bluuebunny/crossref_metadata_2025 huggingface dataset:
178 The Effect of Ophthalmic Surgery for Graves’ Orbitopathy on Quality of Life – A Systematic Review and Meta-Analysis
Authors: Woo T , Li C , Ganesananthan S , Rajendram R , Uddin J , Lee R , Dayan C , Taylor P
Published: November 2022

Background

Graves’ orbitopathy has a profound negative impact on quality of life. Surgery is undertaken to preserve vision, correct diplopia and improve aesthetics. We aimed to quantify the effect of different surgical approaches on quality of life.

Method

Electronic databases were used from inception until 22nd March 2021 to identify studies assessing quality of life pre- and post-surgical intervention for Graves’ orbitopathy. Two reviewers independently extracted data and performed quality assessments. Random-effects and Bayesian models for meta-analyses were utilised.

Results

10 articles comprising 632 patients were included. All used the Graves’ Ophthalmopathy Quality of Life questionnaire (GO-QOL). For GO-QOL appearance, the pooled standardised mean improvement for patients after surgery was +0.72 (95% CI 0.50–0.94) I2=69% (95% CI 52–80%). For GO-QOL visual functioning, the pooled SMD for patients after surgery was +0.41 (95% CI 0.25–0.58) I2=60% (95% CI 36–74%). For visual appearance, orbital decompression yielded the greatest improvement (SMD+0.84, 95%CI 0.54–1.13) followed by eyelid surgery (SMD+0.38, 95% CI 0.05–0.70), while strabismus correction had no significant effect (SMD +0.94, 95% CI -0.10–1.99). Conversely strabismus correction was associated with the greatest improvement (SMD+1.25, 95%CI 0.29–2.21) in visual functioning, outperforming orbital decompression (SMD+0.29, 95%CI 0.15–0.43) and eyelid surgery (SMD+0.12, 95%CI -0.18–0.41).

Conclusions

Ophthalmic surgery results in substantial improvements in quality of life in patients with Graves’ orbitopathy, with greater perceived effects on appearance than visual function. Orbital decompression has particular impact on visual appearance, strabismus surgery may benefit both visual appearance and function equally whereas eyelid surgery benefits appearance alone.
187 The Impact of Electronic Pathways and Digital Systems on Neck of Femur Fracture Outcomes: A Systematic Review
Authors: Tandon D , Curlewis K , Vusirikala A , Subramanian P , Patel A
Published: November 2022

Aim

Electronic pathways and digital systems are novel interventions in medicine that include clinical decision support systems and checklists for care delivery. The primary aim of this systematic review was to outline the impact of electronic pathways and digital systems on neck of femur (NOF) fracture outcomes as according to Best Practice Tariff (BPT) outcomes.

Method

A literature search was conducted using the PubMed, Cochrane Library and MEDLINE databases. Studies were included for review if they addressed the impact of an electronic pathway or digital system on at least one of the BPT outcome measures. Studies were excluded from the review if they were not written in English. After 698 citations were independently reviewed by two authors, 6 papers were included for full text review. The data was significantly heterogenous, hence a narrative synthesis was performed. Risk of bias for each paper was assessed using the Downs and Black scale.

Results

Time to theatre, length of hospital stay and management of osteoporosis for secondary fracture prevention displayed statistically significant improvements. Mortality and post-operative complications demonstrated non-significant improvements. No outcome measures were adversely affected. The identified studies had a similar risk of medium bias.

Conclusions

Electronic pathways and digital systems have a statistically significant positive impact on several NOF fracture outcomes. Due to the novel nature of electronic pathways and digital systems in orthopaedics, a limited number of studies were identified for review. More high-quality homogenous prospective cohort studies are required to allow for a meta-analysis.
853 The Use of 3d-Printed Wrist Models to Aid Patient Understanding of Diagnosis and Treatment
Authors: Carvill M , Brown M , Rust P
Published: November 2022

Aim

Models of the wrist allow for complex anatomy to be visualised and explained, aiding clinician to patient discussion. This pilot study aimed to investigate in impact on patient understanding of their diagnosis and treatment using a 3D-printed model hand in consultation.

Method

3D-printed model wrists based on dissection specimens done in Anatomy, University of Edinburgh, were created to demonstrate a variety of pathologies, including triangular fibrocartilage tears and scapholunate ligament injuries. Patients participated by questionnaire at hand clinic appointment with responses recorded on a visual analogue scale (VAS) for criteria including confidence explaining their condition to others, and satisfaction before and after use of the models.

Results

48 patients participated in the study with 38 questionnaires fully completed. Median age was 44 years old; the right hand was affected more than the left (17 vs. 15) and bilateral in 6 patients.

Use of the models saw a significant improvement in patient confidence to explain their condition to a family member (mean change 2.46, range -3 to 8.5; p<0.001), although a wide range of responses were recorded demonstrating individual differences and preferences. Patient satisfaction was excellent (mean 9.25) when the models were used, and a positive net promoter score (mean 9.29) showing patients would recommend the consultation style.

Conclusions

This pilot study suggests that 3D-printed wrist models aid in patient education at consultation, building patient confidence and maintaining satisfaction. Given the range of responses and individual nature of learning it is likely these models will complement radiological images in this setting.
415 Virtual Reality Simulator use in Orthopaedic Training: What do the Trainees Think?
Authors: Hunt Laurence , Lubwama Baker , Al-Uzri Muntadhir , Lam Angela , Kang Niel
Published: November 2022

Aim

To gather the opinions of orthopaedic trainees on the use of virtual reality (VR) simulators in their training.

Method

Twelve entry level orthopaedic trainees trialled a tibial nailing surgery on a VR simulator. Each participant completed a pre- and post-intervention questionnaire containing twelve 10-point Likert scale questions assessing their opinions on VR simulator use in their training. Paired data sets were analysed using the Wilcoxon signed-rank test.

Results

Only 25% of participants had previously experienced a VR simulator, yet participants felt strongly that VR simulators had a place in orthopaedic training (M = 8.750 ± 1.288) and that if they had access, they would use a VR simulator to practice surgical skills (M = 9.000 ± 1.044). After trying the VR simulator, participants felt more strongly that VR simulators should be a mandatory part of orthopaedic training (M = 6.750 ± 1.658 to M = 7.500 ± 1.567, P = 0.048); VR simulators are an engaging learning tool (M = 8.583 ± 1.379 to M = 9.417 ± 0.793, P = 0.029); access to a VR simulator would improve their training (M = 8.250 ± 1.545 to M = 9.250 ± 0.866, P = 0.036) and VR simulators will form the basis of orthopaedic training in the future (M = 5.250 ± 2.734 to M = 6.667 ± 2.498, P = 0.032).

Conclusions

Orthopaedic trainees want VR simulators in their training and will use them if given access. A positive reception from trainees is vital in order to effectively implement VR simulators into orthopaedic training.
851 3D Printing Technology in Microsurgical Reconstruction of the Maxilla and Mandible at Great Ormond Street Hospital (GOSH)
Authors: Howard Theodore , Eriksson Sofia
Published: November 2022

Aim

Since its development, three-dimensional (3D) printing has been used successfully in many industries, however its use in surgery is still in its infancy. We present two cases where 3D printing technology was used to aid surgical planning and guide free-flap microsurgical reconstruction.

Method

A free fibula flap was performed following a hemi-maxillectomy for a mucoepidermoid carcinoma of the palate. 3D-technology was used to design the position of the osteotomies, osteosynthesis and osseo-integrated dental implants by our in-house 3D technician. A 3D-printed cutting guide was created for the fibula and a custom-made titanium plate was designed for the maxillary reconstruction. Similar 3D-technology was used in a free DCIA flap mandibular reconstruction following resection of a mandibular ameoblastoma. Lower limb CTA showed bilateral peronea arteria magna. Thus, a DCIA flap was performed. A 3D computer-aided design-model for the surgical procedure was created allowing for precise measurement of iliac crest bone and cutting guides were created to aid mandibular resection and ensure accurate bone harvest.

Results

Both patients underwent successful reconstruction, the flaps maintained good perfusion with strong and consistent doppler signals with healthy skin paddles post-operatively. The patients recovered well; one remains in the immediate post-operative period and one-month follow-up of the DCIA flap showed good position of the bone flap with reasonable movement of the mandible.

Conclusions

3D technology has the potential to improve the quality of craniofacial reconstructions. This technology allows the reconstructive surgeon to improve accuracy, demonstrate complex anatomy, plan and execute complex surgical plans with improved functional and aesthetic outcomes.
61 Comparison of Clinical Outcomes of Robotic Versus Open Pancreaticoduodenectomy Using a New ‘Therapeutic Index’ Tool for Quality Assessment of Surgery: A Systematic Review and Meta-Regression Analysis
Authors: Mantzavinou Artemis , Uppara Mallikarjuna , Chan Jeremy , Patel Bijendra
Published: November 2022

Aim

Pancreaticoduodenectomy (PD) is a challenging procedure with peri-operative complications. Robotic surgery offers improved dexterity, visibility, and accessibility. Recently, many centres have reported improved clinical outcomes for robotic PD. We reviewed the safety and efficacy of robotic PD in comparison to open PD using ‘Therapeutic Index’ (TI).

Method

A systematic review of the literature was conducted in various databases. Articles published between January 2010 and March 2021 reporting totally-robotic and open PD were included, according to PRISMA guidelines. The Cochrane tool was used for risk of bias assessment. We compared 30-day mortality rates (MR30), lymphadenectomy rates (LR), R0 resection rates (R0RR) and therapeutic index (TI). STATA 16.1 was used for statistical analysis.

Results

The four studies that met inclusion criteria included 5090 PDs, out of which 617 were totally robotic (RPD) and 4473 were open (OPD).

Variance ratio tests demonstrated a) Higher TI for RPD versus OPD (1807.42 vs 1723.37, p=0.86), b) Significantly smaller MR30 (2.50 vs 19.00, p=0.0004), c) Significantly lower R0RR (130.50 vs 939.25, p=0.00) and d) No significant difference in LR between RPD and OPD (35.63 vs 38.25, p=0.81).

Meta-regression analysis showed a significantly higher TI coefficient of RPD than OPD (0.66 vs -0.40, p=0.08, α=0.1).

Conclusions

Our study suggests that robotic PD is safe and not inferior to open PD and our analysis RPD demonstrated a higher therapeutic index than OPD. Randomised controlled trials are required to establish the efficacy of robotic PD. Also, standardisation of reporting mortality, survival and oncological outcomes is needed for the effective calculation of TI.
158 Virtual Interactive Surgical Skills Classroom: A Parallel-Designed, Non-Inferiority, Adjudicator-Blinded, Randomised Controlled Trial (VIRTUAL)
Authors: Fricker Monty , Nathan Arjun , Georgi Maria , Patel Sonam , Kien Man Kien , Asif Aqua , Sinha Amil , Mullins William , Shea Jessie , Hanna Nancy , Monks Massimo , Peprah David , Sharma Akash , Ninkovic-Hall George , Lamb Benjamin , Kelly John , Sridhar Ashwin , Collins Justin
Published: November 2022

Introduction

Virtual classroom training (VCT) is a novel educational method that permits accessible, distanced interactive expert instruction. We aimed to evaluate the efficacy of VCT in comparison to face-to-face training (FFT) and non-interactive computer-based learning (CBL) for basic surgical skills training.

Method

72 participants recruited from five London medical schools underwent stratified block randomisation into three equal intervention groups based on subjective and objective suturing experience. VCT was delivered via the BARCO weConnect platform and FFT was provided by expert instructors. Optimal student-to-teacher ratio was used, 12:1 for VCT and 4:1 for FFT. The assessed task was interrupted suturing with hand-tied knots. The primary outcome was post-intervention Objective Structured Assessment of Technical Skills (OSATS) score, adjudicated by two blinded experts and adjusted for baseline proficiency.

Results

VCT was non-inferior to FFT (adjusted difference 0.44, 95% CI: -0.54 to 1.75, delta 0.675), VCT was superior to CBL (adjusted difference 1.69, 95% CI 0.41 to 2.96) and FFT was superior to CBL (adjusted difference 1.25, 95% CI 0.20 to 2.29). FFT alone was associated with student travel expenses (mean £4.88, SD 3.70). Instructor hours used per student for VCT and FFT were 0.25 and 0.75, respectively.

Conclusions

VCT has a similar educational benefit to FFT and is a suitable modality of high-quality surgical skills education. VCT provides greater accessibility and resource efficiency compared to FFT. VCT satisfies the requirement for social distancing during the COVID-19 pandemic and is better than non-interactive CBL. VCT has the potential to improve global availability and accessibility of surgical skills training.
713 The Application of Artificial Intelligence for Digital Imaging in the Operating Theatre: A Systematic Review and Narrative Synthesis
Authors: Hardacre Conor , Fowler George , Quek Fang Fang , Skilton Anni , Blencowe Natalie , Macefield Rhiannon
Published: November 2022

Introduction

Promising applications of artificial intelligence (AI) in healthcare are emerging. This systematic review aims to identify and synthesise applications of digital-imaging AI in surgery and inform future work.

Method

Systematic database searches (Medline, Embase, CENTRAL) were undertaken. Studies concerning digital-imaging AI within the operating theatre were identified from title and abstract screening. Selection was further refined to identify video-based AI models with direct supportive output to the surgeon within the operating theatre.

Results

48 studies were included. Studies spanned 13 specialty groupings, with n=42 utilising a pre-specified dataset and the remaining n=6 using AI with human participants. The most common field using AI was urology (n=9 studies). Applications were most commonly for navigation and visualisation support (n=26 studies across 10 surgical specialties) and AI-based intelligent detection systems, intended to identify and highlight useful surgical information using computer-vision pattern recognition (n=18 articles across n=6 specialties). Other applications included video-processing algorithms (n=3 studies across 2 specialties), and a novel imaging modality for visualising blood perfusion (n=1 study), proposing operating theatre-based application. High-performance models were identified across a range of pathologies. This manifested as minimal overlay errors and acceptable frame rates for navigation tools, and high diagnostic performance for detection systems (determined by area-under-the-receiver-operating-characteristic-curve, sensitivity/specificity, negative/positive predictive values).

Conclusions

There is evidence to suggest AI for intraoperative surgeon-support has potential, particularly through augmented-reality navigation and AI-enabled information awareness. Further research and optimisations are required to produce clinically robust models, which remain high-performance despite case variability. Such AI may support improved surgical access, efficiency, and outcomes.
7 Differential Attainment at the Intercollegiate Membership of the Royal College of Surgeons (MRCS) Examination
Authors: Ellis Ricky , Cleland Jennifer , Scrimgeour Duncan , Lee Amanda , Brennan Peter
Published: November 2022

Aim

The recent Kennedy review on diversity and inclusivity highlighted concerns that some groups of individuals are facing barriers to progression in surgical careers. Differential attainment in performance at MRCS has been identified but not investigated. This study aimed to explore the relationship between socio-demographic differences and MRCS success.

Method

UK graduates attempting MRCS Part A (n=5,780) and Part B (n=2,600) from 2013-2019 were identified using the UKMED database. Univariate associations with MRCS performance were identified using chi-squared tests. Multiple logistic regression identified independent predictors of MRCS success at first attempt, adjusted for medical school performance.

Results

Differences in MRCS pass rates were statistically significant according to graduate status, sex, ethnicity, socio-economic status, and educational background (all P<0.05). After adjusting for prior academic attainment, men (odds ratio [OR] 2.34, 95%CI 1.87–2.92) and non-graduates (OR 1.98, 95%CI 1.44–2.74) were significantly more likely to pass MRCS Part A. Non-graduates (OR 1.77, 95%CI 1.15–2.71) and those who attended a fee-paying school (OR 1.51, 95%CI 1.08–2.10) were significantly more likely to pass MRCS Part B. Black and minority ethnic groups were significantly less likely to pass MRCS Part B at their first attempt (OR 0.41, 95%CI 0.18 to 0.92 for Black candidates and OR 0.49, 95%CI 0.35 to 0.69 for Asian candidates) compared to White candidates.

Conclusions

We found significant differential attainment at MRCS that cannot be attributed to learner deficit. Training institutions and Royal Colleges now have a responsibility to identify and address the causes of these attainment differences to facilitate equitable career progression for surgical trainees.
549 A Study Exploring the Impact of Gender and Ethnicity Diversity on the Experience(s) and Career Development of Surgical Trainees
Authors: Shakoor Zainab , Smith Sue
Published: November 2022

Despite notable ethnic diversity amongst doctors in the UK, female surgeons from an ethnic minority background are particularly under-represented. It is not known if they experience additional challenges and difficulties during surgical training and or with their career progression due to any possible impact of their gender and ethnicity.

A qualitative research methodology was employed, and seven one-to-one interviews were conducted with female participants from ethnically diverse backgrounds. An intersectional approach was used to assess any possible impact of gender and ethnic diversity on experience(s) of surgical trainees and whether or not they had any implications for career progression. Interviews were subsequently transcribed and coded for thematic analysis and for construction of possible theories.

Several themes emerged to account for participants' experiences of negative workplace experiences (NWPE) including racism, sexism, and discrimination throughout surgical training. In addition to these factors, unconscious and explicit forms of bias also had the potential to impact a trainee's career progression through reduced access to senior support, mentorship, theatre cases, and research opportunities. Participants detailed other direct contributors affecting career progress including a lack of senior support, reduced access to role models/mentors, conflicting family and cultural pressures, and institutional forms of racism, sexism and discrimination encountered in their job role as a surgeon and the NHS.

Further research is needed to explore the intersectional experiences of surgical trainees in order to improve the training environment, retain trainees and encourage diversity within surgical careers.
161 Gender Representation Within Editorial Leadership Roles of United Kingdom Surgical journals
Authors: Reeves Samuel , Walker Kieran , Brennan Peter
Published: November 2022

Introduction

Women remain under-represented in surgery in the United Kingdom. Representation on journal editorial boards is a key metric of gender representation within academic surgery.

Aim

To quantify the gender representation within editorial leadership of journals affiliated with United Kingdom surgical specialties.

Method

A list of surgical specialties was obtained from the Royal College of Surgeons England. A web search for United Kingdom specialty associations was conducted. Each association webpage was then searched for an affiliated journal. Once identified, the gender of the editor-in-chief and other leadership positions including associate, section and deputy editors was collected. Gender classification was completed by first name recognition and verified by a web search using the name and institution provided. Managing editors without a clinical background were excluded.

Results

9 journals were identified for the following surgical specialties: General Surgery, Trauma & Orthopaedics, Neurosurgery, Cardiothoracic, Urology, Paediatric Surgery, Ear Nose & Throat, Oral & Maxillofacial, Plastic & Reconstructive Surgery. There was no journal associated with the United Kingdom vascular society.

A total of 195 positions were identified. 164 were occupied by males (84%), and 31 by females (16%). There were no female editor-in-chiefs. The average female proportion of editorial leadership per journal was also 16%. One journal did not have any female representation.

Conclusions

Women are under-represented in surgery and this trend translates to leadership roles within academic journals. If initiatives designed to promote gender parity are to be effective and sustained, surgical journals should scrutinise their own imbalances and seek to rectify them.
943 Gender Inequalities in Surgery: A Literature Review and Social Media Analysis.
Authors: Chrystal Anna , Morgan Heather May
Published: November 2022

Aim

This study identified the current barriers to women in surgery in the UK and evaluated the hashtags that are broadcast via Twitter to expose gender bias within surgery.

Method

A literature review was conducted using key terms to identify the barriers to women in surgery. A Twitter search was conducted via NVivo and Ncapture using keywords to identify the hashtags categorising gender bias and sexism in the surgical profession. Tweet content was qualitatively evaluated to assess gender-based inequalities in surgery in the UK. Tweets were further evaluated to identify evidence of trolling or dismissive behaviour towards surgical sexism.

Results

The literature review identified work-family imbalance, lack of female surgical role models, inflexibility of working hours, the gender pay gap, and female objectification as key barriers to women in surgery. Twitter analysis demonstrated evidence of surgical gender bias throughout UK surgical training using #Surgical#Sexism #HammerItOut #CutItOut and #NHSMeToo, with minimal evidence of trolling and dismissive comments. Twitter provided a platform to support and praise users that speak out against surgical gender bias, including whistleblowers.

Conclusions

Twitter as a social media platform can provide an environment to support users who may be experiencing gender-based bias within their surgical workplace. Twitter may also demonstrate further purpose as a useful aid in whistleblowing within healthcare.
503 The Impact of ‘Golden Local Anaesthetic (GLA)’ Principal on Emergency Theatre Efficiency - Analysing 232 Hand and Plastic Trauma Operations
Authors: Freethy Alexander , Hennessy Conor , Tucker Sarah , Teo Isabel
Published: November 2022

Aim

‘Golden local anaesthetic’ (GLA) principals are known to improve theatre efficiency. This first GLA case should be suitable to be completed unsupervised by a registrar and confirmed 12 hours prior to the start of the list with a negative COVID PCR test. This allows for list to be started, whilst the consultant is able to see and consent the remainder of the patients for that list, maximising theatre efficiency.

Method

Operative timings was gathered in real time in our electronic database (TIMS). Initially, retrospective analysis was performed for cases in November 2020, comparing lists whereby a potential GLA first case was present, versus lists that did not. After remodelling this process, lists in October 2021 were analysed. Statistical analysis was carried out using Mann Whitney U Test.

Results

Initially (PDSA-1), 110 trauma cases (58% GA and 42% LA) were performed [3.67/day] whilst post refinement (PDSA-2) 122 cases (52% GA and 48% LA) were performed [3.94 /day]. In PDSA-2, there was a 29% (9/31) uptake of GLA list principals. The average GLA list start time was 09:27hrs in PDSA-1 and 09:08hrs in PDSA-2 [Δ 19 mins, p<0.05] whilst the average non-GLA list start time was worse (09:53hrs and 10:12hrs). By refining the GLA principal, £470.63 was ‘saved’ with a further £445.86 potentially able to be saved when starting at the earliest recorded start time (1)

Conclusions

The GLA model is a simple and sustainable method to improve theatre efficiency which could be adopted by other units.

(1) Ang WW et al. 2016 - doi:10.1016/j.amsu.2016.03.001
840 PSMA PET/CT in Prostate Cancer (PCa) Management: Outcomes from a high-volume tertiary NHS centre
Authors: Mubarak Mohamed , Tanguay Jacob , Rees John , Narahari Krishna
Published: November 2022

Introduction

PSMA PET-CT (PSMA) is a relatively new development in PCa imaging. We report the role and impact of PSMA in the management of both primary and recurrent PCa since our service's inception in January 2020.

Method

A retrospective analysis of PSMA database was conducted. All patients underwent conventional imaging (CI) [CT/MRI & Bone scan] as well. Indications for PSMA were:

Data collected included demographics, PSA, ISUP grade, D'Amico risk classification, and TNM staging. Data are expressed as median (range) and analysed using SPSS v25.

Results

Overall, 454 scans were reviewed; 175 (38.5%) and 279 (61.5%) scans were offered to evaluate primary and recurrent disease, respectively.

On reassessment with PSMA, 54.2% of all scans showed nodal or metastatic involvement that led to re-staging. More specifically, 56%% of primary cases and 77.1% of recurrent cases had their stage, and consequentially, management plan modified. ISUP, cT3 stage, and D’Amico risk classification were not associated with upstaging (p >0.05).

Overall, there was poor agreement between CI and PSMA when evaluating nodal (k = 0.216, p <0.005) and metastases (k= 0.171, p<0.005) in staging either primary or recurrent disease.

Conclusions

PSMA is superior to CI in staging PCa and significantly alters management in these patients. It should be offered as the first line of staging imaging for primary (high-risk) and prior to salvage therapy.
907 Total Ankle Arthroplasty Versus Arthroscopic Ankle Arthrodesis: A Novel Comparison of Clinical Outcomes and Cost-Utility
Authors: Kurar Langhit , Shah Vinay , Grice John
Published: November 2022

Aim

End-stage ankle arthritis poses numerous healthcare challenges, not least given its high prevalence but also significant limitations in treatment modality. This study compares functional outcomes following total ankle arthroplasty (TAR) versus arthroscopic ankle arthrodesis (AAA). Secondary objectives were to compare complication rates and perform a health economic analysis to estimate cost-effectiveness to the NHS.

Method

A prospective, single centre cohort study of TAR versus AAA in patients diagnosed with end-stage ankle osteoarthritis between 2015 and 2020 with homogenous characteristics. Primary outcomes were assessed through comparing Manchester-Oxford Foot Questionnaire (MoxFQ) scores taken pre-operatively and at specific intervals post-treatment up to one year. A cost-utility analysis via decision tree modelling was performed to derive an incremental cost effectiveness ratio (ICER).

Results

The study involved 42 patients. TAR (22 patients) demonstrated a better functional improvement following cast removal at 3 months (Ẋ = 19.1 [TAR]/ 7.4 [AAA], p= 0.044, CI 95%) and 6 months (Ẋ= 26.1 [TAR]/ 11.5 [AA], p= 0.031, CI 95%). The average improvement of MoxFQ scores over the study was greater following TAR. Values derived from cost-utility analysis produced an ICER of £8,639.51/QALY (quality of life year) for TAR implying that the procedure is cost-effective compared to AAA with respect to the NICE treatment threshold of £20,000/QALY.

Conclusions

TAR provided improved patient reported outcome scores following cast removal. Although overall treatment costs are greater with TAR, reduced complications and better functional outcomes demonstrated greater economic benefit with TAR compared to AAA.
814 Evaluating the Impact of Neurosurgical Rotation Experience in Africa on the Interest and Perception of Medical Students Towards a Career in Neurosurgery: A Continental, Multi-Centre, Cross-Sectional Study
Authors: Dada Olaoluwa Ezekiel , Yang Ooi Setthasorn Zhi , Bukenya George William , Kenfack Yves Jordan , Le Chi , Ohonba Efosa , Adeyemo Emmanuel , Narain Kapil , Awad Ahmed Khaled , Barrie Umaru , Sichimba Dawin , Ogunfolaji Oloruntoba , Kitonga Lilian Mwende , Oriaku Adaeze Juanita , Bamimore Michael Abayomi , Okor Douglas Emeka , Rominiyi Ola
Published: November 2022

Introduction

Africa has the second-highest neurosurgical workforce deficit globally, and many medical students in Africa lack exposure to the field. This study aims to assess the impact of a neurosurgical rotation during medical school in shaping the perception and interest of students towards a career in neurosurgery.

Method

This is a continental, multi-centre, cross-sectional study. A Google form e-survey was disseminated to African clinical medical students between February 21st and March 20th, 2021. Data was analysed using descriptive statistics and adjusted logistic regression modelling.

Results

Data was received from 539 students in 30 African countries (n=30/54, 55.6%). The majority of participants were male (n=289/539, 53.6%) and were from Kenya (n=83/539, 15.4%). Most students had undertaken a clinical neurosurgery rotation (n=278/539, 51.6%); the majority reported a rotation length of four weeks or less (n=181/278, 65.1%). Students with clinical experience were less likely to pursue the specialty (p=0.02) and had a stronger perception that it is more difficult for women to pursue neurosurgery (p=0.0001) when compared to those without clinical experience. However, after adjusting for other factors, students with greater than four weeks of neurosurgical exposure were more likely to express a career interest in neurosurgery (odds ratio [OR]=1.75, p<0.04) and men were more likely to express interest in a neurosurgical career compared to women (OR=3.22, p<0.001).

Conclusions

Our findings support standardised, continent-wide, curriculum development, and advocacy supporting improved gender inclusivity in education and policymaking to improve the quality of neurosurgical exposure during medical school and help tackle the neurosurgical workforce deficit across Africa.
820 Management and Outcomes of Traumatic Paediatric Spinal Cord Injuries in Low- and Middle-Income Countries: A Scoping Review
Authors: Dalle David Ulrich , Sriram Smrithi , Bandyopadhyay Soham , Egiz Abdullah , Kotecha Jay , Kanmounye Ulrick Sidney , Higginbotham George , Yang Ooi Setthasorn Zhi , Adeniran Bankole Nourou Dine
Published: November 2022

Introduction

Traumatic spinal cord injury (TSCI) is a subset of neurotrauma, which is a significant contributor to global trauma mortality and morbidity in children. The management and outcomes of paediatric TSCI in low- and middle-income countries (LMICs) is unknown. We conducted a scoping review to characterise the methods of management and outcomes of TSCI in LMICs.

Method

MEDLINE, EMBASE, and Global Index Medicus were searched from database inception to February 15, 2021. Studies reporting management or outcomes of paediatric TSCI in LMICs were included. Pooled statistics were calculated using measures of central tendency and spread.

Results

A total of 1171 studies were identified, of which, five were included. A total of 212 patients were included in our review with age of participants ranging from 2.5 to 18 years old (mean = 15.4 years). Most patients were male (n=162/212, 76.4%, 95% confidence interval [CI] = 70.7–82.1%). The commonest cited cause of injury was falls (n=104/212, 49.1%, 95% CI = 42.3–55.8%). The most common level of injury was cervical (n=83/212, 39.2%, 95 CI% = 32.6–45.7%). The majority of patients underwent surgery (n=134/212, 63.2%, 95 CI% = 56.7–69.7%). The extent of injury was quantified and classified using the ASIA chart in only one paper. Long-term management data was not present in any of the included studies.

Conclusions

There is a scarcity of published studies reporting the management and outcome of paediatric TSCI in LMICs. There is insufficient data to be compared and to draw a strong conclusion. This hinders the development of guidelines to inform best practice.
197 Non-Traumatic Spontaneous Ileal Perforation: Experience With 125 Cases
Authors: Khalid Sadaf
Published: November 2022

Background

Non-traumatic ileal perforation is a common cause of obscure peritonitis in developing and underdeveloped world. The perforation of the ileum is one of the causes of peritonitis that is difficult to diagnose preoperatively. The objective of the study was to determine the increasing frequency of cases of non-traumatic ileal perforations and their subsequent management

Method

This descriptive case-series included 125 cases presenting in surgical emergency of Lahore General Hospital from 1st January 2014 to 1st December 2014. All patients were resuscitated and underwent emergency exploratory laparotomy.

Results

The causes for perforation were enteric fever in 82 cases (65.6%), tuberculosis in 38 cases (30.4%), adhesions and other causes in 5 cases (4%). The main presenting symptom in all patients were severe abdominal pain associated with fever and abdominal distension. Perforations were surgically treated depending upon the number of perforations, general health status of patient and degree of fecal contamination. In total out of 125 cases, primary repair was done in 9 cases, resection, and end to end anastomosis in 19 cases and in 13 patients’ resection and ileotransverse anastomosis was done. In the case of 78 patients loop ileostomy was done and in 6 patients double barrelled ileostomy was performed.

Conclusions

The incidence of terminal ileal perforations due to typhoid and the tuberculosis is high and carries high mortality and morbidity rates in delayed presentations. Therefore, it is high time now that general public health awareness should be created regarding food handling, sanitation, and personal hygiene.
297 The Surgical Trainee Perception of the Operating Room Educational Environment
Authors: Rupani Neal , Evans Ashish , Iqbal Mohammad
Published: November 2022

Aim

Limited hours and service provision are diminishing training opportunities for surgical trainees. It is therefore imperative to maximise each educational event in theatre. The Operating Room Educational Environment Measure (OREEM) evaluates each component of the theatre learning environment; however, it has not been validated in higher surgical trainees in England. We aim to validate the OREEM and evaluate surgical trainees’ objective perspectives of the current operating room educational environment in one region.

Method

Data was collected over one month from surgical trainees within Health Education Thames Valley using an online questionnaire consisting of: demographic data; the OREEM; a global satisfaction score.

Results

54 trainees participated. The OREEM had good internal consistency (α=0.906, variables=40) and unidimensionality. Mean OREEM score was 79.16%. Areas for improvement included better learning opportunities (72.9%) and pre/post-operative teaching (70.4%). Trainees were most satisfied with the level of supervision and workload (82.9%). No differences between gender (p=0.535) or hospital type (p=0.099) were demonstrated. The learning environment favoured senior trainees (p=0.017). There was a strong correlation between OREEM and the global satisfaction score (p<0.001).

Conclusions

The OREEM was shown to be a reliable measure of the educational environment in theatre. It can be used to identify areas of improvement and as an audit tool. Suggested areas of improvement include facilitating pre- and post-operative teaching, reducing service provision, empowering trainees to plan lists, improving teamwork and using tools to optimise the educational value of each operation. There is a favourable attitude regarding the use of such improvement tools, especially for dissatisfied trainees.
928 Can Medical Students Learn Urethral Catheterisation Through an Escape Room?
Authors: Hanson Mark , Coleburt Damien , Badenoch Thomas
Published: November 2022

Aim

Escape rooms are an exciting way to learn through team-based challenges, particularly lending themselves to practical clinical skills. We sought to understand if escape rooms are beneficial for teaching urethral catheterisation to medical students.

Method

12 third year medical students were given an initial knowledge assessment, before completing the escape room in groups of three. The room consisted of a number of tasks including labelling anatomy, checking patient details, and gathering equipment, and culminated in successfully catheterising a model. On completion they were given a post escape room knowledge assessment, which was repeated two weeks later to assess retention. This was compared to a control group undertaking a traditional teaching method.

Results

Initially, on a Likert scale of 1–5, 69% (n=9) stated that they were a 1 for confidence in performing a urethral catheterisation. After the escape room, all students recorded a 3 or 4, and two weeks later confidence remained at an average of 3 (n=8). 34.6% of questions were answered correctly in the pre assessment, improving to 90% at the post assessment, and two weeks later remained high at 84.1%.

Conclusions

Students' knowledge of urethral catheters significantly improved following the escape room, mirrored by their increase in confidence. Despite having never observed or inserted a urethral catheter, all groups successfully catheterised the model, and found the active learning process more engaging.
520 Augmented Reality (AR) Presents a Novel Approach to Improving Surgical Training for Medical Students
Authors: Aziz Khawaja , Chong Dolly Li , Haq Taha , Falconer Stuart , Lewington Andrew
Published: November 2022

Aim

Surgical specialities are underrepresented in medical schools with students often feeling that anatomy teaching is suboptimal. Augmented reality (AR) presents a novel approach of improving anatomical knowledge. This study aims to evaluate AR as a method of preparing students for their surgical placements through a series of surgeon-led anatomy tutorials.

Method

The Microsoft HoloLens 2 was used to project a 3D anatomical model and deliver small group renal anatomy tutorials, with a focus on transplant surgery. Questionnaires and MCQs were completed by participants before and after tutorials, assessing key themes of anatomical knowledge, self-perception of renal anatomy knowledge and a comparison of AR to traditional methods. All responses were anonymised, and qualitative feedback evaluated u­­sing a 5-point Likert scale.

Results

Nineteen medical students, from a variety of year groups, were recruited from a single medical school. 63% were in their 4th year of study. Average MCQ results improved by 18% before and after the tutorial. Self-perceived confidence regarding renal anatomy improved from 2/10 pre-tutorial to 8/10 post-tutorial. 95% of students preferred AR teaching ­to traditional methods such as slide-based teaching. 85% preferred it over dissection-based methods. Technical limitations of the HoloLens were discovered during the study and nearly half of participants reported some symptoms of cybersickness.

Conclusions

AR based anatomy tutorials offer a more interactive and engaging experience than traditional methods and are positively received by medical students. As an adjunct alongside traditional methods, AR offers innovative opportunities of improving anatomy education and surgical training within medical schools.
1016 Assessing the Impact of Axillary Lymph Node Dissection on 30-Day Breast Cancer Surgery Outcomes Across Global Income Settings
Authors: Shiell Bethany , Knight Stephen , Harrison Ewen
Published: November 2022

Aim

To determine the impact of axillary lymph node dissection (ALND) for breast cancer on 30-day mortality and complication rates across different income settings.

Method

GlobalSurg3 was a multicentre, international prospective cohort study of patients undergoing surgery for breast cancer. Primary outcomes were death, major complications (Clavien-Dindo III/IV) or surgical site infection (SSI), as defined by the CDC criteria, within 30 days of surgery. Income levels were defined using the World Bank classification. Patient characteristics, presentation and disease factors were analysed across income levels. Multivariate logistic regression models were used to determine the impact of ALND across income group.

Results

This analysis included 8,406 patients undergoing surgery for breast cancer. Most patients presented with invasive ductal carcinoma (75%). The number of lymph nodes within resection samples were higher in low-lower middle-income countries (mean 13.3, SD 7.8) than in high income countries (mean 4.6, SD 6.3). Mortality and major complication rates were similar across country income groups. However, SSI was elevated in low/lower middle groups (aOR 2.33, 95% CI 1.75–3.12) than in upper middle income (aOR 1.86, 95% CI 1.34–2.59) and high-income groups when ALND was performed. The risk of readmission was also higher.

Conclusions

Major outcomes following ALND in patients with breast cancer were similar, however the high rate of SSI seen in LMICs is likely to significantly impact patient quality of life and potentially delay adjuvant treatment when available. Higher lymph node clearance within this setting may reduce the risk of recurrence but to the detriment of short-term outcomes.
309 Sonograhic Appearances of Hobnail Thyroid Carcinoma: A Rare Tumour
Authors: Karunaratne Nisal , Kirkland Paul , Zhang Ting Ting , Shiekh Ali Zainab Al , Howlett David
Published: November 2022

Background

Hobnail papillary thyroid carcinoma is a rare, recently described papillary thyroid carcinoma variant, with potential for a more aggressive clinical course of disease and poorer prognosis1. The ultrasound features of papillary thyroid carcinoma variants can differ from known traditional features1 and the specific sonographic findings of the hobnail variant itself have not been previously described in the literature.

Case report

A 53-year-old man presented with a left thyroid mass. The ultrasound features of this mass included a predominantly cystic appearance with mobile internal echoes, vascularised internal septations, and murally based solid material. These ultrasound features were deemed benign by classification standards, which led to the patient being managed with active surveillance and interval imaging. However, the mass grew quickly, and the patient underwent diagnostic hemithyroidectomy which led to hobnail variant papillary thyroid carcinoma being found on pathology. Given that papillary thyroid carcinoma variants can lead to aggressive disease, the patient underwent completion thyroidectomy and level VI lymph node clearance, on multidisciplinary team recommendation.

Discussion

The ultrasound features of the hobnail variant of papillary thyroid carcinoma have not been previously described in detail in the literature and, in this case, are features that would be deemed benign by classification standards. The rapid growth of the mass is what led to clinical suspicion of malignancy and resulted in diagnosis. Therefore, careful clinical correlation is advised in order to discern this difficult diagnosis and to facilitate appropriate treatment.
499 A 15-Year Experience of Colorectal Pulmonary Metastasectomy in a High-Volume Tertiary Referral Centre
Authors: Taylor M , Singhania A , Biswas S , Grant S W , Krysiak P , Fontaine E , Granato F , Joshi V , Rammohan K S
Published: November 2022

Aim

PulMiCC trial results have challenged the role of pulmonary metastasectomy as part of the management of metastatic colorectal cancer in contemporary practice. We aimed to review short and long-term outcomes for patients undergoing surgical resection of pulmonary colorectal metastases.

Method

Retrospective analysis of electronic-patient-record data was performed. All patients undergoing lung resection for pathologically confirmed colorectal pulmonary metastatic disease from November-2005 to May-2021 were included. In-hospital, 90-day, 1-year, 2-year, 5-year and 10-year mortality rates were analysed. Cox proportional hazards regression analysis was used to identify factors associated with reduced overall survival. Statistical analysis was undertaken using SPSS version-28.

Results

619 patients underwent surgery during the study period. Mean age was 66.0 years (±10.0) and 61.2%(n=379) were male. 68.7%(n=425) underwent open surgery. 151(24.4%) had multiple metastases resected. Median follow-up time was 45(IQR 23–87) months. In-hospital mortality was 0.3%(n=2) and median post-operative length of stay was 4(IQR 3–5) days. 90-day, 1-year, 5-year and 10-year mortality rates were 1.1%(n=7/619), 4.5%(n=26/580), 40.6%(n=165/406) and 74.0%(n=208/281), respectively. After multivariable analysis, advanced age (HR 1.026, 95% CI 1.011–1.043, p<0.001) and resection of more than one metastasis (HR 1.524, 95% CI 1.108–2.097, p=0.010) were independently associated with reduced overall survival.

Conclusions

Although there is inherent selection bias associated with patients referred for surgical management of colorectal cancer, our results demonstrate extremely low short-term mortality and encouraging longer-term outcomes for these patients. Advanced age and the presence of more than one metastasis at the time of surgery were associated with worse prognosis.
8 The Impact of Early Surgical Training on MRCS Performance
Authors: Ellis Ricky , Cleland Jennifer , Lee Amanda J , Scrimgeour Duncan SG , Brennan Peter A
Published: November 2022

Aim

Surgical training experiences differ across Foundation Programme (FP) and Core Surgical Training (CST) deaneries in the UK. We, therefore, assessed whether MRCS success is associated with FP and CST deaneries.

Method

UK FP (n=553) and CST (n=1104) trainees who attempted MRCS over a three-year period were included. Chi-squared tests examined univariate associations. Multivariate logistic regression identified the likelihood of MRCS success depending on deanery, adjusted for socio-demographic factors.

Results

MRCS Part A success was associated with FP deanery (P<0.01). Part A and Part B success was associated with CST deanery (P=0.01). FP trainees from Thames Valley (Odds ratio [OR] 5.75 (95%CI 1.57–20.99) and North, Central and East London (OR 3.66 [95%CI 1.14–11.80]) were more likely to pass Part A than their peers. CST trainees from Thames Valley (Odds Ratio [OR] 2.52 (95%CI 1.00–6.42), North Central and East London (OR 2.37 [95%CI 1.04–5.40]) and South London (OR 2.36 [95%CI 1.09–5.10]) were more likely to pass Part A. CST trainees from North Central and East London were also more likely to pass Part B (OR 10.59 [95%CI 1.23–51.00]). There was no significant correlation between MRCS performance and National Training Survey satisfaction scores.

Conclusions

MRCS success is associated with FP and CST deanery; however, MRCS performance does not correlate with subjective assessment of teaching or training quality. Academic ability likely has a larger impact on MRCS performance than training experiences with the more popular deaneries attracting the highest performing candidates. These results will be of interest to trainees, trainers, and training deaneries.