bluuebunny/crossref_metadata_2025 huggingface dataset:
How family histories can inform research about germ cell exposures: the example of autism
Authors: Escher Jill
Published: May 2021

Throughout the scientific literature, heritable traits are routinely presumed to be genetic in origin. However, as emerging evidence from the realms of genetic toxicology and epigenomics demonstrate, heritability may be better understood as encompassing not only DNA sequence passed down through generations, but also disruptions to the parental germ cells causing de novo mutations or epigenetic alterations, with subsequent shifts in gene expression and functions in offspring. The Beyond Genes conference highlighted advances in understanding these aspects at molecular, experimental, and epidemiological levels. In this commentary I suggest that future research on this topic could be inspired by collecting parents’ germ cell exposure histories, with particular attention to cases of families with multiple children suffering idiopathic disorders.

In so doing I focus on the endpoint of autism spectrum disorders (ASDs). Rates of this serious neurodevelopment disability have climbed around the world, a growing crisis that cannot be explained by diagnostic shifts. ASD’s strong heritability has prompted a research program largely focused on DNA sequencing to locate rare and common variants, but decades of this gene-focused research have revealed surprisingly little about the molecular origins of the disorder. Based on my experience as the mother of two children with idiopathic autism, and as a research philanthropist and autism advocate, I suggest ways researchers might probe parental germ cell exposure histories to develop new hypotheses that may ultimately reveal sources of nongenetic heritability in a subset of idiopathic heritable pathologies.
Roles ofStra8andTcerg1lin retinoic acid induced spermatogonial differentiation in mouse
Authors: Sinha Nilam , Whelan Eoin C , Tobias John W , Avarbock Mary , Stefanovski Darko , Brinster Ralph L
Published: May 2021

Retinoic acid (RA) induces spermatogonial differentiation, but the mechanism by which it operates remains largely unknown. We developed a germ cell culture assay system to study genes involved in spermatogonial differentiation triggered by RA. Stimulated by RA 8 (Stra8), a RA-inducible gene, is indispensable for meiosis initiation, and its deletion results in a complete block of spermatogenesis at the pre-leptotene/zygotene stage. To interrogate the role of Stra8 in RA mediated differentiation of spermatogonia, we derived germ cell cultures from the neonatal testis of both wild type and Stra8 knock-out mice. We provide the first evidence that Stra8 plays a crucial role in modulating the responsiveness of undifferentiated spermatogonia to RA and facilitates transition to a differentiated state. Stra8-mediated differentiation is achieved through the downregulation of a large portfolio of genes and pathways, most notably including genes involved in the spermatogonial stem cell self-renewal process. We also report here for the first time the role of transcription elongation regulator-1 like (Tcerg1l) as a downstream effector of RA-induced spermatogonial differentiation.
651 Can Two Week Wait Breast Cancer Referrals Be Triaged to Prioritise High Risk Patients for Early Diagnosis and Treatment?
Authors: Blacker S , Jordache R , Pakzad F
Published: May 2021

Introduction

NHS England state there should be a maximum 62-day wait from urgent GP referral to first definitive treatment in 95% of patients. Within this timeframe is the two-week wait (TWW) target from urgent GP referral to first outpatient appointment. This audit aims to identify those at higher risk of a cancer diagnosis and prioritise their outpatient appointment.

Method

A retrospective analysis was conducted of patients on a 62-day breast cancer pathway treated at the Royal Surrey County Hospital (RSCH), from February to July 2019. TWW was identified as a common rate-limiting step. Further analysis of September 2019 allowed the contents of GP referrals to be correlated with subsequent diagnoses.

Results

40% of breast cancer patients breached the 62-day target in this 6-month period; the mean TWW was 11.5 days. In September, 266 referrals were received with a cancer detection rate of 3.95%. The most specific referral characteristic was personal history of a breast cancer. Breast lumps in the >30s are more specific than in the <30s (6.8% versus 0%).

Conclusions

Designated clinics for breast pain and lumps for <30s, would relieve pressure on the high volume of referrals made to TWW clinics, reducing delay to diagnosis and treatment for those most at risk
799 Negative Pressure Wound Therapy Following Excision of Pilonidal Sinus Disease: A Retrospective Review
Authors: Harding T
Published: May 2021

Background

Pilonidal sinus disease (PSD) is a common condition that can have a detrimental impact on patient quality of life. Definitive surgical management for PSD is challenging and remains a contentious issue. Primary closure is associated with a high recurrence rate, while healing by secondary intention comes with slow healing and burdensome wound care. Negative pressure wound therapy (NPWT) is widely used to accelerate healing.

Aim

To evaluate outcomes in patients with PSD treated by a standardised technique of complete surgical excision followed by the application of NPWT.

Method

A retrospective observational cohort study of all patients with PSD managed by complete surgical excision followed by application of NPWT was performed over a 5-year period.

Results

41 patients underwent excision of PSD with application of NPWT during the observation period. All patients’ wounds healed successfully with NPWT. Only one patient (2.4%) developed recurrent PSD and required further surgery.

Discussion

The ideal surgery for PSD should have a low recurrence rate. Our results demonstrate that our technique of complete surgical excision followed by application of NPWT meets all these criteria. To our knowledge, this study contains the largest number of patients with PSD managed by excision and NPWT in the literature.
855 Patient Specific Digital Modelling And 3D Printing of Abdominal Anatomy- The Next Frontier in Surgical Simulation?
Authors: Fletcher J , Myles C , Miskovic D , Jones J , Cahill R
Published: May 2021

Introduction

Innovations in digital technologies afford new opportunities in surgical education.

We describe a novel method of combining medical imaging data with virtual 3D modelling and printing techniques that could facilitate patient specific pre-operative planning and rehearsal.

Method

A series of silicone castings was produced to simulate upper abdominal viscera using a novel polyvinyl alcohol (PVA) injection moulding method. Digital models were generated by segmenting CT dual phase imaging in ITK-SNAP. A 3D polygon mesh was exported and optimised in the computer graphics software: Blender. Two 3D printers were used to manufacture a dissolvable mould of the digital models. Moulds were injected with coloured silicones and dissolved in water to reveal the multicolour/multi-material models.

Results

The silicone models retained the anatomical detail of the digitally segmented CT data sets. The multi-colour models were achieved with a single print and at very low cost (approx. £248/ model) and possessed varying shore hardness between viscera recreating lifelike fidelity.

Conclusions

The hybrid 3D printing/injection moulding method offers an avenue to realistic surgical and anatomical simulation. A combination of both virtual models and 3D physical models may provide an enhanced surgical experience for preoperative and intraoperative planning allowing patient specific rehearsal.
94 An Observational Cohort Study to Evaluate Volume and Severity of Emergency General Surgery Admissions During The COVID-19 Pandemic: Is There A “Lockdown” Effect?
Authors: McLean R , Young J , Musbahi A , Lee J X , Hidayat H , Abdalla N , Chowdhury S , Baker E , Etherson K
Published: May 2021

Introduction

The COVID-19 pandemic has led to changes in NHS surgical service provision. This, combined with the government-imposed lockdown, may have impacted on patient attendance, severity of surgical disease, and outcomes. This study aimed to investigate a possible ‘lockdown’ effect on the volume and severity of surgical admissions and outcomes.

Method

Two cohorts of adult emergency general surgery admissions 30 days immediately before (16/2/2020 to 15/3/2020), and after UK government advice (16/3/2020 to 15/4/2020). Data were collected relating to patient characteristics, disease severity, clinical outcomes, and compared between these groups.

Results

Following lockdown, a significant reduction in median daily admissions from 7 to 3 (p < 0.001) was observed. Post-lockdown patients were significantly older, frailer with higher inflammatory indices and rates of AKI, and more likely to present with gastrointestinal cancer, obstruction, and perforation. Patients had significantly higher rates of Clavien-Dindo Grade ≥3 complications (p = 0.001), all-cause 30-day mortality (8.5% vs. 2.9%, p = 0.028), but no significant difference was observed in operative 30-day mortality.

Conclusions

There appears to be a “lockdown” effect on general surgical admissions with fewer admissions, more acutely unwell patients, and an increase in all-cause 30-day mortality. Patients should be advised to present promptly, and this should be reinforced for future lockdowns during the pandemic.
110 The Results of Treatment of Acute Appendicitis During COVID-19 Pandemic in A District General Hospital
Authors: Urbonas T , Centea D , Wild T , Thomas P
Published: May 2021

Aim:

At the beginning of the Covid-19 pandemic conservative management of acute appendicitis (AA) was advised to reduce the risk the spread of infection during aerosol generating procedures. The aim of this study was to audit the outcomes of the management of AA in a district general hospital during the pandemic.

Method

The prospective data was collected for all patients treated for AA from 12/03/2020 to 18/05/2020. The primary objective was the failure rate of conservative management requiring surgical intervention. Statistical analysis was performed using JASP software.

Results

There were 22 patients included. 19 (86%) were managed conservatively of which 4 (21%) patients failed and progressed to surgery and 3 (14%) patients had appendicectomy on admission. 3 patients (20%) treated non-operatively were readmitted within median 4 days (4-6); 2 (13%) of them developed appendix mass. None of the patients had positive SARS-CoV-2 test. Median length of stay (LOS) was 3.5 (1-8) days; 4 (3-8) days in the immediate appendicectomy group, 3 (1-7) in the group managed conservatively.

Conclusions

The sample size was small hence it is difficult to draw any solid conclusions. We feel that appendicectomy should remain standard treatment for AA. However, antibiotics should be considered as the first line during the pandemic.
174 SARS-Cov-2 Increases The 30-Day Mortality in Hip Fracture Patients. A UK District Hospital’s Experience
Authors: Oduoza U , Mamarelis G , Chekuri R , Estfan R , Greer A
Published: May 2021

Introduction

Coronavirus disease 2019 (COVID-19) is a worldwide pandemic with a case mortality ratio of approximately 6.4%. Hip fracture patients are vulnerable if contracting COVID-19. Evidence is lacking regarding the mortality rate of hip fracture patients admitted during the COVID-19 pandemic.

Method

Retrospective review of all patients admitted to Southend University Hospital from March – April 2020. Demographic data (age, BMI, gender, co-morbidities) along with diagnosis of COVID-19 (clinical + (radiology +/- microbiology positive) and operative characteristics (time to operation, length of stay, ASA grading, Nottingham Hip Fracture Score), blood tests. Primary outcome was 30-day mortality rate in COVID-19 positive/negative patients who had hip fracture.

Results

41 patients were included in the study of which 37 had a COVID-19 swab. Overall mortality in the group was 22%. Eleven patients tested positive for COVID-19. There was a statistically significant difference in mortality between those testing positive compared to those testing negative (54.5% versus 7,69% respectively, Fisher’s exact test, p = 0.004) and when comparing those who had an operation and tested positive for COVID-19 against those who had an operation and tested negative (37.5% versus 4,34% respectively, Fisher’s exact test, p = 0.043).

Conclusions

COVID-19 increases the 30-day mortality in neck of femur fracture patients.
417 COVID-19 and the Return to Head and Neck Outpatient Activity in The United Kingdom: What Is the New Normal?
Authors: Jaikaransingh D , Bola S , Winter S
Published: May 2021

Background

We aim to investigate current head and neck outpatient practices across the United Kingdom during the COVID-19 pandemic.

Method

A cross-sectional study comprising of an online 20-item survey was emailed to members of the British Association of Head and Neck Oncologists (BAHNO). Topics covered included safety measures, protective equipment used and protocols around the use of flexible nasendoscopy (FNE) in clinic.

Results

117 participants completed the survey covering 66 Trusts across the UK. There was a significant reduction in face-to-face clinic patients compared to pre-pandemic numbers. Room down-time after FNE ranged from 0-6 hours and there was a significant increase in allocated down-time after the patient had coughed or sneezed. Natural ventilation existed in 36% of clinics and the majority of responders didn’t know the calculated Air Change Per Hour (ACPH) of the room (77%). Where ACPH was known, it often did not match the allocated room down-time.

Conclusions

Adaptations are being made across the UK to maintain staff and patient safety, but more can still be done by liaising with hospital infectious diseases and the hospital estates team to clarify outpatient protocols.Outpatient activity will likely remain limited and alternative strategies will need to develop to manage the backlog in face-to-face clinics.
579 The Impact of Coronavirus 2 (SARS-CoV-2) in Emergency Surgery. Our experience at the General Surgery Department in Queen Elizabeth Hospital, London
Authors: Chatzikonstantinou M , David M , Pouncey A , Aljarad F , Sorelli P
Published: May 2021

Background

The outbreak of the COVID-19 has had global impact on elective and emergency surgical care. So far, we possess few data to understand the effect of the CoViD-19 on emergency surgery.

Aim

To compare the total number of patients who were referred, admitted, and had an emergency operation under General Surgery (GS) between March and May 2020, to the same period between 2016-19.

Method

Retrospective analysis of prospectively collected local data from surgical take lists and operative data obtained from the hospital’s Business Intelligence Team.

Results

A 22.4% reduction was seen in the referrals per day 15.18+/-2.45 vs. 11.77 +/- 4.54 (2016-9 vs. 2020, mean+/-SD) and a 36% reduction in admissions per day 7.40 +/-1.07 vs. 4.69+/- 2.03 (2016-9 vs. 2020, mean+/-SD). A 55% reduction in the total number of emergency operations during the CoViD-19 outbreak was observed 87 (total, 2020) vs. 194+/-35.96 (mean+/-SD, 2016-19).

Conclusions

CoViD-19 had a significant impact on the number of patients presenting to GS. Interestingly, an even greater reduction in operative treatment was also observed. This may reflect reduction in theatre availability or use of a higher threshold for conservative treatment.
617 Does Wearing Enhanced Personal Protective Equipment (PPE) In Theatre Increase Surgeon Workload and Patient Morbidity?
Authors: Gysling S , Maresca G , Brooks A , Patel A , Caruana E
Published: May 2021

Introduction

Delivery of surgical services during the Covid-19 pandemic has required the use of enhanced PPE in the operating theatre. We sought to evaluate the impact of this change on surgeon workload and intraoperative patient outcomes.

Method

Surgeons performing as primary operator completed an online procedure-specific questionnaire on workload ratings for each operative case, using an extension of the validated Surgeon Task Load Index (SURG-TLX) tool (reported on a 20-point scale), together with operative details. Local approval was obtained at individual sites. Data was analysed in Stata SE v16.

Results

118 responses (17 surgeons, 7 specialties) were collected from June to September 2020. 77.1% used enhanced PPE. There was no association between enhanced PPE use and overall workload (p = 0.151) as measured with SURG-TLX, although surgeons wearing enhanced PPE commonly reported finding individual procedures harder than expected (37% vs 0%, p < 0.001). Communication was rated worse when using enhanced PPE use (MD -4.38, 95%CI -6.74 to 02.03; p < 0.001). There was no association between enhanced PPE use and intraoperative complications (p = 0.745).

Conclusions

The use of enhanced PPE is not associated with complications or increased surgeon workload assessed by SURG-TLX. It is, however, associated with difficulty in communicating, and subjectively experiencing more procedural challenge than anticipated.
649 COVID BOAST In Practice: Our Experience Implementing BOA Recommendations During the UK Coronavirus Pandemic Peak
Authors: Hoyle A , Iqbal K , Henry J , Hughes L , Johnson D
Published: May 2021

Background

In anticipation of the UK coronavirus pandemic peak, BOA published new pandemic-specific guidance (“COVID BOAST”) in April 2020. We describe our experience implementing this restructured T&O service in a busy DGH setting during the pandemic peak.

Method

A rapid retrospective audit was conducted of all patients presenting to our T&O service in April 2020, with particular emphasis compliance with COVID BOAST.

Results

Our service conducted 511 outpatient reviews, and 95 operative procedures. 94% of outpatients were treated non-operatively. We provided telephone appointments to 12.8% of follow-up patients, and 39% of new patients. 82% of patients were treated with removable casts/splints/boots. 23% of patients were discharged direct from VFC or after one face-to-face fracture clinic review. Residual deformity was consciously accepted in 13% of patients. Theatre throughput fell significantly due to pandemic precautions however, femoral neck fracture volumes remained constant.

Conclusions

We demonstrate broad compliance with COVID BOAST guidance. The majority of patients were treated non-operatively, including conscious acceptance of residual deformity. Our pre-existing VFC allowed us to provide a significant number of telephone consultations, although despite the practice shift towards removable splintage, face-to-face consultations were required for clinical and/or radiological assessment. The impact of increased conservative management on patients’ long-term outcomes needs further evaluation.
727 Ambulatory Management of Acute Uncomplicated Diverticulitis During COVID-19 Pandemic
Authors: Harty M , Armstrong L , McElvanna K , McElvanna K
Published: May 2021

Introduction

Acute diverticulitis remains a common acute presentation to the emergency department(ED). During the COVID-19 pandemic, surgical services have been adapted to reduce hospital admissions. Our aim is to assess the safety and efficacy of the surgical ambulatory service in the management of acute diverticulitis.

Method

Data was retrospectively collected on consecutive patients referred to the surgical team with a suspected diagnosis of diverticulitis between 30.04.20-16.08.20. Unsuccessful ambulation was determined by representation at 30 days.

Results

83 patients presented with suspected diverticulitis. 36 patients were deemed clinically stable and suitable for ambulation. 21 of these patients underwent a CT abdomen in the ED, confirming uncomplicated diverticulitis and were discharged with oral antibiotics as per trust guidance. 4 patients were discharged from ED for an ambulatory CT abdomen, with a median waiting time of 3 days. 11 patients received no imaging prior to discharge, all of whom had known diverticular disease. 86% of ambulated patients underwent a telephone review within 72 hours of acute presentation. 8.3% of ambulated patients represented within a 30 day window, 0 of which required surgical management.

Conclusions

Patients presenting with uncomplicated acute diverticulitis can be safely managed in an ambulatory setting. Access to imaging early can facilitate successful discharge.
783 Brachial Plexopathy Secondary to Prone Position Used in The Treatment of a Ventilated Patient With COVID-19: A Case Report and Service Improvement Recommendations
Authors: Baldwin A , Truelove A , Ali T
Published: May 2021

Introduction

Prone position has been recommended by many authorities as part of the management of ventilated patients with COVID-19. However, proning with concurrent use of sedation and muscle relaxants carries the hypothetical risk of brachial plexus injuries, thought to be due to stretch and compression of the abducted shoulder.

Case

We report the case of a long-stay critical care patient who required frequent proning due to SARS-CoV-2 infection, and who presented with new right upper limb weakness. This case was referred to our local plastic surgery service and an injury to the upper trunk of the right brachial plexus was confirmed on nerve conduction studies.

Recommendations

Following this case, we made adaptations to our local practice and modified our prone-specific SSKIN bundle (originally created to prevent pressure sores) to include a section on ‘Nerves’, with an accompanying diagram. We dubbed this the SSKINN bundle. This ensured safe prone positioning. We encourage other hospitals to put in place similar interventions.

Conclusions

We present this as a pathology to consider in patients proned during the COVID-19 pandemic; and recommend checking for signs of focal neurological deficits of the upper limb upon removal of paralysis and sedation, with early referral of suspected cases.
814 The Ambulatory Management of Acute Biliary Disease During the COVID-19 Pandemic
Authors: Lockhart J , Deeny D , Armstrong L
Published: May 2021

Introduction

Biliary pathology creates a significant burden on the NHS in terms of acute admissions, investigative imaging and elective operating. During the COVID-19 pandemic, surgical services were adapted to minimise hospital admissions. Our aim is to review the safety and efficacy of the surgical ambulatory service in the management of varying biliary pathology.

Method

Data was retrospectively collected on consecutive patients referred to the surgical team with presumed biliary pathology between 30th April and 16th August 2020. Patients with presumed cholecystitis were discharged with oral antibiotics following local guidance with follow-up telephone consultations. Unsuccessful ambulation was determined by representation at 30 days.

Results

One-hundred-and-seventy patients were referred to the acute surgical team with presumed biliary pathology; 81 were suitable for ambulatory management and their first line imaging (abdominal ultrasound, MRCP or CT) was performed within a median of 4 days; 17% of these patients underwent second line imaging in the form of MRCP. Fourteen percent of these patients failed ambulatory management and were admitted to hospital; 3 underwent a cholecystectomy and 2 had an ERCP.

Conclusions

Patients presenting with biliary disease can be safely managed in an ambulatory setting. Access to imaging early can facilitate successful discharge and ongoing ambulatory investigation and definitive management.
918 COVID-19: A Detailed Analysis on Fit-Testing for Respiratory Protective Equipment in the UK
Authors: Gani A , Green S , Bailey M , Brown O , Hing C
Published: May 2021

Introduction

There is limited data in the literature regarding the adequacy of generic FFP3 masks and their facial fit to ensure adequate protection. Mask fit-testing is therefore essential to protect healthcare workers.

Method

Using the Freedom of Information Act, 137 acute NHS trusts in the UK were approached on the 26/3/2020 by an independent researcher to provide data on the outcome of fit testing at each site.

Results

85 Trusts responded to the FOI with 51 trusts providing pertinent data relevant to the FOI request. There was a total of 72 mask types used across 51 trusts. The commonest of which was the FFP3M1863 (used by 47/51 trusts, 92.16%). A positive correlation was found between staff members and number of mask types used (r = 0.75, P = <0.05).

Overall fit-testing pass rates were provided by 32 trusts. The mean percentage pass rate was 80.74%.

Gender specific failure rates were provided by seven trusts. 4386 males underwent fit-testing in comparison to 16305 females. Across all seven trusts 20.08% of men tested failed the fit-test while only 19.89% of women failed the fit-test.

Conclusions

Our results may be utilised in choosing respirators for fit testing programme in healthcare-workers during the COVID-19 pandemic.
931 COVID-19 and the Irish National Spinal Injuries Unit: Impact on Service Provision and Strategies to Protect Urgent Care
Authors: Power F , Juhdi A , Macken M , Synnott K A , Butler J S
Published: May 2021

Introduction

The COVID-19 pandemic has had a dramatic impact on the provision of healthcare worldwide. The delivery of a national spinal service for emergent surgery, elective surgery and outpatient assessment has been incredibly challenging.

Method

Prospectively collected data regarding referrals to, and operative workload of, the Irish National Spinal Injuries Unit (NSIU) during the period of national lockdown in response to the COVID-19 pandemic was compared to the same period in 2019.

Results

During the period of national lockdown there was a 47% decrease in the number of urgent referrals to the NSIU and a 61% reduction in the number of surgical cases performed. A particularly concerning finding was that for surgical cases there was a 400% increase in attempted suicide as the cause of injury with this cohort representing 11% of all surgical cases performed during the pandemic lockdown. The introduction of a national instant messaging application (Siilo) referral group resulted in a median time to first response by a National Spinal Injuries Unit (NSIU) surgeon of 15.5 minutes.

Conclusions

The COVID-19 pandemic has had a significant impact on the provision of a national spinal service, however innovative strategies have been adopted to protect the capacity to provide urgent care.
952 In-Patient Trauma Surgery in COVID-19 Positive Patients Carries A Significantly Higher Mortality Risk When Compared to In-Patient Covid-19 Negative Patients and Day Case Trauma Patients
Authors: Qureshi M , Lokanathan S , Adapa A , Stansfield J , Jain N , Bhutta A
Published: May 2021

Introduction

Covid-19 caused many service changes, yet Trauma surgery continued throughout. We compare mortality rates from In-Patient (IP) and Day Case (DC) trauma patients and compare the mortality rates of patients who tested positive or negative for Covid-19.

Method

We reviewed all trauma admissions that underwent surgical intervention in both our IP and DC services during 31 days from March 23rd 2020. We recorded their sex, age, operation, Covid-19 symptoms, Covid-19 test results and mortality. The findings were compared between the groups.

Results

In total 127 patients underwent surgery (66 IP; 61 DC). There were 6 deaths (9.1%) within the IP group and 0 deaths in the DC group (p = 0.006). In the IP group 8 patients (12.1%) tested positive for Covid-19 of which 4 died (50%) compared to the remaining 58 patients (87.9%) of which 2 (3.4%) died (p < 0.001). A higher mortality rate was observed in patients with symptoms but a negative Covid-19 test (6.7%) than patients in whom a test was never indicated (2.3%).

Conclusion

Covid-19 positive patients requiring in-patient admission for trauma surgery have a significantly higher mortality rate than both in-patient admissions that were Covid-19 negative or asymptomatic and patients that were treated with Day Case Trauma surgery.
40 Across the Pond: Why Are Junior Doctors Seeking Surgical Training Abroad?
Authors: Irfan A , Ahmed I
Published: May 2021

Introduction

The loss of junior doctors from the NHS has been an ongoing issue. A subset are now seeking surgical training in other systems, such as the US. This is a costly and difficult process and many enter into undesignated positions with no guarantee of a job. With so much career uncertainty, why are trainees willing to take the risk?

Method

We performed a survey of trainees who graduated from British medical schools; all are currently enrolled in a US surgical training programme. They were asked about their experiences and perceptions of

Results

Nine trainees completed the survey. The most common time for trainees to move was during or after foundation training and the majority initially matched into preliminary positions. The most common reason cited to move was to receive better quality training. Many perceived the US training to be better and felt that they had a reasonable work-life balance.

Conclusions

The potential loss of the future NHS surgical workforce is worrying. Our survey highlights that surgical trainees place a high value on the quality of their training and were willing to enter an intense and uncertain process to achieve it. This needs to be addressed to retain potential trainees.
77 The Development of Core Outcome Sets and Common Data Elements in Clinical Neurosciences: A Scoping Review
Authors: Horsfall H L , Bandyopadhyay S , Chari A , Kolias A
Published: May 2021

Introduction

The use of core outcome sets (COS) and common data elements (CDEs) minimises research wastage by increasing the cross-comparison and meta-analysis of study findings. Our study sought to identify the clinical neuroscience subspecialties that have developed COS and CDEs, the countries of origin of authors, and the process through which COS and CDEs were developed.

Method

A search between 2000-2020 of the top 40 Impact Factor neurosurgical and neurological journals was conducted. A scoping review was performed in accordance with the PRISMA-ScR Checklist.

Results

Our search returned 169 papers, of which 35 were eligible for inclusion. The USA published the majority of papers (20/35). The papers mostly related to neurosurgery (30/35), with the most common neurosurgical sub-specialty being traumatic brain injury (14/35). There is an increasing publication trend over time, with 12 papers published in 2019. Five papers were systematic reviews conducting with the intention of COS/CDE development. 27 papers reported CDE development and 2 papers reported COS development. The COS development papers utilised international consensus meetings and adhered to international development statements.

Conclusions

COS and CDEs are increasingly being developed within clinical neurosciences. There is a need for greater international collaboration with regards to COS and CDEs development.
245 Multidisciplinary Learning in the Elective Orthopaedic Setting: Can Junior Doctors and Nursing Staff Learn Together?
Authors: Gnap R , Carew E , Wijeratna M
Published: May 2021

Introduction

Feedback from junior doctors highlighted dissatisfaction with the educational value of their orthopaedic job. Surveys showed that none had had a formal departmental induction, only 33% felt their confidence had improved during the placement and only 50% reported having adequate opportunities to complete workplace-based assessments. Nurses, overall, were dissatisfied with the relationship with ward-based doctors.

Method

We developed an educational programme for doctors and nurses which sought to cover induction to the specialty and common orthopaedic and allied specialty topics. The biweekly teaching programme utilised a variety of teaching methods including group learning, simulation, and seminars to facilitate interdisciplinary learning and team bonding with the emphasis on mirroring the way care is delivered. Doctors and nurses were re-surveyed at the end of the placement.

Results

75% of doctors had now received an induction and confidence in managing orthopaedic conditions improved from 33% to 75%. Adequate opportunities to complete assessments improved from 50% to 75%. 100% of nurses agreed that multidisciplinary learning was both possible and beneficial compared to only 54% beforehand.

Conclusions

Multidisciplinary education can improve confidence and teamwork among doctors and nursing staff. A service that boasts a robust teaching programme makes orthopaedics a more attractive speciality for nurses and doctors alike.
385 Intra-Operative Use of Biological Products – A Study Investigating the Awareness Amongst Surgeons in The UK
Authors: Bhamra N , Jolly K , Darr A , Bowyer D , Ahmed S
Published: May 2021

Global medical advances within healthcare have subsequently led to the widespread introduction of biological products such as grafts, haemostats, and sealants. Although these products have been used for many decades, this subject is frequently not discussed during the consent process and remains an area of contention.

A nationwide confidential online survey was distributed to UK-based junior registrars (ST3-5), senior registrars (ST6-8), post-CCT fellows, specialist associates/staff grade doctors and consultants working in general/vascular surgery, neurosurgery, otolaryngology, oral & maxillofacial surgery and plastic surgery.

Data was collected from a total of 308 survey respondents. Biological derivatives were correctly identified in surgical products by only 25% of survey respondents, only 19% stated that they regularly consent for use of these products. An overwhelming 74% of participants agreed that further education on the intra-operative use of biological materials would be valuable.

This study highlights deficiencies in knowledge that results in potential compromise of the consenting process for surgical procedures. A solution to this would be for clinicians to increase their awareness via educational platforms and to incorporate an additional statement on the consent form which addresses the potential intra-operative use of biological products and what their derivatives may be.
429 National Evaluation of Confidence and Preparedness for Surgical Rotations in Medical Students and Foundation Year Doctors
Authors: Tan L , Mullins W , Gargan A , Townsend J , Gargan K , Brice J , Shea J , Jang C , Shukla S , Asif A , Fricker M , Mohan M , Nathan A
Published: May 2021

Introduction

Limited published and anecdotal evidence suggests foundation year (FY) doctors start their surgical rotations with lower confidence than medical rotations. This may be due to insufficient undergraduate practical teaching related to common surgical rotations. This study aimed to evaluate the confidence and preparedness for surgical rotations of medical students and FY doctors.

Method

An expert-validated questionnaire was distributed nationally to UK medical students and FY doctors. The primary outcome was confidence in completing common tasks during surgical rotations.

Results

491 participants (84% medical students, 16% FYs) were recruited from 36 UK medical schools. 80% were likely to pursue a career in surgery however only 7% felt confident about starting a surgical FY job. 66% felt neutral or unsatisfied about the quality of medical school surgical teaching, and 80% indicated that placements did not prepare them well to manage common FY surgical tasks. The internal reliability of the questionnaire was high (=0.939).

Conclusions

Medical students and FY doctors lack confidence and preparation for surgical jobs. High-quality, practically grounded educational courses such as the National Surgical Teaching Society (NSTS) webinar curriculum could improve confidence and preparedness for surgical rotations. Further research evaluating the benefits of such courses is warranted.
520 Training in Electrocautery, Too Hot to Handle?
Authors: Waterman J , Osinkolu I , Abdeldayem M , Haray P
Published: May 2021

Introduction

The use of electrical energy has become common practice in surgery. Although electrocautery is deemed safe, arguably its safety is dependent on the level of knowledge among its users. The primary aim of this study is to assess what level of knowledge surgeons in Wales, UK have on the safe use of electrocautery.

Method

A survey was carried out involving 61 surgical doctors across 6 different health boards in Wales. The survey was implemented using an anonymous questionnaire distributed via online and by hard copy.

Results

Of the 61 doctors surveyed, 9.8% had not received any form of training on electrocautery. 54.5% of those who had training, had this through supervision or teaching in operating rooms during live operating. 37% of participants did not know the difference between bipolar and monopolar electrocautery. 77% of the participants expressed an interest in specific training to help increase the level of education and the safe use of electrocautery.

Discussion

This study shows that a gap still exists in the training and education of surgeons on the use of electrocautery. Electrocautery has the potential to cause harm and more needs to be done to improve education around this topic to ensure patient and user safety.
533 The Use of Virtual Reality Simulation to Facilitate Surgical Ward-Based Learning in Medical Students During the Covid-19 Pandemic
Authors: Carty I , Shah R
Published: May 2021

Introduction

The Covid-19 pandemic quickly resulted in the removal of all non-essential personnel from surgical wards. It also resulted in suspending medical student placements which are heavily relied upon to provide the students with necessary “hands-on” experience. Virtual Reality (VR) simulation was employed in order to ensure that the students had a comparable experience.

Method

VR simulations were used to simulate the ward environments and the students were able to gain valuable experience with common scenarios encountered on surgical wards. Each student was allocated a 1-hour time slot per session with a debriefing session after each. The digital immersive environment allowed students to build upon their didactic preparation and previously acquired knowledge base.

Results

Feedback was given at the end of each simulation by the simulation facilitator. Using the technical proficiency that they had acquired in the first scenario; the students went on to employ these skills directly in their next scenarios thereby capitalising on the repetition of core skills to maximize their learning.

Conclusions

In this instance, VR was successfully used to enhance both knowledge acquisition and experience. Feedback from the participating students was overwhelmingly positive with many suggesting that they were more comfortable learning in a simulated environment.
747 YouTube And Neurosurgery: Better Content, More Views
Authors: Mayo I , Manivannan S , Bisson J , Leach P , Zaben M
Published: May 2021

Introduction

YouTube is the world’s largest open-access media sharing platform and contains much content on Neurosurgery. Inserting an External Ventricular Drain is a common procedure, often performed by neurosurgical trainees to treat emergency hydrocephalus. We set out to evaluate the content on EVD insertion posted on YouTube and its usefulness for trainees in learning the procedure

Method

A YouTube keyword search was conducted to identify videos on EVD insertion. Inclusion criteria was used to find videos specifically aimed to EVD insertion. We devised a scoring sheet to give each video an educational score (0-20), which two independent reviewers used to analyse the included videos.

Results

A total of 12/556 videos met the inclusion criteria. Dates posted ranged from 01/07/2012 to 24/04/2019, with views ranging from 359 – 166,388 (mean 30531, SD 49, 570). The mean educational score was 6.91 (SD 3.86), with only four videos scoring 10 or greater. There was a strong correlation between viewership and educational score (R .085 p <.001).

Conclusions

The majority of YouTube content relating to EVD insertion is not useful to trainees, but useful content can attract a greater viewership. There is an opportunity for Neurosurgeons and Institutions to gain exposure on YouTube with high-quality open-access educational content.
843 Improving Practical Skills Training with In-Situ Trauma Simulation
Authors: Fisher R , Nambiar A , Subramanian R
Published: May 2021

Introduction

Safe and effective management of trauma patients requires numerous practical skills. Our in-situ trauma simulation identified key areas requiring increased training and exposure. This enabled improvement to education, patient safety and efficiency when managing these emergencies.

Method

We carried out a simulated trauma call according to ATLS principles, recording the time and person completing each task. Key areas for improvement were identified; most notably the application of Femoral Traction Splints (FTS). 0/7 doctors present were not able to do this. Subsequently, a formal training day was delivered, with 38 attendees across specialties, assessing confidence before and after the session.

Results

Prior to the training session, 52.6% of attendees did not have formal teaching using FTS and 65.8% had never used one. Confidence with FTS application was measured on a scale of 1 (not confident) to 5 (very confident), with an average score of 2.6/5.

After training, the average confidence score was 4.7/5 (p < 0.01). 100% of participants found the session very useful.

Conclusions

In-situ simulation allows identification of key areas for improvement in training of practical skills. Essential tailored teaching can then be delivered to increase exposure and confidence for these necessary practical skills.
879 Establishing the First Eoe Deanery-Wide Trainee Led Virtual Journal Club: Keeping Up Morale by Encouraging Trainee Interaction and Continuous Professional Development During the Hiatus to Teaching Activities Enforced by Coronavirus
Authors: Adegbola S , Rabie M , Currow C , Aly M , Patel K , Aker M , Patel K , Askari A
Published: May 2021

Introduction

Over the initial COVID months and with the cancellation of several teaching programs / courses/ conferences; we identified a NEED for trainee interaction and continuous professional development, despite staff redeployments. We since established a deanery-wide trainee led VIRTUAL journal club, run by the Surgical Trainees of East of England Research collaborative (STEER) group.

Method

Following decision in May2020, the STEER group collated curriculum topics and related landmark papers, drafting a programmed-schedule for sessions (45mins – 1hour). CPD accreditation was sought and received from RCSEd prior to some sessions. Sessions were delivered using the Microsoft Teams app (via desktop/tablet/phone). Targeted audience included FYs, CTs, STs, JCFs, SCFs (candidates preparing for MRCS/FRCS or interested in academia). Live polling / feedback forms and attendance certificates were distributed.

Results

Six journal club sessions have been run to-date. A minimum of 15-20 participants attended each session with spread of junior/senior trainees. Sessions were video recorded for repeat playback for those unable to attend. Feedback was overwhelmingly positive, with good engagement from participants.

Conclusions

A deanery wide virtual journal club was positively received by trainees and benefits included: critique and dissemination of evidence (especially recently with COVID-related literature), trainee interaction and keeping up-to-date and understanding and analysing information.
908 Personal Protective Equipment (PPE) Guidance During A Global Pandemic: A Statistical Analysis of National Perceived Confidence, Knowledge, And Educational Deficits Amongst U.K. Based Doctors
Authors: Al-Hity S , Bhamra N , Kumar R , Gupta K , Howard J , Jolly K , Darr A
Published: May 2021

Introduction

March 11th, 2020 saw the World Health Organisation declare a global pandemic following the eruption of the novel coronavirus disease 2019. Unprecedented global demand for personal protective equipment (PPE) was complicated by limited availability and conflicting guidance from healthcare bodies. This study aimed to assess perceived confidence and knowledge of Public Health England’s PPE guidance amongst doctors of varying specialties and grades.

Method

A nationwide 11-point survey comprising of multiple-choice questions (MCQs) and a Likert scale assessing perceived confidence (1=not confident, 5=very confident) was disseminated to U.K. based doctors using multiple platforms.

Results

Data collated from 697 respondents revealed average perceived confidence was low. Notably, 59% felt they had received insufficient education regarding up-to-date guidance, with 81% advocating further training. Anaesthetics and ophthalmology were the highest and lowest scoring specialties in knowledge based MCQs, achieving 59% and 31% respectively. Subsequent statistical analysis revealed significant differences between specialties."

Conclusions

Ensuring consistency in published PPE guidance and education can develop doctor’s confidence and knowledge of appropriate PPE use. The absence of a unified consensus and global education regarding the use of PPE poses significant ramifications for patient and healthcare professional (HCP) safety whilst risking further depletion of already sparse resources.
986 A Systematic Review of Medical Student Willingness to Volunteer and Preparedness for Pandemics and Disasters
Authors: Byrne M , Ashcroft J , Alexander L , Wan J , Harvey A
Published: May 2021

Introduction

We aimed to identify motivators and barriers to volunteering during a disaster and knowledge and medical school curriculum of disaster and pandemic medicine.

Method

We systematically searched the literature on 28/6/2020, following PRISMA guidelines.

Results

A total of 37 studies met inclusion criteria including 11,168 medical students and 91 medical schools. 24 studies evaluated knowledge (64.9%), 16 evaluated volunteering (43.2%), and five evaluated medical school curricula (13.5%). Weighted mean willingness to volunteer during a disaster was 68.4% (SD = 21.7%, n = 2911), and there was a significant difference between those planning to volunteer and those who actually volunteered (P<.001). We identified a number of modifiable barriers which may contribute to this difference. Overall, knowledge of disasters was poor with a weighted mean of 48.9% (SD = 15.1%, n = 2985).

Conclusions

There is a large number of students who are willing to volunteer during pandemics. However, they are likely to be under-prepared for these roles due to poor overall knowledge and limited teaching. During the current COVID-19 pandemic and in future disasters, medical students may be required to volunteer as auxiliary staff. Medical schools need to develop infrastructure to facilitate this process as well as providing education and training to ensure students are adequately prepared for these roles.
19 Colectomy Rate for Moderate to Severe Ulcerative Colitis with Biologics
Authors: Koh J W H , Ng C H , Lee M H , Chin Y H , Ong Z H , Tham H Y , Chong C S , Shim H H , Fo F J
Published: May 2021

Introduction

Biologics are recommended by both the ACG and ECCO community for the treatment of ulcerative colitis. Yet, current literature has yet to estimate the rate of colectomies after biologic therapy, and thus a pooled meta-analysis was conducted the rate of colectomies in 1month, 6 months, 1 year, 2years and five years after biologics.

Method

Medline and Embase were searched for articles examining biologics use in moderate to severe UC or acute severe UC (ASUC) from inception to 21st May 2020. Analysis of proportions were undertaken after a freeman-tukey double arcsine transformation.

Results

The pooled overall colectomy rates of ASUC and moderate to severe UC were 9% (CI: 4% - 14%) at one month, 18% (CI: 13% - 25%) at six months, 21% (CI:16% - 27%) at one year, 29% (CI:24% - 34%) at two years and 38% (CI:30% - 45%) at five years. Additionally, colectomy rates were consistently lower comparing between articles before and after 2010. At one-year, overall colectomy rate following infliximab use was at 25%, golimumab at 15%, vedolizumab at 14%, and adalimumab at 3%.

Conclusions

Colectomy rates in the era of biologics ranged from 8% to 38% and lower post-2010 showing significant improvement in management and supporting the utility of biologics in Ulcerative colitis management.