bluuebunny/crossref_metadata_2025 huggingface dataset:
811 Surgeons Are Under-Represented in International Multidisciplinary Cardiac Guidelines
Authors: Hara N , Navarro A , Lopez-Marco A , Yates M T
Published: August 2023

Aim

Cardiac guidelines are written by experts in the field based on the strongest scientific evidence and clinical experience. Authorship should theoretically be equal between cardiac surgeons and cardiologists to ensure there is sufficient medical and surgical input. Therefore, this study aims to determine whether there is equal representation and contributions of surgeons and cardiologists in international cardiac guidelines.

Method

Eight international guidelines on coronary revascularisation, atrial fibrillation, aortic disease and valvular heart disease from both Europe and USA were identified. The author's primary speciality was determined using the internet search engine. Their roles were classified and presented as (Cardiologist; Surgeon; Other). Other consisted of roles including but not limited to; anaesthetists, nurses and emergency doctors.

Results

In eight international guidelines there were a total of 228 authors (Cardiologist 151; Surgeon 58; Other 19) This was distributed as follows: Coronary European (14; 7; 1), USA (13; 7; 4), Atrial Fibrillation European 17; 3; 4), USA (12; 1; 2), Aortic European (65; 14; 7), USA (8; 15; 6), Valve European (11;2;2) USA (11;7;0). Across the guidelines, there was an average of 24.7% of surgeons and 63.3% of cardiologists contributing to the authorship.

Conclusions

There is a significantly higher number of cardiologists contributing to international cardiac guidelines that guide treatment management and diagnosis of both medical and surgical patients. The inclusion of more surgeons in the authorship may provide a more balanced synopsis of optimal patient care.
1314 Prediction of Raised Intracranial Pressure in Traumatic Brain Injury Patient by Non-Invasive Methods in Lower-Middle Income Countries: Systematic Review and Meta-Analysis
Authors: Dokponou Y C H , Badirou O B A , Agada K N , Dossou M W , Lawson L D , Ossaga M A D , Nyalundja A D , Adjiou D K F P , Lassissi K U , Houndodjade S M C , Gbenou F B B , Lantonkpode R P , Togbenon N D L , Bankole N D A
Published: August 2023

Background

The prediction of raised Intracranial Pressure (ICP) with accuracy in Traumatic Brain Injury (TBI) patients is a clinical important decision and therapeutic tool. This study aimed to evaluate the existing methods used for non-invasive ICP monitoring in TBI patients in LMICs.

Method

Systematic searches of PubMed, Google Scholar, and ScienceDirect were performed from database inception to November 2021. Studies reporting the prediction of raised ICP in TBI patients by non-invasive means in LMICs were included. Pooled estimates of sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios with 95%CI were calculated for each index test in JAMOVI 2.2.5. We carried out a “Medical Decision”, “Plots”, “Fagan Normogram” and the ROC curve to find the perfect discrimination point of all the five tests used for the non-invasive measurement of ICP in the TBI patients in LMICs.

Results

A total of 1032 studies were identified, of which, 15 included 3316 patients with male predominance (n = 2458, 74.13%). Patients' ages range from 15-96 years with 40-80 (n = 1205, 36.34%), being the most represented population. The ICP measured by Transcranial Doppler (TCD) had a sensitivity of 92.3%, and a specificity of 70%. The positive predictive value was 66.67%, with a negative predictive value of 93.33%. Furthermore, the positive Likelihood Ratio (+LR) was 3.69; 2<+LR<5, and the negative Likelihood Ratio (-LR) was 0.103; 0.1<-LR<0.2.

Conclusions

The TCD had shown high performance in its sensitivity and specificity, placing it on top of the other four different tests used in LMICs for the management of patients with TBI.
954 Oesophagectomy vs. Gastrectomy; a Type II Dilemma
Authors: Owen A , Robinson D B T , Thomas G , Powell A , Witherspoon J , Blackshaw G , Lewis W , Foliaki A , Abdelrahman T
Published: August 2023

Aim

The optimal operation for Siewert type II cancers is unclear, with both oesophagectomy and total gastrectomy being undertaken. This study aimed to investigate the overall survival and associated operative outcomes of both approaches.

Method

A retrospective cohort study was performed of all Siewert type II Gastro-Oesophageal Junctional (GOJ) resections from a single oesophagogastric centralised service between 2010 and 2017. The primary outcome was 5-year overall survival (OS). Secondary outcomes were recurrence rate and operative morbidity.

Results

A total of 163 patients were included; 127 (77.9%) oesophagectomy vs. 36 (22.1%) gastrectomy. The 5-year OS for oesophagectomy vs. gastrectomy were 50.4% vs 41.7% with a median survival of 57 months vs. 31 months respectively (p = 0.062). No differences in the rate of recurrence (44.9% vs. 33.3%, p = 0.216) or overall rate of complications (63.8% vs. 63.9%, p = 0.990) were identified. Yet, significantly more major (Clavien-Dindo III+) complications occurred in the gastrectomy compared to the oesophagectomy cohort (38.9% vs. 20.5%, p = 0.012), driven partially by a higher anastomotic leak rate (19.4% vs 9.4%, p = 0.099). Cox regression revealed no significant difference in the 5-year OS between the two groups when accounting for confounders (HR 0.906, 95% CI 0.339-2.060, p = 0.814). Only age (HR 0.971, 95% CI 0.944-0.999, p = 0.046) and pT stage (HR 1.794, 95% CI 1.097-2.935, p = 0.020) were determinants of 5-year OS.

Conclusions

When accounting for confounders there were no significant differences in the overall survival based on the two approaches. Further multi-centre prospective studies would be advantageous to establish a consensus on the best approach.
750 Fluid Therapy Regimen and Free Flap Failure in Post-Resection Reconstruction for Head and Neck Cancer: A Systematic Review
Authors: Torabi S , MancKenzie A , Rahman T , Arjomandi Rad A , Vardanyan R
Published: August 2023

Background

The importance of developing standardized approaches away from wide-range fluid administration regimens has been growing. The aim of the following study is to evaluate the current evidence with regards to fluid therapy regimens and their effects on flap complications in free-flap reconstruction of head and neck cancer.

Method

A systematic database search was conducted of original articles that included fluid therapy regimens in free-flap reconstruction of head and neck cancer in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to January 2021. Our main outcomes were presence of a flap complication or failure and total length of hospital stay.

Results

We identified 327 studies from our search, of which 11 studies met the inclusion criteria, comprising a total of 1,133 patients. Five studies showed that greater perioperative fluid volume was associated with higher rates of flap complication, with one drawing a cut-off at 5.5 L to predict any flap complication and 7 L to predict a major complication that required re-operation. Three studies assessed goal directed fluid therapy, with two showing significantly reduced intraoperative fluid volume within this group, but no significant difference in flap outcomes. Two studies comparing crystalloid and colloid fluids concluded that there was no significant difference in outcomes when using either.

Conclusions

Excessive fluid administration negatively impacts surgical outcomes. Goal directed therapy presents insufficient evidence as a method for reducing flap complications and length of hospital stay. The clinical benefit of colloid fluid intra-operatively over crystalloids have not been unanimously demonstrated in this review.
1259 Clinical Outcomes of Vascularised Versus Free Regenerative Peripheral Nerve Interface in Upper Limb Neuromas: A Systematic Review
Authors: Satkunabalan M , Tay J Q , Ng Z Y
Published: August 2023

Aim

To compare clinical outcomes of vascularised regenerative peripheral nerve interface (vRPNI) versus free regenerative peripheral nerve interface (fRPNI) in upper limb neuromas.

Method

A systematic review on upper limb neuromas treated with either fRPNI or vRPNI was performed in October 2022 in accordance with the PRISMA 2020 guidelines. A PubMed search using the term “RPNI” was performed. Only papers with clinical results from patients who had undergone either fRPNI or vRPNI to the upper limb were included; review and laboratory papers were excluded. Patient and clinical data collected include the underlying aetiology, time interval to RPNI procedure, as well as mean patient age, post-operative follow-up period and neuroma pain score reduction.

Results

Of 43 papers identified, only four papers fulfilled the inclusion criteria. This provided data for upper limb neuromas in 32 patients where a total of 83 RPNIs (22 vascularised) were performed (43 prophylactically). The means for patient age, duration of neuroma pain, length of reported post-operative follow-up, and reduction in neuroma pain scores were 44.0 years, 1.4 years, 12.2 months and 51.3% respectively.

Conclusions

The currently available data support the use of both fRPNI and vRPNI for the treatment of upper extremity neuromas, both after the development of symptoms and prophylactically at the time of surgery, despite the heterogeneity and inconsistencies in data reporting. Further studies are required in the form of randomised control trials to assess for the superiority (or not) of fRPNI versus vRPNI.
48 Evaluation of Regional Anaesthesia Practice in Plastic Surgery; a Retrospective Cross-Sectional Study
Authors: Mousa S , Adam M , Kerstein R
Published: August 2023

Aim

Our project aimed at assessing the regional anaesthesia practice in plastic surgery department Buckinghamshire trust and finding out ways to improve the service in collaboration with the anaesthesia team.

Method

It is a retrospective study associated with a questionnaire filled by plastic surgeons and anaesthetists to get the full picture behind the numbers. The study period was between 1/3/2022 and 23/5/2022 (12 weeks). Criteria of suitable candidates for regional block were put by the consultant anaesthetists.

Results

For 12 weeks, 1061 operations were performed by plastic surgeons. Local cases were excluded leaving 319 cases. Of the 319, 102 patients were suitable candidates for regional block after applying the criteria. However only 7 patients had their operations under regional block and the rest had general anaesthesia that could have been easily avoided.

An online questionnaire was filled by both plastic surgeons and anaesthetists of different training level to find out the reasons behind the obvious preference of general over regional anaesthesia even if this was against the patients’ interest.

Forty-four clinicians filled the questionnaire, among which was 23 plastic surgeons and 21 anaesthetists. The actual percentage of patients who were good candidates for RA but had GA instead is 93%.

Conclusions

The recommendations were in 5 main accesses which areProtocols and pathways for regional blocksMore training opportunities for anaesthetists on regional blocksProviding a separate block room in the hospitalBetter communication between surgeons and anaesthetistsPatient education about the benefits of regional blocks
130 The GLIMPSE Study: Global Variation in the Quality of Multiparametric Magnetic Resonance Imaging of the Prostate
Authors: Asif A , Ng A , Giganti F , Chan V W S , Rossiter M , Nathan A , Khetrapal P , Dickinson L , Punwani S , Brew-Graves C , Freeman A , Emberton M , Moore C M , Allen C , Kasivisvanathan V ,   PRIME Quality Improvement Group
Published: August 2023

Aim

Multiparametric MRI (mpMRI) is standard-of-care in patients with clinical suspicion of prostate cancer (PCa). However, high variability in MRI quality remains. We aim to offer the first global 'GLIMPSE' into prostate mpMRI quality, analysing PRIME Trial data, to determine whether modifications to MRI protocols improve diagnostic quality.

Method

PRIME (NCT04571840) is an international non-inferiority trial comparing biparametric MRI to mpMRI in detecting clinically significant PCa.

For each scanner, centres were invited to submit MRI scans of patients with suspected PCa, detailed MRI protocols, PI-RADS v2.1 scores and pathology results. Expert radiologists evaluated these in consensus, blinded to MRI and biopsy results. MRI quality was assessed using the PI-QUAL scoring system — using PI-RADS v2.1 recommendations and each MR sequence (DWI, T2-WI and DCE). PI-QUAL score 5/5 demonstrates scans of optimal diagnostic quality. Recommendations were provided for scanners not reaching PI-QUAL 5. Centres were invited to re-submit using modified protocols for re-evaluation.

Results

71 scanners were evaluated from 42 centres across 5 continents. On initial review, 13% scanners scored PI-QUAL 3, 55% scored PI-QUAL 4 and 32% scored PI-QUAL 5. 100% scanners were of adequate diagnostic quality for T2-WI and DWI, whilst only 82% were for DCE.

Recommendations focused on DCE (62%), followed by DWI (35%), then T2-WI (25%). Overall MRI quality increased from 32% to 87% PI-QUAL 5 between initial and final review.

Conclusions

GLIMPSE offers the first global overview into prostate MRI quality. Initial MRI quality needed improvement, particularly with DCE imaging. Basic changes derived from PI-RADS recommendations can improve global MRI quality.
333 Inequity of Access to Investigations and Treatment of Varicose Veins by Clinician Grade: A Single Centre Retrospective Audit
Authors: Farndon D , Bennett P
Published: August 2023

Aim

Following COVID-19, restrictions on investigations and theatre capacity led to a change in the Norfolk & Waveney Clinical Commissioning Group (CCG) referral to treatment (RTT) criteria for varicose veins (VV); Only >C4 disease should be treated. An audit was performed to check for variability in outcomes between grade of surgeon.

Method

Retrospective audit of all VV referrals between 01/04/21-28/02/22. Case notes were reviewed assessing compliance with CCG criteria by surgeon grade and subsequent referrals for investigations and treatment.

Results

250 VV referrals were made, 43.5% Male, mean (±SD) age 54.8 (16.9) years. 71 were rejected outright, 158 should have been rejected and 70 were subsequently reviewed in clinic. 20 were seen by SpRs and 50 by consultants. 62.9% (22) of ineligible patients attending clinic went on to have investigations. Of those seen in clinic, 35 did not meet the RTT criteria and should have been discharged. Significant differences in discharges were seen between SpRs & Consultants (13.3% vs. 45% respectively (p = 0.046)). Duplex scans organised by SpRs (75%) were more likely to not meet the RTT criteria than Consultants (30.3%), p = 0.003. However, once a scan was performed there were no significant differences in proportion of these patients listed for treatment (64.3% vs. 29.4% (p = 0.247)).

Conclusions

SpRs are less likely to discharge patients from clinic who don’t meet RTT criteria than consultants and are more likely to request unnecessary investigations and treatment compared to consultants demonstrating inequity of care. SpRs should be educated on RTT criteria changes when working in different hospitals.
344 Are Rings Removed in Hand Trauma? a Closed Loop Audit
Authors: Guy J , Kolaityte V , Nolan C , O'Hara N , Langley C
Published: August 2023

Aim

Constriction injury secondary to jewellery can be a serious consequence of hand injury. National guidelines therefore advise that all jewellery is removed as the initial step in managing hand trauma, prior to any imaging. This audit evaluated adherence to this guideline, and to assess the effect of a patient and clinician centred intervention.

Method

All patients who had plain film radiographs of the hand performed by the emergency department of a major trauma centre were assessed for radiopaque jewellery in situ. Further data were then collected including demographics, mechanism of injury, and resultant surgical procedures.

A 4-month baseline audit was conducted in 2021. Interventions were implemented, including patient- and clinician-facing posters. A post intervention cycle was completed over 5 months in 2022.

Results

7563 individual patients presenting with hand trauma were included in the audit across both cycles. In 2021, 115 of 3542 patients had jewellery identified in situ. In 2022, 107 of 4021 patients had jewellery identified, an improvement of 18.1%.

General demographics of these patients remained broadly similar across both cycles. The patients were predominantly female (64%) and the jewellery seen most frequently was a metal ring, often on the left ring finger (84%). Injury types included lacerations, fractures, and soft tissue injuries. 1 in 4 of these patients required a further surgical procedure from the injury.

Conclusions

This audit demonstrated the success of both patient and clinician facing interventions to improve the rate of removal of jewellery as the first stage of hand trauma.
366 Vitamin D3 Assessment and Supplementation in Elderly Hip Fracture Patients: A Closed Loop Quality Improvement Project
Authors: Siddiqui R S , Abou Hader K , Mathias C , Pemmaraju G
Published: August 2023

Aim

to improve the assessment and supplementation of vitamin D3 in elderly hip fracture patients in a trauma unit.

Method

This is a single-centre quality improvement project utilising the PDSA cycle based in a trauma unit covering the black country within the West Midlands. Data was collected retrospectively using the National Hip Fracture Database and hospital electronic systems such as clinical web portal, ICE, GP records, edischarge and ePMA. Inclusion criteria consisted of patient age greater than 60 with a radiologically confirmed neck of femur fracture, treated operatively with an orthogeriatrics review within 72 hours of admission, and COVID-19 negative PCR.

Pre-intervention data included 15 patients from July 2020. We assessed 3 parameters including pre-admission vitamin D3 supplementation, measurement of vitamin D3 during admission and vitamin D3 supplementation on discharge. Interventions placed in February 2021 comprised of a postoperative hip blood profile pathway on ICE and guidelines on how to order bloods were circulated with information posters. In addition, teaching sessions for doctors and nurses with twice weekly orthogeriatric reviews emphasising bone protection. Post-intervention data included 15 patients from April 2021.

Results

Improvement in vitamin D3 level assessment during admission; 20% to 93.3% however, decline in vitamin D3 supplement prescribed on discharge; 73.3% to 26.7%.

Conclusions

Interventions showed an improvement in quality of vitamin D3 assessment however, the decline in supplementation on discharge may be due to further planned intravenous bone protection bisphosphonate therapy and miscommunication due to ward doctors rotating every 4-6 months on how to appropriately assess and supplement vitamin D3 levels.
613 The Use of an Online Sepsis Screening Tool to Improve the Initial Management of Sepsis
Authors: Richardson P S , Murphy B
Published: August 2023

Aim

The aim of the project was to improve the adherence to sepsis management guidelines in Trauma and Orthopaedic patients through the use of an online Sepsis Screening Tool (SST). This was created to increase recognition of the early signs of sepsis to guide time critical interventions thus improving patient care.

Method

A retrospective audit of adult Trauma and Orthopaedic inpatients with a NEWS2 score of over 5, or 3 in one parameter, or a new suspected infection within a seven-day period was conducted in July 2020, March 2021 and August 2021 for each audit cycle respectively. We then assessed whether the SST and time critical interventions had been completed.

Results

After the initial audit in July 2020 showed the use of the SST and achievement of time critical interventions was poor, we introduced several interventions including information posters, and sepsis teaching for junior doctors. Further interventions were implemented after repeat audit cycles, including the incorporation of the SST within daily nursing safety huddles. By August 2021 the use of the SST had increased from 10% to 54%. This was associated with improved adherence to the sepsis management guidelines including correct observation frequency and medical review within 1 hour. Communication of a sepsis diagnosis to patients and family members also improved.

Conclusions

The completion of the SST increased adherence to sepsis management guidelines in our patients. We therefore recommend the use of Sepsis Screening Tools to identify patients at risk of sepsis and to improve their initial management.
649 Closed Loop Audit: Improving Surgical Handover in a Major Trauma Centre (RSCH)
Authors: Nour H M , Malik Magsi A , Mohamed M , Qasim M , Swaminathan C , Sajid M S
Published: August 2023

Aim

The goal of handover is the accurate reliable communication of task-relevant information across shift changes or between teams. Effective and safe transfer of clinical information is critical for patient safety. The aim of this study to assess Surgical handover in Royal Sussex County Hospital comparing it to the RCS guidelines as standard as well as improving the current practice.

Method

We undertook two cycles each cycle lasted for 6 weeks. These cycles aimed to assess the surgical handover and comparing them with RCS guidelines using checklists. A teaching session was conducted between the two cycles. In addition, RCS guidelines were handed over to all surgical doctors.

Results

we discussed a total of 2348 patients in morning surgical handover, over a period of 12 weeks (first cycle: 1203, second cycle:1145). Following conduction of teaching sessions and handing over guidelines, there was a significant improvement in documentation of patients age (from 73% to 97%), responsible consultant (from 92% to 98%), significant investigations (from 60% to 93%) and management plan (from 64% to 96%).

Conclusions

Education about proper handover was proven to be successful in improving the quality of surgical handover in a major trauma center.
692 Standardised Management of Hallux Fractures Within Virtual Fracture Clinic: A Quality Improvement Project
Authors: Stevens S , Mirza S , Hodgson P
Published: August 2023

Aim

Hallux fractures are a common referral to Virtual Fracture Clinic (VFC), comprising 6% of all referrals made within our Major Trauma Centre (MTC). The cumulative time taken to process these cases equates to 3.75 hours per month.

This commitment of time and resources endeavoured us to evaluate these hallux fracture referrals with the aim to develop a clear treatment pathway to improve the efficiency of VFC whilst safeguarding patient safety.

Method

A database was created containing all patients seen in VFC between 01/01/2022 and 31/01/2022 (n = 279). From this database 15 hallux fracture cases were identified. Using this data, a treatment pathway was created that stratified hallux fractures into high, moderate and low risk groups. This pathway was then implemented within our local A&E department and surrounding minor injury units to allow clinicians to safely discharge uncomplicated hallux fractures back into the community with appropriate safety netting literature.

A 2nd cycle was carried out to evaluate the effectiveness of the treatment pathway by reviewing the number of hallux fracture cases referred to VFC between 17/10/2022 and 14/11/2022.

Results

After implementing our treatment pathway, we saw a 62% reduction in the number of inappropriate referrals made to VFC. Furthermore, we saw a 100% increase in the number of appropriate complex fractures that were brought back to fracture clinic for formal review.

Conclusions

Our treatment pathway has demonstrated a significant difference in how hallux fractures are managed within our MTC in a manner that improves efficiency without compromising patient safety.
732 Who’s Your Consultant Surgeon? - a Quality Improvement Project
Authors: Hinchcliffe Z , Siah Q Z , Ali J , Iacob G , Gelber E
Published: August 2023

Aim

Recommendation 236 of the Francis Inquiry Report (2013) states that all inpatients should have a nominated clinician responsible for their overall admission, improving accountability, safety, and continuity of care. This relies heavily on effective communication, which can be challenging amongst surgical patients due to illness severity and urgent admission process. This Quality Improvement Project (QIP) aimed to investigate recommendation compliance through patient awareness of their named surgical care-teams.

Method

A two-cycle closed-loop QIP was performed across seven surgical wards at a District General Hospital (May-June 2022). A questionnaire was designed to survey baseline patient knowledge of consultant surgeon and nominated nurse’s names. Data on ward/headboard information was also collected. To implement change, junior doctor education was delivered to encourage communication with patients on their responsible care-teams. Post-intervention, results were re-audited as above.

Results

Forty-two patients were included in the baseline cycle; most did not know their surgeon or nurse’s names at 71% and 62% respectively. Post-intervention, from the 49 patients audited, a 14% improvement in awareness of surgeon’s name was shown. At baseline, 76% of ward whiteboards contained correct information on nominated staff, however only 2% of bed-headboards contained the surgeon’s details. Following intervention, this improved to 95% and 24% respectively.

Conclusions

Patient awareness of their responsible surgeon was poor, creating potential issues in compromised care and patient satisfaction. The intervention was successful in raising surgical inpatient awareness of their responsible consultant surgeon and improving compliance in updating ward/headboard information.
1049 Reducing Postoperative Length of Stay After Thyroidectomy by Implementing Standardized Post-Operative Pathways
Authors: Naseer A , Elkorety M , Haesman F , Shadwell A , Bhatti T
Published: August 2023

Aim

Reducing length of stay programme (RLoS) was conceived to ensure better outcome and experience while preserving capacity. Our unit was an outlier in length of stay after thyroidectomy according to British Association of Endocrine and Thyroid Surgeons (BAETS) annual report. We present the results of implementation of a standardized postoperative care pathway to reduce the length of stay.

Method

Patient expectations were managed for an early discharge. A multidisciplinary postoperative care pathway was developed to facilitate early discharge. Protocol was well publicized among the surgical team and the nursing staff.

We evaluated the implementation and efficacy of the pathway. Discharge data was collected on all total thyroidectomies prospectively over 12 months. Comparison was made with two years data of thyroidectomies prior to implementation of protocol.

Results

Prior to protocol implementation, 29 Thyroidectomies were done for benign disease. They were discharged, on post-operative day one 0% (67%), day two 45% (23%), day three 41% (6%), day four 0% (3%) and day five 7% (1%). Figures in parenthesis are national figures from BAETS annual report.

After protocol implementation, 17 thyroidectomies were carried out for benign disease. 87% were discharged on first postoperative day and 13% on second day. No patients stayed longer than two days. There were no patient safety events as a result of implementation of protocol and early discharge.

Conclusions

A structured and well publicized post-operative care protocol and managing patient expectations can significantly reduce postoperative length of stay after thyroidectomy without compromising patient safety.
1080 A Quality Improvement Project Developing a 'Return to Scan' Failsafe Protocol for Barnsley Hospital Emergency Department Patients with Suspected Cauda Equina and Renal Colic
Authors: Luesley A , Ginnis C , Emberey J , Soar I , Pitt S
Published: August 2023

Aim

A staff survey noted patients returning for scans for suspected cauda equina and renal colic were on occasion not returning or returning late. Overall, staff and patient experience were poor and posed risk to patients. To improve this, aims were to develop a standard process for recording ED patients due to return for scan and formalised information about this process to be provided to the patient.

Method

Three cycles were completed. Staff surveys identified areas of concern, supported by a fishbone diagram and process map. A proforma and patient information sheet were developed. Further staff surveys assessed satisfaction and effectiveness of the changes, leading to replacement of the proforma with a patient notes sticker. A booking system was created identifying patients to reception staff. Further cycles identified 64 patients in a 3-month period by suspected diagnosis using SNOMED codes. Records were accessed electronically using Mediviewer to review documentation and time returned for scan.

Results

98% of patients returned for scan. Process followed: 36% of patients returned late, with an average of 22 minutes and maximum of 40 minutes late. Process not followed: 36% of patients returned late, with an average of 58 minutes and maximum of 219 minutes late. The process was followed correctly in 17% of cases.

Conclusions

Patients were late by a shorter on average time when the process was followed - with providing patient information having the greatest positive impact. Staff education may improve process compliance which is poor. Patient experience and barriers to returning on time must be explored.
1186 Cholecystectomy Operation Notes - a Review and Core Trainee Survey
Authors: Kho J , Kuan J Y , Rajendran I
Published: August 2023

Aim

The “Good Surgical Practice” document by Royal College of Surgeons (RCS) England, in line with GMC’s “Good Medical Practice” emphasises the importance of “clear operative notes for every procedure”. The importance of clear documentation is well-established, facilitates effective handover and represents a legal document. A study was conducted to assess current documentation standards, including a survey amongst core surgical trainees on the use of a proforma for documenting cholecystectomies.

Method

A retrospective review of cholecystectomy operation notes collected from hospital database was performed between February 2022 and July 2022. Operative documentation was compared to the guideline published by RCS England. Specific information relevant to cholecystectomy operation were reviewed; critical view of safety/Calot’s triangle, number and type of clips, gallbladder dissection difficulty and spillage of bile/stones. Compliance to RCS standards was considered satisfactory at ≥80%.

Results

109 typed operation notes were reviewed. Majority of information including date and time (100%), procedure name (99%), name of surgeon and assistant (100%), operative findings (100%) and post-operative care instructions including VTE prophylaxis (92%) were clearly documented. Shortfalls in documentation included priority of operation (63%), intraoperative complications (66%), gallbladder dissection difficulty (53%), anaesthetist name (52%), removal of ports under vision (33%) and local anaesthetic details (70%). Survey of eight core surgical trainees found a consensus that a proforma would improve understanding and documentation of the procedure.

Conclusions

The use of an operation note proforma in cholecystectomies could improve patient care and compliance with RCS guideline, and act as a learning modality for surgical trainees.
538 Audit of Robotic Activities at a Tertiary Centre, an Attempt to Identify training Opportunities
Authors: Brodie A , Ullah M F , Khan S , Runau F , Singh B , Chaudhri S , Sangal S
Published: August 2023

Aim

Training in Robotic surgery is still in the development phase. The training opportunities are competitive with consultants and trainees in the learning phase at many centres. We aimed to analyse the use of robotic activity at a tertiary centre across different specialities to find out parallel training opportunities.

Method

Data was collected retrospectively from a prospectively maintained Electronic Theatre record over an eight-month period. We recorded number of days surgical robots are in use per month, number of operations per day and operating times for three subspecialties. Data was analysed using SPSS version 26

Results

The results show the robot was used on average 14.6 days per month. which equated to an average of 20.25 operations per month with an average operating time of 214.43 minutes per operation. The robot was used by Urology for on average 10 days per month, Gynaecology 3.38, and General surgery 1.5 days. The use depends on days allocated to specialities and ITU bed availability. Urology performed on average 13.75 operations per month compared to 5 for gynaecology and 1.5 for general surgery. Average case finishing time for single operation was 15:29, for two operations in a day was 17:36.

Conclusions

Given the robot was used less than half a month on average for operations, we can increase training opportunities by utilising them for training activities on non-operating days. More studies are needed at national level to help in creating a hub and spoke model by using Robots in non-operating times.
872 Two Years of Levelling the Playing Field. Challenges in Sustainability Providing a Free Online National Webinar Series and Mock Interview Scheme
Authors: Richardson D , Wang Y A , Barton J , Doshi A
Published: August 2023

Aim

The Specialised Foundation Programme (SFP) is a competitive training programme for UK medical graduates providing opportunities to pursue academic, educational, or managerial roles alongside clinical work. SFP interviews require knowledge of research methods and critical appraisal, applicants are also assessed in their approach to managing unwell patients. Information and guidance around the SFP vary greatly between medical schools. Where institutional support is lacking, expensive and poorly evidenced preparation courses have flourished, exploiting applicants, and creating a barrier to access.

We sought to address this inequality by providing a free, national, structured teaching programme and running mock interviews.

Method

For two application cycles we conducted a virtual preparation programme followed by mock interviews with clinical academics, aiming to improve perceived preparation and confidence. Outcomes were assessed using questionnaires following webinars and mock interviews.

Results

In each cohort, >120 students from 33 Universities, attended webinars. On average, students found the webinars helpful (4.75/5) and interesting (4.72/5). Following the webinars students felt more prepared (p<0.0001) and confident (p<0.0001). Similarly, confidence was significantly improved (p<0.001) by mocks for both cohorts. Recruitment of mentors or interviewers from cohort one for the second cohort was only 7%.

Conclusions

We have demonstrated that SFP applicant confidence and competence for interview can be improved via delivery of a free virtual preparation programme. Such a programme can be delivered through recruitment of a cohort of motivated clinical academics at zero cost. However, despite the clear benefits reported by applicants, retainment of interviewers and thus sustainability of this programme remain challenging.
61 “Research in Surgery – Building the Foundations” – a Mixed-Methods Evaluation of a New Collaborative Regional Teaching Series
Authors: Filan J , Rao E , Baxter N , Vyas A , Taylor E , Moir J
Published: August 2023

Aim

Research is integral to the progression of the surgical profession and requires a sustainable pipeline of diverse academics. Interest in academia begins at undergraduate level, however lack of exposure acts as a barrier to participation. We aimed to provide exposure to surgical academia via webinars and review the impact of this series.

Method

Four monthly sessions were delivered and facilitated in collaboration with medical students, foundation trainees, and surgical academics. Sessions covered core topics for students and foundation trainees, including audit/quality improvement, statistics, and research funding. Data were collected via post-event surveys which included scaled-based and free-text responses. These were analysed with appropriate statistics and thematic content analysis respectively.

Results

Across the sessions there were 79 attendances by 58 individuals. n = 52/58 were students, with 38% (n = 20/52) studying outside the region. The median overall rating was 8/10 (quartiles 8-10) and 98.7% (n = 78/79) would recommend to a colleague. Post-session confidence improved significantly for all sessions compared to pre-session confidence (p≤0.010 in all cases).

Thematic content analysis summarised attendees learning points into three semantic themes. (1) how to access research opportunities, (2) pragmatic learning on undertaking research (including funding, statistics, and dissemination) and (3) the importance of mentorship and networking. Respondents valued the insights and experiences of facilitators. Improvements included shorter sessions and clearly explaining novel language.

Conclusions

Our results highlight the benefits of these sessions for providing exposure and improving understanding of surgical academia, with relevance for others aiming to engage students and doctors in academia. We plan future sessions building on this.
973 Plastering Skills and Experience Among Junior Orthopaedic Doctors
Authors: Dellis S , Shabeer M , Ghosh S , Robinson A
Published: August 2023

Aim

The conservative management of fractures with the use of plasters is an essential skill and still forms the bulk of the orthopaedic surgeon’s workload. There is currently concern that junior orthopaedic doctors are receiving limited training in plastering and effectively becoming deskilled. The aim of this study is to provide an insight of the skills and experience of junior orthopaedic doctors in our trust.

Method

An electronic study was conducted in our trust in December 2022.

Results

Only 10% of the respondents had a plaster room induction, and only 40% had attended a plastering course. Half of the respondents had no official plastering training. The majority of junior orthopaedic doctors (80%) stated that during their on call most plasters were applied by A&E nurses and doctors. Only one third of junior T&O doctors were very confident applying a simple Colles’ plaster or a below knee backslab, while one third was not competent at all. All respondents agreed that plastering is a useful and essential skill to acquire for doctors working in T&O or considering a career in orthopaedics.

Conclusions

Application of a correct plaster cast is an essential part of orthopaedic management. It is worrying that junior doctors working in orthopaedics have little to no experience in plaster application and training is limited. All doctors agreed that plastering was a useful skill and should be taught as part of orthopaedic training.
1122 Improving Medical Students’ Confidence in the Theatre Environment and Surgical Scrubbing Technique Through Pre-Placement ‘Theatre Prep’ Teaching: A Quality Improvement Project
Authors: Politis A , Ibrahim Y , Bottomley S
Published: August 2023

Aim

As the GMC states, medical students should be proficient in surgically related procedural skills, including scrubbing up, to ensure patient safety is maintained. Although students and consultants report these skills as top learning objectives for surgical placements, research shows students feel unprepared going into theatres. Evidence suggests that preparatory teaching increases confidence and maximises learning opportunities.

This project aimed to improve confidence and preparedness for theatre amongst students at a large UK Medical School through the delivery of ‘theatre prep’ teaching.

Method

A PDSA structure was utilised through multiple cycles from September to December 2022, using a baseline questionnaire to compare each cycle’s outcomes against a control group. Feedback from students and stakeholders informed lesson plan updates after each cycle. Content focussed on theatre etiquette and practical scrubbing up teaching.

Results

A Likert scale established self-reported students’ confidence, graded from 1 (very unconfident) to 5 (very confident). Data across all cycles showed that prior to attending theatre, students’ confidence in going into theatres, and scrubbing up, was low (average 2.14 and 1.66 respectively). Control group data showed that students’ reported confidence improved by an average of 1.52 and 1.48 respectively post-placement. Comparatively, following 'theatre prep' teaching, groups reported an increase in confidence of 2.13 and 2.53 for cycle one, and 2.2 and 2.67 for cycle two.

Conclusions

Medical students report low confidence before going into theatre, particularly regarding scrubbing up. Confidence in both domains was greatly improved by having a ‘theatre prep’ teaching session. We recommend all medical school curricula incorporate similar content.
1241 A Review: How Is Anatomy Best Taught in Postgraduate Surgical Education?
Authors: Chaudhuri T , George A
Published: August 2023

Introduction

Successful surgery relies on complete appreciation of the appropriate anatomy, with inadequate expertise noted as a key cause of surgical errors. Despite this, there are fewer formal sessions dedicated to anatomy tuition, with surgical trainees expected to be taught “at the operating table” (Older, 2004).

Aim

We investigated how various anatomy teaching methods were received by core surgical trainees (CSTs).

Method

28 CSTs from West Midlands deanery attended a training day at Keele Anatomy and Surgical Training Centre, comprising tuition using cadavers and Primal Pictures software. Feedback forms investigating several factors, including progress through postgraduate surgical examinations, and opinions on resources used for revision, were sent out one week and 3-6 months after the session.

Results

Of the attending delegates, 37.9% had failed Part A MRCS, 27.6% had passed Part A, with a further 10.3% having also passed Part B. Principal resources used for anatomy revision were textbooks and videos, with question banks and anatomy apps also used. Access to cadavers was highlighted as a significant benefit, allowing for “real-life” learning, with 86% of delegates preferring anatomy tuition using cadavers outright or in combination with Primal Pictures.

Conclusions

The opportunity to access human specimens appears unparalleled in its ability to illustrate “real-life” anatomy. However, these are scarce resources, and require experts to facilitate tuition, creating significant limitations to providing regular and reliable teaching. Anatomy textbooks remain a consistent choice, but with the modern migration to a world permeated with a virtual presence, the internet, videos, and apps are becoming prevalent and viable considerations.
480 The Quality of Reporting Inflammatory Bowel Disease Randomized Control Trials: A Systematic Review
Authors: Gordon M , Khudr J , Sinopolou V , Lakunina S , Rane A , Akobeng A
Published: August 2023

Aim

Our objective was to perform a systemic evaluation of the risk of bias of randomized control trials’ (RCTs) reports published on IBD.

Method

We assessed the risk-of-bias using the Cochrane tool, as indicators for poor methodology or subsequently poor reporting. We focused on assessing the risk-of -bias pertaining to appropriate sequence generation, allocation concealment, blinding, incomplete outcome data reporting and other bias.

We systematically selected, with dual independent judgements, all studies published on IBD with no time limits and assessed the methodological quality of included studies again using independent dual ratings, with disagreement solved through a third author.

Results

563 full texts were included after selection and review. When excluding blinding, 103 papers exhibited low risk of bias in all reporting domains, none of which were publications. RCTs published in journals with higher IF were associated with an overall reduced rate of being at high risks. However, only 6% of full RCT publications in journals with IF greater than 10, published in the past 5 years, were free of bias.

The trend over time is towards improved reporting in all areas. Trials published by larger author teams, in full-text form and by industry and public sponsorship were positively correlated with lower risk of bias. Only allocation concealment showed a statistically significant improvement with time (p = 0.037).

Conclusions

These findings are consistent with those of other specialties in the literature. Whilst this may represent poor reporting instead of poor quality, it leaves readers and future secondary researchers with significant questions regarding such key issues.
902 Systematic Review of Suturing Dermatotraction Techniques in Closing Fasciotomy Wounds
Authors: Obuh O , Esomu E J O
Published: August 2023

Aim

A surgical patient post fasciotomy presents a challenge to restore cover of the muscle groups. The use of the suturing dermatotraction techniques presents a cheap and easy means of native cover. This systematic review of case series and case controls explored the trend of this technique including duration to delayed primary wound closure, complications and failure rates.

Method

A literature review was conducted on Medline, Embase and CINAHL yielding a combined total of 820 articles between 1946 and 18 June 2022. Human studies with suturing dermatotraction techniques were included. Twenty-one (21) studies reviewed met the criteria.

Results

The basic anatomy of the dermatotraction technique involves: An anchor point on the skin; A material for traction and a suture pattern. The Shoelace technique was the predominant suture pattern, with staples as skin anchor material and silastic vessel loops as traction sling used by 9 studies. Modifications of this method included use of intradermal prolene sutures and pediatric catheters. The shortest duration to skin apposition was 2 days and 113 days longest, with most mean closure rates at 7 days. This shoelace technique had fewer or no complications. Data showed superficial and early complications were more likely than deep or delayed complications. NPWT and skin graft salvaged few failed closures in 2 studies.

Conclusions

Most fasciotomy wounds closed with suturing techniques can expect to close within 7 days, with minimal complications. There are varying practices of traction rates, and this may account for the wide range to delayed primary closure.
1282 Comparing Overall Survival and Oncological Recurrence in Laparoscopic and Open Hepatectomy for Colorectal Cancer Metastases: A Systematic Review
Authors: Dogan S F
Published: August 2023

Aim

The use of laparoscopic surgery (LS) for liver resection has risen exponentially and is competing, in popularity, with open surgery (OPS). The aim of this study is to compare the oncological recurrence and overall survival of LS and OPS approaches for colorectal cancer liver metastases resection.

Method

A literature search was conducted, in-line with the PRISMA guidelines, via Ovid and PubMed to collect manuscripts dated between 01/01/2010-01/03/2021. The outcomes of interest were recurrence-free survival (RFS), overall survival (OS), and negative resection margins (R0). A modified quality assessment was achieved using the Newcastle-Ottawa Score (NOS) and the ROBINS-I Tool, and the data was analysed using Stata 16.0.

Results

Overall, 10 studies were selected of which included a total of 1924 patients. The results show the 1-, 3- and 5-years RFS and OS for LS and OPS were comparable, therefore not significant. Whereas the R0 differences were small yet significant - the LS group had an 89.9% R0 (95% CI: 87% to 92.8%) and for OPS was 85.4% (95% CI: 81% to 88.9%), Z – score of 1.6550, p = 0.0490 (p < 0.05). Even though the results are not significant for RFS and OS, LS is preferable for patients in improving the quality of life in the long-term.

Conclusions

There is little difference between OPS and LS methods as it pertains to the quality of life. With LS being less invasive and having marginally better results, doctors should consider prioritising LS for patients with colorectal cancer liver metastasis as an alternative to OPS.