bluuebunny/crossref_metadata_2025 huggingface dataset:
557 A Novel Peer-Led Anatomage-Based Teaching Programme for Medical Students
Authors: Banjoko A , Boylan C , Kumar H , McCabe H , Morris S
Published: May 2021

Introduction

Anatomical knowledge is an essential part of surgical practice. However, its delivery lacks a standardised approach across medical school curricula. A student-led anatomy programme was implemented at a single institution, using near-peer teaching and Anatomage virtual dissection. This study aims to describe the methodology of this programme and determine the benefit of a near-peer taught anatomy course.

Method

The programme was organised by senior medical students, utilising Anatomage virtual dissection and techniques in line with Bigg’s constructive alignment. Attendees were asked to complete questionnaires with Likert scales (0-10) and open answer text to determine learners’ benefit. Both quantitative and qualitative analyses are presented.

Results

73 students attended eight sessions from January to March 2020. Students reported a statistically significant (p < 0.01) increase in confidence after the sessions of 3.74±1.83. The quality and relevance of the teaching also scored highly (9.32±0.89 and 9.47±0.86 respectively). Qualitatively, students praised the "informal learning environment”, the structure of the sessions, the handout provided, and the interactivity of anatomage technology.

Conclusions

This study demonstrates how virtual dissection technology and near-peer teaching can derive significant benefit to undergraduate students, in line with previously published data.
572 Virtual Reality Operative Simulation in Orthopaedic Surgical Training During Periods of Restricted Clinical Hours: Systematic Review
Authors: Salaja B , Feeley A , Feeley I , Merghani K
Published: May 2021

Introduction

The public health response to the coronavirus pandemic-imposed limitations upon orthopaedic surgeon’s scheduled care practice, with a consequential diminution of training time for residents. A potentially viable option for maintenance of operative competency is the use of virtual reality (VR) simulation. This review looks at the effectiveness of (VR) as a pedagogical method of learning for orthopaedic trainees.

Question

Can VR be a viable method of learning and skill retention for orthopaedic trainees during periods of diminished operative time?

Method

A systematic search using Google Scholar, EMBASE and PubMed was conducted in July 2020.

Results

Following the PRIMSA guidelines; initial search revealed 779 studies. 35 full text articles were analysed by two reviewers with a final total of 30 articles used in this review. A thematic analysis revealed three broad categories: quality and validity of VR teaching simulations studies (n = 8); learning curves and subject performance (n = 14) and VR simulators utility in orthopaedics reviews (n = 8).

Conclusions

We demonstrated that VR has the capacity to help trainees maintain their technical skills, enhance their precision, and retain rudimentary competency during this pandemic. Additional improvements are necessary to ensure its safety as a training tool.
643 Near-Peer Surgical Teaching for Junior Doctors: A 16-Month Retrospective Analysis
Authors: Hussain S F , Toi T , Laurent E , Seraj S S , Haque S
Published: May 2021

Introduction

Surgical departments across the UK are having to mitigate service demands, budget constraints and changes to work patterns with their statutory duty to provide high-quality training and education. Securing consultant-led teaching has also become increasingly difficult leading to the rise of near-peer teaching. We evaluate the long-term effectiveness of near-peer surgical teaching for junior doctors.

Method

We developed a rolling 12-week trainee-led didactic surgical education programme for Foundation doctors and Core Surgical Trainees. Junior doctors delivered teaching to peers with registrar input; session and supervision feedback was recorded using 5-point scales and free-text responses.

Results

42 junior doctors responded to our end-of-programme feedback surveys covering December 2018 to April 2020. The overall programme (8.83±1.08/10), relevance (4.62±0.58/5), presentation quality (4.60±0.50/5) and supervisor knowledge (4.81±0.40/5) were rated highly by respondents. Attendees also reported significant improvements in subject knowledge (3.72±0.92/5 to 4.50±0.56/5, P < 0.0001), clinical confidence, presentation and teaching skills.

Conclusions

Our near-peer teaching programme addressed the educational needs of junior doctors and developed their presentation and organisational skills. Supervision and input from registrars facilitated discussion and reinforced key concepts. The success of this programme highlights the role that trainees can play in designing, developing, and leading an effective surgical teaching programme.
665 Surgical teaching in times of COVID-19 - The Forth Valley Royal Hospital Experience
Authors: Dearie L , McGivern K , Wilson M
Published: May 2021

Introduction

The COVID-19 pandemic has threatened all aspects of society. Medical education has not been immune to this. Clinical educators have had to enact creative solutions to ensure continued departmental learning and development. We describe our experience in the General Surgery department of a District General Hospital of transitioning to webinar-based teaching.

Method

7 tutorials were delivered virtually from April-May 2020. A database was created to store presentations alongside supporting material. An online questionnaire canvassed attendee responses (n = 28) to individual teaching sessions and the methodology of the teaching.

Results

71% of staff responded. 100% of respondents were “very,” or “extremely,” satisfied with the quality of teaching. 79% thought remote access encouraged attendance. Attendance rose from 45-65% to 60-75% through the use of the learning database. 92% wanted this teaching methodology to continue.

Specific reference was made in free text responses to the quality, convenience, and utility of the learning database. Maintenance of responsible social distancing was also given as a positive aspect of this teaching method.

Conclusions

We report a successful transition from traditional teaching to a virtual platform as a result of COVID-19 restrictions. Our experience is that high quality teaching can be delivered virtually while encouraging attendance and maintaining social distancing.
667 Virtual Learning During The COVID-19 Pandemic Amongst Medical Students in The United Kingdom
Authors: Jayawardena O , Toh S , Fowler H , Fok M , Clifford R
Published: May 2021

Introduction

Throughout the COVID-19 pandemic medical education has predominantly been delivered through virtual learning (VL). This survey was conducted to evaluate the effectiveness of VL amongst medical students in the UK.

Method

An online anonymised SurveyMonkey© survey was distributed through social media amongst UK medical students.

Results

There were 142 completed surveys, 96.5% of students engaged in some form of VL during the pandemic, compared to 57.8% prior to the pandemic. The most frequently used method to deliver teaching was interactive online lectures (74.7%). The students perceived small group online teaching sessions to be the most effective delivery method (weighted average 7.4/10) followed by interactive online lectures (7.4/10). The least effective teaching method was online lecture notes (5.3/10).

Accessibility to coursework (8.6/10) and enhanced flexibility (8.4/10) were considered to be the biggest advantages of VL. Overall, 44% of students felt VL had a negative impact on their learning, with 23% of students considered to have failed to meet the learning objectives set out in these sessions.

Conclusions

Beyond the COVID-19 pandemic VL will continue to play a role in medical education. However, there is room for improvement in both delivery and engagement to improve student experience and satisfaction.
681 How Much Can Medical Students Benefit from A Student-Led Surgical Mentorship Scheme?
Authors: Ghazal-Aswad K , Hamakarim T , Pook C , Iyer P , Kum F
Published: May 2021

Introduction

Mentorship programmes enable students to explore different specialties, observe surgeries and participate in audits, whilst helping trainees develop leadership and teaching skills. We developed such a scheme and asked participants to fill out several questionnaires, to assess its benefits and restrictions.

Method

We set up a student-led mentorship scheme, pairing 54 medical students with surgeons around London. Students completed questionnaires before, during and after the scheme and mentors completed a post-mentorship scheme feedback questionnaire, with the purpose of measuring the participants’ experience on Likert scales from 1 to 5. Quantitative data analysis was performed to assess trends.

Results

In the cohort of students who answered all three questionnaires (n = 34) the biggest improvements seen over the duration of the scheme were ‘exposure to surgery so far in medical school’ and ‘understanding the steps required to improve a surgical portfolio’, with mean values increasing by 1.653 and 1.733, respectively. The main challenges faced were mainly related to time restraints and communication issues.

Conclusions

Mentors and mentees can both benefit from a mentorship scheme, but certain variables, such as time constraints and goal-setting, need to be clearly established for both parties. In the future, the scheme would benefit from more guidance and stricter ruling.
687 The Effectiveness of a Two-Day Conference in Improving Plastic Surgery Knowledge and Skills of Medical Students and Junior Doctors
Authors: Dawidziuk A , Ngadimin C , Kwasnicki R , Jallali N
Published: May 2021

Introduction

Reconstructing the Stereotype is a student-led conference organised by Imperial College Plastic, Reconstructive and Aesthetic Surgery Society providing holistic outlook on plastic surgery with lectures, tutorials, and practical workshops. The aim of this event-evaluation study was to assess the effectiveness of the conference in improving reported knowledge, skills and awareness of the specialty.

Method

25 delegates (21 medical students, 4 junior doctors; mean age 23.2 years; 14 women) volunteered to complete pre- and post-intervention online questionnaires comprising 26 five-step Likert scale questions on knowledge, skills, and career in plastic surgery. Significance of comparisons was established with Wilcoxon signed-rank test using IBM SPSS V26 (p < 0.05).

Results

Post-conference, there was a significant increase in participants’ self-ratings across all domains investigated (p-values 0.000-0.001). Understanding of the reconstructive ladder showed largest improvement in knowledge (mean±SD: 1.96±1.27 vs 3.80±1.08), performing Z-pasty in skills (1.72±1.17 vs 3.72±1.06) and portfolio development in career category (2.28±1.17 vs 4.08±1.04). Two more participants declared considering career in plastic surgery after the conference.

Conclusions

A two-day student-organised conference significantly improved plastic surgery knowledge and skills of medical students and junior doctors. It also provided them with a realistic idea of what a career in the specialty entails.
771 Shaping the Virtual Learning Environment: Emojis As A Novel Feedback Modality for Content Delivery in Postgraduate Medical Education
Authors: Rajdev K , Watts E , Eastwood M , Goh S , Ahmed U , Bowyer D
Published: May 2021

Introduction

Postgraduate medical education in the wake of a pandemic has sparked creativity, evolving novel platforms concordant with socially distanced learning. Inevitably, evaluation is critical in navigating improvements in content delivery. However, as culture continues to shift away from didactic teaching, students are at risk of ‘feedback overload’. We propose a novel emoji scale to facilitate rapid appraisal.

Method

A three-point emoji scale was developed within the novel virtual learning environment for core surgical training in the West Midlands. Engagement with the emoji system was assessed and correlated with conventional post-course questionnaires.

Results

The novel emoji system provided a rapid mechanism for trainees to express opinion on individual modules immediately following completion. Parallels to social media meant this modality felt familiar to trainees. Simplification of feedback permitted prompt, targeted review of modules for improvement, as opposed to laborious collection and analysis of standard post-course questionnaires. Literature review revealed limited research regarding similar emoji-based responses, or the validity of Likert or free-text based feedback systems.

Conclusion

As virtual learning evolves following COVID-19, feedback systems help guide evolution. Emoji-based feedback may provide the key to prompt, accessible evaluation of VLE platforms.
930 Impact of the COVID-19 Pandemic on Higher General Surgical Training – A West of Scotland Experience
Authors: Khan K S , McLellan M , Galbraith N J , Lannigan A , Mahmud S , Stewart B
Published: May 2021

Introduction

COVID-19 pandemic has caused significant disruption in all aspects of training. Our aim was to explore the degree of impact caused by the pandemic on higher general surgical trainees.

Method

All higher general surgical trainees in a single UK deanery were invited to participate in an online, voluntary, anonymous survey via SurveyMonkey.

Results

64 (72.7%) of the trainees responded. 39.1% were ST3/4, 29.7% were ST5/6, 20.3% were ST7/8 and 10.9% were out of training (maternity & research). Thirty-five (55.6%) worked in district general hospitals. Forty (68.9%) trainees felt that they had fewer opportunities to be primary surgeon. Forty-two (67.7%) trainees did not have access to laparoscopic simulation trainers. Fifty-two (88.1%) trainees had their courses and 2 (3.4%) had their FRCS part 2 exam postponed. 16 (27.1%) trainees reported they had been off-sick, with a median of 7 days off (range 3-35 days). Thirty-three (55.9%) trainees felt more stressed due to the pandemic and 35 (59.4%) had symptoms of burnout.

Conclusions

The COVID-19 pandemic has had an unprecedented impact on all aspects of higher surgical training. The most noticeable impact has been on the reduction in the confidence in laparoscopic and endoscopic skills.
940 Mesenteric Haematoma Complicated by A Perforated Sigmoid Diverticulum Following Extracorporeal Shockwave Lithotripsy
Authors: Sorooshian P , Luangsomboon A , Al-Robaie B
Published: May 2021

A 78 year old female presented with sudden onset lower abdominal pain, vomiting and fresh rectal bleeding. She had undergone extracorporeal shockwave lithotripsy (ECSL) for a left renal stone two weeks earlier and was taking Rivaroxaban for atrial fibrillation. A CT Abdomen & Pelvis revealed a large mesenteric haematoma and a contained sigmoid perforation secondary to compressive forces of the haematoma on the sigmoid artery, resulting in ischaemia. While mesenteric angiogram-guided embolisation initially controlled the active sigmoid artery bleed, the patient clinically deteriorated the following day warranting a laparotomy. This revealed an ischaemic sigmoid colon with contained faeculent material within the mesentery. An extended left hemi-colectomy with end-colostomy was performed. Despite optimal critical care input, the patient developed multi-organ failure and passed away one week later. Mesenteric haematoma should be considered as a rare complication in patients with sudden onset abdominal pain following ECSL; especially with concurrent anti-coagulation use.
165 A Review of The Current Literature on LMWH Administered at Different Times in Relation to MOS (Major Orthopaedic Surgery): Assessment of The Safety and Efficacy of The Different Proposed Strategies
Authors: Placella G , Pace V , Antinolfi P , Salini V
Published: May 2021

Nowadays venous VTE represents an important perioperative and postoperative complication in patients undergoing elective Major Orthopedic Surgery (MOS). There are significant discrepancies between clinical practice, international recommendations, and published guidelines. Although thromboembolic events may be less common these days than in the past, they can still lead to serious medical complications. Therefore, most patients undergoing MOS procedures are provided with one of the thromboprophylactic treatments. The optimum timing of LMWH administrations remains debated.

Customized structured electronic searches in PubMed and Cochrane database. Meta-Analysis, Randomized Controlled Trials, Systematic Reviews on different strategies of the use of LMWH for MOS.

Studies on prophylactic regimens showed that subcutaneous LMWH plays a key role in the management of thromboprophylaxis in MOS. However, some controversies still stand. Among those most relevant, it remains unclear whether to start thromboprophylaxis before or after MOS to better balance the risks of clotting and bleeding.

With regards to different times of LMWH administration, there is no convincing evidence that starting prophylaxis 12 hours preoperatively is associated with lower risks of VTE compared to prophylaxis started 12 to 24 hours postoperatively. Furthermore, it seems that the most safe and efficient LMWH regimen is the one called “Just-in-time” (LMWH started 6 hours post-op).
295 Radiotherapy for Curative-intent Metastatic Rectal Cancer: A Systematic Review and Meta-Analysis
Authors: Nistala K R Y , Yeo J W , Ow Z G W , Ng C H , Law J H , Wong K Y , Soon Y Y , Chong C S
Published: May 2021

Introduction

The role and optimal regimen of radiotherapy in curative-intent treatment of metastatic rectal cancer is unclear and hence a single arm meta-analysis was performed.

Method

Medline, Embase and Cochrane Library databases were searched up to 16 May 2020. A Meta-analysis of binomial data was performed using a Freeman-Tukey double arcsine transformation, and pooled estimates were used to construct risk ratios and confidence intervals via the Katz-logarithmic method. Additionally, comparative meta-analysis was performed with the Mantel Haenszel model.

Results

18 studies were included. Rectal pathological complete response (pCR) was observed in 14% of tumours treated with radiotherapy (n = 57/388, CI 0.07 to 0.23). Comparative meta-analysis of cohort studies showed that treatment regimens including radiotherapy were associated with higher pT1 tumour and better oncological outcomes compared to regimens without radiotherapy. Katz-logarithmic method showed that neoadjuvant radiotherapy had a higher proportion of pN0 staging (RR = 1.81, 95% CI 1.06 to 3.09, p = 0.029) and better oncological outcomes compared to adjuvant radiotherapy, and that short course radiotherapy (SCRT) had a lower proportion of pT3 tumours (RR = 0.778, 95% CI 0.609 to 0.994, p = 0.044) and similar oncological outcomes compared to long course radiotherapy (LCRT).

Conclusions

This study supports the evidence that radiotherapy should be used in curative intent metastatic rectal cancer.
169 Literature Review on Efficacy of Manual Therapy in The Conservative Treatment of Adolescent Idiopathic Scoliosis (AIS)
Authors: De Larrea E A , Pace V , Caraffa A , Rinonapoli G
Published: May 2021

AIS is a common condition whose conservative options usually involve physical therapy. Manual therapy can be part of an adequate conservative strategy due to his ability to improve range of motion and decrease muscle tone and pain. However, his indications and efficacy remain controversial. What is the current evidence on indications and efficacy of manual therapy in the treatment of AIS?

Customized structured electronic searches: PubMed, Cochrane. Key terms: AIS manual therapy, AIS manipulative therapy, AIS mobilization exercises. 17 works included.

5 case reports, 3 case series, 2 group-control studies, 3 narrative reviews, 4 systematic reviews. Complications:0. Reviews suggested that manual therapy is a promising option if in adjunct to physical therapy exercises. Prevention of curve progression and better spine flexibility are often achieved. It remains unclear whether this should be attributed to physical therapy, manual therapy, or combination of both. Lacks in methodology leave room for uncertainty.

Only few papers analyse the indications and efficacy of manual therapy in treatment of AIS. The current evidence suggest that manual therapy is a promising beneficial treatment strategy for AIS with conservative indications, especially if in conjunction with physical therapy. This is further supported by absence of reported complications. Further research with better methodology is needed.
337 Barriers to Laparoscopic Surgical Training for Abdominal Conditions in Low- and Middle-Income Countries (LMICS): A Systematic Review
Authors: Wilkinson E , Aruparayil N , Gnanaraj J , Jayne D
Published: May 2021

Introduction

Resource-deprived low-and-middle-income countries (LMICs) can benefit from the reduced perioperative morbidity of laparoscopic surgery. However, utilisation is low, partly due to paucity of appropriately trained staff. This study aims to explore the barriers to the training of healthcare professionals in laparoscopic techniques in LMICs.

Method

Medline, Embase, Global Health and Web of Science databases were searched, using the key terms ‘LMIC’, ‘Laparoscopy’ and ‘Training’. Eligible papers were in English, focused on abdominal laparoscopy and addressed barriers to training qualified health professionals. Papers focusing on advanced surgeries, paediatrics, and training in high-income countries were excluded. PRISMA guidelines for systematic reviews were followed.

Results

Funding was the first of seven key barriers identified, but feasible low-cost methods have been developed in some settings. Equipment limitations and lack of local trainers were highlighted, and expatriates may provide limited quality training opportunities. Stakeholder dynamics can create barriers, as can lack of knowledge on effective training curricula. Surgical departmental structure can limit the practical opportunities of trainees.

Conclusions

Themes are apparent across LMICs, but local factors reduce their generalisability, highlighting the need for larger-scale studies focusing on specific barriers. National investment in training programmes with research-backed curriculums and increased availability of local trainers and equipment is needed.
452 Exploring the Merits and Availability of Smartphone Applications Related to Bariatric Surgery
Authors: Kabbani J , Kabbani J
Published: May 2021

Introduction

Smartphone applications transcend healthcare specialties, with applications related to bariatric surgery widely available on mainstream application stores. We reviewed published literature regarding bariatric surgery-related applications, and the number and types of applications available for download.

Method

A literature search of “bariatric surgery” and “smartphone” was used to find publications assessing such applications. “Bariatric surgery” was searched in Apple’s (iOS) “App Store” and Google’s “Google Play” to analyse application purposes, pricing, and ratings.

Results

22 articles explored smartphone usage in relation to bariatric surgery, describing benefits to patient self-management and wellbeing. However, concerns include a perceived lack of involvement of healthcare professionals in application development, and further investigation of application benefits to diet prior to bariatric surgery is needed. Searches on the App Store and Google Play identified 33 and 250 apps respectively. 85% of iOS results were categorised as clinical and weight management tools, 9% as educational, and 6% as recreational. The corresponding figures for Google Play were 60%, 6%, and 34%.

Conclusions

The results demonstrate the widespread availability of applications related to bariatric surgery aftercare, particularly for patient support. Input from healthcare professionals during application development, and assessment of impacts on physical outcomes, are important aspects to consider.
622 Potential Application of Electrocardiographs (ECG) to Diagnose Breech Presentations of Fetuses
Authors: Murugan R , Hastie C , Narayanan N , Wong S
Published: May 2021

Breech presentation, i.e. the abnormal lie of a foetus longitudinally with the buttocks closest to the mother’s cervix, is a common issue affecting up to 5% of women during delivery resulting in poor outcomes such as traumatic labour, infection and increased neonatal mortality.

Currently, abdominal palpation is the screening method of choice for breech presentation; however, 15,000 breech presentations remain undiagnosed across England annually. While routine ultrasonography has been suggested, its cost-effectiveness and scalability remain concerning, especially in low/middle-income countries.

Various algorithms have been applied to maternal trans-abdominal ECGs to obtain foetal ECGs, but current applications only allow heart rates, congenital heart defects, hypoxia, and foetal distress to be identified. The use of ECG is proposed to determine foetal position as breech foetuses tend to display QRS complexes in a similar pattern to the maternal trace, whereas cephalic foetuses would demonstrate inverted QRS complexes.

ECGs are cost-effective, safe and do not require highly skilled technicians to operate, which makes it an ideal starting platform for the development of a device with high sensitivity and reasonable diagnostic speeds to identify breech foetuses. Future considerations include the use of artificial intelligence to increase diagnostic accuracy and development of a patient-facing mobile application.
710 A Novel Ventriculoperitoneal Shunt Design Aiming to Reduce Shunt Failure Rates
Authors: McColm L , Asbalaili E E , Khandakar T , Razak N A , Yuyi A T , Yau J D
Published: May 2021

Introduction

Ventriculoperitoneal (VP) shunt insertion is the most common surgical treatment for hydrocephalus. While shunt obstructions are frequent and subsequent revision operations carry significant morbidity, there is limited advancement in shunt design to address this problem.

Method

A literature review of aetiology and mechanism of shunt blockage was performed. Design concepts of current medical and non-medical grade devices were studied. Design improvements to VP shunt were focused on the proximal catheter and lumen configuration. Concept dimensions and computer flow simulations using different diameters were generated.

Results

An improved prototype VP shunt design was proposed. It has multiple lumens and communicating channels between neighbouring lumens to provide alternative routes for cerebrospinal fluid drainage in the event of individual lumen obstruction. Our design also features a novel cone-shaped proximal end to minimise occlusion by nearby choroid plexus.

Conclusions

By targeting common causes of VP shunt blockage through proposed novel design, the mean service-life of shunts can be extended, necessitating fewer revision procedures and reducing both patient health and financial burdens. Further investigation, optimisation, and validation of this proposed shunt design is required before further product development.
920 Long Term Outcomes After Resection of A 'Normal' Appendix
Authors: Hammett F , Ali S , Adair R , Peter M , Dobbins B , Saha A
Published: May 2021

Introduction

Recent studies have suggested that there should be diagnostic confirmation of appendicitis prior to surgical resection to reduce the rate of negative (normal) appendicectomy. There are few long-term analyses of morbidity after negative appendicectomy.

Method

All appendicectomy specimens removed for suspected appendicitis from June 2010 to August 2015 at a single-centre surgical unit were identified. Patients with a histologically 'normal' appendix were analysed. Demographics, pre-operative and operative details and post-operative outcomes (Clavien-Dindo system) were recorded. Minimum follow-up was 5 years.

Results

There were 1977 patients. Most (1938 patients, 98%) had a laparoscopic procedure. There were 241 normal specimens (12.1%); none of these patients had pre-operative CT imaging. Thirty-two patients had at least one re-admission in the 5 years after surgery; 12 of these patients had multiple re-admissions (range, 2-5 re-admissions). 22 patients (69%) had a re-admission within 30 days after primary surgery. 4 patients (<1%) required further surgery and mortality was 0%. 6 patients (2%) had a Grade III complication, and none had a Grade IV complication.

Conclusions

There was low long-term morbidity after negative appendicectomy in this study. The cost of confirming a normal diagnosis by way of mandatory pre-operative CT does not represent a cost-effective method of management.
27 Do Microbiology Swabs Taken During Incision and Drainage of Acute Perianal Abscess Affect Clinical Management and Future Clinical Course?
Authors: O'Connor A , Sabri S , Ullah S
Published: May 2021

Introduction

This study assesses whether microbiology swabs taken during incision and drainage of perianal abscesses have any impact on the post-operative clinical course and management.

Method

Data from emergency operative theatre lists were interrogated for patients undergoing incision and drainage of perianal abscess in the period March 2019 – March 2020. Each electronic medical record for patients who had perianal abscess surgery was interrogated for age, sex, smoking status, diabetic status, whether microbiology swab was taken for analysis, what organism was grown and any post-operative fistula development.

Results

71 patients met inclusion criteria. 55 (77.5%) patients had pus swabs sent at incision and drainage for microbiological analysis. Of the 55 patients swabbed, 20 (36%) had no organism growth, 22 (40%) had anaerobes growth – the most common organism in this study. Of all 55 swabs sent, only 14 (25%) were acknowledged. The presence of smoking (p < 0.05) was statistically significantly associated with development of fistula-in-ano longer term.

Conclusions

Our data may indicate that microbiology swabs do not influence management of patients with acute perianal abscess. There are discrepancies in whether swabs are taken and acted upon. No organism was associated with fistula development. We would suggest national scale studies to explore our conclusions.
192 An Audit of The Delivery of Paediatric Orthopaedic Services at The Bristol Royal Children’s Hospital in Response to The British Orthopaedic Association Standards for Trauma (BOAST) COVID-19 Guidance
Authors: Benning M S , Berwin J , Monsell F , Carpenter C , Kendall J , Crosswell S , Thomas S , Knapper T
Published: May 2021

Introduction

Guidance from the BOAST helped structure our paediatric orthopaedic service n response to COVID-19. We assessed our compliance with 'BOAST COVID-19 standards', whether it is possible to run a safe and effective paediatric orthopaedic service.

Method

We performed a prospective audit of clinic and theatre data (16th March to 30th April 2020), from the paediatric orthopaedic department at the BRCH against the 'BOAST COVID-19 standards'. We also performed a retrospective audit.

Results

Patients booked into acute fracture clinic (AFC) and fracture clinic follow-up (FFO) reduced by 40% and 48% respectively from 2019 to 2020. A virtual fracture clinic (VFC) was implemented with an increasing trend seen. The number of patient initiated follow-up appointments increased in AFC and FFO from 16% to 75% and 12% to 35% respectively. Radiography was reduced; only 17% and 39% of AFC and FFO patients respectively required radiographs. On-call referrals and trauma cases dropped by 50% with similar case mix year-on-year. All elective operating was cancelled in 2020.

Conclusions

By reducing clinic admissions and theatre throughput, it was possible to run an effective paediatric orthopaedic service in a busy tertiary referral centre. Our aim now is to determine the long-term efficacy, cost, and sustainability of our COVID-19 service.
210 Prognosis of Breast Cancer in Very Young Age (Less Than 30 Years)
Authors: Abid M , Bano R , Salim M , Khan A I , Chaudhry M Z , Khan H M
Published: May 2021

Background

Breast cancer diagnosed at younger age has aggressive biology being triple negative and high grade and associated with poor prognosis.

Method

Retrospectively data of 121 patients age 30 years or younger registered during the year 2008 was reviewed. Demographics studied were age at diagnosis, gender, pregnancy, or lactation associated, family history, histopathological diagnosis, stage of the disease, receptors, type of treatment, response, local recurrence, distant relapse, survival.

Results

One patient was male. Age range 20 -30 years, single patient had bilateral involvement. half 50.4%(n = 61) patients had locally advanced disease at presentation. Pregnancy/ lactation associated breast cancer was seen in 29.8%(n = 36). Most common stage was stage III (52.1%) & stage II (33.9%). IDC was the most common histology 94.2% (n = 114) Triple negative was most common molecular subtype present in 46.3%(56). After 5 years follow up, local recurrence was observed in 12.4%(n = 15), cancer related deaths were 42.1%(n = 51).

Conclusions

Breast cancer in very young has very aggressive tumor biology, needs aggressive treatment with surgery, chemotherapy, radiation therapy and hormonal therapy, furthermore there is need to identify possible environmental factors which may contribute in the rising incidence in this age group.
264 Intertrochantic Hip Fracture Fixation at Musgrove Park Hospital
Authors: Latif R , Macdonald H , Griffith A , Kelly A
Published: May 2021

Background

Hip fractures, the commonest fragility fracture in the UK, carry a 6.7% 30-day mortality. NICE-CG124 guide advises extramedullary implants for trochanteric (AO3.1A1/2) and intramedullary nails for subtrochanteric fractures.

We carried out a retrospective study on the use of cephalomedullary nails (CMN) at MPH to determine compliance with CG124.

Method

National Hip Fracture Database (NHFD) from 2019 was reviewed. Trust records were used for fracture type, surgery, and reasons for deviation from CG124.

Results

201 fractures were identified. NHFD revealed 38 A3 fractures of which 36 underwent CMN, one SHS and one non-operative management. Of 163 A1/A2 fractures, 33 received CMN and 130 CHS.

Only 77% of the NHFD data was correct. Further analysis revealed 18 CMNs were used for AO1/2 injuries. All had justifiable reasons for deviation from CG124, although not documented.

Conclusions

There is scope to improve accuracy of NHFD data. Deviation from guidelines may be appropriate but reasons must be documented and, when appropriate, discussed with patient. Similar nationwide inaccuracy can have significant implications for research based upon NHFD data. To prevent input of incorrect data, our recommendations include: Consultant to confirm AO grade during trauma meetings Reason CMN used for AO1/2 fractures to be documented Monthly local NHFD data audit
289 Blood Loss in Robotic-Assisted Knee Arthroplasty: A Retrospective Analysis
Authors: Khan H , Dhillon K , Mahapatra P , Popat R , Nathwani D
Published: May 2021

Introduction

Significant blood loss is associated with a delayed postoperative recovery in joint arthroplasty. Emerging evidence suggests robotic-assisted knee arthroplasty reduces soft-tissue trauma, length of stay, and can facilitate a faster recovery. This study compares the total blood loss in patients undergoing robotic-assisted knee arthroplasty compared to conventional methods.

Method

Patients undergoing robotic-assisted total knee arthroplasty (TKA) or unicomparmental knee arthroplasty (UKA) were identified using patient records. Robotic-assisted groups were compared against contemporary sex-matched controls undergoing jig-based arthroplasty. The mean total blood loss was estimated using the Gross equation. Statistical significance was identified using the Student's t-test and Mann-Whitney U test for parametric and non-parametric data, respectively.

Results

Robotic TKA and UKA groups were successfully matched to contemporary controls (n = 50 in all groups). No differences in preoperative haematological parameters or blood volume were found between the robotic-assisted and control groups. Robotic TKA experienced 23.7% less blood loss compared to control TKA (911.0ml vs 1193.7ml, p < 0.01) which was found to be statistically significant. There was a non-significant difference in mean total blood loss in robotic UKA compared to control UKA (821.7ml vs 854.7ml, p = 0.69).

Conclusions

The use of a robotic surgical system reduces blood loss in TKA but not UKA in knee arthroplasty.
292 Publication of Individual Surgeon Outcomes Data: The Wishes of Orthopaedic Patients and Their Surgeons
Authors: Harris H , Poole W , Ricketts D , Rogers B
Published: May 2021

Background

The Paterson report recommended increased release of individual surgeon data to the public. There is limited evidence in the literature about patients’ or orthopaedic surgeons’ wishes regarding release of such data to the public.

Method

We surveyed 80 joint replacement patients and 41 orthopaedic surgeons to determine their wishes regarding collection and release of individual surgeon data to the public.

Results

Patients expected more current monitoring of data than actually occurs. Of the patients, 95% wanted data to be available describing surgeon experience, length of stay and complications. Regarding currently available data, 50% of patients who were aware of it were likely to view it on the internet.

Surgeons were aware of the data available, but 80% did not think it was accurate. Surgeons did not think this data improved standards, that it negatively affected innovation (61%) and training (76%) and led to risk averse behaviour (61%). Surgeons wanted a minimal data set accurately presented and risk adjusted.

Conclusions

We recommend an agreed minimum dataset of good quality data is collected and discussed in clinical governance sessions. It can then be released to the public with explanatory notes.
311 Can We Predict Extraprostatic Extension (EPE) Prior To Radical Prostatectomy? – A Single Institution Comparison of Pre-Operative Biopsy Histology and Multiparametric MRI (mpMRI) With Radical Prostatectomy Specimen Histology
Authors: Pavithran A , Gowda B G , Pillai R , Corr J , Deshpande A
Published: May 2021

Introduction

Prostate biopsies and mpMRI play an integral role in diagnosis of prostate cancer. The aim of our study was to assess the ability to predict EPE based on pre-operative histology and mpMRI.

Method

We retrospectively analysed 235 patients who underwent radical prostatectomy between January 2015 and April 2017. All patients underwent pre-biopsy mpMRI scans and prostate biopsies. All mpMRIs were reported by dedicated uro-radiologists and all histology was reported by dedicated uro-pathologists.

Results

17/25 patients showing EPE on mpMRI had it confirmed on final histology.

a53/210 patients showing organ-confirmed disease on mpMRI had EPE on final histology.

40/49 patients who had Gleason 6 adenocarcinoma were organ-confined.

61/186 patients with > Gleason 7 adenocarcinoma had EPE.

Sensitivity of mpMRI was 25% with a specificity of 95%. The positive predictive value (PPV) was 68% and negative predictive value (NPV) was 75%.

The specificity of pre-biopsy Gleason score > 7 to predict EPE was 81% and sensitivity was 33% with a PPV of 87%.

Conclusions

Our data suggests that by using > Gleason 7 and mpMRI as a combination, we can reliably predict EPE on final histology which in turn will help counsel patients appropriately for treatment options. Further data collection is ongoing at our institution.
381 Is There A Role for Tranexamic Acid in Upper GI Bleeding? A Systematic Review and Meta-Analysis
Authors: Burke E , Malik H , Awan F , Balfe P
Published: May 2021

Introduction

Upper Gastrointestinal bleeding is associated with increased morbidity and mortality. It has been suggested that tranexamic acid (TXA) may be useful in arresting bleeding.

Aim:

To synthesise available evidence of the effect of TXA on upper GI bleeding.

Method

A systematic review was conducted. PubMed, EMBASE and Cochrane central register of controlled trials were searched for relevant studies. A random effects meta-analysis was performed to determine the risk ratio of primary and secondary outcomes.

Results

8 studies were included in the review. Total number of patients included was 12994 including 4550 females (35%). The effect of TXA on mortality: risk ratio was 0.95 which favoured TXA however the 95% CI ranged from 0.80 to 1.13 and was not statistically significant. The re-bleeding rate risk ratio was 0.64, which favoured the TXA group and with a 95% CI ranging from 0.47 to 0.86 this was statistically significant. The risk of adverse thromboembolic events: risk ratio was 0.93 favoured the TXA group however the 95% CI extended from 0.62 to 1.39 and so was not statistically significant.

Conclusions

We cannot recommend the routine use of TXA in the setting of acute upper GI bleeding outside its use in randomised controlled clinical trials.
404 Endonasal Endoscopic Management of Spontaneous Cerebrospinal Fluid Rhinorrhoea: Birmingham Experience
Authors: Jolly K , Gupta K K , Bhamra N , Aslanidou A , Batra R , Ahmed S
Published: May 2021

Spontaneous cerebrospinal fluid (CSF) leak (SCSFL) occurs in the absence of any trauma, surgery or underlying intracranial pathology. SCSFL can lead to complications such as brain abscess, meningitis, decreased intracranial pressure (ICP), headache and brain herniation. We present our experience of SCSFL repair performed by a single surgeon at a tertiary centre via the endonasal endoscopic approach.

All patients who underwent CSF fistula repair at the Queen Elizabeth Hospital Birmingham, between 1st January 2012 and 31st December 2019, were identified and had their case notes analysed retrospectively.

We identified 33 patients who satisfied our inclusion criteria. They consisted of 27 (81.8%) female patients, ranging in age from 31 to 81 years (mean age 55.2 ± 13.2 years). Combined CT/MRI imaging was able to identify the leak in 30 patients (91%). Post-operative complications occurred in 2 patients (6.1%) with 1 patient developing meningitis (3.0%) and 1 patient experiencing epistaxis (3.0%). Overall, there was a successful primary repair in 32 (97.0%) cases.

Endoscopic endonasal repair of SCSFL has rapidly grown in popularity and now become the treatment of choice, overtaking open transcranial approaches. Several studies have demonstrated success rates of between 80-94% for spontaneous leaks however not all have addressed the issue of concurrent IIH post-operatively.
439 Conservative Versus Surgical Management of Complicated Diverticulitis - A Retrospective Study of Long-Term Outcomes
Authors: Durity E , Elliott G , Gana T
Published: May 2021

Introduction

Management of complicated diverticulitis has shifted towards a conservative approach over time. This study evaluates the feasibility and long-term outcomes of conservative management.

Method

We retrospectively evaluated a consecutive series of patients managed with perforated colonic diverticulitis from 2013-2017.

Results

Seventy-three (73) patients were included with a male to female ratio of 1:2. Thirty-one (31) underwent Hartmann’s procedure (Group A) and 42 patients were managed with antibiotics +/- radiological drainage (Group B). Mean follow-up was 64.9 months (range 3-7 years).

CT Grade 3 and 4 disease was observed in 64.5% and 40.4% of Group A and Group B patients, respectively. During follow-up, 9 (21.4%) Group B patients required Hartmann’s.

Group A had longer median length of stay compared to Group B (25.1 vs 9.2 days). Post-operative complications occurred in 80.6% with 40% being Clavien-Dindo grade III or higher in group A. Stoma reversal was performed in 8 patients (25.8%).

Conclusions

In carefully selected cases, complicated diverticulitis including CT grade 3 and 4 disease, can be managed conservatively with acceptable recurrence rates (16.7% at 30 days, 4.8% at 90 days, 19.0% at 5 years). Surgical intervention on the other hand, carries high post-operative complication rates and low stoma reversal rates.
466 Resection or Enucleation for Extremely Giant Hepatic Haemangiomata? A Case Report and Review of The Literature
Authors: Fraser R E , Layton G R , Kuan L L , Dennison A R
Published: May 2021

Background

Cavernous hepatic haemangiomas are benign liver tumours and although common when small, giant haemangiomas (usually accepted as being greater than 10cm) are infrequent. Treatment is indicated in patients who are symptomatic or if diagnosis is unclear, although with giant haemangiomas, many support expectant management of asymptomatic lesions due to the risk of major complications. Traditionally hepatic resection has been the primary treatment option for these lesions, but a variety of other techniques, including enucleation, have been described as safe and effective alternatives. There remains equipoise in respect of the best management of giant haemangiomas above 10cm. Cases of such size are rare and so there is a paucity of data available.

Case presentation

We present a case of a 65-year-old male who underwent successful anatomical liver resection for a 5kg giant cavernous haemangioma of 26cm diameter following its incidental identification during an ultrasound scan. We also discuss and compare the role of resection and enucleation for the treatment of haemangiomata greater than 20cm in diameter.

Conclusions

This case demonstrates successful resection of an unusually giant haemangioma which, in contrast to the majority of literature, provides a valuable addition to the limited evidence base for management of this condition by anatomical resection.
502 Pain Prevention with Intraoperative Music: A Review and Meta-Analysis of The Impact of Intraoperative Music on The Post-Operative Pain of Abdominal Surgery Patients
Authors: Dale V
Published: May 2021

Introduction

Postoperative pain is a significant problem that can lead to a range of complications including inadequate healing. Music has been shown to reduce postoperative pain across a range of surgical disciplines. This poster is novel as intra-operative awareness is an area of some debate and there has not previously been a systematic review of the impact of intraoperative music on the post-operative pain of abdominal surgery patients.

Method

A systematic review of Cochrane Library, PubMed, and Scopus identified randomised controlled trials comparing an intraoperative music intervention with standard care with postoperative pain as a measured outcome. To assess the quality of the studies and determine inclusion in meta-analysis the author collaborated with Robot Reviewer software based on the Cochrane bias methodology. Meta-analysis used standard mean difference and a random-effects model.

Results

The review found the majority of studies looking at intraoperative interventions determined that there was no significant impact on postoperative pain. However meta-analysis of the 250 subjects included determined that there is a significant reduction in pain (p = 0.02). The studies included also looked at opiod use, however this was not reported.

Conclusions

Whilst the meta-analysis is promising, findings support further investigation into intraoperative music as a low-cost addition to postoperative pain management.