bluuebunny/crossref_metadata_2025 huggingface dataset:
561 Outcome of Patients Undergoing Neck of Femur Fracture Surgery During COVID Period
Authors: Saha A , Demoulin E , Newman J
Published: May 2021

Introduction

The aim of the study is to determine the 7- and 30-day mortality rate, hospital stay period and pre- and post-operative symptoms in NOF fracture patients undergoing surgery and compare between COVID-19 positive and negative cohorts.

Method

This was a retrospective, descriptive study involving 188 NOF fracture patients who underwent operation from 21/03/20 to 21/07/20 in Mid Yorkshire Hospitals Trust. Only people who tested positive for COVID-19 within 30 days of operation were counted in the positive cohort.

Result:

Total 21 patient tested positive for COVID-19, 16 within 30 days of operation and 5 tested beyond 30-day period. 24 were not tested. 143 tested negative. The average age of patients was 79.02±11.163 years. Average hospital stay was 14.688±10.657 days (average stay for positive patients 22±13.789 days). 12 patients had pre-operative symptoms (respiratory symptoms, fever) out of which 2(16.67%) tested positive. 7-day post-op mortality was 2.128% (6.25% for COVID-19 positive patients). 30-day mortality was 6.383% (5.814% for untested/negative patients and 12.5% for positive patients). 41 patients (21 .81%) developed post-operative respiratory symptoms (56.25% for positive patients). 8.51% developed post-operative sepsis (25% of positive patients).

Conclusions

Mortality and morbidity rate was higher for NOF fracture patients with positive COVID-19 test.
575 Management of Acute Appendicitis During the COVID-19 Pandemic. Our Experience at The General Surgery Department in Queen Elizabeth Hospital, London
Authors: Chatzikonstantinou M , Pouncey A , David M l , Aljarad F , Sorelli P
Published: May 2021

Introduction

The pandemic of CoViD-19 had a major impact on provision of emergency services. National (CoViD-19) Guidelines (NG) were issued by the Colleges of Surgeons for the management of surgical patients.

Aim

To assess the impact of CoViD-19 in the management of patients with acute appendicitis (AA) and review patients’ characteristics and compliance with NG.

Method

A single-centre retrospective analysis of prospectively collected data on surgical admissions with suspected AA between March and May 2020. Main outcomes of interest were the pre-operative investigation, the type of operation and the negative appendicectomy rate (NAR) comparing to 2019.

Results

A total of 109 patients were referred for suspected AA. Out of 39 patients who had surgery 21 (53.8%) were investigated with a CT and 13 (33%) with an ultrasound. There was a 31.6% reduction in appendicectomies compared to 2019. 30 patients (76.9%) had an open procedure vs 9 laparoscopic (23.1%) in alignment with the NG2. Histology showed AA in 37 out of 39 of the cases. The NAR was 5.12 vs 12.2 for 2019.

Conclusions

There was a 31.6% reduction in appendicectomies during CoViD-19. Most patients were investigated with a CT and underwent an open procedure. Pre-operative investigation with a CT led in reduction of NAR.
594 Optimising Hand Trauma Care at a Major Trauma Centre (MTC) During the COVID-19 Pandemic
Authors: Khajuria A
Published: May 2021

Introduction

This study evaluates the management of hand injuries during COVID-19 following the prompt implementation of the BOA guidelines; reconfiguration of hand services and implementation of the ‘one-stop’ model.

Method

285 cases OVER A 1-MONTH PERIOD were RETROSPECTIVELY reviewed to evaluate the effectiveness of managing patients using the ‘one-stop’ model and the new Urgent Treatment Centre (UTC).

Results

277 patients were included in the study. During Covid-19, operative cases fell by 62%. 86.3% (239/277) of cases were managed in the UTC; 54.4% (130/239) required conservative management and 45.6% (109/239) required minor procedures (in UTC). REMOVABLE SPLINT USE was optimized through design of ‘softcasts’ for non-operative management of distal radius fractures. A patient education video: ‘softcast removal at home’ was created and in cases requiring sutures, 95.1% (39/41) were absorbable, thereby avoiding COVID-19 exposure for follow-up. Only 50.5% (140/277) of patients had formal follow-up arranged and patient information follow-up cards were developed.

Conclusions

The one-stop model prevents delay in definitive treatment, allows effective initial treatment, and minimizes the need for face-to-face follow up. In light of a possible second wave of COVID-19 cases, this new model should be considered for implementation by all hand’s units for the foreseeable future.
664 The ICON Trauma Study: The Impact of the COVID-19 Lockdown on Major Trauma Workload in the UK
Authors: Adiamah A , Thompson A i , Lewis-Lloyd C , Dickson E , Blackburn L , Moody N , Gida S , La Valle A , Reilly J J , Saunders J , Brooks A ,   ICON Trauma Study Group
Published: May 2021

Introduction

Anecdotal evidence suggest a direct impact of the SARS-COV-2-pandemic on presentation and severity of major trauma.

Method

This observational study from a UK Major Trauma Centre matched a cohort of patients admitted during a 10-week period of the SARS-CoV-2-pandemic (09/03/2020 to 18/05/2020) to a historical cohort admitted during a similar time period in 2019 (11/03/2019 to 20/05/2019). Demographic differences, injury method and severity were compared using Fisher’s and Chi-squared tests. Multivariable logistic regression examined the associated factors predicting 30-day mortality.

Results

Of 642 patients, 405 and 237 were in the 2019 and 2020 cohorts respectively. 1.69%(4/237) of the 2020 cohort tested SARS-CoV-2 positive. There was a 41.5% decrease in trauma admissions in 2020. The 2020 cohort was older (median 46 vs.40 years), more comorbid and frailer (p < 0.0015). There was a significant difference in injury method with a decrease in vehicle related trauma, but an increase in falls. There was a 2-fold increased risk of mortality in the 2020 cohort that in adjusted models, was explained by higher injury severity and frailty. Positive SARS-CoV-2 status was not associated with increased mortality on multivariable analysis.

Conclusions

Patients admitted during the SARS-CoV-2-pandemic were older, frailer, more co-morbid and had an increased risk of mortality.
720 Outcomes of Conservative Management of Acute Appendicitis During The COVID-19 Pandemic
Authors: Oxenham M , Jull P , Karunaratne D , Laskar N , Harshen R
Published: May 2021

Introduction

During the SARS-CoV-2 (COVID-19) pandemic, appendicitis was managed conservatively to reduce peri-operative mortality; spread of infection; and hospital admissions. We describe the outcomes observed from conservative management during the pandemic.

Method

This prospective single centre study included all patients with clinically acute appendicitis between 31/3/2020 to 31/5/2020. Length of admission and 30-day complications were recorded. This was compared to retrospective data from 31/3/2019 to 31/4/2019.

Results

Of the 35 patients included between 31/3/2020 to 31/5/2020: 19 patients were managed conservatively with antibiotics; 8 required operative management after trial of antibiotics; and 8 required surgery on admission. Of the initially conservatively managed patients, three suffered complications (Clavien Dindo >1). Length of admission in conservative patients averaged 1.3 days (0-5 day range).

In May 2019, 30 patients admitted with clinical appendicitis were all managed with appendicectomy. The average admission was 2.93 days (1-50 day range) with 4 patient complications. There was no difference (P = 0.22) when comparing the length of admissions within the pandemic and non-pandemic cohorts.

Conclusions

Our study demonstrates no increase in complications or length of admission during the pandemic. We support the recommendation that conservative management of uncomplicated appendicitis is continued during the COVID-19 pandemic.
729 Effect Of COVID-19 On Orthopaedic Trauma Admissions in A London District General Hospital
Authors: Zahoor U , Malik C , Raja H , Ramaraju S , Sri-Ram K
Published: May 2021

Introduction

The coronavirus pandemic (COVID-19) has presented orthopaedic services with new challenges across all aspects of healthcare delivery. This study explores the effect of the COVID-19 lockdown on trauma admissions at a London District General Hospital.

Method

Data was collected retrospectively from electronic patient records during the lockdown period (16th March -30thApril 2020) and compared to the same dates in 2019. Patient age, date and time of admission, operation and anaesthesia timings and length of stay (LOS) were analysed.

Results

Fewer trauma patients were admitted in 2020 (108 vs. 65). Additionally, there was a patient demographics shift, with mean age increasing from 55.6 years to 64.1 years (p = 0.038). Falls remained the leading cause of injury, although the proportion dropped from 75% to 62%. Anaesthesia duration was longer in 2020 (136 vs 83 minutes, p < 0.00001). Similarly, there was a 13.6% increase in median operation length. Finally, although LOS was similar, admission-operation was greatly reduced in 2020 (1.22 days vs 4.74, p < 0.0000001).

Conclusions

Orthopaedic trauma care remains a vital service, particularly in high-volume hospitals. By understanding the effects of the lockdown on trauma admissions, healthcare managers can more effectively plan for future changes in non-emergent trauma service delivery as we move towards easing lockdown restrictions.
739 The Management and Outcomes of Patients with Fractured Neck of Femur During The COVID-19 Pandemic; A District General Hospital Experience
Authors: Lancaster P , Selvarajan S , Dasari K
Published: May 2021

Background

The UK announced a “lockdown” in response to COVID-19 on 23/03/2020, despite this NHS England did not anticipate a significant decrease in hip fracture cases. Early data from Europe had shown mortality rates of up to 30.4% in patients who develop COVID-19 and a hip fracture.

Method

Prospective study of patients presenting with a hip fracture between 23/03/2020 and 18/05/2020. Primary outcomes were 30-day mortality and COVID-19 status. Secondary outcomes were length of stay, discharge destination and readmission.

Results

50 patients identified, mean age 82. 49 patients underwent operation, 34 (69.4%) within 48 hours of admission. 14 Patients (28%) tested positive for COVID-19 within 30 days. 30-day mortality was 10% (n = 5). 2 patients who died were COVID-19 positive. Mean length of stay was 12.3 days. 7 patients (14%) re-admitted within 30 days, 4 with COVID-19.

Conclusions

Despite extra strain on the hospital, we believe we achieved good outcomes for this cohort. Compared to previous NHFD data we decreased our length of stay and time to operation. 30-day mortality increased (8.4% in 2018) but we believe this to be expected in vulnerable patients during a pandemic. We hope to take lessons we have learnt during the pandemic into the post-pandemic era.
786 Retrospective analysis of paediatric ENT surgery outcomes during the COVID pandemic
Authors: Huang J , Bhargava E , Walsh M , Pennell D , Attya H , Jablenska L , Ferguson L , Lilly I , Pepper C , Tweedie D , Possamai V
Published: May 2021

Introduction

Studies show high morbidity/mortality for adults with peri-operative SARS-CoV-2 infection, leading to recommendations curtailing elective operations during the height of the pandemic. Our understanding of the risks associated with paediatric surgery is more limited, with preliminary data suggesting lower morbidity/mortality than in adults. A < 1% incidence of COVID-19 in paediatric patients undergoing preoperative universal screening is reported, and even in those testing positive, morbidity and mortality seem to be low. As waiting lists swell and the detriment associated with delaying surgery mounts, it is imperative to accurately quantify the risks of surgery in the paediatric population.

Method

Retrospective review of all paediatric ENT operations performed at the Evelina Children’s Hospital at the height of lockdown, from March to May 2020.

Results

61 procedures were performed on 56 patients. 50% had a pre-operative SARS-CoV-2 nasopharyngeal swabs. All cases involved a change in anesthetic practice; 2 cases involved a change in surgical practice. We noted 2 medical complications and 1 surgical complication. All patients are currently extant. No staff or patients subsequently developed COVID.

Conclusions

Our perioperative infection rates and mortality/morbidity figures concord with figures published elsewhere in literature. We are cautiously optimistic regarding risks associated with paediatric ENT surgery.
815 The Impact and Implications for The Workload for Vascular Surgery as A Result of the COVID-19 Lockdown
Authors: Nicholls J , Stewart C , Coulston J
Published: May 2021

Introduction

The emergence of the coronavirus pandemic and subsequent UK lockdown resulted in a significant reduction in elective vascular surgery to increase critical care capacity. We aimed to ascertain the impact of lockdown on the workload of a busy vascular surgical unit.

Method

Data on all major vascular procedures performed between March 2020 and June 2020 were collected prospectively. Comparison to the same time period over the last 6 years was performed using a prospectively maintained database.

Results

92 major cases were performed, a reduction of 30% compared with cases performed during similar periods (803 cases total, mean 133), with an increased proportion of unplanned & emergency cases(35.9% & 31.5% vs 31.4% & 20.5%).

There was a significant reduction in aortic procedures (19 vs mean 36). Despite the reduction in cases there was a similar number of amputations performed (9 vs mean 10).

Conclusions

The lockdown period resulted in a 30% reduction in cases performed with far fewer aortic procedure performed and a similar number of amputations. These pending cases will need consideration, especially with critical care capacity to ensure they are completed within a timely period. Considerations for capacity are also pertinent given the approach of winter and the possibility of a second wave.
816 The Effect Of COVID-19 And Service Delivery Changes On 30-Day Mortality in Fractured Neck of Femur Patients: A Case-Control Study
Authors: Winarski A , Williams L , Ingoe H
Published: May 2021

Introduction

The majority of neck of femur (NOF) fractures occur within the home, therefore admissions were not expected to change during the COVID-19 pandemic(1) . This study investigates the effect of coronavirus and our department’s response on 30-day mortality for patients admitted with NOF fractures.

Method

Data from 65 fractured NOF admissions (22nd March - 24th May 2020) was compared with 62 patients from the same period in 2019. Binary logistic regression was used to explore 30-day mortality; accounting for differences in ASA, anaesthetic type, anticoagulation status, surgery type, age, time to surgery and year of admission.

Results

The odds of 30-day mortality was statistically significantly higher in patients who were suspected/confirmed COVID-19 positive (n = 10),(OR 2.39, 95%CI (1.60-74.13)). In COVID-19 negative patients (n = 55), the odds of 30-day mortality was lower in 2020, and approached statistical significance (0.232, 95%CI (0.053-1.02)), compared to the same period in 2019. Median length of stay (LOS) in patients who survived was 11 days in 2020 and 15.5 days in 2019 (p = 0.003).

Conclusions

The results suggest that a COVID-19 diagnosis significantly increases the 30-day mortality in patients with a fractured NOF. The changes implemented in service delivery have shortened LOS and appeared to improve 30-day mortality for those without COVID-19.
890 Predictive Factors for Mortality Following Trauma & Orthopaedic Surgery in The Covid-19 Pandemic. The Manchester Equation
Authors: Waugh C , Jain N , Bhutta A , Havenhand T , Qureshi M , Stansfield J , Lokanathan S
Published: May 2021

Introduction

Covid-19 caused many service changes including limitations on operations due to potential increased mortality risk to patients. We report our findings from Trauma & Orthopaedic (T&O) surgical mortality through this period and the effectiveness of using a scoring system (The Manchester Equation) to predict likelihood of mortality.

Method

We reviewed all T&O admissions that underwent surgical intervention during the height of the pandemic. We recorded numerous factors for each patient including mortality and Covid status. From this we created a scoring system which is the product of Covid status, Anaesthetic type, Medical co-morbidities and other medical factors and ASA Score. We then analysed the findings to determine whether the score could be predictive of mortality rate.

Results

Of 123 patients undergoing surgery 6 deaths were observed (mean score of 51.3) compared to 117 patients surviving (mean score 31.9), p = 0.001. A score of less than 32 carried a 0% chance of death whereas a score of 32 or more resulted in a 14.6% mortality rate (p = 0.01).

Conclusion

The Manchester Equation can be used to help predict the mortality rate of T&O surgery in the presence of Covid-19 and may be useful for clinical decision making and consent purposes.
905 How to prioritise patients and safely resume elective surgery during the Covid-19 pandemic
Authors: Subbiah Ponniah H , Ahmed M , Edwards T , Cobb J , Dean E , Clark C , Logishetty K
Published: May 2021

Introduction

There are now over 2.5 million NHS patients awaiting elective surgery, with the most in orthopaedics. We present an algorithm and results for safely and equitably restarting surgery at COVID-light sites.

Method

An MDT applied the COVID-19 Algorithm for Resuming Elective Surgery (CARES) on 1169 patients awaiting elective orthopaedic surgery. It assessed safety, procedural efficacy, and biopsychosocial factors, to prioritise patients. They were assigned to five categories and underwent surgery at one of three COVID-light sites (1. access to HDU/ITU/Paediatrics/specialist equipment, 2. an NHS elective surgical unit and 3. a private elective surgical unit).

Results

21 ‘Urgent’ patients received expedited care; 118 were Level 1/2; 222 were Level 3; 808 were Level 4. In 6 weeks, 355 surgeries were performed, with Urgent and Level 1/2 cases performed soonest (mean 18 days, p < 0.001). 33 high-risk/complex/paediatric patients had surgery at Site 1 and the rest at Sites 2 and 3. No patients contracted COVID-19 within 2 weeks of surgery.

Conclusions

We validated a widely generalisable model to facilitate resumption of elective surgery in COVID-light sites. It enabled surgery for patients in most suffering, undergoing the most efficacious procedures and/or at highest risk of deterioration, without compromising patient-safety.
907 Reduction of Nasal Fractures During COVID-19: A Single-Centre Experience
Authors: Crotty T , Corbett M , Hussain T , Diaconescu A , Patil N
Published: May 2021

Introduction

The utilization of local or regional anaesthesia for manipulation of nasal fractures (MNF) avoids the need for general anaesthetic (GA), and the risk associated with instrumentation of the airway during the COVID-19 pandemic. Furthermore, MNF under local anaesthetic (LA) provides similar results with regards to cosmesis and patient satisfaction. We present our experience of performing MNF under LA during the COVID-19 pandemic.

Method

A single-centre, prospective study of all patients undergoing MNF under LA was conducted (13th July/20–11thSeptember/20). Following reduction, pain scores and patient satisfaction surveys were administered.

Results

A total of 25 patients (M/F:16/9, median age, 25.6yr (14-52yr)) were enrolled. The majority of patients received either one or two instillations of LA (n = 19, 76%). Pain reported during the MNF procedure was 4.4/10, whilst pain during LA administration was reported as 3.2/10. 80% of patients felt instillation of LA was less painful than expected. 88% of respondents tolerated the LA well, and only 8% would have opted for general anaesthetic. 24 (96%) participants were happy with the cosmetic result.

Discussion

MNF under LA is a safe and effective alternative to MNF under GA. More literature is needed to define the best method of administering LA prior to performing MNF.
936 Outcomes of A Single Site Receiving Model for General Surgery During the COVID-19 Pandemic in A Scottish NHS Board
Authors: Kilpatrick R , MacDonald A
Published: May 2021

Aim:

To assess overall patient outcomes of converting to a single-site receiving unit for general surgery during the height of the covid-19 pandemic.

Method

Prospective study of all general surgery inpatients, who would normally be looked after at University Hospital Monklands, between 17/04/20-06/06/20, the beginning and end of a single-site receiving model within NHS Lanarkshire.

Results

There was a 32% reduction in admissions from 278 to 188, from the same time period in 2019. The 30-day mortality rate was 3.2% in comparison to 2.8% in 2019.

Of 59 patients (31.4%) who had surgery, 13.5% had a complication of varying degree. The post-operative 30-day mortality rate was 0%. Only 4 patients (2%) were diagnosed with covid-19, none of which died.

Laparoscopic appendicectomy was favoured over conservative management, with average length of stay (LoS) being 3.2 days and 5 days respectively. Acute cholecystitis was overall managed conservatively with average LoS being 8.8 days for operative management, compared to 4.1 days for conservative management.

Conclusions

Overall outcomes during this time were not found to be significantly worse when compared to the previous year. The rate of contracting covid-19 in the unit was low. Laparoscopic surgery can still be carried out safely for selected acute surgical conditions.
954 A Framework Recommendation for Surgeons Legal Liabilities During an Acute Health Crisis
Authors: Schaffer S , O’Neill P , Thomas M C
Published: May 2021

Introduction

Ethical and professional duties compelled surgeons to act outside their specialties during the SARS-CoV-2 pandemic. Our work explored the legal liabilities that have arisen for surgeons during this period.

Method

A literature review was conducted of medical and legal databases; PubMed, MedlineOvid, WestLaw, and LexisNexis. Statues and case law across three jurisdictions; Canada, the United Kingdom, and the Republic of Singapore were retrieved and analyzed.

Results

Professional regulatory bodies impose a duty to act in healthcare emergencies. Yet, formal legal protection has not been codified by either professional regulatory bodies or governments. These discrepancies between legal and professional standards leave surgeons vulnerable to litigation.

Conclusions

Following our analysis of cases and outcomes within these jurisdictions we propose a framework that provides basic protection to surgeons acting outside their surgical specialty, but within a general medical capacity, whilst providing care during acute health crises.
971 Impact Of COVID-19 Surgical Guidelines on Sternal Wound Infections During The COVID-19 Pandemic in A Large London Hospital: An Unexpected Benefit
Authors: Ike I D , Durand-Hill M , Hussain A
Published: May 2021

Introduction

Sternal wound infections (SWI) are typically associated with a high morbidity and mortality. Rigorous peri-operative guidelines were instituted during the pandemic. The impact of these measures on SWI was investigated.

Method

We performed a retrospective analysis of all patients who underwent cardiac surgery at our institution since March 2020 post intervention (new COVID-19 peri-operative guidelines). A retrospective analysis of all patients who underwent cardiac surgery in the 12 months preceding the lockdown was also performed as a baseline cohort group.

Results

A total of 2,600 patients (493 during the COVID-19 pandemic) were included in this study. Urgent/emergency procedures accounted for more than 60% of procedures performed during the lockdown compared to 39% previously. 67 (2.6%) surgical wound infections occurred in the study population. During the COVID pandemic, there were 4 SWIs with an overall incidence rate of 0.8%. Patients who underwent cardiac surgery during the COVID pandemic had a lower than expected rate of surgical wound infections (P = 0.006). Other significant predictors of surgical wound infections included a diagnosis of diabetes and being a smoker.

Conclusions

This report suggests that a significant proportion of SWI’s are iatrogenic related and can be avoided through a rigorous attention to detail in the peri-operative setting.
998 Utilisation of A “COVID-Free” Hospital in The Independent Sector - Endourology Service Provision and Outcomes During The COVID-19 Pandemic
Authors: Bratt D , Satherley H , Konstantinidi K , Ratan H , Bodiwala D
Published: May 2021

Introduction

COVID-19 may negatively affect peri-operative outcomes, requiring strategies to allow operating whilst minimising risk. We present our endourology service provision throughout the “lockdown” period.

Method

Endourological operations 23rd March to 11th May 2020 were designated to the base hospital or independent “green” site by urgency and comorbidity status. Base hospital emergencies underwent surgery in main theatres, whilst elective patients had dedicated “COVID-free” theatres and wards.

A portable Holmium laser enabled lasertripsy at the independent site.

After 27th April, elective cases required a negative swab and 2-week self-isolation pre-operatively.

Results

70 operations were performed: 42 ureteroscopies, 20 stent procedures, 8 PCNLs. Mean age was 57 and 58 at base and independent sites respectively, mean ASA 2.1 and 1.9.

37 operations (53%) occurred at the base hospital, including 14 emergencies (38%). 19 patients received post-operative COVID-19 swabs: 3 positives (8%), all emergencies. 2 patients (5%) died of COVID-19 pneumonia within 35 days; both had negative pre-operative swabs.

Of 33 patients at the independent site, 3 (9%) received post-operative swabs, all negative. None had COVID-19 symptoms post-operatively.

Conclusions

“COVID-free” hospitals, wards and theatres enable elective operating whilst minimising peri-operative virus risk. Further utilisation of independent hospitals would more safely allow operating throughout the pandemic.
1017 Audit of Sore Throat Management During the COVID-19 Pandemic
Authors: Eastwood M , Lovett A , Metcalfe C , Bhimrao S
Published: May 2021

Introduction

The COVID-19 pandemic has meant otolaryngologists have faced significant uncertainty and has them to change their clinical practice. ENT UK published guidance on the management of common emergencies encountered aimed to optimise safety for patient and clinician alongside reducing admission rate. We present an audit of our management of patients presenting with sore throat during the COVID-19 pandemic.

Method

Prospective data collection was undertaken between 1st April 2020 and 1st July 2020, inclusive. All patients presenting acutely to ENT services with sore throat were reviewed. Local practice was compared to the ENT UK COVID-19 adult tonsillitis and quinsy management guidelines published on 6th April 2020.

Results

A total of 19 patients presented to the ENT department with an acute sore throat during the audit period. Twelve patients were tested for SARS-CoV-2, with all results being negative. All patients underwent an oral examination on review. Seventy-nine percent were discharged within 24 hours of admission. One patient required readmission within 30-days.

Conclusions

With reduction in admissions, these results provide otolaryngologists with the reassurance for change of clinical practice. We recommend that for future practice to be safe for both patient and practitioner, the ENT UK guidelines are used to aid clinical decision-making especially during the COVID-19.
36 A Randomised Trial to Compare How Undergraduates Diagnose Common Ear Pathology Using A Smartphone Otoscope and Standard Otoscope in A Simulated Setting
Authors: Schuster-Bruce J , Ali A , Van M , Rogel-Salazar J , Ofo E , Shamil E
Published: May 2021

Introduction

Competent otoscopy is a key otolaryngology skill for a broad range of medical careers, yet undergraduate’s confidence to perform otoscopy is reported as low. This study aimed to evaluate whether a smartphone-otoscope could enhance medical undergraduates recognition of common ear pathology.

Method

52 medical students were randomised into a standard group (traditional otoscope) and an intervention group (smartphone-otoscope). Following a short didactic presentation, participants were asked to diagnose four simulated pathologies. Force response items and 5-point Likert scales loaded on an electronic platform recorded their diagnosis and their perceptions towards the otoscope.

Results

The smartphone-group (n = 20) had higher overall rates of correct diagnosis compared to control (n = 22) (84% vs 39%, p = <0.001). Only the grommet station did not show a significant improvement between the two groups (100% vs 91%, p = 0.49). 90% (n = 20) of participants felt the smartphone-otoscope was preferential for their learning. The same number expressed they want to use it in future learning. The remainder were indifferent.

Conclusions

The smart-phone otoscope enabled learners to better observe and recognise middle ear pathology. This popular learning tool has the potential to accelerate the learning curve of otoscopy and therefore improve the proficiency of future doctors at recognising middle ear diseases.
102 Peer Teaching in Hip Fracture: Responding to the Medical Needs of Surgical Patients and Educational Needs of Junior Doctors
Authors: Jones N , Francis J , Parikh R , Shaath M
Published: May 2021

Introduction

Fractured Neck of Femur (FNOF) patients are complex. A mortality project identified topics for a peer-led teaching programme.

Method

Eight bite-sized case-based sessions were devised, to provide a framework to approach the following topics: Anaemia, delirium/dementia, ECG abnormalities, metastatic cancer, osteoporosis, renal disease, respiratory disease, and vascular complications. Attendees were asked to complete pre- and post- teaching programme questionnaires using a Likert Scale to indicate agreement with statements relating to the topic areas chosen (1=strongly disagree and 5=strongly agree).

Result

Pre-programme questionnaire: respondents were neutral (average 3.04) when asked whether topic areas were currently “well managed”. Attendees lacked confidence, indicating preparedness as neutral (average 3.35). Trainees agreed that they would benefit from teaching (average 4.56).

Post-programme questionnaire: increased confidence was reported when considering preparedness (average 4.3). Attendees felt the teaching programme was “accessible” and the “topics well-chosen”. 100% of attendees regarded the teaching as ‘excellent’ or ‘very-good’.

Conclusions

Matching patient needs to an educational programme is important.

The “bite-sized” nature of the programme paired with case-based learning increased confidence. A peer-led teaching programme is a positive response to themes emerging from morbidity and mortality reviews.
127 Standardising Access to Fracture Fixation Simulation for Core Surgical Trainees
Authors: Brown R , Curwen C , Mutimer J
Published: May 2021

Introduction

Simulation is increasingly being used to augment clinical experience. However, access to simulation varies geographically and national courses can be costly. The Severn School of Surgery aimed to provide a locally run, cost-neutral “Basic Principles in Fracture Fixation” course to standardise access to simulation for core surgical trainees (CSTs).

Method

The course ran from a district general hospital, accommodating lectures, case discussions, and practical stations (screw fixation, plate fixation, dynamic hip screw, and external fixation). Faculty donated their time and a devices company provided kit and dry bones. CSTs organised the course. Pre- and post-course self-rated Intercollegiate Surgical Curriculum Programme (ISCP) global competency ratings in the practical stations were recorded and usefulness of aspects of the course was recorded.

Results

32 candidates attended. Mean self-rated competency increased by at least one global rating in all practical stations (p < 0.05). All aspects of the course were deemed useful (pre-course reading by 27/28, lectures by 31/32, and case discussions by 31/32). No net cost was incurred.

Conclusions

Increases in self-rated competency in surgical skills can be obtained through a cost-neutral, trainee-organised, regional skills course. Pre-course reading, lectures, case discussions, and practical sessions are all useful. This model can be used by others to standardise the simulation curriculum.
138 Sexual History, Is it Important?
Authors: Duggal S , Wanis C
Published: May 2021

Oral candidiasis (OC) is the most common opportunistic infection seen in patients infected with Human Immunodeficiency Virus (HIV) and remains the second AIDS-defining illness in Europe, as it has previously been reported in 11-51% of cases. We present a case of a 70-year-old male who attended the Oral and maxillofacial surgery department with refractory OC and was later diagnosed with HIV after multiple visits to various departments in hospital. Sadly, the patient declined medically and died of multi-organ failure one month following this diagnosis. On reflection, it was found that the patient suffered from the medical conditions and opportunistic infections which can be associated with HIV, but as no sexual history was ascertained this diagnosis was missed. It is prudent that we, as clinicians, take a step back and look at each patient as a whole, in order to ensure complete and holistic care. We argue that sexual history is sometimes vital in achieving a complete history of a patients’ condition, especially in cases of refractory OC where it can be a key piece in the diagnostic puzzle.
154 Enhancing Communication Between Foundation Doctors and Radiologists
Authors: Chuang Y H , Jones V , Trail M , Szewczyk-Bieda M , Nandwani G M
Published: May 2021

Introduction

Facilitating radiological imaging for patients is an essential task for all Foundation Year (FY) doctors. Achieving competence in this task can expedite patient management. We evaluated the confidence and skills of FYs in facilitating radiological imaging before and after introduction of formal training.

Method

Surgical FYs working at a teaching hospital were surveyed to evaluate their baseline level of competence in booking and discussing imaging with radiology colleagues. Parameters were measured on a Likert scale, including confidence in discussing requests and satisfaction of their own performance following discussions. Eight radiology consultants were surveyed to evaluate their opinions on FYs’ communication and established areas for improvement. A teaching session was then delivered to improve communication skills. Furthermore, PACCSS poster was introduced to remind the FYs of the salient information required when discussing imaging.

Results

One month after the intervention, the participants were re-surveyed. This demonstrated a statistically significant improvement in self-reported confidence from 5.3/10 to 7.3/10 (p < 0.001), and in satisfaction of own performance from 5.4/10 to 7.0/10 (p < 0.001).

Conclusions

We identified deficiencies in surgical FY doctors’ confidence and skills in facilitating radiological imaging. There was a demonstrable benefit with focused training. Inter-specialty communication should be introduced into under- and post-graduate educational curriculum.
171 Surgical Trainee Suggestions to Improve Surgical Training and the Surgical Recruitment Process in View of the COVID-19 Pandemic
Authors: Stoner R , Catania S
Published: May 2021

Introduction

The COVID-19 pandemic has had a significant impact on medical education and surgical training. The experiences of surgical trainees were sought to seek feedback on how both training and recruitment can be adapted to reflect these changes.

Method

A survey was circulated amongst surgical trainees, to ask what changes to the recruitment process and surgical training they would suggest, in view of the changes related to the COVID-19 pandemic. Circulated amongst surgical trainees in London. 25 surgical trainees from London responded. Results were analysed and tabulated.

Results

Suggestions for the recruitment process include an appreciation by the recruitment panel about reduced academic achievement, relaxation of requirements, clinically oriented interviews and extension of training. Suggestions for surgical training include resumption of educational activities, ensured surgical activities and protected theatre time, mentorship and run through training.

Conclusions

The effects on surgical training due to COVID-19 must be appreciated, and trainees’ experience and feedback should be considered when adapting training and recruitment to this.
172 The Perceived Effect of COVID-19 on Surgical Training in Malta and the UK
Authors: Catania S , Stoner R
Published: May 2021

Introduction

Surgical training comprises of learning in a number of environments – practical experience in hospital, educational activities, reaching core competencies and academic development. The COVID-19 pandemic has had significant effects on healthcare systems, and this likely will have impacted surgical training. This survey set out to assess the perceived effects of COVID-19 on surgical training.

Method

A survey was circulated amongst surgical trainees to assess perceived effects from the COVID-19 pandemic on their surgical training. This was circulated amongst surgical trainees in Malta and London. 32 surgical trainees from Malta and 25 from London responded. Results were analysed, tabulated and compared.

Results

Less Malta trainees were redeployed than UK (3% vs 80%), whist both had rotations postponed or cancelled (62.5% vs. 92%). Trainees felt logbook opportunities (78% vs 100%) and theatre experience (97% vs 100%) had reduced. Trainees were unsure of how this would affect their progression (56% vs 52%), and some felt recruitment criteria should be adjusted in view of the above (50% vs 68%). Overall, both groups agreed their surgical education had been negatively impacted (84% vs 100%).

Conclusions

Both UK and Malta trainees feel that surgical training has been negatively impacted during the COVID-19 pandemic.
173 Early Results of a Variable-Angle Volar Locking Plate for Distal Radius Fractures: A Bi-Centre Study
Authors: Elerian S , Singh T , Jagodzinski N A , Norris R , Tan S , Power D , Jones J , Rajaratnam V
Published: May 2021

Introduction

This study examines the clinical, functional and radiological outcomes of distal radius fracture fixation with the Aptus® (Medartis, Pennsylvania) locking plate in order to determine its efficacy and to identify notable findings related to treatment variations.

Method

This is a retrospective bi-centre study collecting patient details from a District General Hospital and a Regional Hand Unit. We assessed 61 consecutive patients with distal radius fractures (AO grade A = 19, B = 9, C = 33) fixed using Aptus® plate with a minimum of six months follow-up. Outcome measures included the DASH score, wrist range of movement and grip strength, and complications. Radiographs were reviewed to assess restoration of anatomy and union.

Results

All but two fractures united within six weeks. Mean ranges of movement were only mildly restricted compared to the normal wrist (flexion/extension = 102°; radial/ulna deviation = 53°; pronation/supination = 169°). Mean postoperative grip strength was 23.8kg which was comparable to the contralateral side at 31.5kg. The mean DASH score was 18.2. Seven patients had screws misplaced outside the distal radius although three of these remained asymptomatic.

Conclusions

Variable-angle locking systems benefit from flexibility of implant positioning and may allow enhanced inter-fragmentary reduction for accurate fixation of intra-articular fractures.
213 A Novel, Cost-Effective and Convenient Model for Simulating Facial Wound Repair
Authors: Rowe A , Rapaport B , Al-Najjar Y , Chaudhry B , Leow J , Thomas S
Published: May 2021

Introduction

We describe the use of a novel synthetic simulation pad for learning complex facial wound management including local flaps. The simulation pad is a cost effective and convenient model of facial wounds. We have compared the use of animal tissue to the simulation pad in the context of a workshop for surgical trainees and collected feedback from delegates.

Methods

Feedback was collected from 14 of 16 attending delegates.

Results

It was clear from feedback that animal tissue is not an ideal model of facial wounds with 71% of delegates stating that they did not consider it to be high-fidelity. The synthetic pad was rated more favourably with 100% of delegates reporting that it was a valuable exercise and well designed for local flaps.

Conclusions

It is imperative that training opportunities are high quality and useful to clinical practice. Techniques learnt in the context of a course or workshop are more valuable where targeted practice may occur following learning. The use of a synthetic pad is more amenable to continued practice where it may be taken home following a workshop. Feedback from this event suggests a well-designed synthetic pad is more useful than animal tissue in learning local flaps.
222 Simulation Training in Aesthetic Medicine; A Safe, Effective and Ethically Sound Modality to Teach Basic and Advanced Aesthetic Interventions
Authors: Chalhoub X , Ghanem A
Published: May 2021

Introduction

The role of high-fidelity prosthetic simulation models for Botulinum Toxin Type A (BoNT-A) and cross-linked Hyaluronic Acid dermal fillers (HA) was evaluated and its efficacy and safety discussed in addition to its ethical and cost-effective advantages.

Method

The experiment group (N = 26) included a high-fidelity simulation silicone head to inject as part of dexterity training prior to injecting live adult voluntary models. The control group (N = 8) had only live adult voluntary models for the practical session. Pre-test and post-test of self- assessment of procedure competence and confidence to perform the procedure unaided was evaluated using a modified reflective CEX.

Results

The average competency and confidence pre-test for score for students was (mean±SD) 7.2±4.6 and 2.9±2.9 respectively. The post-test scores rose to 15.8± 2.5 and 7.8±1.5. The improved competency and confidence score were statistically significant (p < 0.05). There was no statistically significant difference of pre-test or post-test scores between the experimental and control group.

Conclusions

High fidelity synthetic simulation models allow novice practitioners to improve pre-procedure counselling, technical skills, management plan and follow up as well as confidence to perform the procedure effectively. We therefore recommend this method as a first-line training model in aesthetic medicine.
326 Student Perceptions of Neurosurgery: Evaluating the Role of Undergraduate Neuroscience Societies
Authors: Aw K L , Lee S H , McLarnon M , Raveendran D , O'Callaghan C , Mullan G , Fearon M , Samuel S , Sekar V , Rogan P
Published: May 2021

Introduction

Many institutions lack an organized system of informal network for medical students wishing to explore neurosurgery. We sought to evaluate the role of extracurricular neurosurgical events in influencing student perceptions of neurosurgery.

Method

Participants for this study were recruited from a neurosurgical careers seminar and practical workshop. Responses were collected prospectively using a multi-method strategy consisting of closed and open-ended questions. Additionally, semi-structured interviews were conducted to gain a deeper insight of students’ evaluation of these events and their perceptions of neurosurgery.

Results

A total of 124 students attended our extracurricular neurosurgery events. These events showed benefits in clinical knowledge and career planning. Students perceived the practical workshops to be useful in improving their basic surgical skills. Semi-structured interviews revealed that students felt their opportunities in exploring clinical neurosciences to be limited, which was seen as contributing towards the wider culture of neurophobia.

Conclusions

Undergraduate neuroscience societies provide useful educational platforms for students interested in neurosurgery, even in regions lacking institutional neuroscience networks. To help mitigate the wider culture of neurophobia, undergraduate neuroscience societies should focus on non-academic aspects of neurosurgery that are more personal and engaging, in an effort to spark interest in those who have had little exposure to the specialty.
354 Differential Attainment in Surgical Training
Authors: Vinnicombe Z , Little M , Super J
Published: May 2021

Introduction

Differential attainment (DA), according to the General Medical Council (GMC), is the gap between attainment levels in different groups. Attainment measures should cover aspects that include academic performance and career progression. Two such areas in surgical training are the MRCS examinations and ARCPs, both of which are required for progression in a career in surgery.

Our aim was to investigation whether socio-economic background was a significant factor for progression in surgical training.

Method

Data from the GMC for Core Surgical Trainees (CSTs) taking the MRCS examination between 2016 and 2019 and CST ARCP outcomes between 2017 and 2019 were obtained. Socio-economic background was assessed using the Index of Multiple Deprivation (IMD). ARCP and MRCS outcomes were assessed against IMD.

Results

Trainees from IMD Q1&2 (most deprived) had a significantly higher (p < 0.01) mean number of attempts (1.86) to pass MRCS examinations than trainees from IMD Q4&5 (least deprived) (1.54). IMD Q1&2 were significantly more likely to obtain unsatisfactory outcomes (24.4%) than trainees from IMD Q4&5 (14.2%) (p < 0.05).

Conclusions

There is clear evidence that differential attainment exists within Core Surgical Training. The reasons for this are likely to be complex and more work is needed to further investigate the relationship.
374 Simulation and the Surgeon during COVID-19: The Double 2s Surgical Emergencies Course
Authors: Bhojwani D , McNutt A
Published: May 2021

Educational opportunities for surgeons have been limited by COVID-19. This is due to reductions in elective operating, clinic cancellations and redeployment of doctors to medical wards. Surgical education has evolved to address anxieties from staff about missing out on valuable skills and experience. Although there has been a big emphasis on virtual learning, in-person simulation remains highly relevant.

The Double 2s MDT Surgical Emergencies Course was piloted amidst the pandemic at UHBW Foundation Trust. Places were restricted in view of social distancing (n = 13). Foundation doctors and nurses engaged in two simulation sessions based around acutely deteriorating surgical patients. Feedback was collected anonymously via an online google form.

All participants agreed that the course was pertinent to their clinical practice. 77 and 100% learners felt that their confidence had improved in assessing and managing surgical emergencies respectively.

The feedback shows that simulation can and should be employed alongside virtual learning to maintain the integrity of surgical education. Whilst the situation may eventually return to ‘business as normal’, the Double 2s course is appropriate to run again during winter pressures which may have similar implications for surgical training. It could also be adapted for medical students and higher surgical trainees.