bluuebunny/crossref_metadata_2025 huggingface dataset:
248 Exploring Early Practice and Application of NovoSorbⓇ Biodegradable Temporising Matrix in the United Kingdom: A Case Series on Wound Reconstruction
Authors: Tam S S C , Taylor K , Patel P , Goon P , Khatib M
Published: August 2024

Aim

To identify patients treated with NovoSorbⓇ Biodegradable Temporising Matrix (BTM). To examine defect aetiology, indications of BTM and operation details. To investigate treatment outcomes and possible complications.

Method

From October 2021 to February 2023, 12 patients were treated with BTM for wound reconstruction at Lister Hospital, Stevenage. Patient information, defect size, the reason for BTM use, operation details, and complications were recorded from medical records. The length of initial hospital stays, the time from BTM application to integration, and the length of inpatient stay for post-secondary reconstruction were noted. Indications for BTM were grouped into four categories: covering wounds with exposed bone, covering wounds with exposed tendon, burn wound temporisation and aesthetic reconstruction. Complications were grouped into infection and non-adherence.

Results

This case series comprises defects from head to ankle caused by burns, surgical wounds, post-oncological resection, dermal infections, or traumatic loss. The median time for inpatient stay was 3.5 days, and patients who required skin grafts after full BTM integration were treated as day cases. One case had the post-operative complication of infection.

Conclusions

The team found that the BTM is a versatile dermal substitute that can be used to treat various defects in different parts of the body. Most patients showed no signs of infection or excessive scarring supporting the use of BTM. However, some cases were complicated, possibly due to other medical conditions. Therefore, careful patient selection, close monitoring, and appropriate wound care are recommended.
797 Outcomes From Head-and-Neck Defect Reconstruction with Double Simultaneous Free-Flaps – a Comprehensive Analysis and Showcase of Virtual Surgical Planning Experience
Authors: Chung N , Aslam F , Friebel T , Shahzad F , Khurshid A P , Tarar M M , Peat C , Ahmed O A , Berner J
Published: August 2024

Aim

Extensive composite head-and-neck-defects pose significant reconstructive challenges. This study describes experiences and outcomes associated with double simultaneous free-flap (DSFF) reconstruction for malignant and traumatic head-and-neck indications.

Method

Retrospective study spanning consecutive DSFFs from 2013 to 2023 at Freeman Hospital (FRH), UK, and Jinnah Burn and Reconstructive Surgery Center Lahore (JSC), Pakistan.

Results

Nine patients (18 free-flaps) were included. All patients underwent an osteocutaneous free fibula flap commonest in combination with an anterolateral thigh (n = 3) or free radial forearm flap (n = 2).

In the FRH and JSC groups respectively: mean ages were 53 years versus 27 years, cardiovascular/diabetic comorbidity rates were 60% versus 0%, surgical indications were malignancy (100%) versus trauma (100%), mean operative times were 13.7 (SD 2.8) hours versus 13.0 (SD 3.6) hours and significant complication rates were 60% versus 0%. The commonest complications were anaemia requiring transfusion (n = 3), seroma (n = 2) and wound infection or dehiscence (n = 2). All flaps survived.

Virtual Surgical Plans (VSPs) derived from CT imaging were utilised in all FRH operations. Plans guided construction of custom cutting jigs for precision osteotomy, implantation of osteointegrated teeth and pre-bending of reconstructive plates. 3D-printed end-reconstructive models were employed intra-operatively to enhance surgeon visualization.

Conclusions

This study emphasizes the risks associated with head-and-neck DSFF reconstruction in older, comorbid patients undergoing malignancy treatment compared to the younger, less-comorbid post-traumatic reconstruction group. There were no flap losses. VSP harbours potential in improving intra-operative planning efficiency, contributing to precise reconstruction and augmenting surgeon and patient understanding.
1180 A Cross-Sectional Analysis of Facial Aesthetic Botulinum Toxin Injection Education in the United Arab Emirates (UAE)
Authors: Zargaran A , Mansour H R Khademi , Mohamed F , Sousi S , Zargaran D , Davies J , Woollard A , Mosahebi A
Published: August 2024

Aim

The increasing demand for aesthetic facial botulinum toxin injections have resulted in a significant public health challenge internationally. There is variation in international practice pertaining to accreditation and licensing of practitioners to perform such procedures. The Keogh Review of 2013 identified education as a key area for improvement, however subsequent Health Education England recommendations for Level 7 accreditation were never formally adopted into UK law. This study explores educational practice in UAE, methodology, and compliance with national standards.

Method

A systematic online, social media and local database search was performed in English and Arabic using Boolean operators. Providers were contacted and data triangulated with benchmarking against national guidance including the Dubai Health Authority (DHA), which was broken down into three parts (i) theoretical ii) practical iii) assessments.) Descriptive statistical analysis was performed.

Results

Eighteen courses were identified, of which sixteen were included in the study. All courses had entry requirements, with 50% only allowing Doctors to participate, the remainder extending to other healthcare professionals such as dentists. 62.5% had assessments, including both practical and written, and all courses were accredited. 75% were compliant with national guidance for theory, 87.5% for practical, and 56.3% for assessments. Mean course price was AED13,624 (£2,888), whilst mean duration was 2.8 days.

Conclusions

Aesthetic Botulinum Toxin education in UAE is governed by clear criteria which in many instances are not being adhered to. All courses have specific entry requirements pertaining to professional background. The highest area for improvement in compliance was for assessments.
1244 Bridging the Gap: Enhancing Wound Management and Burn Skills in Junior Doctors
Authors: Khan R , Krzak A
Published: August 2024

Aim

This study aimed to improve Foundation Year 1 (FY1) doctors' understanding and confidence in wound and burn management through incorporation of wound and burn management teaching into the Thames Valley Deanery Foundation Training teaching curriculum.

Method

We employed a comprehensive pedagogical approach, integrating both theoretical knowledge and practical application. Initial assessment was conducted via a structured questionnaire, assessing participants' objective knowledge and perceived confidence in managing wounds and burns. The questionnaire was completed by 16 out of 46 and 10 out of 46 participating FY1 doctors pre- and post-teaching, respectively.

Results

Our analysis revealed a 48% (p<0.001) rise in self-reported confidence in managing burns, wounds, dressing choice, and knowledge of potential reconstructive options. A 13% rise in objectively assessed knowledge was noted, though did not reach statistical significance (p=0.6). Qualitative feedback indicated a gap in the medical curriculum, with doctors reporting that essential aspects of wound and burn management had not been adequately addressed during their prior medical training.

Conclusions

Our findings emphasise the benefit of continuous medical education to address knowledge gaps not met by traditional medical curricula. The incorporation of burns and wound management teaching into the curriculum increased the level of confidence but did not objectively assess knowledge. It may therefore be beneficial to incorporate such frequently encountered Plastic Surgery topics at an earlier stage in medical education. Further research should assess the impact of such teaching sessions on patient outcomes and the broader implications of delivering this specialised education.
361 Is Adrenaline Safe for Use in Digital Blocks? Changing Departmental Perceptions
Authors: Chu O , Mustafa Q , Mills R
Published: August 2024

Aim

We aimed to improve the understanding and perception of safe local anaesthetics with adrenaline injection in fingers among a cohort of registrars and consultants.

Method

Guided by the Plan-Do-Study-Act framework, we designed a survey looking at the key aspects of safe administration of adrenaline in fingers i.e., dose, mechanism of action, administration and toxicity. We collected data from registrars and consultants within the T&O team, developed and implemented evidenced based teaching at a local meeting within the hospital department. We repeated the survey following the intervention to assess changes in understanding and perception of adrenaline injection in fingers.

Results

The number of surgeons involved in two phrases were 13 and 11. Only 38% of the surgeons would consider injecting local anaesthetics with adrenaline into digits before the intervention. Understanding of safe adrenaline injection in fingers before the intervention was generally suboptimal. 64% correctly identified the safe maximum dose of adrenaline with local anaesthetics injection. 46% and 23% were able to identify the mechanism of actions and optimal time of haemostatic effect. The majority (92%) identified phentolamine as an agent to reverse the effect of adrenaline. Following the intervention, understanding of the 4 areas have significantly improved to 82%, 64%, 64% and 100% respectively. Perception of adrenaline injection in fingers has also shifted. 91% of registrars and consultants would use adrenaline with local anaesthetics in fingers injection.

Conclusions

This intervention effectively improves surgeons’ understanding and therefore the likelihood of using this safe technique in the selected group of patients’ cohorts.
405 Giant Cell Arteries: Diagnostics
Authors: Naseer A , Elkorety M , Anton J , Sarin S
Published: August 2024

Aim

Giant cell arteritis (GCA) poses a risk of severe ischaemic complications such as irreversible blindness which mandates early recognition of condition. We aimed to evaluate effectiveness of ultrasound doppler (USD) in diagnosing GCA compared to temporal artery biopsy (TAB) and American College of Rheumatology (ACR) score.

Method

This retrospective study included patients with suspected GCA who had consecutive TAB and USD examinations performed over course of three years (2017-2022) which was correlated with ACR score. The data was also analysed to assess further management.

Results

There were 64 patients over this period who had both studies performed (22 were excluded as they did not have TAB) with 64% having an ACR score ≥3. Twenty males and forty-four females with a median age of 77 years (IQR 84-67). Overall, 81% patients had a negative USD result. Comparing USD results with TAB gold standard, there was sensitivity of 63% and specificity of 84%. Comparing USD results with ACR as gold standard, there was sensitivity of 20% and specificity of 83%. Forty percent patients with negative doppler result were continued on treatment mainly due to improvement of symptoms in response to steroids.

Conclusions

US Doppler has high specificity and low sensitivity which makes it time-efficient, cost-effective and allows for the implementation of fast-track management pathway for majority patients. In certain circumstances, as cases of low clinical suspicion and positive doppler result, an additional test (TAB) would be required to confirm the diagnosis and cases where clinical suspicion is high with negative doppler, TAB should be considered.
423 Implementation of Standardised Consent Forms for Hip Fracture Surgery: A Quality Improvement Project
Authors: Singh S , Bompalas P , Pang J , Hinton A , Genena A , Mohamed R , Modi N
Published: August 2024

Aim

Informed consent is pivotal for patient care. We assessed the quality of written consenting for surgical management of neck of femur fractures (NOFF) at a UK District General Hospital. This resulted in the development of standardised consent forms to promote best clinical practice.

Method

A retrospective review of consent forms for 50 consecutive patients admitted with NOFF from July 2023 evaluated legibility, documentation of procedure name, benefits, risks, and consenter details. Standardised consent forms endorsed by the British Orthopaedic Association were used as a standard and a guide for our standardised consent forms, introduced in September 2023. We reviewed the compliance with the new forms for inpatients with NOFF in October 2023 (n=21).

Results

On consent 1 forms (n = 37), nearly 60% lacked documentation of benefits (pain relief and mobility), and 78% missed more than 5 risks. All forms were legible and 98% completed by speciality registrars or consultants. Venous thromboembolism was documented on all forms. Chronic pain, stiffness and death were missed on most forms. Procedure name was the only documentation found on consent 4 forms. The new standardised forms included both consent 1 and 4 forms and were utilised in 86% of cases. Users of the new form also included foundation year 2 doctors who clerked the patients on admission.

Conclusions

Standardised forms prevent oversight of crucial procedure risks, facilitate time efficiency, and instil confidence in junior team members to consent. Future steps aim to extend this standardised approach to other common orthopaedic procedures, like wrist and ankle fracture fixations.
478 Improving the Prescription of Key Medications for Inpatients Admitted to the Royal Cornwall Hospital with an Acute Sore Throat: A Quality-Improvement Project
Authors: Merchant H , Lambert A
Published: August 2024

Introduction

The regular administration of intravenous antibiotics, analgesia, steroids, and adequate venous thromboembolism (VTE) prophylaxis is important when managing patients with an acute sore throat. Therefore, a quality-improvement project, aiming to improve the prescription of these medications within the Royal Cornwall Hospital (RCHT) Ear Nose and Throat (ENT) department, was undertaken to enhance patient recovery and reduce length of stay (LOS).

Method

Electronic drug charts of adult patients admitted under ENT with an acute sore throat from March to May 2023 were consulted. Information on whether patients had been prescribed regular analgesia, antibiotics, steroids (if indicated), adequate VTE prophylaxis and their LOS was sought.

Results

A total of 58 patients were included. The majority (59%) were male, and the mean age was 29. The most common diagnoses were Tonsillitis (43%), followed by Quinsy (30%) and Supraglottitis (10%). The mean LOS was 1.2 days. Regular analgesia was prescribed for 52% of patients on admission, and 78% during their inpatient stay. Regular antibiotics were prescribed for 73% of patients on admission, and all patients during their inpatient stay. Regular steroids were only prescribed to 42% of patients that needed them, and 69% of patients were prescribed VTE prophylaxis.

Conclusions

These findings indicate a need to improve the prescription of regular analgesia, antibiotics on admission, VTE prophylaxis and steroids if indicated. An Acute ENT Sore Throat electronic prescribing protocol has subsequently been developed and disseminated amongst RCHT junior doctors. A second cycle of data-collection will be undertaken to examine the subsequent effects on patient care and LOS.
649 Retrospective Audit into Management of Periprosthetic Joint Infections as per National and International Guidelines
Authors: Chaudhary A , Harrison R , Przybylo M
Published: August 2024

Aim

The main aim of this quality improvement project is to improve care of patients with peri-prosthetic joint infections (PJI), by assuring appropriate diagnostics are sent and antibiotics recommended are as per Pro-Implant and British Orthopaedic association (BOA) guidelines, which are international and national guidelines.

Method

Retrospective analysis of all tissue samples received for patients with periprosthetic joint infections during August 2022 and August 2023 from patients across Manchester. There were 68 samples (17 patients) in total with peri-prosthetic joint infections out of 197 samples (62 patients). These were all compared to standards set by the Pro-Implant and BOA. Multiple criteria were compared by analysing clinic letters and Labcentre documentation.

Results

The results show a 100% compliance in discussion of PJI diagnosis with microbiologists, correctly labelling samples, and CRP analysis. However, we struggled with making diagnosis as per guidelines, sending more than 5 samples and discussing discharge antibiotic plans with microbiologists. Furthermore, we didn’t utilise sonification, PCR and histology to aid diagnosis. We also struggled with meeting the appropriate interval time between stages of two stage exchanges.

Conclusions

In conclusion, there is room for improvement in certain criteria’s’ as per the guidelines:Engagement with orthopaedic stakeholder to explore barriers to compliance.Dedicated MDT compromising of orthopaedic surgeons, infection doctors.Creation of an intraoperative pro-forma for suspected PJIs’ to act as a reminder to surgeons and allow clear documentation.Availability and awareness of guidelines to orthopaedic teamFunding for PCR, sonification and histopathologyJoint follow up clinic with microbiologist to improve patient follow up plans.
668 Analysis of Delays in Pathway Causing Negative Clinical Impact: Time for Change
Authors: Borra P , Lau J , Marla A , Parthiban S , Butler P , Ponniah A
Published: August 2024

Background

Skin cancer rates in the UK are 250,000 annually and are due to increase by 60% in the next decade. This increased demand may lead to delays in treatment and therefore adverse patient events. The objective of this study is to quantify delays and identify the main causes.

Method

Over the last 10 years the skin cancer service has grown from 200 referrals/month to approximately 750. A deeper analysis of data from 2021 to 2023, consisting of 26,114 referrals to the Royal Free Hospital was conducted. Pathway breaches were collected prospectively and analysed using root cause analysis.

Results

1326 referrals required treatment for suspected skin cancer. 657 patients breached the two-week diagnostic wait. Results for the root cause analysis identified the main causes for delays as being administrative delay (26%), inadequate capacity (12%), medical delays (9%) and patient initiated delay (7%), etc. 87.9% of patients who had missed the 31 day treatment target also missed the two week wait (2WW) target for their initial appointment.

Conclusions

Administrative issues account for the majority of pathway delay, specifically within the 2WW referrals. Missing the 2WW target significantly increases the risk of a patient missing the treatment targets which may lead to clinical harm. Inadequate capacity in clinics and diagnostics cause delay in our pathway suggesting that the current infrastructure is not sufficient to meet patient needs. This analysis has identified the key issues which need to be addressed to optimise patient transit through the treatment pathway.
799 Improving Delivery of Post-Operative After-Care Advice Following Laparoscopic Procedures
Authors: Ravikumar K , Srivastava K , Burrows L , Murphy Lonergan R
Published: August 2024

Aim

Patients undergoing laparoscopic surgery lack sufficient post-operative after-care instruction from the surgical team to facilitate recovery and reduce re-presentation. Our project aims to evaluate the impact of a standardised post-operative care leaflet compared to existing methods.

Method

A needs analysis was conducted via semi-structured interviews with healthcare professionals to explore existing procedures. From this, we produced a leaflet detailing important information surrounding post-operative care, addressing FAQs and red flags. Eighteen patients were presented with the leaflet pre-discharge and invited to collate questions for the surgical team based on its content. Patients were surveyed before and after reviewing the leaflet, including estimating confidence levels on completing activities of daily living and seeking help post-discharge.

Results

Needs analysis suggested a leaflet would relieve time pressure on the surgical team to relay instruction verbally and facilitate faster safe discharge. Following our intervention, 93% of patients felt confident in managing at home on discharge (an increase of 46%, p<0.05). Notably, patients also felt better prepared to manage bowel movements and recognise when to seek additional help; both factors aligned with the needs analysis findings. 94% of patients wanted the leaflet as part of their care plan, citing reasons such as increased awareness, health empowerment, practicality, and pictorial references.

Conclusions

Patients perceive existing after-care information to be insufficient. The implementation of a post-operative advice leaflet for patients following laparoscopy, arms them with the knowledge and safety nets needed for speedy recovery. It additionally benefits staff as a time-saving device, by providing an efficient framework for after-care discussion.
1102 Maximising Safety on Surgical Ward Rounds with a Concise Ward-Round Template: A Quality Improvement Project
Authors: Vaughan-Burleigh S , Ejide C
Published: August 2024

Aim

Concerns raised at clinical governance meetings highlighted incomplete ward round documentation and near miss events in prescribing. Checklists have demonstrated improved patient safety and ensure standards of care are maintained. We evaluated documentation and prescribing accuracy in a baseline audit and sought to improve these with the implementation of a concise ward-round template.

Method

We identified essential patient safety orientated criteria for ward round documentation from trust and departmental guidelines. Compliance with criteria was assessed by audit before and after the introduction of a standardised ward-round template. A root cause analysis was performed to identify reasons for errors between cycles and to optimise the design of the ward-round template. A poster promoting the template was circulated to junior doctors and the results presented in clinical governance. Each cycle included fifty consecutive patients.

Results

The baseline audit identified no ward-round documentation in 8% of inpatient days. Prescribing errors with near misses were identified in two cases. Poor documentation and communication were the most significant contributing factors in root cause analysis. After implementation of a ward-round template all inpatient days had a ward round entry, 96% using the template. Documentation of essential criteria improved from 32% to 93% (p<0.05) and there were no prescribing errors. Compliance with VTE guidelines improved from 70% to 98% (p<0.05).

Conclusions

This quality improvement project implementing a ward-round template improved documentation of essential patient safety orientated criteria and compliance with trust guidelines. Adherence to the ward round template was high several months after implementation, suggesting that ongoing use is viable.
1277 Audit: Patient-Controlled Epidural Analgesia vs. Continuous Infusion
Authors: Salloum L Al
Published: August 2024

Aim

Investigating and quantifying continuous infusions require post-operatively. Determining the agent of choice in epidural top-ups. Investigating Diamorphine dosing in epidural infusions peri-operatively and post-operatively.

Method

Retrospective cross-sectional study. A comprehensive literature review utilizing PubMed, where exclusion criteria involved including only ‘free full text’ and publications released in the last decade. Data from operations requiring continuous analgesic infusion from the previous year was collected via spreadsheet software, and statistically analysed.

Results

In a study of 70 surgical patients receiving peri-operative and post-operative epidural analgesia, the average duration of epidural use was 3 days, with an average of 1.77 top-ups per patient. Of these patients, 36 required top-ups, primarily using Levobupivacaine (53.98%) and Diamorphine (46.02%). Levobupivacaine frequency increased with more top-ups, whilst fewer top-ups were required with Diamorphine. In intra-operative continuous epidural infusion, Diamorphine doses of 10mg were most common, with 15mg as the second preferred dose, correlating with lower top-up frequencies.

Conclusions

Introducing patient-controlled epidural analgesia (PCEA) in our surgical department would allow manual Levobupivacaine dosing to be replaced by patient self-administration, reducing clinician input by 54%. This hybrid approach, termed 'continuous infusion with demand dosing,' involves a background infusion set by the anaesthetist and supplemented by patient demand. PCEAs offer immediate pain relief and a dose-sparing effect of ∼47% of local anaesthetic. Transitioning from continuous epidural infusions to PCEA could significantly reduce healthcare staff intervention in post-operative pain management by at least 50%, simplifying the process and potentially introducing a Diamorphine dosing protocol for enhanced safety and consistency.
976 A Cost-Effective Wireless Laparoscopic Camera System for Enhanced Utilisation of Minimal Access Surgeries in Developing Countries
Authors: Saranga K G V , De Silva H M S S
Published: August 2024

Aim

This study addresses the limited availability of laparoscopic surgery in resource-constrained settings like Sri Lanka, primarily due to cost and instrumentation complexity. The aim is to develop a cost-effective method by replacing the monitor and video processor units of the Standard Laparoscopic Stack System with a wireless digital camera.

Method

At a tertiary care centre in Sri Lanka, a team designed a metal adapter capable of holding a wireless digital camera with an adjusted focal length. The camera was mounted on the laparoscope using this adapter, and the study evaluated image resolution, system flexibility through testing in a dummy and a live patient and cost analysis was also done comparing our system with the Standard Laparoscopic Stack System.

Results

The new system achieved an outstanding cost reduction of 98.7% compared to the existing setup. The live images produced were of comparable quality, demonstrating the feasibility and effectiveness of the modified camera system. The approach ensures that while achieving substantial cost savings, there is no compromise in the quality of diagnostic laparoscopic and cystoscopic surgery.

Conclusions

The newly developed wireless system, featuring an innovative adapter and modified camera, proves to be a practical and cost-effective alternative to the traditional Standard laparoscopic Stack System. Beyond significant cost reductions, this innovation simplifies the laparoscopic setup, enhancing flexibility and manoeuvrability during surgeries. The wireless design not only overcomes financial barriers but also revolutionizes the accessibility and usability of laparoscopic procedures in resource-limited healthcare environments.
558 The Importance of Bowel Evaluation Before Reversing Ileostomy in Cancer Patients: A Single Centre Experience
Authors: Vimercati M , Khan A , Hawezi J , Raman S
Published: August 2024

Aim

Water-soluble contrast enema (WSCE) is a well-recognized imaging modality to determine the feasibility of ileostomy reversal, giving a good baseline of anastomotic conditions, prior to reversal. The aim of this study was to evaluate the role of WSCE as a sole imaging modality to investigate anastomotic integrity prior to reversal.

Method

For this study a retrospective database was set including patients who underwent ileostomy for colorectal cancer in a single high-volume institution, between January 2016 and December 2022. Patients who had ileostomy for other reasons than cancer, were excluded. Primary outcomes assessed were reversal rate and overall survival. Secondary outcomes assessed were rate of WSCE imaging and complications.

Results

A total of 256 patients with colorectal cancer underwent resective surgery followed by a loop ileostomy. Median observed follow-up was 36 months (18.3-53.5). A total of 48 patients [men 33 (69.0%); mean age 68.4 years (SD 11.8)] were suitable for reversal, with an overall reversal rate of 18.7%. 30-day mortality after index procedure was 0%, with an overall survival of 93.8%. WSCE as a sole preoperative imaging was performed in 93.7% of the cases. Only two patients underwent additional colonoscopy or computed tomography (CT) prior to reversal. In terms of complications, 6/48 patients (8%) had parastomal hernia requiring further surgery.

Conclusions

Enema as a sole imaging modality prior to ileostomy reversal is associated with acceptable early and mid-term outcomes, making it an acceptable alternative to other imaging techniques. The incidence of postoperative complications is extremely low. Patients will still require rigorous oncological follow up.
734 Perceptions to Gamification in Surgical Simulation Training
Authors: Shoker J , Avrova A , Lestas F , Burke J , Harji D
Published: August 2024

Aim

To explore surgeon and surgical trainee perceptions to gamification in surgical simulation training.

Method

A mixed-methods questionnaire, generated through steering-group expert consensus, was conducted nationally with surgically inclined medically trained professionals, ranging from medical student to consultant grade.

Results

20 participants (70% male) were surveyed. 70% were aged 25-35, 25% aged <25, 5% aged 36-45. Gamification meant “making something like a game” to the majority of participants. Minor themes included the ideas of “fun” and “rewards” or “points”. 10% had “no idea”. 90% had used games for fun previously. For 65%, this was via a mobile platform, while for ≥75% this was via console. 90% self-report as very or extremely competitive. 100% think the use of gaming platforms of virtual simulators are useful for surgical training. 90% think gaming platforms or virtual simulators are useful for warming up before performing a procedure. The most common reasons for this were: it's a patient “safe environment”, “fun”, improving and theatre competition. The commonest reason against was no protected time. 80% think competition on simulators would improve the motivation to practise in a virtual environment during/after their learning curve. Aspects of surgical training thought beneficial to gamify were technical skills and laparoscopic surgery. ≥60% of participants would want to see gamification achieved through leader boards/competition, tiered task difficulty and/or task based incentives.

Conclusions

Gamification is perceived as useful in surgical simulation training and for warming up, due to it offering a patient safe environment and fun. Barriers include a lack of protected time.
311 The Surgical Modern Apprentice – Preparing Final Year UK Medical Students for Foundation Year 1 Using Targeted Small Group Tutorials During an Apprenticeship-Style Placement
Authors: Gandhi S , Santos-Paulo S , Khera G
Published: August 2024

Aim

Apprenticeship-style placements for final year (F0) medical students act as a bridge between the education focused nature of medical school placements and the practical nature of the Foundation Year-1 (FY1) job. We aimed to deliver and evaluate a programme of in-person small group tutorials for F0’s to complement a contemporaneous apprenticeship-style placement in general surgery.

Method

Four F0's spent eight weeks on placement in general surgery at a UK University teaching hospital. Students were encouraged to undertake ward jobs under supervision and within the constraints of their unregistered status. Alongside this, four interactive, in-person tutorials focusing on the practical aspects of working as a general surgical FY1 were delivered by current surgical FY1’s. Post placement, free-text, anonymous and voluntary feedback was collected from the F0’s. We performed a thematic analysis to understand which aspects of the programme F0’s felt were useful, and what they felt could be improved.

Results

The following key themes emerged from analysis of the F0’s evaluation of the sessions: 1) Teaching relating to the real working environment 2) Interactive teaching 3) How to prioritise ward tasks 4) How and when to escalate 4) Understanding FY1 work-life balance.

Conclusions

Supplementing apprenticeship-style placements with targeted small group tutorials can help F0’s appreciate and practice non-technical skills (such as task management and team working) which are key to practicing as an FY1. F0’s benefited from being encouraged to think in the context of the real-world environment of their apprenticeship - this approach should be considered when designing similar surgical apprenticeship teaching programmes.
323 Acquiring Technical Surgical Skills During Orthopaedic Surgical Training in the UK: A Qualitative Study
Authors: Al-Jasim A , Williams C
Published: August 2024

Aim

The study question is “What are the experiences and opinions of orthopaedic surgical trainees and educators in the UK regarding the acquisition of technical surgical skills during postgraduate surgical specialty training?’’

Method

This is a qualitative study following the principles of grounded theory. It was conducted in the East Midlands region between May and September 2023 with a purposive sample of six surgical trainees and four trainers using individual semi-structured interviews. Data analysis applied the constant comparative approach with open, axial, and selective coding of data to develop themes.

Results

Four overarching themes arose from the data collected. These included the role of the trainer, the shape of the training curriculum, theatre experience, and service delivery challenges. These themes were found to be interconnected.

Conclusions

The findings of this study provide an understanding of the process of acquiring technical surgical skills. Insights gained from the experiences and opinions of orthopaedic surgical trainees highlighted the pivotal role of trainers, the necessity for an adaptable curriculum, the nature of varied theatre experiences, and the effects of service delivery challenges, which have continued since the COVID-19 pandemic. These insights shed light on surgical education and training, offering a basis for further investigation and refinement in training approaches, curriculum formulation, and instructional settings.
957 Lightness of Touch, Firmness of Teaching
Authors: Copperwheat A , O’Regan D
Published: August 2024

Aim

Correct surgical instrument hold is one of the first steps to being a surgeon. This project assessed the correctness of forceps handling in social media posts advertising basic surgical skills courses. This is an important topic as injudicious use of the surgical forceps, such as pinching, can damage tissue.

Method

Over a period of 4 months, X (Twitter) and Instagram were prospectively scanned twice a week for images of forceps handling. The images were analysed for posture of the hand, grip, application of multiple fingers and flexion of the interphalangeal joints. Images were categorised based on the body (college, professional, surgical or student society) that produced them.

Results

109 images were saved, of which 50 contained forceps. Overall, only 32.4% of images contained evidence of a good hold, with pinching occurring in 7.0%. A good hold was less prevalent, and displacement of the forceps or aberrant hold more prevalent in student advertised courses. Flexion of the proximal interphalangeal joint and pinching was present across all bodies except the college.

Conclusions

If we wish to teach with the correct technique, then advertisements must show this in their images. This project demonstrated that all bodies show incorrect technique in at least some of their images, with student run bodies advertising poorer technique. This suggests that bodies with more senior members may teach with a greater technique. However, the project also leads to a bigger question- if bodies are not advertising with the technique are they really teaching in the correct way?
1158 The Impact of COVID-19 on Cardiothoracic Surgical Training- an Insight from the GMC National Training Surveys
Authors: Raven-Gregg T , Chan J , Angelini G , O’Hanlon J
Published: August 2024

Background

Coronavirus disease (COVID-19) leads to a significant impact to the cardiothoracic surgical practice and training. The number of procedures logged by trainees in the esurgical logbook is yet return to the pre-pandemic level. The GMC national training surveys was first started in 2006, with an aim to determine the quality of the national training standard. We aimed to evaluate cardiothoracic trainees’ satisfaction pre and post pandemic and determine the impact of COVID-19 on cardiothoracic surgical training.

Method

The national training survey report in cardiothoracic surgery from 2018 to 2022 was obtained from the General Medical Council website. Both trainees and trainers’ survey were included for analysis. Overall satisfaction for both trainees and trainer were compared pre (2018,2019) and post (2021, 2022) pandemic.

Results

Thirty cardiothoracic centres are included in this study. There is a significant reduction in trainee satisfaction pre and post pandemic (76.82 vs 74.53, p= 0.019). However, no differences in trainers’ overall satisfaction were found (67.41 vs 70.41, p=0.52). There was a low correlation between trainee and trainers’ satisfaction pre and post pandemic.

Conclusions

There was a significant impact of COVID-19 on cardiothoracic trainee satisfaction. Individual hospital and deanery should reflect on trainees’ evaluation on the national training surveys report and improve on specific areas if deemed unsatisfactory.
1183 IV Fluid Prescribing: How Can We Improve?
Authors: Campbell L , Kwok K , Leitch F
Published: August 2024

Aim

Intravenous (IV) fluid therapy is frequently utilised in conditions affecting fluid/ electrolyte balance. Its inappropriate use can worsen outcomes. Foundation Year 1 (FY1) doctors often prescribe IV fluids. Understanding IV fluids is therefore key in promoting optimal administration and minimising associated risks. We aim to assess fluid prescribing knowledge amongst our FY1s, and for differences between those who received IV fluid teaching from the Intestinal Failure (IF) Team, and those who did not.

Method

General Surgery FY1s attended IV fluid teaching from the IF Team, subject to availability. A survey was composed of questions regarding daily requirements, fluid composition, clinical scenarios, confidence levels, and relevant teaching. FY1s were surveyed, and the results analysed.

Results

Each FY1 (15) answered 16 questions- the total number answered was 240 98 (41%) questions were answered correctly, 142 (59%) incorrectly Those who received IF teaching answered 43/80 (53.8%) questions correctly, versus 55/160 (40.8%) for those who did not 75% of daily requirement questions were correct among those who received teaching, versus 47.5% among those who did not 50% of fluid preparation questions were correct among those who received teaching, versus 26.3% Clinical scenario answers were 45% correct in those who had teaching, versus 40% Confidence in prescribing maintenance/ replacement fluids was 3/3.2 out of 5 respectively among those who received teaching, versus 2.3/2.8.

Conclusions

Those who received the teaching outperformed their peers, highlighting the session's efficacy. Fluid prescribing continues to pose challenges. Areas for development include more clinical scenario-focused teaching, and production of a ward resource to aid fluid prescribing.
523 Systematic Review of Total Hip Arthroplasty Outcomes in Cerebral Palsy
Authors: Costa C , Moniati F , Chatzimatthaiou M , Chatzimatthaiou M , Papaioannou C , Athanasakopoulou S
Published: August 2024

Aim

Total Hip Arthroplasty (THA) in patients with cerebral palsy (CP) is considered high-risk due to neuromuscular instability, contractures and altered muscle tone. The purpose of this systematic review is to investigate the surgical indication, surgical approach, and clinical outcomes of THA in CP patients.

Method

A systematic review was undertaken in accordance with PRISMA guidelines, encompassing original articles that investigated the outcomes of THA in CP patients and compared it with controls. The systematic literature search was conducted using COVIDENCE® software (Melbourne, Australia). The primary endpoints of interest included: surgical indication, clinical outcomes (complications, survivorship) and surgical approach (cementing, additional procedures, bearing surfaces).

Results

The initial search generated 190 studies out of which 21 met the inclusion criteria. The most frequently reported indication was painful hip dislocation or subluxation followed by treatment failure for prior femoral neck fractures and secondary arthritis. The most frequently reported complication was dislocation affecting overall 7.5% (0-28%) of all patients followed by periprosthetic fractures 5.6% (0-21%) and heterotrophic ossification 4.2% (0-37.8%). The survival rates of primary THAs ranged from 85%-100% at 5 years and from 73%-86% at 10 years.

Conclusions

The current literature suggests that THA is a beneficial procedure for patients with CP through pain reduction and functional improvement. However, the increased rates of potential complications compared to the general population require careful consideration. We suggest that further investigations on the most appropriate time of procedure, implant type and procedure type are needed.
691 The Efficacy of the Transversus Abdominis Plane Block in Abdominoplasty: A Systematic Review and Meta-Analysis
Authors: Taha N , Hodson L , Tong K , Zahari F , Hoo Z L , Wong Y W , Rahman S
Published: August 2024

Aim

The transversus abdominis plane (TAP) block is a regional abdominal anaesthetic technique frequently used within non-cosmetic abdominal surgery. The literature is devoid of a meta-analysis to quantitatively amalgamate the results of individual reports analysing the efficacy of TAP block compared to alternative analgesic methods in abdominoplasty surgery. The authors aimed to conduct the first meta-analysis within the literature to evaluate this technique’s effectiveness in abdominoplasties.

Method

PRISMA guidelines were referred to conduct this systematic review and meta-analysis. All observational and randomised controlled trials (RCTs) comparing the postoperative outcomes of patients who underwent abdominoplasties with TAP blocks versus no TAP blocks were included in this study. The time taken to first analgesia and the amount of analgesia used were the primary outcome measures. The secondary outcome measures include severity of pain, time to mobilisation, and length of stay. Random effect modelling was used for the analysis.

Results

The time taken to the first analgesic was significantly lower in the TAP cohort (p <0.05). In addition, there was a lower incidence of postoperative nausea/vomiting (OR 0.18, 95%CI 0.04 - 0.90, p=0.04). Mean total opioid use and operative time were comparable between the TAP and no TAP groups. A qualitative review of the visual analogue scale for pain amongst the included studies showed that it was lower in the TAP group.

Conclusions

The authors report the first meta-analysis within the literature showing the efficacy of the TAP block in abdominoplasties. Further high-quality trials are recommended to further the current evidence base.
792 Long-term outcomes of laparoscopic versus open gastrectomy for the treatment of localised gastric cancer: a systematic review and meta-analysis
Authors: Chansiriwongs A , Wong P Y , Lau S , Sng D , Wong Q N , Ganesh P , Marini P
Published: August 2024

Aim

As localised gastric cancer (LGC) is one of the most common cancers worldwide, the choice of curative laparoscopic (LG) over open gastrectomy (OG) is widely studied. Yet, the literature surrounding the long-term outcomes of LG remain inconclusive. Therefore, this systematic review and meta-analysis aimed to evaluate the long-term efficacy of LG as compared to OG in the treatment of LGC.

Method

A search strategy was used to identify studies from MEDLINE ®, Embase, Web of Science Core Collection, and the Cochrane Centre for Registered Randomised Controlled trials that investigated the long-term outcomes of LGC treated by LG or OG. All-cause mortality and disease recurrence were defined as the primary outcomes. Secondary outcomes included post-operative complications, length of hospital stay, and pain control. Quality of evidence was assessed using the Cochrane risk of bias tool.

Results

14 studies that compared LG and OG outcomes were included. Pooled long-term mortality (RR 0.96, 95% CI 0.82-1.13) and recurrence (RR 1.16, 95% CI 0.95-1.41) of both groups were similar and did not reach statistical significance (p>0.05). Qualitative analysis also showed comparable post-operative complication rates, however, LG had shorter admissions and reduced analgesia requirements. Generally, the quality of evidence was low with trials at risk of potential bias.

Conclusion

Overall, this review suggests that LG may be preferable over OG in treating LGC, with improved short-term outcomes and noninferior long-term outcomes. However, given the quality of evidence, further studies are required prior to implementing LG as the gold standard treatment option.
838 Review of the Literature on Iris Implantation in Aniridia Patients: Techniques and Clinical Outcomes
Authors: Stobiecka R
Published: August 2024

Aim

This review aims to identify a variety of implantation techniques and their effect on clinical outcomes, and the surgical technique and prosthesis with the most favourable outcomes.

Method

Advanced searches were performed on PubMed, Scopus, Cochrane and Web of Science for studies up to and including 2021, using a set of pre-defined search terms. 17 studies were included in this review.

Results

The most common post-operative complications amongst the studies in this review were secondary glaucoma (47%), corneal endothelial decompensation (35%), retinal detachment (18%), prosthesis decentration (18%), limbal stem cell failure (12%) and vitreous haemorrhage (12%). 53% of studies included best-corrected visual acuity (BCVA) deterioration, of these; 67% used an iris-lens prosthesis, 33% used an artificial iris and none used an endocapsular capsular tension-like ring. 78% included the trans-scleral suture approach, 33% included sulcus implantation and 33% included in the bag implantation. 35% of studies showed all patients had experienced an increase in BCVA; 55% had used the ArtificialIris, 45% had used an iris-lens diaphragm.

Conclusions

There appears to be no definitive answer on which surgical technique and iris prosthesis has the most favourable outcomes. The ArtificalIris has slightly better outcomes throughout this review, however, longer follow-up times are needed. The trans-scleral suture technique is most commonly used, therefore, no real comparisons against other techniques could be made. Overall, iris implantation is beneficial as visual acuity is likely to be improved. Further research into mechanisms of complications, especially glaucomas, is recommended to prevent their formation in the future.