bluuebunny/crossref_metadata_2025 huggingface dataset:
159 Online Information Regarding Lymphoedema: A Systematic Review Assessing the Quality of Websites’ Content
Authors: Kok C , Karamitros G , Gokani V
Published: August 2024

Aim

In the 21st century, the internet is a major source for patients searching for answers regarding health-related issues. However, the quality of information online is not regulated, creating the potential for poor-quality, or incomplete information which could lead to confusion and distress for patients. The aim of this study is to assess the quality of patient information on lymphoedema, available online.

Method

An internet search for the term ”lymphoedema”, was performed, and the first 100 relevant websites were identified from the three most popular search engines (Google, Yahoo and Bing). The websites were evaluated using the validated modified Ensuring Quality Information for Patients (EQIP) instrument.

Results

Of the 300 websites identified via our search strategy, 105 (35%) were included in our final analysis after removal of duplicates, non-English or irrelevant websites, and websites targeting the scientific community. The median EQIP score of the assessed websites was 22. Most websites (62.9%) failed to mention surgical treatment as a potential option for lymphoedema, did not provide any description of the risks of treatment options (75.2%), and did not report any quantitative risks (98.1%).

Conclusions

Our comparative qualitative analysis contributes to the broader understanding that the overall low quality, structure, and readability of available online information on lymphoedema are potential levers that promote disparities in patient access to care for this population group. The content of the websites should be updated to include surgical treatment options and risks associated with treatment options.
392 Artificial Intelligence Approach in Hip Prosthesis Identification and Assessing Radiographic Outcome Measures
Authors: Soteriou I , Hadjixenophontos S , Musbahi O , Jones G , Pouris K , Cobb J
Published: August 2024

Aim

Radiographic assessment is crucial for the success of a hip replacement procedure as an accurately positioned prosthesis indicates favourable long-term outcomes. This project aims to develop a novel artificial intelligence (AI)-based method that can: (1) automatically identify the presence of a hip resurfacing prosthesis in radiographs and (2) calculate the radiographic neck-shaft angle (NSA) of the prosthesis from two-dimensional plane images using both anterior-posterior (AP) and lateral x-rays with high accuracy.

Method

Using a computer vision and pattern recognition algorithm, the femur shaft and prosthesis regions were identified, and their respective angles were extracted for NSA calculation. A neural network (NN) was then trained using clinician-generated AP radiograph NSAs as ground truths and AI-generated AP and lateral NSAs as features. Spearman's correlation and Kruskal-Wallis tests were calculated to explore any significant association between the final AI-generated and clinician-generated AP x-ray NSAs. Mean absolute error (MAE) and R-squared values were calculated with and without the NN model to identify the model's accuracy and variability.

Results

There was a statistically significant correlation between the final AI-generated AP x-ray NSAs and the clinician-generated AP x-ray NSAs (rs=0.83,p=0.00). MAE and R2 without the NN were 3.09 and 0.37 respectively. MAE and R2 with the NN were 1.94 and 0.53 respectively.

Conclusions

The results of this study demonstrate that the identification of hip resurfacing prostheses using artificial intelligence is feasible. By incorporating additional features such as the lateral NSA, the model can provide an accurate prediction of the AP radiographic NSA, closely approximating the ground truth.
603 Quality Improvement Project: Improving Patient Understanding of Dietary Fibre Content Post-Bowel Surgery
Authors: Smith L , Katsaros P , Eshak A , Mahapatra A , Camilleri G , Qurashi K
Published: August 2024

Aim

Patients recovering from bowel surgery or an acute flare-up of diverticulitis, are advised to adhere to a low fibre diet and then transition to a high fibre diet. Despite these dietary recommendations, patient-friendly educational materials are lacking. This project aims to investigate:Patient and doctor understanding of dietary fibre contentThe impact of a patient-friendly flyer on patient understanding and satisfaction

Method

A questionnaire was given to patient’s post-bowel surgery at Northwick Park Hospital, exploring their knowledge of what constitutes low and high fibre food. A questionnaire was also distributed to general surgical doctors (non-consultants), exploring their confidence in giving dietary fibre advice. Resources from the Association of UK Dieticians were used to create a patient-friendly flyer. QR codes were included, connecting patients to high and low fibre recipes. The same cohort of patients were surveyed after reading the flyer, and their knowledge of high and low fibre food groups was remeasured.

Results

75% of doctors were ‘somewhat confident’, whilst 25% were ‘not confident’ giving dietary fibre advice. The introduction of patient-friendly flyers increased patients’ ability to recognise high and low fibre food by 57.9%. A 72.7% increase in patient satisfaction with the dietary advise was recorded.

Conclusions

This project demonstrates poor patient knowledge of dietary fibre content, a lack of patient-friendly resources and low confidence amongst junior doctors in providing such dietary advise. A patient-friendly flyer significantly increased patient understanding and satisfaction and should be routinely provided to patients upon discharge post-bowel resection.
996 Mobilising Medical School UK University Surgical Societies (SurgSocs) Surgical Teaching in Advance of the UK GMC National Examination Medical Licensing Assessment (MLA)
Authors: Abulhawa Q , Vaghela M , Madume R , Khera G
Published: August 2024

Aim

With the imminent implementation of UK GMC MLA for medical school finals, engaging SurgSocs to design and deliver extra, out of hours, revision focused regional surgical teaching programme for years 3 and 4 medical students.

Method

Working closely in conjunction with two SurgSocs, online teaching was delivered by doctors in training and covered core surgical specialties with a revision focused theme, optimising upcoming examination preparations. In addition, also provided careers guidance and advice on training pathways for aspiring surgeons. Four 60–120-minute sessions were delivered regionally to students who were all members of their respective SurgSocs. An average session had 25-30 attendees.

Results

Online anonymous feedback survey with 14 questions was used to assess quality and content. 40% of attendees responded, of which 90% found the programme excellent and geared appropriately towards their teaching. The programme received high praise for the design of its interactive style of teaching, as well as providing flexibility through its delivery online. Interestingly, some students also noted the programme provided surgical teaching that they may have not had enough exposure to locally in their clinical placements otherwise. All students who provided feedback have expressed interest for sessions to resume next semester.

Conclusions

SurgSoc committee and Surgeons were able to design and deliver a revision themed regional surgical teaching programme. Ensuring high standards of regional teaching is essential within the framework of the new national MLA medical school exit examination. Future collaboration with more SurgSocs would embed this from a regional to national level.
1283 Non-Operative Management of Paediatric Orbital Fractures at a Major Trauma Centre in the UK: A 12-Year Review
Authors: Lopez J , Fan K
Published: August 2024

Aim

The aim of this project is to present an up-to-date review on paediatric orbital fracture presentations and outcomes that are managed non-operatively in a UK major trauma centre over a 12-year period.

Method

Data was collected retrospectively from patients aged 16 and under at the time of injury that sustained an orbital fracture and had been assessed by the Oral and Maxillofacial Surgery Department between 2010-2022 and was managed non-operatively.

Results

25 cases were identified. The median age of patients was 14 years old. 20% (n=5) of cases were female and 70% (n=23) male. The primary mechanism of injury was road traffic collisions occurring in 44% (n=11) of cases. Accidental injury occurred in 40% of cases (n=10). Alleged Assaults accounted for 16% (n=4) of cases. One case was a combined alleged assault and road traffic collision. 32% (n=8) of patients were also found to have an intra-cranial injury. 96% (n=24) of cases had the orbital fracture(s) confirmed on computed tomography imaging. 48% (n=12) of fractures involved the inferior orbital wall. 100% (n=25) of patients had no visual disturbances upon discharge.

Conclusions

Paediatric orbital fractures are rare and require timely assessment to ensure they can be managed appropriately. This study highlights the success of case selection for conservative management. surgical intervention is predominantly done on an urgent basis and clinicians must be acutely aware of cases that can be managed on an operative or non-operative basis. A nationwide review of operative and non-operative paediatric orbital fracture outcomes would aid in establishing guidelines for management.
1224 Signs & Symptoms Predictive of CSF Shunt Dysfunction in Children & Young People Presenting to ED
Authors: Aldabbagh Y , Riaz S , Wiffin R , Hollingworth M
Published: August 2024

Aim

To investigate signs and symptoms in children and young people (CYP), with cerebrospinal fluid (CSF) shunts, presenting to a CYP emergency department (ED) with onsite paediatric neurosurgical facilities; and assess their association with 30-day shunt revision rate.

Method

Retrospective analysis of CYP (<17 years old) with CSF shunts presenting to the CYP ED. Univariate and multivariate analyses were performed to assess the relationship between patient characteristics, presenting signs and symptoms, and 30-day shunt revision rate.

Results

We analysed 107 presentations between 03/11/2021 and 25/10/2022. 42% of patients were female with a mean age of 5.64 years. The most common shunt aetiologies included tumour (30%) and intraventricular haemorrhage (30%). Vomiting (37%), reduced alertness (27%), and behaviour change (27%) were the most common symptoms. 13% of patients underwent shunt revision within 30 days of presentation. No individual sign or symptom was highly sensitive, with the most sensitive being headache (64%) and vomiting (64%). Univariate analysis demonstrated that ≥2 (two or more) previous shunt revisions, fever, pallor, headache, and surgical site swelling, were significantly more common in those who underwent shunt revision (p<0.05). However, only headache and shunt site swelling were independently predictive using multivariate analysis (p<0.05).

Conclusions

CYP with CSF shunts present with complex symptomatology. Number of shunt revisions, headache, and shunt site swelling were predictive of shunt revision at 30 days. Understanding and integrating key predictors of CSF shunt failure into the diagnostic pathway is essential for improving efficiency and minimising the impact on CYP and their families.
254 Establishing Equipoise: Does the Use of Acellular Dermal Matrices (ADM) in Women Undergoing Pre-Pectoral Implant-Based Breast Reconstruction Increase Operative Success Versus Non-Use of ADM in the Same Setting?
Authors: Cook H , Zargaran D , Glynou S P Panagiota , Zargaran A , Akhavani M , Williams N , Hamilton S , Mosahebi A
Published: August 2024

Aim

Breast cancer is the most common malignancy among females in the UK. Surgical management commonly comprises mastectomy and reconstruction, of which implant-based breast reconstruction (IBBR) are most prevalent. Acellular dermal matrices (ADM) are widely used in pre-pectoral implant-based breast reconstruction, however there is limited high-quality evidence supporting their efficacy. This study aims to establish equipoise via an expert consensus survey.

Method

An online survey was designed with a steering group of experts. Questions covered participant information, opinions regarding surgical outcomes with ADM use in pre-pectoral IBBR and opinions regarding available scientific evidence on the topic. The survey was advertised via national and international professional organisations. Quantitative and qualitative analyses were performed.

Results

Thirty-two participants from the UK, Italy and Australia completed the survey. Breast and plastic surgeons from consultant to registrar grade participated. Participants who believed that ADM reduced the risk of short-term complications and implant failure/explantation comprised a minority – 21.9%. Participants who felt that ADM use improved cosmetic outcomes and reduced long-term complications made up a relative majority – 34.4% and 40.6%, respectively. 56.3% of participants felt there was scarce scientific evidence on the topic.

Conclusions

This study provides international expert insight into the lack of consensus on surgical outcomes, efficacy and evidence-base supporting the use of ADMs in pre-pectoral IBBR. Given the growing burden of breast-cancer associated morbidity and the need for reconstruction, this study highlights the requirement for large-scale, prospective, randomised-controlled data to support decisions surrounding use of ADMs in pre-pectoral IBBR.
337 A Review of Autologous Stem Cell-Based Therapy as a Potential Treatment Option for Androgenetic Alopecia
Authors: Lim J S , Cui X , Wai J
Published: August 2024

Aim

Androgenetic alopecia (AGA) is a condition characterized by the gradual deterioration of hair follicles and apoptosis, affecting both males and females. It is the most common form of alopecia, with 80% prevalence in the Caucasian population. The etiology of AGA is multifactorial, involving androgens, genetics, and hormonal miniaturization. The primary androgen responsible is dihydrotestosterone (DHT), which activates pathogenic pathways and leads to the shortening of terminal follicles. Alopecia can disrupt patients' quality of life, causing psychological stress and financial burden. Current treatment modalities are limited, and a therapeutic option that addresses these limitations could be of great significance in plastic surgery in the next decade.

Method

A literature search is conducted across multiple databases: PubMed, Medline Ovid, and Embase. Studies are filtered, and eligible studies are included.

Results

Regenerative medicine would be a potential future intervention for AGA, such as autologous stem cell micrografting and Rigenera®. The bulge area is a crucial source of epidermal and melanocytic stem cells (SC). Rigenera® can extract and isolate these SCs, resulting in a significant 29% ± 5% increase in hair density after 6 months. Other multipotent SCs, such as adipose tissue, bone marrow, and human umbilical cord blood, may also be viable for hair regeneration. Potential benefits include fewer biopsies, a shorter treatment duration, and being unrestricted by the number of donor follicles compared to surgical intervention.

Conclusions

Autologous stem cell therapy shows promising efficacy and should be investigated further to improve the treatment efficacy of AGA.
571 Improving Information Resources and Access to Hand Trauma Patients
Authors: Marar M , Ramjeeawon A , Opel S , Curran T A , Senarath-Yapa K
Published: August 2024

Aim

Over 110 per 100,000 of the population sustain a hand injury every year. Tendon injuries in particular involve a strict rehab protocol with protection of the tendon repair in a splint. A poor understanding of the protocols and compliance with wearing splints can adversely impact the outcome. The variety of media platforms available offers a wealth of mediums for information delivery. The aim of this project was to establish how well we transfer information currently and which medium our patients prefer for information resources.

Method

A survey was conducted for 20 consecutive patients who underwent hand surgery regarding their understanding of pre-operative instructions, the operative procedure, aftercare, and whether they thought a resource to refer back to would have been useful.

Results

Of the patients surveyed, 6/20 patients were unclear of the splint protocol and duration of use. 19/20 expressed that they would value a patient information resource to refer to. With respect to the platform for information delivery, 7 patients preferred an online resource, 6 preferred paper leaflets and 6 expressed a partiality for an audio-visual resource.

Conclusions

This survey has highlighted the importance of patient information resources for hand trauma patients and that surgeons should provide this information via a variety of platforms to embrace both the traditional and evolving digitalized generations. Plans are underway for creating leaflets and videos for each of the following conditions: Tendon repair, fracture fixation, washout of infection, nailbed repair, digital nerve repair, and wound closure.
580 An Assessment of the Adequacy of Initial Photography of Open Lower Limb Injury Patients in the Emergency Department of a Major Trauma Centre
Authors: Roocroft H , O’Grady E , Wheble G
Published: August 2024

Aim

As per BAPRAS/BOAST guidelines, all open lower limb injury patients should have a photograph taken of their injury as part of their initial assessment in the ED. A good photograph helps to triage the injury and can aid with operative planning. These photographs are almost always taken by medical or nursing staff with no medical imaging training and as such quality can be variable. By assessing the adequacy of these initial photographs and determining which factors are impacting this, we hope to develop helpful guidance for non-medical image trained clinical staff.

Method

Open lower limb injury patients identified by review of 2 months of orthopaedic operating lists on Bluespier (1st July – 31st August 2023). Initial patient images reviewed on Careflow and assessed as Adequate or Inadequate. An image is judged as inadequate if (1) the position of wound cannot be determined or (2) the whole wound cannot be seen.

Results

Patients identified in timeframe – 34

Limb affected

Right - 23

Left - 10

Bilateral – 1

Could orientate

Yes - 28

No – 6

Could see whole wound

Yes - 25

No – 9

Adequate – 21 (61.8%)

Inadequate – 13 (38.2%)

Conclusions

Further education of ED staff is required to improve initial photography of open lower limb patients. The authors’ have designed a bespoke information poster to be placed in ED, explaining the importance of adequate photography on admission. Further research will determine if this could be an effective tool.
1032 Sentinel Lymph Node Biopsy for Malignant Melanoma: An Audit Assessing Departmental Compliance with National Guidelines
Authors: Dummer L , Hinchcliffe Z , Wigley C , Hamad M , Unsure Z , Hobday D , Esmaeili A , Al Omran Y , Hamilton S
Published: August 2024

Aim

To investigate and improve local departmental compliance with the current NICE Guidelines (2022) on sentinel lymph node biopsy (SLNB) for malignant melanoma (MM).

Method

Two consecutive audit cycles of all patients undergoing SLNB for MM: Cycle A (1st June-22nd August 2023) and Cycle B (1st September–31st November 2023). Data collected from electronic records (Pathpoint/Cerner), including demographics; T-stage; Breslow Thickness; lymphovascular invasion (LVI); mitotic index; ulceration; intraoperative SNLB assessment and sentinel lymph node positivity. Results of Cycle A were delivered to the department prior to Cycle B. Exclusion criteria: SLNB not for MM (e.g., breast cancer), nodal clearance.

Results

Cycle A: 35 patients included: 20 Females + 15 Males, aged 33–80 years (Mean 62.26 years).

Cycle B: 42 patients included: 15 Females + 27 Males, aged 25–88 years (Mean 60.0 years).

Cycle B summary:

3/42 (7.1%) – no clear indication for SLNB (8.6% Cycle A)

0/42 (0%) - no T stage documented (0% Cycle A)

0/42 (0%) - no Breslow Thickness documented (2.9% Cycle A)

4/42 (9.5%) - no LVI documented (14.3% Cycle A)

4/42 (9.5%) - no mitotic index documented (14.3% Cycle A).

Conclusions

Our department demonstrated successful compliance with NICE guidelines on SLNB for melanoma at 92.6% in Cycle B (91.4% in Cycle A). Documentation of preoperative staging, Breslow Thickness and intraoperative narrative was also satisfactory at 100% for both cycles. Further work is required to ensure histology findings (Ulceration, Mitotic Index & LVI) and node appearance is accurately documented.
321 Improvement of Nasal Spray Technique in Patients in an ENT Outpatient Clinic: A Quality Improvement Project
Authors: Aziz S
Published: August 2024

Background

anagement of allergic rhinitis involves administration of intranasal corticosteroid sprays and efficacy relies on correct technique. Treatment failures result in poor disease control, non-compliance, increased ENT appointments and unnecessary surgeries. The correct technique involves applying the spray to the turbinates (side wall), to reduce inflammation that leads to obstructive symptoms.

Aim

To improve Nasal spray technique amongst patients in an ENT outpatient clinic, using a patient education tool.

Method

PDSA 1: Designed a survey to assess current technique and identify areas for improvement. PDSA 2: First cycle identified 4 key steps for improvement. A leaflet was designed highlighting these steps and handed out to patients who were prescribed the spray. Patients were called 2 weeks later to assess technique. PDSA 3: Leaflet and teach-back method was used to demonstrate correct technique and patients were called back in 2 weeks.

Results

PDSA 1: Only 2% (1/53) of patients used spray correctly and 86.8% of patients administered the spray in the centre of the nose. PDSA 2: 60% (7/11) of patients used spray correctly. PDSA 3- 100% (6/6) of patients used correct technique. Aim of spray to the side of nose was only 5.7% in PDSA 1 which increased to 100% in PDSA 3.

Conclusions

This QIP identified poor nasal spray technique amongst 98% of ENT patients, which may cause treatment failure. Introducing simple and cost-effective interventions, increased the number of people using the spray correctly. These interventions could easily be implemented in ENT and GP clinics, to improve technique reducing repeat appointments and unnecessary referrals.
534 A Retrospective Evaluation of Non-Clinical Limitations to Day Case Urology at a District General Hospital
Authors: McGurk S , Wilson G
Published: August 2024

Aim

This service evaluation aimed to define the rate of >24 hour stay, following planned day case urological procedures, within the setting of our district general hospital main theatres. Of particular interest was the non-clinical reasons patients were admitted for longer than expected.

Method

Retrospective review of theatre schedule and eCare documentation, during January and February 2023. Excluding TURP and Nephrectomy, all other cases were included as potentially day case. Patients with a clinical reason to remain in hospital were not analysed further. All other patients remaining in hospital longer than 24 hours were investigated.

Results

Out of a total of 87 patients, 44 remained in hospital overnight. 19 patients had a clinical reason to remain. Other non-clinical reasons to stay included social circumstances (7), trial without catheter (TWOC) issues (3), patient preference (1). Inadequate documentation limited analysis in 13 patients.

Conclusions

Half of the patients attending for day case procedures in the main theatre were still in hospital at >24 hours. This limits the bed availability for the following morning’s operating, potentially leading to delays, cancellations, and poor patient satisfaction. The majority of these were for non-clinical reasons. Suggested improvements ahead of re-audit include educational sessions with ward nurses to empower nurse-led discharge into the evening, alongside a standardised procedure-specific discharge criteria; highlighting of anticipated day cases to bed managers early; avoidance of TWOC on day of procedure; and updating of patient information leaflets to highlight the expectation of same-day discharge.
537 Optimising Analgesia and Improving Outcomes of Rib Fracture Patients at a Large District General Hospital
Authors: Vasanthakumar S , Park J , Abbotts K , Shaw A
Published: August 2024

Aim

Our aim was to improve outcomes of rib fracture patients at Croydon University Hospital.

Method

We collected retrospective data on rib fracture patients at Croydon University Hospital. Main factors analysed included pre-admission risk factors, number of rib fractures, presence of rib fracture/pain scoring, analgesia, chest physiotherapy/pain team input, complications, and discharge outcomes. New guidelines were developed and circulated, and the project was presented at the surgical/anaesthetic governance meeting. The second cycle assessed the impact of intervention.

Results

In cycle 1, 35 patients were reviewed. Analgesia prescribing was inadequate and only 28% of patients received physiotherapy/pain team input. Rib fracture scoring on admission was performed on one patient and no dynamic pain scoring was documented. Following intervention, 10 patients were reviewed. 30% of patients had their STUMBL (STUdy of the Management of BLunt chest wall trauma) score assessed on admission, and 20% had dynamic pain scoring documented. Paracetamol and codeine remained the most prescribed analgesia, with prescribing rates relatively unchanged. Regular morphine prescribing improved significantly (17% to 60%). Physiotherapy and pain team input increased by 21% and 41% respectively. Average number of rib fractures was 1.5x greater and an increase in hospital-acquired pneumonia was noted (17% to 50%). Average length of stay remained 5 days.

Conclusions

Improvements following intervention include STUMBL scoring, morphine prescribing, and increased physiotherapy and pain team input. However, respiratory complications increased, and length of admission remained unchanged. Further work is needed to improve pain control, including discussions with anaesthetics to increase availability of regional blocks.
543 Improving Outcomes in Patients with Fragility Femur Fractures: A Quality Improvement Project
Authors: Abdolrazaghi S , Vusirikala A , Kelly C , Luker R , McConnell J
Published: August 2024

Aim

To improve compliance with measurable variables of the Best Practice Tariff (BPT) for fragility femur fractures. These include Abbreviated Mental Test Score (AMTS), 4AT delirium screen, Malnutrition Screening Tool (MUST) and Falls Assessment.

Method

Utilising the Plan-Do-Study-Act (PDSA) methodology, a quality improvement project was designed in a UK district general hospital to enhance compliance with four BPT measurable variables. Retrospective baseline data collection commenced in November 2022.

The first PDSA cycle, in April 2023, resulted in the introduction of daily fractured femur reports, identifying patients admitted with a fragility femur fracture and tracking completion of the BPT parameters. The second PDSA cycle, in August 2023, involved teaching sessions at the junior doctor induction and the creation of a fragility femur fracture handbook for junior doctors facilitating accurate completion of BPT parameters on the patient electronic records. Prospective identification of post-intervention patients allowed for comparison of pre-intervention and post-intervention compliance.

Results

From November 2022 to October 2023, 331 patients over 60 were admitted with a fragility femur fracture. Following the PDSA cycles, completion rates for AMTS and 4AT assessments rose from 54.5% to 100% and 16.6% to 97.8%, respectively. MUST assessment completion improved from 82.7% to 100%, while falls assessment consistently exceeded 95%.

Conclusions

The project demonstrated the need to enhance best practices in fragility femur fracture care. Targeted junior doctor education and addressing assessment completion gaps significantly improved BPT compliance, leading to overall elevated care standards. Moreover, meeting BPT criteria contributed to increased revenue, allowing the trust to receive up to £100,000 annually.
684 Improving Day-Case Rates of Transurethral Resection of Bladder Tumours: How Efficacious Is a Solitary Educational Afternoon in a District General Hospital?
Authors: Nabavi M , Quraishi M , Calleja E
Published: August 2024

Aim

Initiatives like Getting It Right First Time (GIRFT) are highlighting the significance of day case Transurethral Resection of Bladder Tumours (TURBTs) in patient care and addressing the national waiting list crisis. Our quality improvement project aimed to assess the enhancement in day case rates of TURBTs through an educational afternoon on this topic delivered to the entire Urological unit including surgeons, nurses, and ward staff.

Method

A 2-stage medical record review was performed (2 months before and after an educational afternoon implement), to evaluate day-case rates and surgical outcomes. Demographics and clinical parameters collected include discharge date, surgeon grade, re-admissions, and post-op complications.

Results

Seventy-two patients were identified in the study period across 4 months with an overall day-case rate of 20.8, undergoing TURBTs. The actual day-case rates decreased from 24 to 18 following the education implement in the middle of the study period. An expected discrepancy in age of patient was identified between day-case(median 63.4)and in-patient cases(median 75.4). Thirty-day re-admission rates were found to be lower in the day-case TURBTs. Mean length of stay was 1.3 days for the cohort.

Conclusions

Our study alludes that a solitary educational implement is insufficient to achieve a paradigm shift to day-case TURBTs. The low day-case rates in our cohort may reflect an elderly co-morbid demographic of the region. Implementing a robust multi-faceted and multidisciplinary day-case TURBT pathway may align us with national averages. We intend to re-evaluate our day case TURBT day-case services following the implementation of this streamline’s bespoke day-case pathway.
805 An Audit on Managing Acute Pancreatitis in the Adult Critical Care Unit in a DGH
Authors: Lau W Y S , Sy H C , Sannapareddy D , Dhokia V
Published: August 2024

Aim

The aim of the audit is to describe current practice in the management of patients with severe acute pancreatitis admitted to ACCU and to improve quality and consistency of care for this group of patients by developing local clinical guidance on the use of antibiotics and nutritional support.

Method

A retrospective case note study of the 2-year period between 01/09/2020 to 31/09/2022 at a district general hospital. All adult patient admitted to critical care with acute pancreatitis was included in this study.

Results

A total of 11 patients were included in our study. 10 patients had antibiotics prescribed during their stay in critical care while one did not as advise by microbiologists. Antibiotic was initiated in 7 cases prior to admission to critical care, with 5 completed the courses of antibiotics which 3 of whom did not have a positive culture or any other sources of infection. With regards to nutrition support, 7 patients were fed via nasogastric tube and 1 with nasojejunal tube. 4 patients were not reviewed by a dietitian during their stay under critical care due to short length of stay over weekend.

Conclusions

This audit suggests the need for a separate management guideline on managing acute pancreatitis patients in critical care settings. Routine prophylactic antibiotics should be avoided. Regular microbiology rounds would be beneficial in improving quality of care. Early initiation of nutrition on patients in hypercatabolic state is a priority in improving care. Daily dietitian review would enhance the quality and consistency of care.
972 Improving Surgical Ward Round Documentation: A Closed-Loop Audit
Authors: Ghosh D , Makanjuola S
Published: August 2024

Background

The surgical ward round (WR) is a critical multidisciplinary process. Adequate documentation of WRs have medicolegal and patient safety implications. Checklists have been known to improve outcomes, but there is no set template recommended for WR documentation.

Aim

This quality improvement project aimed to firstly, identify areas of poor documentation in WR notes and secondly, to improve these areas with the use of a template.

Method

Over three months, 20 dates were randomly chosen with an online random data generator. Variables were identified from literature recommendations. WR notes from 54 patients were analysed (cycle 1). Results were discussed in an expert-led meeting, and templates were constructed. To assess any improvement, 20 prospective WR notes were similarly analysed (cycle 2).

Results

Templates significantly improved documentation of lab findings (p=0.02), investigations (p=0.02) and plan (p=<0.01). For all other variables, no significant change was found. Fluid balance and drug chart reviews were significantly worse after the template introduction. Fluid balance, Estimate Discharge Date (EDD) and nursing presence on the round scored particularly poorly in both cycles.

Conclusions

The use of a WR template improves some aspects of documentation. Further work and perhaps a more robust intervention is required to improve overall WR documentation.
1071 Evaluation of Adhesive Small Bowel Obstruction Management: Insights from a Retrospective Analysis
Authors: Lee S , Ting N , Kok A , Thambi P
Published: August 2024

Adhesive small bowel obstruction (SBO) is typically managed conservatively with early administration of gastrografin within 12 hours of admission. However, at our institution, there is currently no established protocol. Therefore, our study aims to evaluate the variability in SBO management and summarise the existing practices.

This was a retrospective audit between November 2022 and August 2023. Our primary objective was to assess the timing of gastrografin administration and the timing of subsequent imaging.

Our analysis included 49 patients with a mean age of 65.6 years (±16.8 years). The average time elapsed between CT imaging and the first dose of gastrografin was 1 day, 5 hours, and 51 minutes (±8 hours, 33 minutes). The average time between the first dose of gastrografin and follow-up imaging was 7 hours and 37 minutes (range: 2 hours, 58 minutes – 10 hours, 14 minutes). The average interval between discharge date and the first dose of gastrografin was 4.0 days (±3.2 days). Only 22% of patients were referred to a dietitian during their hospital stay, with an average referral duration of 3.5 days (±4.7 days). The average length of hospital stay was 6.7 days.

Conclusions

Our findings highlight an underutilization of gastrografin in conservative SBO management. While follow-up imaging approximated the ideal 6-hour window in practice, there were deviations from this target on several occasions. Additionally, the use of dietitian referrals did not align with management targets. We recommend the establishment of a formalized protocol for SBO management, incorporating guidelines for a 6-hour follow-up abdominal X-ray and timely dietitian reviews.
397 Perioperative Outcomes from Robotic-Assisted Colorectal Cancer Surgery in High BMI Patients
Authors: Wrobel A , Ingham A , Kong C Y , McSorley S , Mansouri D , Chong D , MacKay G , Roxburgh C
Published: August 2024

Aim

Provide insight into the short-term outcomes associated with high BMI patients undergoing robotic-assisted surgery for colorectal cancer.

Method

Retrospective review of colorectal cancer patients undergoing robotic anterior resection or Abdominoperineal resection from May 2021 to March 2023. Explanatory variables were collected including sex, age, BMI, ASA, and TNM score. Outcomes variables were collected: CRP post-operatively, Margin resection, blood loss, unexpected surgical events, conversion to open surgery, return to theatre, length of hospitalization, readmission, Surgical site infections (SSIs), and Clavien Dindo (CD) score. Four BMI groups were formed, as according to the WHO BMI ranges. CRP levels in BMI groups were compared and analysed with laparoscopic and open surgery research.

Results

ASA3 was found to be significant in the high BMI group (P=0.011). No significance between BMI groups and blood loss, length of hospitalisation, conversion to open surgery, readmission, return to theatre, SSIs, and CD score. Intraoperative unexpected events were higher in High BMI groups, 17.6% in Highest BMI vs 6.9% in normal/low group (P=0.072). The CRP range for all the BMI groups was between 50 – 110 mg/L. The highest BMI group did not have the highest CRP levels but experienced a rise on day Four. CRP levels post-robotic surgery were lower when compared to open and laparoscopic surgery.

Conclusions

Robotic surgery for colorectal cancer is safe regardless of BMI, with each BMI group in this cohort displaying similar short-term outcomes. Further research in this field is required, especially focusing on the relation between BMI, robotic surgery, and CRP levels.
201 Interdisciplinary Simulation Based Training for the Operating Room Team - a Systematic Review
Authors: Rathore A , Lennox L , Bickerton M , Baliga S , Gardner T
Published: August 2024

Background

The interprofessional nature of the surgical environment poses unique challenges surrounding patient safety, often due to lapses in non-technical skills. Dysfunctional teamwork dynamics and communication breakdowns within the operating room team are prominent factors giving rise to preventable adverse incidents. Incorporating the most recent evidence, we sought to explore the effects of multidisciplinary simulation on operating room team performance, as well as barriers to program implementation.

Method

A systematic literature search was conducted from January 2003 to October 2023 utilising the following databases: EMBASE, Ovid Medline, ERIC, Cochrane Library, CINAHL and Web of Science. All included studies trained and assessed the surgical multidisciplinary team with simulation-based scenarios in the operating room.

Results

Sixteen articles met the inclusion criteria for the review. A total of 1137 healthcare staff participated in the simulated OR training programs across studies. The majority of participants were surgeons (n = 379), followed by nursing (n = 355). 240 anaesthetists participated along with 163 other staff ranging from operating department practitioners, technologists, and midwives. The six main themes identified were technical skills, communication, teamwork, patient safety, simulation fidelity and barriers to implementing multidisciplinary simulation-based training.

Conclusions

Simulation-based multidisciplinary training for operative teams improves both technical and non-technical skills. Integrating surgeons, anaesthetists and nurses into the training programs allows for improved team cohesion, more effective communication as well as boosting teamwork scores. Major barriers to multidisciplinary simulation are cost and staff availability, which may be mitigated by salvaging consumable supplies and coordinating professional development days with study leave.
319 Validation of Lamb Head Model for Septoplasty Simulation Training
Authors: Tan J Y , Hulse K , Hopkins M , Iyer A , Yaneza M
Published: August 2024

Aim

Septoplasty is one of index rhinology procedures which has a steep learning curve. This study aimed to measure the effectiveness of a lamb head model as a septoplasty simulation model for doctors in the early training stage.

Method

The model validation study was incorporated in a surgical simulation course. A 12-question anonymous questionnaire was used to record the participants’ training grade, experience with septoplasty, the face and content validation data of the lamb head model for septoplasty simulation. A Likert scale from 1-5 was used for the rating.

Results

A total of 14 participants (2 faculty members and 12 participants) attended the simulation course. The response rate of the questionnaire was 64%. The lamb head model passed the pre-set face and content validation thresholds. The median values were 4 for face validity (realism) and 5 for the global content validity (usefulness).

Conclusions

Based on this study, the lamb head is an inexpensive, easily accessible model with high fidelity tissue to simulate open septoplasty for doctors in their early training.
46 The Impact of a Student Led Surgical Conference on Student Knowledge and Interest in Surgical Training
Authors: Vesey M , Dablouk L , Kearney L
Published: August 2024

Aim

To establish the impact of a student-led surgical conference on medical student interest and understanding of surgical training pathways.

Method

The University College Cork Surgical Society organized a two-day conference aimed at medical students. Specialties represented were neurosurgery, cardiothoracic, orthopedic, maxillofacial, colorectal, and plastic surgery. An anonymous digital survey was distributed to attendees following the conference. Ethical approval was obtained from the social research ethics committee. Paired sample T-tests and Wilcoxon signed rank tests were used in data analyses.

Results

48.9% attendees completed the questionnaire (44/90). Students' self-reported knowledge of surgical specialties increased from mean 2.84 ±0.31 to 4.09 ±0.24 (p<0.001). Overall understanding of training pathways increased from 2.52 ±0.39 to 3.66 ±0.35 (p<0.001). Pre-clinical students' knowledge of specialties increased from mean 2.64 ± 0.33 to 4 ± 0.27 (p<.001) and clinical year students’ knowledge increased from 3.75 ± 0.59 to 4.38 ± 0.62 (p<.05). Pre-clinical students' reported understanding of the pathways increased from 2.17 ± 0.4 to 3.5 ± .39 (p<.001). Clinical year students’ understanding of surgical training pathways increased from 3.63 ± 0.43 to 4.5 ± 0.45 (p<0.05). The most frequently perceived barrier reported to a surgical career was the competitiveness of such a career (36.4%), followed by work-life balance (34.1%). Male and female students reported different perceived barriers. 50% students reported they were more likely to pursue a surgical career after the conference.

Conclusions

The study highlights the impact of educational strategies directed at undergraduate level. These have the potential to engage, educate and recruit future surgical trainees.
740 Subspecialty Career Choices in Orthopaedics – What Factors Affect the Decision-Making Process?
Authors: Crowther L , Hughes K , Molyneux S
Published: August 2024

Aim

Orthopaedics has become increasingly subspecialised, nevertheless, reduced diversity in the profession persists. There is limited data on the importance of factors affecting subspecialty career choice among orthopaedic trainees. Aims of this study were to evaluate the importance of factors informing subspecialty career choices of trainees and assess whether these differed between the respondents’ gender and seniority.

Method

An anonymised online survey was designed and distributed to collect demographic information, stage of training and subspecialty career plans of orthopaedic trainees in the four Scottish training regions. Participants ranked the importance of 15 factors covering clinical, academic and lifestyle domains which may influence subspecialty choice on a Likert scale.

Results

From 37 responders, there were 27% junior trainees (ST1-3), 65% senior trainees (ST4-8) and 8% in research posts. Only 30% of junior trainees had selected their subspecialty in contrast to 75% of senior trainees (p=0.02). No significant difference in subspecialty choice was found between men and women (p=0.41) or junior and senior trainees (p=0.21). Most popular subspecialties overall for both genders were arthroplasty (35%), hand & wrist (19%), and trauma (19%). No difference in the importance of each factor was observed between genders or junior and senior trainees. The most important factors on subspecialty choice were interest in field, clinical opportunities, and influential mentor(s).

Conclusions

Most trainees approach completion of orthopaedic training with clear subspecialty preferences. A variety of factors affect this decision. Focus should be on wider subspecialty exposure at earlier stages in orthopaedic training programmes with concurrent mentor provision.
1292 Surgical Immersion in Endoscopy with a Clinical and Leadership Fellow
Authors: Babikir A , Banerjee S , Boulton R
Published: August 2024

Aim

The effectiveness of immersion training in endoscopy for surgical trainees has not been documented previously and we aimed to assess the impact at a busy gastrointestinal surgical unit within London. This involved providing the surgical registrars with a week of endoscopy training every month, during which time their clinical duties would be covered by an appointed clinical leadership fellow – externally funded by HEE.

Method

Surgical trainees currently rotating at Queen’s Hospital Surgical unit are each enrolled in endoscopy immersion and assigned a week per month with prior notice to hand over their clinical duties to the clinical fellow. During the immersion week, the surgical registrar is exposed to hands-on training, simulator access, and interactive sessions with experienced endoscopists.

Results

Three surgical trainees were enabled access since September 2023 to immersion training. Another trainee mentioned performing around 6-7 colonoscopies per day during immersion to a total of 65 in two weeks. A third trainee has attended a total of 8 endoscopy lists in 1 week. He competed 28 colonoscopies and 2 OGD’s, achieving TI intubation in 4, caecal intubation in 18.

Conclusions

The feedback supports the efficacy of immersion week as a valuable adjunct to traditional surgical training. Integration of immersion weeks into the curriculum can potentially optimize the training pathway for surgical registrars allowing them to achieve the required numbers for CCT and building competencies. Study leave blocks for endoscopy training could also be an alternate option.
1058 “A Survey of Medical Students’ Attitudes Towards Sustainable Healthcare”
Authors: Stephen S , D’Souza H , Divekar O , Kanegaonkar R G
Published: August 2024

Aim

With the climate crisis becoming increasingly prevalent, there is growing emphasis on environmental sustainability. The healthcare sector (a significant contributor to environmental impact) is particularly of interest: sustainable healthcare and environmental awareness within the NHS is crucial. Despite this, few medical schools include environmental teaching in their curricula. We undertook this survey to assess environmental awareness and perspectives amongst medical students.

Method

An online questionnaire was distributed to London medical students. Participants were asked demographic data, questions concerning the environmental impact of products and practices in the NHS, and suggested methods to reduce the environmental impact of healthcare.

Results

87% of students stated that the environmental impact of healthcare is of concern to them, 97% agreed that the environmental impact of products should be considered during development. 65% agreed that the environmental impact of a product should influence its use, but 95% agreed that a device being recyclable/reusable would influence their practice. Students felt the factor most negatively impacting the environmental burden of healthcare was ‘disposable plastic items’, mentioned in 57% of responses, and ‘general waste’ in 44%.

Conclusions

A significant majority of medical students find healthcare's environmental impact a concern to them and express a desire to choose the most sustainable options. Whilst the distribution of academic year and the London demographic limited this study, we believe it is the first survey of its kind assessing medical student's attitudes towards the environmental impact of healthcare. With this initial benchmark, we hope that future surveys aim to assess and improve the environmental awareness of doctors in training, as well as the inclusion of environmental teaching in medical school.