Holter ECG. The trial aimed to recruit 120 patients across two locations - urban teaching hospital (Kings College Hospital, London) and suburban district hospital (Princess Royal University Hospital, Orpington). ISCRTN Registration 50253271. Results: In August 2016, the interim analysis detected PAF in 4/17 cases in the active arm and 0/16 cases in the control arm. The commonest arrhythmias detected were atrial tachyarrhythmias followed by PAF. Those in the control arm of Holter ECG’s had significant delays to initiate cardiac monitoring due to scheduling delays and patient non-attendance. There were no device-attributable serious adverse events. Further late-breaking results will be available in February 2017. Conclusion: The convenience of the Zio® Patch cardiac monitor substantially increased the uptake and efficiency of cardiac monitoring early after ischaemic strokes and TIA.

PWE-422 The impact of an alcohol awareness day in a large district general hospital

Introduction The Princess Royal University Hospital (PRUH) is held an alcohol awareness day in January to encourage local people to reflect upon their drinking habits and make positive lifestyle changes. The awareness day came in response to the number of patients requiring the hospital’s services due to the effects of excessive alcohol consumption. In November and December 2014, the number of people who attended the PRUH–s Emergency Department (ED) due to excessive alcohol consumption totalled 92, and of that number 36 patients had to be admitted for further treatment. Ninety-one per cent of those who attended the ED due to alcohol-related problems were of working age. An audit of 100 inpatients found that 16 were drinking at potentially hazardous levels. Method Information was made available on the recommended weekly maximum levels of alcohol consumption and sources of help. A stand was erected at the hospital front entrance and literature disseminated to staff and patients given plus a direct opportunity to ask questions. Reflection of weekly alcohol consumption was aided by the use of diary cards. Results Over the course of the day, 145 people visited the stand and our team disseminated information on recommended weekly alcohol limits. Staff were particularly interested in understanding the units they were consuming and patients were surprised to learn that they should have three alcohol-free days per week. Visitors to the stand were encouraged to keep a diary of their drinking habits and take part in our competitions to create non-alcoholic recipes for smoothies and mocktails. A few quotes from staff included “it is a real eye opener to keep a diary card”, “alcohol histories are often take too long to pin down an answer”. Patients semed particularly keen to ask about binge drinking and many were unaware about the need for alcohol free days. Conclusion The number of people we are seeing across our services as a result of alcohol misuse – from the Emergency department to outpatients and endoscopy illustrates the damaging effect it can have. Lack of awareness of the maximum weekly consumption plays a big part. The New Year is an ideal time for people to reflect on their health and consider making lifestyle changes. It is up to individuals to recognise the problem and want to make a positive change in their lives. The alcohol awareness day was local success and both patients and staff gained insight into the impact of alcohol on our current NHS resources. Disclosure of interest None Declared.

The association of surgeons in training (ASiT) foundation skills in surgery course: 6 years of aspiring surgeons

s / International Journal of Surgery 12 (2014) S13eS117 S85 those applying to the ‘medical training application service' (MTAS) in 2006. Methods: The Association of Surgeons in Training (ASiT) developed an online questionnaire at the time of MMC implementation. A paired, selfreported online survey was re-issued to original respondents in 2013, mapping their working patterns since MMC and utilising Likert scales to assess perceived satisfaction with the MTAS/MMC changeover. Results: Of 1005 primary respondents, 142 were no longer contactable. 195 (23%) completed follow-up (M:F 76:24, median age: 36). 99% of respondents were still working in the medical profession. 80.3% remained in a surgical speciality. 53.3% made >1 unsuccessful application to a national training number (NTN), with 8.7% still without one. An overwhelming majority reported negative experiences of MMC (86.2%) and detriment to quality of life (81.7%). 56.5% considered continuing their careers abroad, with 10% eventually doing so. Conclusions: The attrition rates from surgery, the medical profession in general and the United Kingdom demonstrate the lasting effects on professional's careers resulting from of the mismanaged implementation of MMC. 1162: THE ASSOCIATION OF SURGEONS IN TRAINING (ASIT) FOUNDATION SKILLS IN SURGERY COURSE: 6 YEARS OF ASPIRING SURGEONS Joseph Shalhoub , Laura Derbyshire, Andrew Beamish, Jonathan Wild, Piriyah Sinclair, James Edward Fitzgerald. Association of Surgeons in Training, London, UK. Introduction: The Association of Surgeons in Training (ASiT) has run Foundation Skills in Surgery (FSS) courses for six years. Aimed at senior medical students and Foundation (FY) doctors, FSS focuses on basic surgical skills, offering an overview of surgery. This study evaluates the course and career progression of delegates. Methods: A non-mandatory online questionnaire was distributed via email to previous FSS delegates. Questions focused on demographics, career intentions and course feedback. Results: Of 214 delegates, 72 responded (35.0%); 58.0% were male. At the time of survey, 27.7% were FYs, 27.5% Core Surgical Trainees, and 15.9% fifth-year students. 40.6% attended at FY1 and 17.4% as fourthyears students. At the course, 89.9% intended on surgical careers; 85.5% currently intend. The most popular specialities are Orthopaedics (26.2%) and General Surgery (18.0%). 95.7% would recommend FSS, with 94.2% feeling it benefitted their surgical training. >50% said the course ‘very much’ enhanced their basic surgical knowledge; 81.2% felt ‘more confident’ in surgical skills. Most enjoyable course aspects were high tutor:delegate ratio, practice, and orthopaedic skills. Suggested improvements included advanced suturing and higher practical:lecture ratio. Conclusions: Evaluation of the current course format indicates it is successful in meeting its aims, with high reported satisfaction from delegates. 1197: MENTAL PRACTICE RESTORES SURGICAL PERFORMANCE FOLLOWING SLEEP DEPRIVATION: A RANDOMISED CONTROLLED TRIAL Anneka Varma , Rasiah Bharathan, Sonal Arora, Rajesh Aggarwal, Ara Darzi. Imperial College London, London, UK. Introduction: To investigate the efficacy of mental practice (MP) and physical practice (PP) in restoring surgical performance following sleep deprivation. Methods: 31 novice surgeons underwent curriculum based simulation training in laparoscopic cholecystectomy. The 3 stages of performances were (1) rested, (2) following 24 hour of sleep deprivation and (3) 5-7 days later in a rested state. Epworth sleepiness scale (ESS), mental imagery questionnaire (MIQ), global rating scale (GRS) and simulator metrics served as outcome parameters. Results: At baseline no difference in psychomotor aptitude existed. In the rested state, no significant differences were observed between the groups with regards to ESS scores or performance quality, however the MP group had higher MIQ scores than the control (median 44 versus 43; p1⁄40.043). Following sleep deprivation the performance quality of control and PP groups significantly deteriorated [23 & 21.5 (p1⁄40.001) and 22.5 & 20 (p1⁄40.035) respectively] whilst MP group (23 & 23 p1⁄40.52) maintained a performance equivalent to the rested state. Comparison of all outcome measures between the rested and rested states 5-7 days later demonstrated the absence of a learning effect. Conclusions: MP can counter the effects of sleep deprivation on the quality of surgical performance. Further study amongst trainees is warranted to appraise the full benefits of MP. 1198: AUDIT OF STAFF KNOWLEDGE REGARDING POST-OPERATIVE DIETARY STAGES IN A DISTRICT GENERAL HOSPITAL Ertong Yang , Shaukat Majid. Princess Royal University Hospital,

Long-term stability of keratometric astigmatism after limbal relaxing incisions

To study the keratometric stability of limbal relaxing incisions (LRIs) performed during cataract surgery. Princess Royal University Hospital, Kent, United Kingdom. Retrospective case series. Medical notes of patients who had small-incision cataract surgery combined with LRIs between November 2006 and December 2010 were reviewed. Keratometric astigmatism was measured using Scheimpflug pachymetry (Pentacam). Surgically induced astigmatism (SIA) was calculated using the Astig Plot application. Twenty eyes of 20 patients were evaluated. The median keratometric astigmatism preoperatively and 2 weeks, 10 weeks, and 3 years postoperatively was 2.1 diopters (D) (interquartile range [IQR], 1.7 to 2.4 D), 1.3 D (IQR, 0.9 to 2.1 D), 1.2 D (IQR, 0.5 to 1.7 D), and 1.0 D (IQR, 0.7 to 1.4 D), respectively. There were no significant differences in keratometric astigmatism between 2 weeks and 10 weeks postoperatively (P=.35) or between 10 weeks and 3 years postoperatively (P=.72). The median SIA 2 weeks, 10 weeks, and 3 years postoperatively was 2.2 D (IQR, 1.6 to 4.1 D), 2.1 D (IQR, 1.2 to 2.7 D), and 1.8 D (IQR, 1.2 to 2.5 D), respectively. There was a statistically significant difference in SIA between 2 weeks and 10 weeks postoperatively (P=.002) but not between 10 weeks and 3 years postoperatively (P=.72). The keratometric effects of LRIs were stable from 10 weeks to 3 years postoperatively. Dr. Borasio is the creator of Astig Plot. No other author has a financial or proprietary interest in any material or method mentioned.