bluuebunny/crossref_metadata_2025 huggingface dataset:
165 Schools Engagement Will Improve Equality and Diversity Within Orthopaedics and Surgery
Authors: Schenk E , Maggs R , Franklin M
Published: July 2024

Aim

Inclusivity and diversity of individuals from lower socioeconomic backgrounds is unequal within surgery. Diversification of the workforce is a requirement for the future of surgery to ensure high quality patient care is provided (Hassan, 2023). The School’s Engagement Session, originating with the British Hip Society and replicated with British Orthopaedic Association (BOA), aimed to introduce the idea of a career in medicine or surgery to children from non-selective state schools.

Method

Three school groups, twenty-four students and three staff members, attended day three of the annual BOA conference. Highly engaging medical student presentations, industry stand activities, and hands-on consultant led surgical based stations sparked interest and provided ‘work-experience’ opportunities; an increasingly challenging pre-requisite for applicants to acquire. Resources, lunch, and room availability were all supported by the BOA.

Results

Directly addressing students from lower socioeconomic backgrounds about a career in surgery, which many had not previously considered, stimulated their interest in this as a career. Feedback from accompanying educators, acknowledged their lack of insight regarding accessibility, and students explicitly demonstrated the positive impact of these in-person engagement events. Many students explained how this newly acquired knowledge had empowered the possibility of pursuing a medical career.

Conclusions

Replication of this highly successful event demonstrated the impact of engagement with individuals from diverse backgrounds upon future surgical diversity. Nationwide reproducible events are therefore warranted to reduce inequality in medicine and surgery. Medical student through to consultant involvement with future engagement work will diversify and sustain the surgical workforce within the UK.
550 Implementation of Inclusive Initiatives at a Grassroot Level to Ensure Long-Term Equality, Diversity, and Inclusivity in Surgery
Authors: Salem Fouda S , Asim N , Alberto I , Irfan M
Published: July 2024

Aim

Promoting equality, diversity and inclusion in surgery begins at ensuring accessible initiatives are executed at a grassroot level for prospective students. The Royal College of Surgeons illustrated that 20% of their surgical leadership positions were from BAME communities.

SGUL MedEd Society aims to support students from widening participation (WP) backgrounds in their medical application by addressing disparities and providing support within these areas.

Method

We conducted free sessions aimed at different aspects of the medicine application with the intention of facilitating understanding and support for WP students. Multiple domains were covered such as a UCAT webinar, an ‘Experience into medicine’ simulated workshop covering the key learning styles employed in university as well as multiple mini-interview (MMI) preparation through an online webinar and in-person mock. Feedback forms were implemented before and after sessions using 5-Point Likert scales to measure changes in confidence.

Results

An increase in confidence applying to medical school was observed in the ‘Experience into medicine’ workshop (n=25) with a 60% rise in students rating 4/5. Statistical analysis was carried out on the results obtained from the MMI webinar (n=169) using the Wilcoxon signed-rank test which suggested the initiative significantly improved students’ confidence (w=14, a=0.005). This was followed by a practice MMI session (n=68) whereby 50% of students reported feeling more prepared for a real MMI.

Conclusions

These results suggest there is a substantial improvement in confidence in WP students after the event, increasing the likelihood of inclusivity in medicine. This has wider implications in supporting applications into surgery in the future.
711 Bullying Culture Within Neurosurgery and Spinal Surgery Centres - a Scoping Review of the Current Social Inclusion Policy Surrounding Neurosurgical Practice in the United Kingdom
Authors: Wellington J , Yu Ka Chun J , Yassa B
Published: July 2024

Aim

Homogeneity within surgical academia has been shown to precipitate increased risks of erroneous diagnoses and impede innovation. Successive generations have introduced equality, diversity, and inclusivity (EDI) to the surgical workforce. However, healthcare professionals, especially those in training, still experience bullying and harassment, particularly in neurosurgery and spinal surgery (SS). Therefore, a scoping review (SR) was conducted to evaluate bullying culture within neurosurgery and SS centres globally, focussing on British institutions.

Method

SR complied with the Arksey and O'Malley framework, where PubMed/MEDLINE, Embase, and Google Scholar were searched between 2020-current. Only relevant papers were screened per inclusion criteria to keywords: ‘bully’, ‘harass’, ‘neurosurgery’, and ‘spine surgery’, adhering to PRISMA-SR guidelines. Using pretested forms, two separate reviewers conducted review selection and characterisation.

Results

Articles searched surmounted 13,298, where 37 select articles, of which 8 were included in final analysis. Of these, letters, editorials, and cross-sectional surveys accounted for 25%, 37.5%, and 37.5%, respectively. Common themes comprised EDI workforce embracement and collective policy implementation for dynamic social change (n=62.5%). Issues related to institutional reputation (n=50%), barriers to career prospects (n=25%), retaliation (n=12.5%), and stress (n=25%) amongst healthcare professionals raising concerns.

Conclusions

Facing discrimination, prejudice, and harassment is immoral and unethical in the context of neurosurgical or SS training. While original research evaluating EDI issues in surgery has proliferated, emphasis should be exercised when assessing this impact among neurosurgical and SS trainees. Our SR elucidates that social change remains contentious in neurosurgery and SS. Further work is warranted to establish such perspectives within the UK.
439 Predictors of Treatment Pathway Completion in Stage IV Rectal Cancer: A Nationwide Observational Study of 15,727 Patients
Authors: Lakha A S , Chammas L , Morris E , Gordon-Weeks A
Published: July 2024

Aim

Stage IV rectal cancer carries a 10% 5-year survival rate. Curative-intent management requires treatment of both the primary and metastatic disease. This study aimed to identify patterns in stage IV rectal cancer treatment pathway at population level across the UK, and to identify predictors of treatment pathway completion.

Method

Patient demographics and treatment data were extracted from the UK Colorectal Cancer Intelligence Hub’s CORECT-R repository, national chemotherapy (SACT), and radiotherapy (RTDS) datasets. Treatment pathway completion was defined as receipt of intervention to the primary tumour (radiotherapy and/or surgery) in addition to metastasis-directed therapy (surgery, radiotherapy, OR ablation), or the combination alongside chemotherapy. Multivariable logistic regression analysis was performed to identify independent predictors of treatment completion.

Results

A total of 15,727 patients with stage IV rectal cancer diagnosed between 2010-19 were identified. Multivariable analyses showed that sex, age, number of cancer alliances (CAs) attended, ethnicity, and deprivation score were all statistically significant in predicting completion of treatment (p-values<0.02). The number of CAs attended was identified as having the strongest predictive effect of treatment completion (OR=3.9, CI: 3.5–4.3). Being male also increased the odds of completing treatment (OR=1.2, CI: 1.1-1.3), while increased deprivation reduced odds of completing treatment.

Conclusions

Across the UK, there is variation in Stage IV rectal cancer patients completing treatment for both their primary and metastatic disease. Further work is needed to determine whether differences in treatment pathways stem from variation in access to specialist services between alliances or whether they are due to differences in MDT decision making.
822 Burn Bright, Learn Brighter: Igniting Expertise in Burns Care with Virtual Reality
Authors: Hirniak J , Nikookam Y
Published: July 2024

Aim

To assess the effectiveness of a burns assessment and management course for junior doctors, comparing virtual reality (VR) training with traditional didactic instruction and moulage.

Method

Foundation doctors (n=36) were divided into two groups: one receiving VR training and the other traditional instruction with in-person moulage practicals covering burns assessment and emergency management. An objective structured clinical examination (OSCEs) and pre, post and 6-weeks post-course questionnaires assessed knowledge retention and performance. Analysis involved paired sample t-tests. Qualitative analysis evaluated post course feedback.

Results

The VR group exhibited a significant increase in burns assessment accuracy and knowledge (p<0.05) but a decrease in burns management (p<0.05) compared to the control group in the OSCE. Both groups demonstrated significant improvement of 24% (VR, p<0.05) and 21% (control, p<0.05) in knowledge post-course. There was also significant retention at 6-weeks, with mean improvement of 19% (VR, p<0.05) and 17% (control, p<0.05). Qualitative feedback highlighted the VR's superior visualisation in assessment scenarios, while moulage-based practicals were perceived as more realistic for burns management. 33% considered an occupation in burns as a subspecialty, 100% reported increased confidence in burns assessment and management.

Conclusions

VR training proved effective in enhancing burns assessment skills, but its realism in burns management scenarios was questioned. Integrating VR alongside traditional methods demonstrated a comprehensive improvement in participants' overall burns care competency and a notable boost in confidence levels. Findings underscore the importance of balancing technological advancements with practical realism in plastic surgery education.
531 Research Priorities for Oesophageal Cancer : Results from a Priority Setting Partnership
Authors: Crotty F , Ao Lik L , Tan E , Gergaghty V , Murray P J , Murray T , O’Connor P , Delaney F , Tansey C , Moore J , Lysaght J , Ravi N , Reynolds J , Donohoe C
Published: July 2024

Aim

Oesophageal cancer is the seventh most common cancer worldwide and the sixth leading cause of cancer-related deaths, and it remains one of the hardest cancers to treat. Despite advances in the last decade, oesophageal cancer still has high morbidity and mortality burdens, and further research is needed to improve those outcomes. The aim of the Priority Setting Partnership was to bring together patients, family, caregivers, and the multidisciplinary healthcare team to identify and prioritise the most important unanswered questions for future research.

Method

Following the James Lind Alliance methodology, different stakeholders were asked to list their uncertainties about oesophageal cancer, which were then checked against existing evidence, categorised, and formed into questions. These then went through a survey for interim ranking, and those shortlisted were discussed at a final workshop to identify the Top 10 unanswered research questions.

Results

230 responders to the initial survey, two-thirds of which were patients, revealed 365 uncertainties. After removing duplicates and previously answered questions, sixty-three remained for interim ranking, and twenty-five were shortlisted for the workshop. Participants agreed on their Top 10 priorities, which covered topics such as prevention, current and novel treatment options, nutrition, survivorship concerns, and risk factors for developing oesophageal cancer, particularly at a young age.

Conclusions

Patients, family members, carers, and healthcare professionals collaborated to identify the most important questions for oesophageal cancer research. The results can help direct funding and attention to the shared priorities of those with personal experiences living with and providing care for oesophageal cancer.
231 A Comparative Study Between Open Pre-Peritoneal Approach Versus Laparoscopic Trans-Abdominal Pre-Peritoneal Approach in Recurrent Inguinal Hernia Repair: A Prospective Cohort Study
Authors: Hassan B , Awad P , Elkomos B
Published: July 2024

Aim

To compare the open pre-peritoneal approach and Laparoscopic trans-abdominal pre-peritoneal approach in the management of recurrent inguinal hernia which was previously managed through an open anterior approach regarding their intra-operative time, the post-operative outcomes.

Method

The current study is a prospective cohort study, a single-center trial conducted from June 2021 to June 2022 at Ain Shams University Hospitals.

Results

There were 74 patients in our study 37 patients in each group. Group (I) underwent an open pre-peritoneal approach and group (II) underwent a Laparoscopic trans-abdominal pre-peritoneal approach. Regarding intra-operative time, the mean time in minutes in the group (I) is 63.33 with a standard deviation of ±11.95. While in group (II) the mean time in minutes is 81.21 with a standard deviation of ±18.03 (p=0.015). Regarding the hematoma occurred in 4(10.8%) patients in group (I). While in 2(5.4%) patients in group (II) (p=0.674). The wound infection was found in 5 (13.5%) patients in group(I) and zero patients in group (II)(p=0.021). Finally, recurrence after one year was found in 3(8.1%) patients in group(I) and 1(2.7%) patient in group (II) (p=0.615).

Conclusions

The results of this study demonstrate that both approaches are effective for recurrent inguinal hernia following anterior approach mesh hernioplasty, with comparable results. Laparoscopy has been associated with a lower rate of recurrence and overall complications compared to open technique, however, it is difficult to draw definitive conclusions about the preferred option due to its lengthy learning curve and difficulty to perform.
1172 Innovative Low-Cost Vascular Anastomosis Simulation Training Model for Vascular Anastomosis Training
Authors: Abdullah M , Deshpande R , Khambalia H , Giuffrida G , Moinuddin Z , van Dellen D
Published: July 2024

Aim

Vascular anastomosis is an important but complex skill requiring mastery by trainees across multiple specialities, with significant risk of suboptimal outcomes. Simulation allows multiple repetitions of a procedure within controlled environment, allowing training without accompanying patient risk. Current simulation courses on vascular anastomosis are expensive and inaccessible to several junior trainees. A low-cost scaffold was developed for vascular anastomosis training and aimed to assess trainee feedback on utility and acceptability.

Method

The kit was built using following: Six 27 x 0.9 cm latex balloons, Ferrero Rocher chocolate box, Polypropylene 6.0 surgical sutures, Castroviejo needle holder and Forceps. Sharp scissors were used to make openings in the chocolate box, the balloons were then passed through. The kit’s utility was assessed via trainee feedback (N=16, ranked 1-5 where 1 was Unsatisfactory and 5 was Excellent).

Results

Trainees were able to perform various types of anastomoses: end-to-end, end-to-side, and patching, using our model. The resistance to needle passage through latex balloons was found to closely resemble that of real arteries and veins. Median rating of different categories in trainee feedback were as followed: Improved understanding 4, Helped practice 5, Realistic 4, Appropriateness for learning 4 and Affordability 5, ranging between 3 and 5.

Conclusions

Improved skills lead to better outcomes in surgical practice. Steps should be taken to make simulation more accessible. Low-cost models help reduce financial impact on trainees and are suitable for a wide range of institutions, including those with limited resources. Subsequent research should assess the effectiveness of this model across various contexts.
503 An Audit of the Management of Ankle Fractures Undergoing Open Reduction Internal Fixation (ORIF) Against the British Orthopaedic Association (BOA) Standards for Trauma
Authors: Yung E , Senthilkumaran S
Published: July 2024

Aim

To assess compliance of the management of ankle fractures with ORIF at Aberdeen Royal Infirmary and Woodend Hospital against the management of ankle fractures guidelines in the BOA standards for trauma.

Method

A retrospective analysis of patients who underwent ORIF of ankle fractures from 12/06/2022 to 06/06/2023 was conducted. Pilon fractures and open fractures were excluded. Operations notes, admissions, discharge and clinic letters, and imaging were used.

Results

201 patients met the inclusion criteria. 155 patients had complex fractures (posterior malleolus involvement, Maisonneuve, or syndesmotic injury); 46 had non-complex fractures. Only 47.74% of the complex fractures underwent CT imaging. Post-operation, only 14.43% and 12.45% of patients were full weight-bearing and partially weight-bearing, respectively. 97.01% of all patients had a follow-up clinic within 6 weeks post-operation. However, following the first clinic follow-up, only 24.88% and 25.87% were full weight-bearing and partially weight-bearing, respectively. The remaining patients were classified as non-weight-bearing.

Conclusions

Most of the patients were managed according to the guidelines. However, greater use of CT imaging for complex fractures can be done for defining fracture configurations. Additionally, more patients need to be allowed weight-bearing immediately post-operation and after their first follow-up clinic, as promoted by the BOA. Results were presented at the 21/11/23 mortality and morbidity meeting, and this issue was acknowledged by the orthopaedic surgeons. The post-operation note template will be revised, and a poster including the BOA guidelines on weight-bearing and imaging will be introduced in the department. A re-audit will be done in 2024 to assess any changes.
541 Development and External Validation of the “Global Surgical-Site Infection” (GloSSI) Predictive Model in Adult Patients Undergoing Abdominal Surgery
Authors:   GlobalSurg Collaborative NIHR Global Research Health Unit on Global Surgery, McLean K
Published: July 2024

Aim

To develop a novel prognostic score to predict 30-day surgical-site infection (SSI) following gastrointestinal surgery, and externally validate in comparison to existing prognostic models.

Method

This was a secondary analysis of 3 independent prospective international cohort studies conducted on a global basis. This included adults undergoing gastrointestinal surgery. Model development was performed in the GlobalSurg-2 dataset (January-July 2016). The primary outcome was 30-day SSI, with two predictive techniques explored: penalised regression (LASSO) and machine learning (XGBOOST). Final model selection based on prognostic accuracy (Area Under the Curve [AUC], 95% confidence interval) and clinical utility. Novel and previous scores were externally validated in GlobalSurg-1 (July-November 2014), and GlobalSurg-3 (April-October 2018).

Results

30,029 patients were eligible: 14,019 (SSI=12.3%) in the derivation cohort, and 8,464 (SSI=11.4%) and 7,546 (SSI=15.7%) in the validation cohorts (GlobalSurg-1 and GlobalSurg-3 respectively). The LASSO model was selected due to similar discrimination to XGBoost in the GlobalSurg-2 dataset (AUC: 0.738, 0.725-0.750 versus 0.737, 0.709-0.765), but greater explainability. The final GloSSI score included six variables: country income, ASA, diabetes, and operative contamination, approach, and duration. Discrimination remained good on external validation in GlobalSurg-1 (AUC: 0.730, 0.715-0.744), but moderate discrimination in GlobalSurg-3 (AUC: 0.606, 95% CI 0.588-0.623). Nonetheless, this demonstrated superior performance to external validation of all previous models evaluated within GlobalSurg or prior datasets.

Conclusions

The GloSSI score allowed accurate prediction of SSI with 6 simple variables routinely available at surgery across income settings. This can inform use of intraoperative and postoperative interventions to modify the risk of SSI and minimise associated harm.
229 A Comparative Study Between Laparoscopic Sleeve Gastrectomy with Omentopexy Versus Conventional Laparoscopic Sleeve Gastrectomy: A Prospective Cohort Study
Authors: Awad P , Hassan B , Elkomos B
Published: July 2024

Aim

Sleeve Gastrectomy, is a widely used procedure globally. However, omentopexy is a newly added variation, which involves reattachment of the omental to the stomach. Currently, there is not enough data regarding this technique, so this study evaluates the impact of omentopexy in Laparoscopic Sleeve Gastrectomy on intra-operative time and complications within one year of follow-up.

Method

A prospective cohort study was conducted from June 2021 to June 2023 in Ain Shams University Hospitals and other non-government hospitals, which included 174 for a one-year follow-up.

Results

In our study 87 patients in each group. Both groups underwent Laparoscopic Sleeve Gastrectomy, Group (I) with omentopexy while Group (II) without omentopexy. Regarding intra-operative time, the mean time in minutes in the group (I) is 115.45 minutes with a standard deviation ±11.19. While in group (II) is 79.8 minutes with a standard deviation of ±13.3 (p=O.001). Regarding complications rate within one year. leakage occurred in 1(1.14%) patient in group (I). While, in 3(3.4%) patients in group (II) (p=0.62). Bleeding was found in 1 (1.1%) patient in group(I) and 2(2.3%) patients in group (II) (p=1). GERD was found in 10(11.49%) patients in group(I) and 12(13.7%) patients in group (II) (p=0.82).

Conclusions

Omentopexy with LSG has shown to be a successful merging technique in terms of decreasing the rate of leakage and bleeding, although it appears to require more operative time, further refinement of the learning curve is possible to further reduce operative time.
230 A Comparative Study Between Central Quadrantectomy and Nipple Resection with Areola Preservation Versus Grisotti Flap Mammoplasty in Central Breast Lesions Extending to Nipple: A Randomized Clinical Trial
Authors: Awad P , Hassan B , Elkomos B
Published: July 2024

Aim

To evaluate central quadrantectomy and nipple resection with areola preservation (CQ-NR-AP) as a new reconstructive oncoplastic technique Versus Grisotti flap mammoplasty (GFM) in central malignant tumours of the breast extending to the nipple, in terms of time procedures, breast symmetry, patient satisfaction, post-operative complications and local recurrence.

Method

The current study is a single-blind, prospective, randomized, controlled, single-center trial conducted from May 2018 to May 2023 in the breast surgical unit of Ain Shams University Hospitals, which included 40 patients presented with central breast lesions extending to the nipple including one-year follow-up postoperative.

Results

As regards the mean intra-operative time in minutes, in the group (I) was 80.1 with a standard deviation of ±13.9, and ingroup (II) was 138.9 with a standard deviation of ±14.02(p=0.001). The seroma was detected in zero cases in group (I) and 2(10%) cases in group II (p=0.487) and those two cases were managed by aspiration only. Regarding, the wound infection was found in one case (5%) in group (I) and 3(15%) cases in group II (p=0.605). Regarding patient satisfaction and breast symmetry was much better in the group (I)

Conclusions

Central quadrantectomy and nipple resection with areola preservation were determined to be safer, easier, and associated with a lower incidence of complications in one-year follow-up as compared to the Grisotti flap mammoplasty technique. In addition, better patient satisfaction is one of the most difficult accomplishments in the management of centrally located breast tumors.
127 Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention in Heart Failure with Reduced Ejection Fraction Patients: A Systematic Review and Meta-Analysis Stratified by Left Ventricular Ejection Fraction
Authors: Hammad A , Jubouri M , Al-Tawil M , Awad W , Bashir M
Published: July 2024

Aim

The primary objectives were to assess differences in mortality, repeat revascularization, new postoperative myocardial infarction (MI), and cerebrovascular accidents (CVA/stroke) between PCI and CABG in HFrEF patients, stratified by the degree of LVEF reduction.

Method

A comprehensive search of electronic databases was conducted, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria comprised clinical trials or observational cohort studies with ≥20 patients per group, comparing long-term outcomes in HFrEF patients (LVEF <50%) who underwent PCI or CABG. Data was extracted, and quality was assessed using the New Castle Ottawa (NOS) Risk of Bias tool. Hazard ratios (HRs) were pooled for time-to-event outcomes, with subgroup analysis based on LVEF. Heterogeneity was assessed, sensitivity analysis conducted, and publication bias evaluated.

Results

Twenty studies involving 25,031 patients met the inclusion criteria. In the severe LVEF reduction group (<35%), CABG was associated with significantly higher long-term survival, reduced repeat revascularization, and fewer postoperative MIs compared to PCI. In patients with moderate LVEF reduction (<40%), there was no difference in long-term survival, but repeat revascularization was lower in the CABG group . In the mild LVEF reduction group (<50%), CABG was associated with superior long-term survival and reduced repeat revascularization. Stroke rates were similar between PCI and CABG in all groups.

Conclusions

Individualized patient care should consider the degree of LVEF reduction when selecting between PCI and CABG, with CABG generally favored for improved outcomes in HFrEF patients. However, clinical presentation, patient characteristics, and cost-effectiveness should also be considered in the decision-making process.
232 A Comparative Study Between Stapled Hemorrhoidopexy and Harmonic Scalpel Hemorrhoidectomy in Management of Third and Fourth-Degree Piles: A Randomized Clinical Trial
Authors: Hassan B , Awad P , Elkomos B
Published: July 2024

Aim

This study compares the results of stapled hemorrhoidopexy (SH) and harmonic scalpel hemorrhoidectomy (HSH) in the management of Grade III and Grade IV piles.

Method

The current study is a single-blind, prospective, randomized, controlled, single-center trial at Ain Shams University Hospitals.

Results

There were 70 patients in our study 35 patients in each group. Group(I) underwent stapled hemorrhoidopexy (SH) and Group (II) underwent harmonic scalpel hemorrhoidectomy (HSH). The mean time of the procedure in SH was 24.42 mins ± 2.367. While in HSH was 31.48 mins ± 2.21. Post-operative pain in SH showed to be less painful during the first two weeks. However, there is persistent mild pain in most of the patients of SH postoperative during and after two weeks. However, in HSH there was significant improvement in pain after two weeks. Wound infection was detected in 3(5%) patients in group (I) and no patients in group (II) (p=0.077). Postoperative bleeding occurred in 4(11.4%) patients in group (I), While no patients were detected in group (II) (p=0.039). there were 3(15%) cases of incontinence to gases only scored by Wexner score 3/20 in group (II). Recurrence in one-year follow-up occurred in 7 (20%) patients in group (I). While in group II 1(2.9%) patient was reported with recurrence (p=0.024).

Conclusions

HSH was determined to be safer, easier, and associated with a lower incidence of recurrence in one-year follow-up as compared to the SH technique. In addition, better patient satisfaction is one of the most difficult accomplishments in the management of hemorrhoids.
1053 Parathyroid Phenomenon Causing Primary Hyperparathyroidism: A Case for Surgeons, Radiologists and Pathologists
Authors: Griffin K , McKnight K , Al-Kendi B , Kerin M , Abd Elwahab S M
Published: July 2024

Background

Parathyroid lipoadenomas are a rare parathyroid phenomenon and an unusual cause of primary hyperparathyroidism. The histological composition of these neoplasms makes them a diagnostic challenge, as their high adipose content leads to difficulty localising them on imaging and can lead pathologists towards a wrong diagnosis. There are less than 100 cases in the literature since they were first described in 1958, and to our knowledge this is the largest parathyroid lipoadenoma to be reported.

Method

A minimally invasive parathyroidectomy with intraoperative parathyroid hormone monitoring was performed in the case of a male with a large neck mass and symptomatic primary hyperparathyroidism.

Results

A giant parathyroid lipoadenoma was excised, with an appropriate decrease in intraoperative parathyroid hormone level observed. The patient has been cured of his primary hyperparathyroidism, with no issues following his discharge from our institution.

Conclusions

We highlight the importance of having the parathyroid lipoadenoma as a differential diagnosis for patients who develop primary hyperparathyroidism.
258 Ultrasonography-Guided Drainage Versus Surgical Drainage for Deep Neck Space Abscesses: A Systematic Review and Meta-Analysis
Authors: Alzaid M , Ramadhan M , Abul A , Karam M , Alsaif A , Stapleton E
Published: July 2024

Aim

Deep neck space abscesses (DNAs) are relatively common otolaryngology-head and neck surgery emergencies. We conducted the first and robust systematic review and meta-analysis to evaluate outcomes for ultrasonography-guided drainage (USD) versus conventional surgical incision and drainage (I&D).

Method

The protocol was published a priori (PROSPERO: CRD42023466809) and the study adhered to PRISMA guidelines. MEDLINE, EMBASE, Cochrane CENTRAL and key ENT journals were searched. Primary outcomes were length of hospital stay and recurrence. The secondary outcomes included scar formation/cosmetic, reported complications and cost savings. The quality of included studies was assessed using the Cochrane ROBINS-I and RoB2.0 tools. Fixed effects model was applied.

Results

Of 646 screened articles, seven studies enrolling 384 participants were included. USD was associated with a significantly shorter length of hospital stay (Mean Difference [MD] = -2.31, P < 0.00001), but no statistically significant difference was noted in the recurrence rate compared to I&D (odds ratio [OR] = 2.02, P = 0.21). USD appears to be associated with more cost-savings, better cosmetic outcomes, and fewer post-operative bleeding events.

Conclusions

USD appears to be associated with a shorter length of hospital stay, making it a viable and more cost-effective alternative. More randomized trials with adequate outcomes reporting are required to optimise the current evidence.
701 Do We Shy Away from Issuing Duty of Candour?
Authors: Farooq R , Tetley H , Daniel S , Riyad K
Published: July 2024

Aim

Transparency and openness are the key elements that clinicians must offer. Certain events mandate a duty of candour (DOC). An apology must be provided to the patient/family/carer, providing a factual account of events. Francis Enquiry, 2013 recommended that a statutory DOC should be introduced. Numerous Trusts have been fined by CQC for failing to comply with statutory DOC. The aim of this audit was to study the compliance of our department in issuing a DOC for unexpected return to theatre following an acute laparotomy.

Method

We carried out two retrospective audits between January 2022 – March 2023 in general surgery department at St. James University hospital, Leeds. Approval was gained locally, and audit was conducted by reviewing electronic notes of each patient for evidence of issuance of DOC. All initial operations were acute laparotomies.

Results

A total of 46 patients were identified during second cycle of audit as compared to 21 patients during first who had unexpected return to theatres. 4 out of 46 had written evidence of DOC following their return to theatre; 8.7% compliance rate with Statutory Duty of Candour Guidelines which is 2.3% lesser than the first cycle. (P=0.193).

Conclusions

There appears to be poor compliance in performing a DOC or if provided, evidence of its documentation. Providing verbal and written DOC should become normative behaviour. There needs to exist an automated alert system for those incidences that requires a DOC and appropriate time in the job plan to accomplish this.
320 Views and Awareness of Egyptian Surgical Trainees on Pursuing Membership of the Royal College of Surgeons (MRCS) in the UK: A Single-Institutional Study
Authors: Miller J
Published: July 2024

Aim

International surgical trainees view training overseas as an attractive pathway for achieving excellence in surgery. The internationally recognised MRCS examinations provide a benchmark that trainees can use to meet this aspiration while also benefitting from great international mobility. We aimed to look at the awareness and views of Egyptian surgical trainees to training in the UK and pursuing MRCS. The motivations for and the barriers to these aspirations were explored.

Method

An observational cross-sectional study of interns, residents, and assistant lecturers at Ain Shams University Hospitals was conducted from October to December 2023 using a 26-item paper-based survey. This was designed to assess understanding of UK surgical training and ascertain views on UK surgical training and pursuing the MRCS examinations.

Results

194 participants were involved in this study, with 58.76% being male and the mean age being 26.84 ± 2.58 years. 73.4% generally agree that pursuing surgical training in the UK is an attractive career option. 55.85% generally agree that it is a financially viable career option, and 31.38% remain neutral. 66.5% personally know someone who has trained in the UK and/or sat MRCS. 51.59% report it is easy to find information on UK training and the MRCS exams.

Conclusions

It is evident that surgical training in the UK and pursuing MRCS is an attractive option for Egyptian surgical trainees. However, many barriers and a lack of information make these aspirations hard to achieve. Further work is required to improve support structures and to assess if these sentiments are shared with trainees elsewhere.
488 Surgical Site Infection After Hand Trauma Surgery in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis
Authors: Shaw A , Chaplin G , Graham S , Beard D , Agarwal-Harding K , Wormald J
Published: July 2024

Aim

In low- and middle-income countries (LMICs) surgical site infections (SSIs) are the most common post-operative complication. Associated with increased morbidity and mortality, they impose a significant financial burden on patients. A recent meta-analysis found the overall SSI risk following hand trauma surgery is 5-10%. In this study a top-up-search and re-analysis was performed to establish SSI risk in the context of countries’ income classification.

Method

Our PRISMA-compliant systematic review searched MEDLINE, Embase, CINAHL, CENTRAL and clinicaltrials.gov to identify studies reporting SSI rates in adults undergoing hand or wrist surgeries for trauma. Studies were grouped by country-of-origin using World Bank income classifications. Meta-analysis of proportions was performed using R and risk of bias was evaluated.

Results

Of 11,056 screened s, 236 studies were included. None originated from low-income countries (LICs), 40 came from LMICs (16.9%), 48 from upper middle-income countries (UMICs) (20.3%) and 148 from high-income countries (HICs) (62.7%). Of LMIC studies, 70.0% were at high risk of bias, compared to 47.7% of UMIC and 31.1% of HIC studies. Meta-analysis demonstrated SSI risk in LMIC studies as 7.9% [95%CI 6.3-9.9], UMIC studies as 6.3% [95%CI 4.4-8.8] and HIC studies as 4.5% [95%CI 3.5-5.8].

Conclusions

No studies were identified from LICs, perhaps indicative of the limited hand surgery capacity. Reduced research was found from MICs compared to HICs. We concluded that SSI risk following hand trauma appears lower in HICs compared to UMICs and LMICs but may be under-reported in MIC studies. Further research into hand trauma burden and outcomes in LMICs is required.
681 Application of Low-Cost Automated Progress Tracking System (APS) on Laparoscopic Appendicectomy Simulation Models (LaApSi) for the Laparoscopic Simulation Training in the Lower-Middle-Income-Countries (LMICs)
Authors: Karki B B , Sharma S , Neupane P , Phuyal S l , Shrestha S , Katuwal S , Satyal S , Loubani M
Published: July 2024

Aim

To assess the effectiveness of the Low-Cost Automated Progress Tracking System on Laparoscopic Appendicectomy (LA) Simulation Models (LaApSi) for Laparoscopic Training in Lower-Middle-Income-Countries (LMICs). To assess and record the progression of trainees’ performance during simulation training.

Method

After the successful application and validation of the LaApSi model during laparoscopic courses at LMICs, the APS system has been prototyped to assess the trainee’s progression of LA. This system helps to assess surgical steps during simulated LA with the help of the LaApSi model integrated with wires at various anatomical positions giving real-time computer feedback and allowing users to assess the timing of operation, blood vessel excision and injury to the base of the appendix/caecum.

Results

The prototype version tested in LMIC showed excellent results in the detection of the above-mentioned parameters (shown in photos). This cost-effective model (LaApSi< £5 and docking system <£15) showed huge potential as a laparoscopic training model in LMICs. There will be additional validation of 16 APS models during the Laparoscopic Surgery Course in Nepal in Jan 2024 in collaboration with Nepalese Doctors Association-UK which we believe will further solidify its application in the LMICs

Conclusions

There is a need for the transition to high-fidelity low-cost laparoscopic simulation models from the traditional training methods in the LMICs which in the long-term address global surgery values. These systems have the potential for remote proctorship in the rural parts adapting the Hub & Spoke model and integrating AI and Machine Learning which eliminates the use of wires and sensors in the models.
1153 Pediatric Renal Stone Management in Africa: A Scoping Review and Analysis of Current Practices
Authors: Davis S , Anyakora C , Zubair A , Igbokwe M , Haladu Z , Ajibade A , Noah O , Agyeman C , Oisamokhai K , Enemoh O , Ikuborije P , Nwokeocha E , Ajari O , Adejala I , Mastaki V , Akinro O
Published: July 2024

Aim

Renal stones are solid deposits formed from minerals and salts that develop within the kidneys and urinary tract. While the condition is more common among adults, children and even infants can also be affected. There is an increasing incidence of paediatric renal stones in Africa alongside multiple challenges faced in managing the condition. This scoping review aimed to provide an overview of the management modalities of paediatric renal stones in Africa.

Method

This study utilised Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. A systematic search was conducted in three electronic databases: PUBMED, African Journal Online (AJOL), and Google Scholar, with 1,180 articles curated. After extensive examination, ten articles satisfied the inclusion criteria.

Results

The review found that calcium oxalate stones were the most prevalent type, accounting for 34.03% of cases, followed by whewellite stones and ammonium urate stones. The kidney was the most frequent location for stones, and the most common symptom was pain. Abdominopelvic ultrasound was the most frequently utilised investigation. Of the 886 patients managed for renal stones, 75.4% were managed surgically, 2.9% medically, and 21.7% spontaneously resolved without intervention.

Conclusions

This review identifies opportunities for improving the management of paediatric renal stones in Africa, including the need for standardised diagnostic and treatment protocols and the development of evidence-based guidelines tailored to the African context. Overall, this review provides valuable insights into the patterns and management of paediatric renal stones in Africa and highlights the need for further research to improve its management in the region.
1082 Maximising Surgical Outcomes in Midline Incisional Hernia Repairs: Are We Employing Every Possible Optimisation?
Authors: Belbase S , Naseer A , Jayawardena P , Lo T , Hamady A , Owera A
Published: July 2024

Introduction

Large midline Incisional hernia repair can involve complex surgery which poses many challenges, with a high recurrence and complication rate. The recently published European Hernia Society Guidelines has identified several risk factors contributing to the increased complications after surgical repair. We aim to assess the effect of these modifiable risk factors for adverse outcomes within our patient population.

Method

All adult patients who underwent a repair of midline incisional hernias larger than 3cm in a DGH hospital between July 2021 and July 2022 were included. Data on patient demographics, modifiable risks factors and complications were collected. Analysis was performed using Microsoft Excel.

Results

26 patients (age: 64 [33-84] years; M:F, 9:17) underwent a midline incisional hernia repair were included. The average hernia size was 8cm. The average body mass index (BMI) was 33.1, seven were smokers and three had diabetes mellitus. Of the three patients who developed a recurrence, average BMI was 36 and two were smokers. None of the patients were counselled for weight loss or smoking cessation.

Conclusions

In our cross-sectional study, patients with a large hernia, high BMI, diabetes, a smoking history are associated with adverse outcomes. We aim to highlight and raise the awareness to surgeons who perform these repairs to counsel their patients on their modifiable risk factors and its associated risk of hernia recurrence. Preoperative optimisation improves surgical outcome and subsequently reduces healthcare costs.
340 Investigating the Effectiveness of Folic Acid-Fortified Iodized Salt on Serum Folate Concentration- a Primary Prevention Strategy for Spina Bifida in India
Authors: Pattisapu J , Manda V , Rao M N , Kajana P M , Kancherla V , Veerappan V R , Kumar A , Oakley G P
Published: July 2024

Aim

Investigate the effectiveness of folic acid-fortified iodized salt in increasing serum folate concentrations among non-pregnant and non-lactating women of reproductive age

Method

All households in four rural Indian villages agreed to consume FA-fortified iodized salt (study salt) in a pre- and post-intervention study. Pre- and post-intervention serum folate levels were analysed from 83 eligible participants. A cohort study was done after consumption of approximately 300 mcg of FA daily using double fortified salt (FA + Iodine). We assessed the differences in median serum folate concentrations at baseline and 4 months.

Results

The median serum folate concentration increased from 14.6 nmol/L at baseline to 54.4 nmol/L at end of study. Two-tailed Wilcoxon Signed Rank Test showed the difference to be highly significant (p-value = 1.8 × 10-14). The villagers found the salt acceptable in color, taste and cooking properties. No untoward effects related to the study salt were noted.

Conclusions

Folic Acid for the prevention of Spina Bifida has over 3 decades of evidence to support it. In 2023, the World Health Assembly unanimously recommended FA to prevent incidence of Spina Bifida. India, currently estimated to bear a third of the global Spina Bifida burden, poses a unique challenge to mandatory fortification due to the heterogeneity in population, culture, and dietary patterns. FA-fortified salt presents an equitable opportunity to reach the entire population of India and avert a significant burden of Spina Bifida and its associated morbidity and mortality. Moreover, salt fortification infrastructure currently exists so FA-fortified salt poses a cost-effective primary prevention method.
547 Creation of a Machine Learning Model to Predict Cognitive Outcomes Post Deep Brain Stimulation Surgery for Parkinson’s Disease
Authors: Deshpande R , Haliasos N
Published: July 2024

Background

Parkinson’s disease (PD) is the second most common neurodegenerative disorder and continues to affect an increasingly large portion of the world’s population. Limitations of the medical treatment of PD with levodopa have led to deep brain stimulation (DBS) therapy being used to alleviate symptoms in advanced PD patients. Despite its efficacy with motor symptoms of PD, DBS has been noted to lead to worsening of cognitive outcomes in a percentage of cases. There is currently no predictive model for individual patient cognitive outcomes post DBS.

Aim

The aim of this study is the creation of a machine learning (ML) model which can help facilitate decision making for clinicians regarding offering DBS to patients. ML has the potential to analyse multiple variables and produce a predictive model for neurocognitive outcomes. The volume of variables analysed by ML is beyond the remit of calculations that can be performed by individual medical professionals for each patient.

Method

This study used mild cognitive impairment (MCI) as the outcome, at six months post DBS surgery to measure neurocognitive impact. Clinical and radiomics variables were used to train the models.

Results

Two predictive models were successfully generated – random forest and logistic regression, which showed an accuracy of 0.87 and 0.74 respectively.

Conclusions

The study concluded that it is possible to use ML to generate a prediction model for outcomes post DBS. The model can help optimise the decision-making process behind offering DBS surgery to patients and lend insight into the possible causes of poor outcomes.
1177 A Critical Review: What Do We Currently Know About the Genomics of Spinal Chordomas?
Authors: Woo Y T , Czyz M
Published: July 2024

Aim

To provide an insight into our current understanding in the genomics of spinal chordomas with regards to pathogenesis and treatments.

Method

Three terms – ‘spine’, ‘chordoma’ and ‘genomics’ were searched on PubMed and Embase. Papers published until 2022 were included. Exclusion criteria were conference s, letters, and duplicates. The final result was nineteen papers on PubMed, which were analysed in this review. Data collected were discussed under the respective subtopics.

Results

From the nineteen papers, the published evidence surrounding the genomics of spinal chordomas with respect to molecular pathogenesis and treatment modalities were collected and analysed. Brachyury and microRNAs (miRNAs) are two of the more significant molecular markers related to chordomas. Other molecular aberrations include chromosomal instability, long non-coding RNAs (lncRNAs), Sonic Hedgehog (Shh), as well as modifications in genome, exome, transcriptome, and proteome. Apart from surgical management, which is usually the gold standard approach to chordomas, genomic findings in chordomas have led to advancements in targeted therapy and immunotherapy. The integration of hyperthermia into radiotherapy could also be a potential novel therapy.

Conclusions

To date, great advancements have been made around the genomics of chordomas, but these are not specific to spinal chordomas. As such, apart from improving on the respective knowledge gaps identified in this review, studies focusing specifically on spinal chordomas would also be recommended.