Assessment of Anxiety due to COVID-19 among the Surgery Staff of the René ESSOMBA Theater "BORE" at the Yaoundé Central Hospital

Background: The COVID-19 pandemic has had a negative impact on healthcare systems worldwide, including surgical disciplines. To date, only a few studies have assessed the effects of the ongoing pandemic on the mental state of those potentially exposed through their daily activities, such as operating theatre staff. The present study aimed to determine the prevalence of anxiety among the operating theatre staff "BORE" during the COVID-19 pandemic. Methods: From 13 January to 19 February 2021, we conducted a cross-sectional study using a pre-designed online form. This form was disseminated to participants via social networks. The data collection form was divided into three parts: one part was for socio-demographic information, the second part was for professional information, and the third part was for assessing the anxiety score by the Hamilton Anxiety Scale (HAM-A). Results: A total of 42 questionnaires were fully completed and retained for analysis. The sex ratio was 1.67, with 16 men and 26 women. COVID-19 anxiety with mild severity (HS ˂ 17) was found in 22 (55.4%) of the participants, and 33.3% had moderate to severe depression, while 11.3% had severe anxiety. Conclusion: About 4/5 of the participants in our survey suffered from anxiety due to the COVID-19 pandemic. This study highlights the need for psychological assistance for health care workers, especially the operating theatre staff of the Yaounde Central Hospital.

The History of Creating and Developing the National Jewish Theatre named for L. Kaganovich in the 1930s

В 1920-е годы в РСФСР начинается процесс развития национального искусства, который тесно переплетался с задачами национальной политики, проводимой в стране. Российская Федерация так же, как и советская власть, предоставляет всем гражданам обширные права и свободы. Однако Советское государство давало возможность всем народам, проживающим в тот период, развивать свое национальное искусство, создавать собственные театральные коллективы; именно этот опыт, на наш взгляд, следует использовать при проведении национальной политики в ХХI веке. Именно поэтому автор статьи исследует особенности развития театрального дела в Еврейской автономной области. Автор подробно изучает процесс создания и работы театрального коллектива Еврейского театра имени Л. Кагановича на протяжении 1930-х годов, уделяя особое внимание формированию актерской труппы, ее профессиональным успехам. Статья повествует о начальном периоде становления театра, когда в условиях переселенческой политики евреев на Дальний Восток начинается его формирование как профессионального коллектива. При этом автор отмечает, что актерский состав на протяжении всех лет работы оказывал поддержку всем учреждениям культуры автономии: организовывал самодеятельные кружки, участвовал в смотрах, осуществлял шефскую работу над частями Красной армии. В период массовых репрессией члены творческого коллектива подвергались арестам, но это не сломило творческий настрой актеров, их профессионализм продолжал расти. В заключении статьи автор приходит к выводу, что профессиональная деятельность Еврейского театра Биробиджана, его жизнь в условиях формирования и развития Еврейской автономной области стала отражением национальной политики советского руководства в отношении еврейской диаспоры в 1930-е годы. In the 1920s Soviet Russia witnessed rapid development of national art which was intricately connected with the national policy promoted by the Soviet government. Soviet Russia as well as the Russian Federation granted all its citizens ample rights and freedoms. The Soviet State enabled all peoples inhabiting its territories to develop their national art, to create national theatres. The author of the article believes that this experience is worthy and should define the national policy of the 21st century. Driven by this conviction, the author of the article analyzes the peculiarities of the development of the theatre in the Jewish Autonomous Region. The author focuses her attention on the development of the National Jewish Theatre named for L. Kaganovich in the 1930s paying special attention to the theatre staff and their achievements. The article tells about the initial stage of the theatre formation when due to the resettlement policy many Jewish actors were forced to move to the Far East. The author underlines that the actors of the theatre supported all the cultural establishments of the autonomous region by helping organize amateur dramatic societies, giving patronage to the Red Army. The author concludes that the professional development of the National Jewish Theatre of Birobidzhan was a reflection of the Jewish policy of the Soviet government in the 1930s.

EP.FRI.469 A closed-loop audit regarding the practice of sending Pus Swab for culture and sensitivity in Pilonidal abscess drainage

Aim The purpose of this study was to determine the role of Microbiological swabs taken during an Incision and drainage for Pilonidal abscess in patient management. Method We performed a closed-loop audit to determine the role of pus swabs in the management of pilonidal abscess. Parameters like patient demographics, date of surgery, whether or not pus sent for microbiological examination, the subsequent report, the time required for sample processing, antibiotics prescribed were considered. The data was collated, analysed, and presented at clinical governance. We then implemented in our treatment protocol to stop the practice. This data was again, prospectively collected to complete the audit cycle. Result A total of 250 patient were included in this study. Prior to the change of practice, swabs were sent in 77% of the cases. The average reporting time of the swabs was 4.3 days and 92% of the patients were discharged on antibiotics. After conducting multiple teaching sessions for the trainees and educating the theatre staff, the percentage of swabs sent was brought down to 58%. Conclusion The pilonidal abscess has high infection and recurrence rate. Hence, the management involves incision, drainage and antibiotics cover in most cases. In our study, the swab results did not alter patients management. Most of them were treated with Co-Amoxiclav and some required additional Metronidazole. Hence, we suggested the routine use of swab for culture in pilonidal abscess cases are unwarranted. This change of practice resulted in huge cost savings at our hospital.

EP.WE.126Survey on surgeons’ experience of wearing full PPE in theatres

Aims With the invasion of surgical work space by SARS-CoV-2 virus in 2020, the surgical safety concerns have been escalated to a new height. COVID-19 risk has questioned the adequacy of traditional Personal Protective Equipment (PPE) that has been in practice until now. Full PPE including respirator masks and visors in day today practice by all theatre staff across all surgical disciplines being implemented during and post pandemic time. However this implementation is not without its drawbacks as much as its positive merits. We conducted a survey among surgeons to ascertain their personal experience of wearing full PPE in theatres in day today practice. Methods Survey Monkey questionnaire was sent to surgeons at various levels in their carrier in different disciplines in the region. Results 47 surgeons responded to the questionnaire. 65% of the respondents were from General surgery and 38% of them were consultants. 85% of surgeons considered full PPE uncomfortable. Communication and visibility were main issues. Majority (52%) thinks that full PPE can affect their performance. The length of the procedure makes the negative effects of full PPE worse. More than 50% of respondents were not sure of the beneficial effects of full PPE in theatres. Conclusions Full PPE can have impact on the performance of surgeons. Communication being one of the main issues in wearing full PPE, an alternative strategy needs to be developed to improve communication between individuals in theatres.

TP7.2.4 Skin-to-gel is a safe and effective method to prevent patients sliding during minimally invasive colorectal surgery

Aims Minimally invasive colorectal surgery often requires manipulating the patient position to facilitate exposure of the surgical field, such as a steep Trendelenburg position. However, this exposes patients to risks of sliding on the operating table. Preventive interventions are available, such as bean bags; we explore our experiences of gel pads within a district general hospital. Methods A retrospective analysis was performed of all colorectal patients undergoing laparoscopic resections over the last ten years, identifying complications associated with the use of intra-operative gel pads (skin-to-gel) with no shoulder support. Results Over 500 patients have undergone laparoscopic colorectal resections during this time, all utilising pressure-relieving gel pads. Patients are placed skin-to-gel, lying on a single torso-length gel pad laid directly on the operating table mattress. Dependent upon the operative approach, the legs can be placed in stirrups or maintained supine on table extensions. There have been no DATIX recorded skin-tears, pressure or position-related injuries. The pads have also proven to prevent patient movement on the operating table, negating the use of shoulder supports when adopting the Trendelenburg position. On discussions with theatre staff, the Consultant body and interrogation of the DATIX database, there has only been one reported incidence of slipping when a patient was left on the slide sheet on top of the gel pad. They are relatively inexpensive, durable and easily maintained, proving a highly cost-effective piece of equipment. Conclusion Gel pads have proven to be highly effective in preventing both pressure-related injuries and patient movement during laparoscopic surgery.

TP6.2.2 Multi-disciplinary interventions to increase utilisation of NELA scores and critical care involvement following emergency colorectal surgery

Aims This audit aimed to assess pre-operative NELA risk score documentation and subsequent specialist peri-operative critical care involvement. Methods This complete audit cycle retrospectively reviewed notes (electronic patient records, anaesthetic charts and CEPOD booking forms) of all patients undergoing emergency laparotomy between March and May 2019. The NELA score was calculated retrospectively if not documented. Following the initial audit, the following multi-disciplinary interventions were instituted: alteration of the physical CEPOD booking form to include NELA score (Surgical); a sticker added to anaesthetic charts to prompt NELA calculation (Anaesthetic), formal recording of NELA score during theatre brief (Theatre staff); and by increasing awareness of NELA via departmental education (All). The audit cycle was completed by reassessment between October and November 2020. Results The initial cycle included 34 patients, with only 2 (6%) having a NELA documented. The repeat cycle included 35 patients, with 29 (83%) having a NELA documented. Regarding post-operative critical care admissions, both cycles found that 100% of patients with a NELA of ≥ 5%, were admitted to either surgical HDU or ICU (n = 17 in first cycle, n = 17 in second cycle). For those with a high-risk NELA of ≥ 10% (n = 11 in first cycle, n = 7 in second cycle), only 2 (18%) were admitted to ICU in the first cycle vs 7 (100%) in the second cycle. Conclusions This complete audit cycle demonstrates improved NELA score calculation following institution of several multidisciplinary interventions. The improved NELA score uptake was associated with increased critical care review and admission to ITU in high-risk cases.

SP4.1.11 Acute general surgical emergency and COVID-19 is a pandemic challenge for surgeons: a UK based practical experience

Background Transmission of COVID-19 is a considerable risk during the perioperative period of emergency surgery. We aimed to provide a practical experienced adaptation to reorganize the emergency surgical pathways during the COVID-19 pandemic. Methods A prospective observational study was performed between 30th March 2020 to 30th June 2020 at a large DGH in England. The primary outcome was perioperative COVID-19 related complications and secondary outcome measures included incidence of COVID-19 infections among the surgical doctors and healthcare workers. Data was collected on the number of acute surgical admissions and operations performed. The perioperative COVID-19 status of the patients, doctors and the healthcare workers were recorded. Results 584 patients admitted through the emergency surgical pathway and 43% (n = 253) underwent surgical intervention. Approximately 5% (n = 30) patients contracted with COVID-19 during the perioperative period and 6 of them died. Eight surgical doctors, 11 nurses and theatre staff were confirmed for COVID-19 by swab test. Acute cholecystitis and early appendicitis were managed conservatively. Conclusion High mortality (20%) observed among the patients who contracted COVID-19 perioperatively. Acute surgical emergencies and perioperative management of the urgent surgical patients during the COVID-19 pandemic is a global challenge but adequate preparedness and strategic plan to adjust the surgical services can reduce the exposures to this highly contagious virus.

The Role and Impact of Operating Theatre Background Music on Users and Patients: Opinion of Theatre Staff

Aim: To determine the opinion of operating theatre users on the role of operating theatre background music on theatre users and patients in tertiary health care facilities in Port Harcourt. Background: The relationship between music and health has been described by researchers. Music has been used in several hospital settings with effects which some consider beneficial and others harmful. Materials and Methods: This cross-sectional descriptive study was carried out among theatre users from March to June 2020 in two multispecialty tertiary healthcare facilities in Port Harcourt Nigeria. Using the convenience sampling method, data collected with pretested semi-structured questionnaires were analyzed using the Statistical Package for the Social Sciences (SPSS) version 20.0. Results: One hundred and twenty-one (82.9%) respondents asserted to knowledge of relationship between music and stress hormone. 97 (66.4%) agreed that music has positive effect on workers in the operating theatre. One hundred and seventeen (80.1%) respondents were of the opinion that background music in the operating theatre is not a distraction, while 22 (15.1%) respondents felt otherwise. One hundred and forty-four (98.8%) respondents agreed to usefulness of background music while at work. High proportion of respondents who lack knowledge of the relationship between stress hormone and music had no preference for operating theatre background music and the relationship was statistically significant (P<0.05). Conclusion: Operating theatre background music is useful as opined by the majority of operating theatre staff, though its preference is low among those with less knowledge of the positive relationship between such music and stress hormones.

1184 Operation Note – Are We Documenting Accessibility to The Larynx

Introduction Diagnostic laryngeal procedures are often done under general anaesthesia to aid in assessment and management of laryngeal lesions. Obtaining tissue samples for histology is an extremely important tool used to aid in further surgical planning. Documentation of accessibility to the larynx is paramount to patient care and future surgical planning. We aimed to highlight operative notes for those undergoing diagnostic procedures and assess whether sufficient detail is documented. The Royal College of Surgeons recommends that all operative notes must be comprehensive and “all problems/complications” must be documented for good practice. Method We carried out a 3-month retrospective data collection on patients who have undergone diagnostic laryngeal procedures at the Royal Glamorgan Hospital. We included microlaryngoscopies, panendoscopies and laser-specific procedures. We accessed the theatre booking system and retrieved the operation notes. Results During the 3-month period, 33 procedures were undertaken. 52% of the operative notes did not document level of accessibility. 48% of the operative notes included the level of accessibility, highlighting keywords such as “good access”, “difficult access” and “difficult access but possible for laser therapy”. Conclusions Documentation of intra-operative findings can aid further surgical management and help prepare the surgeon and theatre staff. It is especially important in patients who have vocal cord lesions that might benefit from laser therapy. We recommend documenting the intubation grade (Malampati Score) and accessibility to the larynx.