bluuebunny/crossref_metadata_2025 huggingface dataset:
513 Surgical Science Secrets - an Innovative Way to Supplement Undergraduate Surgical Education
Authors: Kwan T Y , Yeo V , Mukhopadhyay S , Baskaran R , Li C H , Chin C , Wijaya A
Published: August 2023

Aim

In recent years undergraduate medical curriculum has been focusing on general practice. Together with the impact of COVID-19 pandemic, time spent on surgical education has been significantly reduced. Hence, medical graduates feel stressful when start working in surgical rotations. Our team has designed a peer reviewed teaching derived from National Undergraduate Surgical Curriculum which aims to prepare medical graduates for their surgical jobs.

Method

Four fundamental series covering general, orthopaedics, head and neck and vascular surgery were delivered every fortnight online from April to October 2022. Audience was invited to rate from a Likert Scale 1-5 to assess their confidence levels before and after the sessions. Sign test is used to ascertain whether the change in confidence level is statistically significant. Mann-Whitney U test is used to compare inter-series difference.

Results

There were in total 744 participants from UK and overseas medical schools. The average confidence level before and after the teaching sessions were 3.23 and 4.19. The change was statistically significant in each series (p<0.05) Majority of the audience preferred case discussions and MCQ-based teachings which helped with their final exam preparation. There was no inter-series statistical difference between orthopaedics and head and neck series (p>0.05). However, other series had demonstrated differences due to inconsistent audience size.

Conclusions

Online peer-to-peer teaching is a new trend to medical education since COVID-19 pandemic. With high yield contents and practice questions, it can enhance participants’ confidence in making medical decisions. Future work should be conducted with a constructive aligned teaching to standardise undergraduate medical education.
525 Undergraduate Barriers to Surgical Training
Authors: Leiberman C , Shaw J
Published: August 2023

Aim

To identify potential barriers in undergraduate medical students to surgical training.

Method

One hundred and one third-year medical students, with no prior surgical experience, were asked what they consider to be a potential barrier to surgical training.

Results

Seventy-eight students responded with a total of eighty-eight reasons given (n = 88). Of these, 17 (19%) students cited lack of exposure or experience, 10 (11%) stated manual dexterity, and 3 (3%) anatomical knowledge as potential barriers. Various reasons were given regarding surgical training itself. A perceived poor work-life balance was given by 14 students (16%), 13 (15%) stated the competitive aspect of training, and 6 (7%) cited the long duration of training. With regards to surgery as a specialty, 9 (10%) students said the long hours, 6 (7%) the perceived lack of patient contact, 6 (7%) observed the male dominance of the specialty and lack of female surgeons, and 4 (5%) said the rumoured negative work environment.

Conclusions

This survey identifies clear barriers to surgical training with three main themes being identified: experience of the specialty, surgical knowledge and skills, and aspects of the training and specialty. More effort should be given to expose students earlier to the discipline, improving undergraduate surgical skills teaching, as well as providing clear descriptions of what the training process entails. It would be prudent to resurvey the students in their final year, after having had sufficient exposure.
534 Investigating the Role of Gender-Affirming Surgery in Medical Education
Authors: Mapako T J , Tay T
Published: August 2023

Aim

Gender-affirming surgery is defined as a group of procedures that help individuals transition from their Sex assigned at birth to their gender identity. A literature search on PubMed showed this topic has not been investigated previously in undergraduate medical education. From personal experience, this topic and associated trans+ health is rarely covered in undergraduate and postgraduate medical education. We aim to investigate the duration if any, of each medical school dedicates to teaching this topic for both undergraduate and graduate entry medicine.

Method

Six questions were curated by both authors around teaching, learning and communication skills dedicated to the topic of Gender affirming surgery. A freedom of information request was sent to all General Medical Council-recognised medical schools in the United Kingdom. Data from responses were collected and analysed using Google Spreadsheets.

Results

A total of 38(90%) medical schools responded to our request. 60%(n = 23) covered this topic in traditional lectures, 32% organised session(s) on patient perspectives, 5.2% of universities provided e-learning, 18% in self-directed learning, and 42% in communication and practical skills session. 66% included Trans+ members in the consultation of their curriculum development.

Conclusions

This study highlights that gender-affirming surgery is a poorly covered topic. While nearly all medical curricula involve LGBT+ Health, more needs to be done to focus on trans+ health involving co-design with trans+ persons to ensure that the medical curriculum promotes equality, diversity and inclusivity in medical education.
599 Improving Confidence of Medical Students Towards Surgical Specialities Using a Near-Peer Teaching Programme
Authors: Dighero I , Fishwick A , Bawa J , Pace E , Kyriakides J
Published: August 2023

Aim

Medical students express anxiety relating to the hidden curriculum of a junior doctor, in particular, relating to working in surgical specialities. ‘Near-peer teaching’ is proven to be effective for educating doctors. Further, ‘near-peer teaching’ allows doctors to gain experience in teaching roles. This study aimed to improve confidence and preparedness of incoming foundation trainees into surgical specialities using a near-peer teaching programme.

Method

Teachers were recruited from ‘near-peer’ training levels, all having graduated within the last 3 years. The curriculum was designed based on anecdotal experience of the ‘hidden curriculum’ across surgical specialities. A five-session, online teaching programme was delivered. The course was free to attend. Post-course feedback data was collected using a five-point scale with free-text options.

Results

156 incoming foundation trainees from 21 medical schools attended the course and responded to the feedback survey. After completing the course, 93% of participants agreed or strongly agreed that they felt more confident when approaching surgical patients. 98% agreed or strongly agreed that the course was appropriate to their stage of training; 98% would recommend the course to colleagues.

Conclusions

New foundation trainees responded well to a near-peer surgical teaching course. There was a significant improvement in confidence to approaching surgical patients after attending this course. Through feedback, which included free-text recommendations, there is scope for future iterations of this course. This will continue to provide a platform for junior doctors to fulfill their role as teachers, whilst benefiting future incoming foundation trainees in preparing for jobs within surgical specialities.
625 The Public’s Perspective on the Amount of Time Surgeons Spend Operating
Authors: Fu K , Abdelrahman M , Walmsley J , Chan D
Published: August 2023

Aim

As waiting lists for elective surgery grow, there seems to be a disconnect between the public’s expectations on the amount of time surgeons spend operating compared with reality. On average, a surgeon in the NHS spends one day a week performing elective surgery. We aimed to investigate the public’s perception on the amount of time surgeons spend performing elective surgery and what they would desire.

Method

Members of the public in the UK were approached randomly either on-line or in-person to complete an anonymised 6-question survey. The questionnaire included demographic details, surgical history, occupational experience in the healthcare sector, the number of days a week they believe and wish for surgeons to be performing elective surgery.

Results

252 members of the public responded to the survey nationally (150 females, 102 males). 38.5% have experience working in the healthcare sector and 58.5% have had surgery in the past. 83.7% believe surgeons spend at least 3 days a week performing elective surgery [3-4 days (43.2%), 5-7 days (40.5%)]. 45.7% of respondents want their surgeon to operate between 5-7 days per week.

Conclusions

The public appears to overestimate the amount of time that surgeons spend performing elective surgery and have unrealistic expectations of how much they want their surgeons to operate.
835 Experience of a Virtual Surgical Education Teaching Programme During the Covid-19 Pandemic
Authors: Onifade A , Perikleous Y , Vincent E , Kinross J
Published: August 2023

Aim

Though most doctors will undertake a surgical placement as part of their foundation years, recent papers have demonstrated variability in perceived preparedness for these posts. The COVID-19 pandemic has also resulted in unprecedented challenges for surgical foundation doctors to advance their learning around the provision of surgical care. In view of this, we developed a virtual consultant-led surgical teaching programme to level the playing field by offering high-quality surgical educational opportunities during the pandemic.

Method

Six online teaching sessions were delivered from June to July 2021. The sessions were delivered using Microsoft Teams and lasted one hour. Participants were based within Imperial Healthcare Trust and a teaching hospital - Ahmadu Bello University, Nigeria. A foundation doctor presented a case in each session, followed by relevant consultant teaching. There were opportunities for questions and further discussion. Verbal and written feedback was sought throughout.

Results

Overall, we received positive feedback. 85% of participants rated the teaching excellent; whilst the remaining 15% rated it very good. All participants reported the session objectives were met, delivery was at the appropriate pace and the delivery was clear.

Conclusions

Through the delivery of teaching virtually we were able to reduce geographical barriers to surgical education and contribute to the prevention of COVID-19 transmission. Going forward, we plan to deliver these sessions again, and develop a pre- and post-session assessment to further assess its effectiveness. Nevertheless, we achieved our main objective - to promote equal access to surgical educational opportunities for junior doctors in the U.K. and overseas.
920 Regular Formal Surgical Skills Training for Undergraduates - an Easy Way to Increase Enthusiasm for Postgraduate Surgical Training?
Authors: Skan O , De Andres Crespo M
Published: August 2023

Aim

Despite the publication of a clearly defined surgical curriculum by the Royal College of Surgeons of England, the availability of surgical training opportunities at medical school remains highly variable [1]. While one-off training days can increase students’ surgical skills confidence, we wanted to explore the effect of a regular skills course on students’ skills confidence, and the effect this had on their willingness to attend theatre lists and purse surgical training after graduation.

Method

We designed a 6-session training program covering the Basic Surgical Skills curriculum produced by the RCS. It also included robotic surgery simulation. The course was run twice due to high demand for places. Core trainees were recruited to help supervise the course. The course was sponsored by both ASiT and Medtronic and was free for attendees.

Results

The course received excellent feedback. Free text sections highlighted how regular skills training allowed for consolidating learning. Attendees were significantly more likely to feel confident in performing all the techniques covered after the course (Chi Squared, p < 0.05). 16/17 attendees (94.1%) candidates agreed that the course filled a gap in what teaching is provided by the medical school, and all attendees felt more confident attending theatre lists after attending the course. Of note, most students agreed the course had increased their inclination towards a surgical career (12/17 70.2%.).

Conclusions

The course highlights the importance of regular surgical skills teaching. It also highlights an important knock-on effect of making students more confident attending lists, and more likely to pursue surgical careers.
935 “…And How Are You?” – a Call for Routine Wellbeing Checks in Educational Supervisor Meetings
Authors: Brown R
Published: August 2023

Aim

The rates of burnout, stress, anxiety, and suicide amongst doctors are increasing. Trainees may not recognise their wellbeing deteriorating or seek support, particularly when they are conditioned to “cope” with extreme experiences. Mental health charities advocate colleagues #starttheconversation to help in destigmatise perceptions of mental health and give those who may not otherwise seek support an opportunity to talk. However, without experience or expertise, this can be daunting.

Surgical trainees are mandated to meet their educational supervisor (ES) six times per year. This is an ideal opportunity for trainers to enquire about their trainee’s wellbeing. However, meetings do not mandate any wellbeing discussion and it is unclear how equipped trainers are to have these discussions. This study investigated wellbeing checks within training.

Method

Two 24-hour cross-sectional polls were conducted via social media asking UK trainees “During your ES meetings, are you routinely asked about your #wellbeing?” and asking trainers “Have you received any formal training in discussing #wellbeing and #mentalhealth with your trainees?”.

Results

Over 24 hours, 222 trainees voted, with 63.1% not routinely asked about their wellbeing during meetings. 87 trainers voted, with 76.3% without any formal training in discussing wellbeing and mental health with trainees.

Conclusions

This limited snapshot poll demonstrates that trainee wellbeing is not routinely being checked and that supervisors are variably trained to undertake these discussions. Wellbeing checks should become a standard part of every ES meeting and formal training in discussing well-being should be undertaken to instil confidence. Provisions for checking consultant wellbeing also require investigation.
1005 Core Surgical Training Applications: Moving Goalposts and the Introduction of the MSRA
Authors: Tincknell L , Spazzapan M , Pasha T , Fortune-Ely M , Songra L , Ogunmwonyi I , Sarsam M
Published: August 2023

Aim

The core surgical training (CST) application has changed year-on-year for the past 3-years. The 2023 application cycle saw the inclusion of the Multi-Specialty Recruitment Assessment (MSRA) for long-listing. Our aim was to assess the impact of the new CST application requirements on applicants.

Method

A questionnaire was distributed to attendees of a CST preparation course. Demographic data were collected. A Likert scale was used to determine agreement with a series of statements regarding the CST application and inclusion of the MSRA. Respondents were also given free text to express opinions regarding CST applications.

Results

One hundred fifty-eight (158) responses were collected, 67 [42.4%] were FY2 doctors, 66 [41.8%] were FY3/out of training in the UK, 8 [5.1%] outside of the UK, 14 [8.9%] FY1s and 3 [1.8%] were in another non-training post.

Eighty-nine (89) [56.3%] respondents applied to CST only, with 60 [38.0%] stating that inclusion of the MSRA made them more likely to apply to other specialties requiring the exam. 16 [10.1%] applicants felt that the MSRA was a fair addition to the application progress.

The common themes of qualitative data included: frustration at the short notice given to criteria changes, as applicants felt they spent years preparing their applications. Concern was expressed that candidates with no interest in surgery may consider applying due to inclusion of the MRSA.

Conclusions

Changing the CST application criteria had an overall negative effect on applicants. Most respondents reported the need for changes to applications to be communicated earlier in advance.
1018 Emergency Urology Crash Course: Teaching Non-Urologists Pays Back
Authors: Desouky E , Koura M , Ibrahim M , Dallash M , Kalsi J
Published: August 2023

Aim

To improve the knowledge, practical skills as well as professional skills of non-urologist health care professionals and bridge the gap between different specialties.

Method

One-day emergency urology crash course has been organised by urology team in our trust. The course is provided by 4 urology SpR under supervision of a urology consultant. Our course includes alternating sessions between lectures and practical skills. Lectures include interactive talks about common emergency urology case scenarios including obstructive uropathy, urinary infections & sepsis, andrological emergency, urologic trauma etc. Hands-on training using mannequin models includes difficult catheter, bladder wash out, 3-way catheter irrigation, flexible cystoscopy, foreskin problems, SPC insertion etc. Pretest and posttest questionnaires as well as a feed-back forms have been used to collect data used to analyse performance and the overall outcome of the course. We ran the course 3 times so far.

Results

Candidates included 60% A&E, 20% General surgery, 10% medical, 10% others. 70% were SpR,25% SHO and F1 or 2, 5% Nursing staff. 80% of candidates were from our trust and 20% from other trusts who got interested to attend. Candidate to faculty ratio was 5:1. Pre and post test result showed increase in knowledge by 4 points and increase in practical skills of 3 points.

Conclusions

One-day emergency urology course can achieve a lot on practical grounds as candidates feel more confident dealing with emergency urology cases after bridging the gaps in their knowledge and practical skills. This reflects on the overall service provided to urology patients presenting in the acute settings.
1050 Application of Bloom’s Taxonomy and Kolb’s Experiential Learning Theory While Designing Low-Cost Surgical Skills Courses for Junior Doctors & International Medical Graduates (IMGs) in the NHS
Authors: Karki B B , Basamh M , Sinha A , Walshaw J , Loubani M
Published: August 2023

Aim

To design a surgical skills course underpinned by Bloom’s & Kolb’s learning theory for junior doctors in the NHS. To develop an affordable skills course for the acquisition of the necessary skills & confidence among junior doctors.

Method

RCSEd CPD approved 1-Day Surgical Skills Course with course fees of £95 was designed based on the learning theory and was attended by 12 foundation-level doctors (>60% IMGs). The course contents were Knot Tying, Suturing Technique, Skin-Lesions excision, Bowel Anastomosis & Tendon Repair. All six levels of Bloom’s Taxonomy were adopted for the Knot Tying session and Kolb’s for designing the remaining skills sessions.

Results

There was the flexibility of learning for the delegates as someone with good clinical knowledge and skills was able to reach level 6 Taxonomy (e.g one-finger knot-tying techniques) rather than limiting to Level 3(Apply) as seen in the conventional courses. Kolb’s learning theory helped the delegates to enter the learning cycle through any stage adopting any learning cycle complementing IMGs with their wide concrete experience. 100% n = 11 delegates responded their course expectations were met. Avg.54.5%n = 6 strongly agreed & 45.5%n = 5 agreed on improvement in their post-course surgical skills.

Conclusions

The low cost of the surgical skills course was found to be one of the confounding factors for the wide participation by junior doctors & IMGs (54.5% n = 5 scored 5/5 & 45.5% n = 6 scored 4/5 for appropriateness on course fees). Adapting these learning theories helped enhance the course outcomes by widening the horizons of skills acquisition.
1132 UseBeforeSurgery-Practical Tips (UBS-PT) Initiative: Enhance Patient Safety with Tips Inspired by Military and Civil Aviation
Authors: Di Stasi L L , Sánchez Carrión J M , Mawhin B , Diaz-Piedra C
Published: August 2023

Aim

The healthcare system, to improve its culture of safety, often have looked at high-reliability organisations including the aviation industry. However, while some flight-safety tools have been slowly introduced into perioperative procedures (e.g., Surgical-Safety Checklist), many guidelines related to Non-Technical-Skills for Surgeons (NOTSS) have obtained low adherence. The apparent time-consuming nature of their implementation have represented a major barrier to the flourish of the NOTSS system. Thus, complementary initiatives, such as the UBS-PT presented here, are needed. The UBS-PT is a list of practical tips aimed at improving patient safety and surgical performance.

Method

By applying a reiterative evidence-based developing process involving healthcare professionals, military pilots, human factors, and legal experts, we identified several practical tips to enhance surgical performance. The developing process and operationalization were complemented by a deep literature review to weight tips’ efficiency, cost-effectiveness, usability, and ease of implementation.

Results

Within NOTSS system framework, we defined ten practical tips promoting the use of (1) group chair-flying, (2) colour-coded stickers, (3) standardised layouts, (4) closed-loop communication, (5) labelled and colour-coded surgical caps, (6) cross-checking and (7) two-challenge rule procedures, (8) the sterile cockpit rule, (9) self-checklist, and (l0) tactical napping.

Conclusions

In an attempt to meet the increasing standards of quality and safety in patient care, the UBS-PT initiative might encourage surgical teams and patient safety boards to find more suitable initiatives for each specific context. The UBS-PT initiative might represent the first step towards a tailored approach, offering concrete measures for the development of safety practices at individual and team levels.
1192 Optical Neuroimaging and Neurostimulation in Surgical Training & Assessment: A State-of-the-Art Review
Authors: Goble M , Caddick V , Patel R , Modi H , Orihuela-Espina F , Leff D
Published: August 2023

Aim

Understanding surgeons’ cognitive patterns may improve surgical training and patient outcomes. Functional near-infrared spectrometry (fNIRS) is a non-invasive optical neuroimaging method increasingly used in surgical training measuring cerebral cortical blood flow using the principle of neurovascular coupling. This review outlines the effect of expertise and stress on surgeons’ neural activation patterns and highlight key progress areas required in surgical neuroergonomics to modulate training and performance.

Method

A literature search of PubMed and Embase was conducted to identify neuroimaging studies using fNIRS in surgeons. This data formed a narrative review.

Results

Novices exhibit greater activation of the pre-frontal cortex than experts when performing simple tasks. Decreased pre-frontal activation correlates with a decline in performance in response to stress; an understanding of neural pathways paves the way for interception of stress upstream of the subsequent deterioration of performance. Trends in fNIRS include measurement of systemic (e.g. heart rate) and regional (e.g. scalp perfusion) physiology to account for confounding factors in cerebral blood flow. FNIRS may be more accurate than current metrics in being able to reliably distinguish levels of expertise between trainees and provide a picture of global cognitive state during surgery which could lead to the development of cognitive benchmarks of expertise. Advances in machine learning facilitating improved data processing will aid bedside fNIRS use, offering the possibility of live feedback on the surgeon’s cognitive state during training or operating.

Conclusions

fNIRS is a burgeoning technology with multiple applications to surgical training with the potential to improve operative outcomes.
1295 To What Extent Would an Augmented Reality Surgical Skills Mobile App Effectively Supplement Surgical Skills Training for UK Medical Students and Foundation Doctors?
Authors: Sule E , Ghaderi R , Tariq S , Kamel Y , Maliyil J
Published: August 2023

Aim

Augmented Reality (AR) has been identified as having high potential to provide early, focused and satisfactory surgical skills education for UK surgical trainees. AR overlays digital information onto the physical world, providing an interactive experience. Mobile applications are effective, low-cost methods of delivering technology-enhanced learning (TEL). This study aimed to determine the viability and efficacy of augmented reality (AR) mobile applications for immersive simulation training for surgical trainees in the UK.

Method

A systematic search using pre-determined terms and criteria was used to identify and screen relevant literature on seven major databases, including EMBASE, MEDLINE, CENTRAL and JBI. Further search of citations, dissertations, and theses (ProQuest) were also conducted. Identified publications were further screened using pre-defined criteria.

Results

34 unique publications were identified in total, from database searches (n = 31) and review of reference lists (n = 3). Following detailed review of abstracts, 14 publications were omitted from ongoing analysis. All remaining publications (n = 20) discuss TEL. Five positive themes emerged: widespread acceptance, improved surgical accuracy, reduced time wasted, telementoring and real-life scenario replication. 2 barriers of AR identified were the lack of tactile feedback, and accessibility, particularly AR implementation.

Conclusions

As a digital technology, AR has the potential to supplement and enhance surgical training. Current literature suggests wide acceptance, skill improvement and time efficiency of digital compared to traditional training and educational methods. However, little research exists specifically evaluating the efficacy of AR mobile applications in delivering surgical skills to early surgical trainees. More research is therefore needed to inform appropriate adoption of this emerging technology.
92 UK Medical Students' Perceptions of Trauma and Orthopaedics as a Specialty, Career and Culture
Authors: Woods J
Published: August 2023

Aim

In 2022, Trauma and Orthopedics’ waiting lists grew to their largest for over a decade. Therefore, the specialty of T&O must ensure that no medical student is dissuaded from pursuing their interest in T&O because of perceptions of the specialty that cause them to doubt their ability to succeed in their career on non-meritocratic grounds. This study seeks to understand and characterise:The reasons why students are / are not attracted to a career in T&OThe perceived barriers and challenges to pursuing a career in T&O

Method

Medical students were invited to share their ambitions, experiences and concerns about challenges and barriers to a career in T&O online.

Results

18 students from multiple medical schools participated. 16 participants stated they were considering T&O as a future career; their reasons included positive placement experiences, diversity of working environments and caseload, innovation, and practical application of skills. The perceived barriers to medical students pursuing their interest in T&O included competition, work-life balance, male domination of the specialty and a hostile working environment.

Conclusions

T&O appeals to many medical students as an exciting career. Unfortunately, students have concerns about being held back by characteristics with no bearing on their performance. However, negative perceptions of the specialty may be remediable by publicising up-to-date competition ratios; raising the profile (including on social media) of female T&O surgeons as role models and mentors; and increasing awareness of support structures available to students and trainees.
758 Green Surgery: Save the Suture, Save the Future
Authors: Ong C S , Rahman K R , Saqib M W , Jesudason E
Published: August 2023

Background

The health sector is pivotal to mitigate climate change due to its responsibility for 4-5% of global greenhouse gas emissions. In 2019, the carbon footprint of NHS England totalled 25 megatonnes of carbon dioxide equivalent (CO2e).

Aim

To reduce the number of the unnecessary opening of suture packs and suture wastage to reduce environmental, social, and financial costs in general surgical procedures.

Method

A prospective audit was conducted at a District General Hospital by collecting data on the number of suture packs opened and unused for general surgical procedures for 2 weeks in November 2022. Intervention was done by raising awareness using posters and sustainability education. The data was collected again for 2 weeks and analysed using GraphPad Prism.

Results

For laparoscopic surgery, there was a reduction in redundant suture packs opened (P = 0.86) and subsequently unused (P = 0.86) but the result was insignificant. In contrast, for open surgery, the reduction in suture pack opened (P = 0.028) and subsequently unused (P = 0.034) was significant. The financial savings were extrapolated to be £2799 yearly. The yearly environmental savings including transport and waste incineration totalled approximately 367kg CO2e. The survey used for social impact showed improved staff sustainability awareness and development of new sustainable practices.

Conclusions

The building of global regime for the mitigation of climate change is vital but the small scales of positive action like reducing suture wastage need to also be encouraged. The emergence of a polycentric system to reduce greenhouse gas emissions will become the inspiration for the national ambition of delivering a net zero NHS.
206 Outcome Measures Reported Following Feminising Genital Reconstructive Surgery for Gender Affirmation in Transgender Women and Gender Diverse Individuals: A Systematic Review
Authors: Iakovou D , Pidgeon T , Franchi T , Lo A C Q , Matthew G , Shah H V , Borrelli M R , Sohrabi C , Rashid T
Published: August 2023

Background

The comparison of differing methods of gender affirming feminising genital reconstructive surgery (fGRS) in transgender women and gender diverse individuals may be confounded by variable outcome reporting and the use of inconsistent outcomes and definitions.

Method

This systematic review examined all outcomes and outcome definitions reported in published studies after gender affirming fGRS in transgender women. Candidate studies were sourced via an electronic, multi-database literature search. Search terms were broad to maximise capture of fGRS procedures. All primary, clinical research studies were included with no date limits. Paired collaborators screened each study for inclusion and performed data extraction.

Results

After screening 1225 studies, 93 studies proceeded to data extraction, representing 7681 patients. 2621 separate individual outcomes were reported, 857 (32.7%) were defined, and the time of outcome assessment was given for 1856 outcomes (70.8%) but relied on wide, non-specific ranges of follow-up dates. 24 discreet outcomes were reported 10 or more times and comprised 20.7% of all outcomes reported. Profound heterogeneity existed in the definitions used for these and for all outcomes reported in general. Only 6 studies declared a primary outcome.

Conclusions

Outcomes and outcome definitions reported following fGRS in transgender women and gender diverse individuals were varied and heterogenous. Improved outcome definitions and the adoption of a consistent Core Outcome Set will aid the fair comparison of future studies evaluating the outcomes of fGRS. This review is the first step in the process of developing such a Core Outcome Set.
223 Comprehensive Geriatric Assessment (CGA) in Perioperative Care: A Systematic Review of a Complex Intervention
Authors: Miller R , Barnes J , Mouteon R , Braude P , Hinchliffe R
Published: August 2023

Aim

Comprehensive geriatric assessment (CGA) is a complex intervention applied to older people with evidence of benefit in medical populations. The aim of this systematic review was to describe how CGA is applied to surgical populations in randomised controlled trials. This will provide a basis for design of studies focused on optimising CGA as a complex intervention.

Method

A systematic review of randomised controlled trials. A systematic search was performed for studies of CGA in the perioperative period across Ovid MEDLINE, Ovid EMBASE, CINAHL and Cochrane CENTRAL, from inception to March 2021. Any randomised controlled trials of perioperative CGA versus 'standard care' were included.

Results

12 121 titles and abstracts were screened, 68 full-text articles were assessed for eligibility and 22 articles included, reporting on 13 trials. 10 trials focused on inpatients with hip fracture, with 7 of these delivering CGA on a geriatric medicine ward, 3 on a surgical ward. The remaining three trials were in elective general surgery all delivering CGA on a surgical ward. CGA components, duration of intervention and personnel delivering the intervention were highly variable across the different studies. Trials favoured postoperative delivery of CGA (11/13). Only four trials reported data on adherence to the CGA intervention.

Conclusions

CGA as an intervention is variably described and delivered in randomised controlled trials in the perioperative setting. The reporting of both the CGA and standard care is often poor with little focus on adherence. Future research should focus on clearly defining and standardising the intervention and measuring adherence within trials.
350 Identifying Malnutrition in Emergency General Surgery (EGS): A Systematic Review
Authors: Ashmore D , Rashid A , Wilson T , Halliday V , Lee M
Published: August 2023

Aim

Emergency general surgery (EGS) practice is high risk. Surgery is a key part of treatment, with resultant catabolic stress and frequent need for nutritional support. Aims of this study were to examine the current methods of defining and determining malnutrition in EGS. This included examining the use of nutrition screening and assessment tools, and other measures of malnutrition.

Method

Medline, Embase, CINAHL, trial registries and relevant journals published between January 2000 and January 2022 were searched for studies of adult patients with any EGS diagnosis, managed operatively or conservatively with an assessment of nutritional status. Mixed populations were included if more than 50% of patients were EGS or EGS results could be separately extracted. Studies whereby patients had received nutritional support were excluded.

Results

From 6,700 studies screened, 324 full texts were retrieved, and 31 were included in the analysis. A definition of malnutrition was provided in 75% (n = 23) of studies, with nutritional status being determined by a variety of methods. Seven nutrition screening tools and nine ‘assessment’ tools were reported. To define malnutrition, the most commonly used primary or secondary marker of nutritional status was body mass index followed by albumin level.

Conclusions

Wide variation exists in approaches to identify malnutrition risk in EGS patients, using a range of tools and nutrition markers. Future studies should seek to standardise nutrition screening and assessment in the EGS setting as two discrete processes. This will permit better understanding of malnutrition risk in surgical patients.
879 The Review of Autologous Fat Grafting Utilizing Negative Pressure for Breast Augmentation
Authors: Bin Mohamed Ebrahim M E , Taghavi S M J , Sidiqi M , George R
Published: August 2023

Aim

There may be a role for topical negative pressure in autologous fat grafting to breasts since it enhances angiogenesis during wound healing for open and closed wound. Here, we present a review of the literature on this topic.

Method

Medline and Embase were utilised, with searches ranging between 1960 – 2019. Terms (“Liposculpting” OR “Fat grafting” OR “Lipofilling” OR “Lipograft” OR “Fat transfer”) AND (“Negative Pressure” OR “Brava” OR “Kiwi”) AND (“Breast”) were merged as keywords. Inclusion criteria were females, autologous fat graft to breast with negative pressure prior to procedure. Studies were excluded if there was no primary endpoint or non-original article. Primary outcome measured was fat graft survival post breast augmentation with post-operative morbidity as a secondary outcome.

Results

Upon reviewing 219 articles, 2 met inclusion criteria. A total of 611 breasts were treated using negative pressure devices, with each cohort having different pre- and post-operative pressure settings. Khouri et al. cohort had higher graft survival (79%) compared to Del Vecchio et al. cohort (64%), however the latter had fewer complications compared to Khouri’s cohort e.g. fat necrosis, pneumothorax and infection.

Conclusions

There is still limited evidence regarding the use of topical negative pressure for fat grafting to the breasts. Autologus fat grafting to breasts without the use of negative pressure is shown to have graft survival of 60-70%. Given its potential benefits, more future studies are needed to fully understand the impact of this technique.
884 Optimising Analgesic Strategies in Patients Post-Oesphagectomy – a Systematic Review and Network Meta-Analysis of Randomised Clinical Trials
Authors: Ramjit S E , Davey M G , Ryan E J , Arumugasamy M , Robb W B , Donlon N E
Published: August 2023

Aim

To perform a systematic review and network meta-analysis (NMA) of randomised clinical trials (RCTs) evaluating the optimal analgesia strategy post-oesophagectomy.

Method

A Network Meta-Analysis was performed according to PRISMA-NMA guidelines. Statistical analysis was performed using Shiny and R.

Results

14 RCTs which included 565 patients and assessed 9 analgesia techniques were included. Relative to systemic opioids (SO), thoracic epidural analgesia (TEA) significantly reduced static pain scores at 24 hours post-operatively (mean difference (MD): −13.73, 95% Confidence Interval (CI): −27.01−0.45) (n = 424, 12 RCTs). Intrapleural analgesia (IPA) demonstrated the best efficacy for static (MD: −36.2, 95% CI: −61.44−10.96) (n = 569, 15 RCTs) and dynamic (MD: −42.90, 95% CI: −68.42−17.38) (n = 444, 11 RCTs) pain scores at 48 hours. TEA also significantly reduced static (MD: −13.05, 95% CI: −22.74−3.36) and dynamic (MD: −18.08, 95% CI: −31.70−4.40) pain scores at 48 hours post-operatively, as well as reducing opioid consumption at 24 hours (MD: −33.20, 95% CI: −60.57−5.83) and 48 hours (MD: −42.66, 95% CI: −59.45−25.88). Moreover, TEA significantly shortened intensive care unit (ICU) stays (MD: −5.00, 95% CI: −6.82−3.18) and time to extubation (MD: −4.40, 95% CI: −5.91−2.89) while increased post-operative forced vital capacity (MD: 9.89, 95% CI: 0.91−18.87) and forced expiratory volume (MD: 13.87, 95% CI: 0.87−26.87).

Conclusions

TEA provides optimal pain control and improved post operative respiratory function in patients post-oesophagectomy, reducing ICU stays, one of the benchmarks of improved post operative recovery.
1007 Antithrombotics in Renal and Mesenteric Arterial Disease: A Systematic Review
Authors: Mercer R , Ahmed H , Wong K , Hinchliffe R , Twine C
Published: August 2023

Aim

This systematic review aims to pool the literature on antithrombotic therapy for patients with renal or mesenteric arterial disease.

Method

Medline, EMBASE, Cochrane library, and the ICTRP were searched for studies comparing outcomes in atherosclerotic renal or mesenteric arterial disease for patients using antithrombotic therapy. Primary outcomes included major adverse cardiovascular events, major bleeding, and mortality.

Results

Seventeen full texts were included for narrative synthesis (2427 patients). Five studies assessed antithrombotic use for atherosclerotic renal disease. One retrospective cohort study (serious risk of bias) found antiplatelets (62 patients) reduced all-cause mortality compared to those not receiving antiplatelets (162 patients) for renal arterial disease (P = 0.01). One study (77 patients) reported no significant differences in risk of renal artery restenosis between aspirin or clopidogrel (P = 0.052), the second study (28 patients) reported aspirin was associated with increased eGFR post intervention (P = 0.006) (both high risk of bias). One randomised control trial (some concerns for bias, 100 patients) found that those receiving both abciximab platelet inhibition and embolic protection devices had reduced platelet-rich thrombi compared to those on either therapy alone (P<0.01). Bleeding rates were similar between all patient groups. Twelve cohort studies (serious risk of bias) assessed antithrombotic use for mesenteric disease. Results were mixed between a reduction (3 studies) or no reduction (9 studies) in all-cause mortality.

Conclusions

Disease-specific data supporting the use of antithrombotic therapy in renal and mesenteric disease are of low-quality. High-quality data (randomised or registry) is necessary to further support current treatment recommendations.
1084 The Prognosis of Physical Function Following Ankle Fractures. a Systematic Review and Meta-Analysis
Authors: Chowdhury M
Published: August 2023

Aim

This systematic review and meta-analysis aims to quantify the prognosis of physical function following a traumatic ankle fracture. The purpose of the study was to review the existing literature with a view to providing essential information for patient care and also to update the existing literature for healthcare professionals.

Method

A literature search was performed for studies using electronic databases MEDLINE (Interface: EBSCOhost); EMBASE (Interface: OvidSP); CINAHL (Interface: EBSCOhost); CENTRAL (Interface: Cochrane Library.) Two reviewers searched citations for inclusion, evaluated quality of methodology, risk of bias and extracted appropriate data relating to physical function and activity limitation. A 100-point scale was used to conform the data where higher scores correlated with improved outcomes. Estimating equations of a general nature was used to conduct the meta-analysis.

Results

57 studies were included. There is significant activity limitation in the short term (6 week: mean 48.9,95% confidence interval), but it improved in the short-to-medium term (6 month: mean 73.2, 95% confidence interval.) In the long term the recovery was not as marked (12 month: mean 84%, 95% confidence interval.) The demographics that had the worst results were male and the older populations.

Conclusions

Meta-analysis demonstrated that adults with traumatic ankle fractures improve rapidly in the initial stages but the recovery plateaus and is incomplete at 24 months. Healthcare professionals may consider this information to influence patient care.
1242 Clinical Outcomes in Combined Lung-Liver Transplants vs Isolated Lung-Transplants: A Systematic Review and Meta-Analysis
Authors: Sheehan R , Wong W , Bentley T
Published: August 2023

Background

The combined lung-liver transplant is an infrequent but established therapy for patients with end-stage lung and liver disease. Recent evidence suggests that the liver may reduce rates of graft rejection and increase overall graft survival for cotransplanted organs.

Method

To establish a comprehensive summary of safety and efficacy data and explore whether there may be a tolerogenic effect conferred by the liver in combined lung-liver transplants (CLuLi), we systematically searched 4 databases (Medline, Embase, Cochrane, OVID Transplant library) for all studies comparing clinical outcomes between CLuLi and lung transplants alone (LTA). Key outcomes included overall survival, acute rejection and length of hospital stay.

Results

3 observational studies were deemed eligible for inclusion including a total of 21, 608 transplant patients- 86 CLuLi and 21,522 LTA. The most common indications for CLuLi included cystic fibrosis (50%) and noncholestatic liver disease (23%). 1- and 5-yr survival rates for CLuLi ranged from 80-91% and 59-84%, respectively, and were not significantly different to LTA in any of the studies. Our random effects inverse variance meta-analysis demonstrated an insignificant difference in hospital stay length for CLuLi compared to LTA (95% CI -8.10 to +19.52, p = 0.42). 1 study reported on acute rejection and found comparable rates between CLuLi and LTA (40% vs 46%).

Conclusions

Overall, this systematic review has shown CLuLi transplants to be at least as safe and effective as lung transplants alone. At present, there is insufficient quality evidence to evaluate the tolerogenic effect of the liver in CLuLi transplants.
129 Evaluating Long-Term (≫5 Years) Patient Reported Outcome Measures and Kneeling Function in Patients with Tibial Intramedullary Nails
Authors: Johnson H , Han Win Aung A , Ahearn N
Published: August 2023

Aim

1) To assess the long-term (>5 years) patient reported outcome measures (PROMs) and kneeling ability in patients with tibial intra-medullary nails (IMNs). 2) To correlate the PROMs with superior and anterior IMN cortex protrusion, measured radiologically.

Method

129 patients, from one UK centre, were invited to participate by completing a KOOS score, Kujala score, EQ-5D-5L and a four-posture kneeling assessment. Superior and anterior IMN prominence was measured using lateral radiographs. Pearson’s two-tailed correlation test was performed using SPSS v28.

Results

45 patients responded to the questionnaire. 81.8% of patients were satisfied with their surgery. 20.5% of patients experienced daily AKP. The mean Kujala score was 80.7 (74.5, 86.8). The mean KOOS score was 83.2 (77.9, 88.5), 83.9 (78.3, 89.5), 85.8 (79.6, 92.0), 70.7 (60.8, 80.7) and 72.8 (64.8, 80.8) for symptoms, pain, daily living, sport and quality of life, respectively. Participants found the praying position and high flexion kneel the most difficult postures, with pain being the most common limiting factor. More than half of participants found all four kneeling postures easy to achieve. No significant correlation was found between the overall KOOS or Kujala score and nail-plateau distance (p = 0.408, p = 0.979), nail-anterior cortex distance (p = 0.552, p = 0.492) or the overall nail prominence (p = 0.608, p = 729).

Conclusions

AKP effects a subset of patients more than five years post-tibial IMN, limiting their ability to kneel. Most patients experience little or no pain with good knee functionality. Tibial IMN prominence does not seem to be associated with AKP in our sample.