bluuebunny/crossref_metadata_2025 huggingface dataset:
1367 Five Years of Robotic Surgery in Colorectal Service: James Cook University Hospital Experience
Authors: France K , Aradaib M , Jha M
Published: October 2021

Aim

This paper gives an account of our institutional experience with safe adoption of robotic surgery in colorectal service.

Method

Analysis of our prospectively maintained database of all patients who underwent robotic colorectal surgery in our institute between February 2015 and February 2020. Overall surgical and oncological outcomes were interrogated.

Results

A total of 255 patients underwent robotic surgery between 2015 and 2020. 148 were males, and 107 were females. Median age was 68 years (range: 35–89). 198 patients had bowel cancer and 57 had benign conditions. Operative procedures performed were anterior resection (n = 125), right colectomy (n = 77), abdominoperineal resection (n = 40), subtotal colectomy (n = 5), completion proctocolectomy (n = 2) and reversal of Hartmann’s procedure (n = 6). Mean operative time was 164 (SD ± 47.5) for right colectomy and 267 (SD ± 77.8) for anterior resection. Median length of hospital stay was 6 days (IQR: 4 – 9). There was no 30 days mortality or intraoperative complications. Conversion to open or laparoscopy surgery rate was 5.1% (n = 13). Anastomotic leakage occurred in 3 patients (1.2%). Median lymph nodes harvested were 21 (range 4 – 79) and the R0 resection rate was 96.5%.

Conclusions

Our results demonstrate that colorectal robotic surgery is feasible and can be adopted safely for both benign and neoplastic conditions without undermining clinical or oncological outcomes.
1420 ViRtual prOficiency Based prOgression for Robotic Training (VROBOT): A Prospective Cohort Study Protocol
Authors: Nathan A , Patel S , Georgi M , Hang K , Mullins W , Asif A , Fricker M , Ng A , Sridhar A , Collins J
Published: October 2021

Introduction

Robotic surgery is an evolving field that requires specialist training. Historically, robotic surgery training has lacked standardisation. Recently, training centres have introduced proficiency-based modules and curriculums to certify and progress the skills of novice robotic surgeons. However, training tends to be self-directed and non-interactive. Limited interactive teaching does exist but can be inaccessible and expensive. We aim to validate the effectiveness of the current Fundamentals of Robotic Surgery (FRS) training curriculum with the addition of interactive virtual classroom teaching.

Method

16 novice surgical trainees will be assigned to two training groups. The interventions will be implemented following a one-week robotic skills induction. Both groups will receive access to the FRS curriculum for one week. The intervention group will additionally receive virtual classroom robotic skills training. The primary outcome will be the objective performance scores after training using a synthetic model based on task errors, time taken and contact pressure. In week 3, each group will receive the alternate intervention and objective performance scores will be measured to determine the trajectory of scores.

Results

Significant objective performance improvement following the intervention will be indicative of intervention quality.

Conclusions

This will be the first feasibility study evaluating the efficacy of interactive virtual robotic surgery training. It will determine the effect size of virtual classroom training on the development of basic robotic surgical skills in addition to the proficiency-based FRS curriculum. The findings will assist the development and implementation of further resource-efficient virtual robotic surgical skills training programs.
1670 The 50 Most Cited Manuscripts in Paediatric Robotic Surgery: A Bibliometric Analysis
Authors: Schaffer S , O'Neill P , Thomas M C , Randev J K
Published: October 2021

Introduction

Robotic assisted surgery is increasingly utilised in paediatric surgery. The purpose of this study was to establish a ranking of the 50 most frequently cited articles addressing this subject and analyse their bibliometric characteristics.

Method

Articles related to paediatric robotic surgery were searched in The Web of Science citation indexing database utilising defined search terms. Results were filtered to include only English language and full manuscripts. The dataset was then ranked by the absolute number of citations and analysed by the journal of publication, impact factor of the journal, title of publication, article type, year of publication, first and senior author, geographic origin, and level of evidence.

Results

The search yielded a total of 352 papers which were ranked in order of citations. The 50 highest cited articles had 2669 citations cumulatively. The most cited article by Lee, RS et al had a citation count of 207. The publication years spanned from 2002 to 2018. 2013 saw the greatest number of publications on this topic. Most articles were of the ‘’Clinical science’’ type. Geographically the USA accounted for most of these publications. All published articles demonstrated a high level of evidence.

Conclusions

The 50 articles identified in this study are clearly influential in this new and evolving field of surgery. Identification of these seminal papers is intended to assist clinicians and scientists in formulating an overview of current and developing trends in this cutting-edge discipline as well as providing a foundational basis for further discussion and future research.
127 Electronic Collection of Patient-Reported Outcomes Following Discharge After Surgery: A Systematic Review
Authors: Tsang C , Lee K S , Richards H , Blazeby J , Avery K
Published: October 2021

Aim

Little is known about the electronic collection and clinical feedback of patient reported outcomes (ePROs) post-surgical discharge. This review summarised the evidence on the collection and uses of electronic systems to collect PROs after discharge from hospital following surgery.

Method

Systematic searches of Medline, Embase, PsycINFO, CINAHL and Cochrane Central were undertaken from database inception to July 2019 using terms for “patient reported outcomes”, “electronic”, “surgery” and “at home”. Primary research of all study designs was included if they used electronic systems to collect PRO data away from formal health care settings. Only studies in adult patients admitted for surgery then discharged from hospital were eligible.

Results

From 9,474 records identified, 15 studies were reviewed including three randomised controlled trials. Seven studies were in orthopaedic surgery. Most studies used commercial ePRO systems (n = 9/12). Six studies reported types of electronic devices used to collect data: tablets or other portable devices (n = 3), smartphones (n = 2), combination of smartphones, tablets/portable devices and computers (n = 1). Systems had limited features or functions such as real-time feedback to clinicians (n = 6) and messaging service for patients to communicate with care teams (n = 3). No studies described integration of the ePRO system with electronic health records to support clinical feedback.

Conclusions

There is limited reporting of ePRO systems in the surgical literature. ePRO systems lack integration with hospital clinical systems. Future research should describe the ePRO system and ePRO questionnaires used, and challenges encountered during the study, to support efficient upscaling of ePRO systems using tried and tested approaches.
987 Braidlock - The Evolution of a Novel Drain Securing Device
Authors: Byrne C , Ali E , Qureshi R , Cheng L
Published: October 2021

Introduction

The use of drains in Oral and Maxillofacial Surgery is widespread and the securing method using a silk suture laddering along the drain in a standard ‘roman sandal’ pattern is well established. Other methods include tie-lock with sutures and adhesive dressings. We describe the use of a braided device (Braidlock®) without using sutures, based on the concept of a Chinese finger trap, to secure the drain onto patients' skin using tissue adhesive. We report the evolutionary changes of Braidlock.

Device Evolution

Braidlock® is a Class I non-invasive disposable medical device which provides securement of lines, drains and catheters to a patient using tubing from 3.5Fr to 36Fr. The diameter of the Braidlock® expands when the device is compressed, similar to a ‘Chinese finger trap’. A line can then be inserted through the device and into the body. When decompressed, the Braidlock® squeezes the line tightly and securely. The initial Braidlock® device was hook & loop which required suturing to secure onto skin. Integrated adhesive is a recent invention.

Advancement

With advances in adhesive dressing and ultrasonic wielding between the plastic casing and adhesive pads, Braidlock® drain securing device appears to be a safe medical device that enables successful securement of drains. Braidlock® may represent a cost saving relative to the conventional suture pack for drain securement.

Conclusions

This new drain securing device offers a cost effective and reliable alternative to the standard suture fixation. This will eliminate the risk of sharps injury and allow shortening of the drain by ward staff with minimal training.
1165 Reporting Patient Selection in Robotic Cholecystectomy: Less than IDEAL? A Systematic Review
Authors: Biggs S , Dixon L , Brankin-Frisby T , Dewi F , Torkington A , Olivier J , Kirkham E
Published: October 2021

Introduction

Laparoscopic cholecystectomy is the gold standard definitive treatment option for benign biliary disease. There has been increasing interest in novel robotic surgical techniques; robotic cholecystectomy (RC) represents the most recent innovation in the management of gallstones. The IDEAL Collaboration has provided guidance for the rigorous and comprehensive reporting of surgical innovations, despite this, transparency in patient selection has been limited. We aimed to assess the reporting of patient selection in studies reporting RC.

Method

A collaborative, systematic review was conducted in accordance with the PRISMA guidance to identify all published studies reporting RC. Study specific inclusion and exclusion criteria were detailed in a protocol.

Results

Searches identified 1425 abstracts; 90 papers were included for data extraction. Inclusion criteria were reported in 38 (42%) studies. The most frequently cited were age (20%), aetiology (20%), presence of symptoms (16%) and comorbidities (10%). Forty-nine (54%) studies reported exclusion criteria. Numerous and variably reported exclusion criteria were reported; acute cholecystitis (26%), previous abdominal surgery (25%), comorbidity (17%), pregnancy (13%), common bile duct stones (13%) and pancreatitis (10%) among others. Seven reported no exclusion criteria. Three reported numbers of patients who declined RC.

Conclusions

Patient selection criteria were inconsistently reported and when present lacked standardisation. Concern persists around patients being “cherry picked” for inclusion in studies reporting innovative robotic surgical procedures, making interpretation and applicability of results impossible. Standardised inclusion criteria are needed to enable greater transparency and reproducibility to ensure the safe adoption of new technologies into clinical practice.
943 Beyond the Adenoma Carcinoma Sequence
Authors: Daniel S , Iype S
Published: October 2021

Introduction

Looking beyond the adenoma carcinoma sequence researchers have discovered alternate morpho-genetic routes, and tumour biomarkers in colorectal cancer. This has caused a paradigm shift in the management, resulting in improved diagnosis, prevention, and delivery of tailored treatment aiming at specific molecular pathways.

Aim

This review summarises

Method

PubMed, Google Scholar, NLM searches based on aims and key words were conducted. Further, academically, and clinically relevant searches were made if more information was required. When required, references of articles were also retrieved.

Results

The two main theories regarding the morphological origins of colorectal cancer are the adenoma carcinoma sequence and the De-novo origins. The underlying genetic models are the (i) chromosomal instability pathway (CIN), (ii) the microsatellite instability pathway (MSI) and (iii) the CpG Island methylator phenotype (CIMP) pathways. Though unique, the pathways communicate with each other. The genetic fingerprinting of colorectal cancers has an impact on their tailored management and consequently a through grounding in the basics are essential for those in gastrointestinal subspecialties.

Conclusions

Two morphologically distinct pathways and three unique genetic mechanisms have been described. There are significant interactions between them. Behaviours of sporadic and inherited colorectal cancer, their treatment and prognosis depend on our understanding of these mechanisms and the availability of targeted therapies to assist surgical resection.
228 Outcomes of Gallstone Complications During the COVID Pandemic
Authors: Isherwood J , Karki B B , Chung W Y , AlSaoudi T , Wolff J , Malde D , Bhardwaj N , Garcea G , Dennison A
Published: October 2021

Background

The Intercollegiate General Surgery Guidance on COVID-19 recommended either non-surgical management or cholecystostomy drains for the management of acute biliary disease replacing gold standard practice of early laparoscopic cholecystectomy within 1 week of index admission with drainage reserved for high-risk patients where surgery is not appropriate.

Method

This is the retrospective study presenting the impact of gallstone disease in our unit during five months of the COVID- 19 pandemic (March 2020-August 2020) compared with the equivalent period in 2019.

Results

Patients presenting to the HPB unit with a coded diagnosis of gallstones were included and during the study period 1447 patients presented compared with 1413 in 2019. In 2020 compared with 2019 there was a significant decrease in patients presenting with cholecystitis (240 vs 313; p = 0.031) but no significant difference in patients presenting due to gallbladder perforation (44 vs 51). Interestingly the numbers of cholecystostomies were comparable, with 11 in 2020 and 15 in 2019 representing significantly less than the 7.2% figure published by Peckham-Cooper et al.

Conclusions

In our study there was a decrease in patients with cholecystitis and perforation and there was an increase in patients with gallstone pancreatitis, increase waiting lists with increase in the incidence of serious complications. In our trust we currently have 656 patients awaiting cholecystectomy compared to 280 in august 2019. With the recent elevation of the alert level to 4 and increased government restrictions, a consistent National approach is required to mitigate these risks.
632 Analysing Laser Doppler Images - A Modified Approach to the Assessment of Burn Depth
Authors: Shahid S
Published: October 2021

Aim

To establish a method of quantifiably determining burn depth from Laser Doppler (LD) images of burns.

Method

NICE advises for LD scanning to be utilised for the assessment of intermediate depth burns, where there is doubt about burn depth following experienced clinician examination. However, these scan images do not provide a quantifiable measure of burn depth. LD determines burn perfusion, with deeper burns appear blue, and superficial burns appearing red. We retrospectively studied LD images from 110 patients over the course of 2019. Using Adobe Photoshop, Histogram software, we highlighted the burns using the selection tool, and determined the proportion of the burn that was deep/poorly perfused. We then correlated these results with time till recovery.

Results

Burns with a poorly perfused region of larger than 20%, had a proportional increase in time till full recovery. This proportional increase was also reflected in burns with a 30% and 40% poor perfusion. Burns with less than 20% of poor perfusion were found to recover at the same rate as superficial burns. This novel method for the measurement of burn depth will allow for the examining plastic surgeon to make a decision on treatment based on concrete and quantifiable burn depth data.

Conclusions

We have demonstrated the initial validity of a novel method for the quantifiable measurement of burn depth. Further study is required, to establish the validity of this novel approach to the quantifiable detection of burn depth.
751 Improving Engagement with Home-Based Surgical Skills Simulation
Authors: Falconer R , Semple C , Cleland J , Walker K , Watson A
Published: October 2021

Introduction

Surgical simulation has been repeatedly shown to facilitate technical skill acquisition. However, trainee engagement with self-directed practice remains variable, despite access to resources. Understanding the motivators and barriers to participation is crucial to develop modules which can effectively meet the learning needs of current, and future, surgical trainees. The aim of this qualitative study was to examine factors which influence trainee engagement with home-based surgical skills simulation.

Method

A series of one-to-one semi-structured interviews were conducted remotely with ST3 vascular trainees who had previously consented to take part in a national programme of home-based technical skills simulation. Interview data was transcribed and thematically analysed.

Results

12 trainees were interviewed during a 4-week period. Overall, trainees valued simulation but found it difficult to balance against clinical commitments and mandatory training requirements, particularly if there were limited opportunities for skill transfer to the real-world environment. Although simulation was acknowledged to be a safe environment for experiential learning, trainees alluded to an underlying culture of perfection which limited willingness to learn from mistakes, even within a simulated setting. In addition, traditional attitudes about the apprenticeship model of surgical training prevail, with simulation often viewed as inferior to learning “on the job” in theatre.

Conclusions

Trainee engagement with home-based surgical skills simulation may be influenced by a range of systemic factors. In future, formal certification of simulation modules, mandating simulated competencies and curricular integration may help improve participation, as well as supporting cultural shift towards recognition of simulation as a vital component of modern surgical training.
79 Remote Delivery of an International Surgical Education Webinar Series for Medical Students During COVID-19
Authors: Zaver V , Ahari D , Jayawardena P , Sayed M A
Published: October 2021

Aim

The 2019 novel coronavirus (COVID-19) pandemic caused the cancellation of lectures and clinical placement-based education for medical students across the UK. With resumption of university teaching, remote delivery via online platforms has seen increased implementation to prevent overcrowding and comply with social distancing measures. This article explores the efficacy of an internationally delivered online surgical webinar series to facilitate undergraduate surgical education on a long-term basis.

Method

The University of Manchester undergraduate surgical society, Scalpel, in collaboration with three Junior Surgical Trainees designed and organised an online surgical teaching programme aimed at medical students. The syllabus was constructed in accordance with the Royal College of Surgeons England’s (RCSEng) National Undergraduate Curriculum in Surgery. Multiple-choice questionnaires (MCQs) were used to evaluate knowledge during the sessions and Likert scales were utilised to assess subjective improvement of knowledge. The teaching programme was delivered remotely using Zoom (Zoom Video Communications, Inc.).

Results

he average attendance for the lectures was 68. The reach of the webinar series was international. The average increase in correct answers between pre and post lecture MCQs was +78.7% (+72.4, +18.6, +76.6, +43.5, +161, +100). Likert scale analysis demonstrated 100% improvement of knowledge.

Conclusions

This study demonstrates a positive outcome to remote, extra-curricular surgical education in the time of COVID-19. The methodology outlined herein has the potential for easy replication on a more widespread scale to provide routine supplementation for medical student and surgical trainee education during the ongoing pandemic.
245 An Introduction to Surgery: Effectiveness of An Online, Lecture-Based Programme in Providing Surgical Career Guidance for Pre-Clinical Students
Authors: Kelada M , Kawka M , Komor J
Published: October 2021

Aim

Early exposure to surgery has been found to impact medical students’ decisions to pursue a career in surgery. Despite this, students are often not exposed to surgical specialties until senior years of medical school. The aim of this study was to determine if a student-led, three-month online lecture series can facilitate early exposure to surgical careers.

Method

Participants volunteered to complete pre- and post-lecture questionnaires. The four domains discussed across the lecture series included: what a surgical career entails, the day-to-day life of a surgeon, advances in surgery and surgical portfolio. Participants self-rated confidence in the knowledge of each of the four domains was measured on a five-step Likert scale. Changes in perceived confidence were measured using a paired Student’s t-test. Data were analysed using R 4.03 (Vienna, Austria). The threshold of significance was <0.05.

Results

A total of 45 respondents completed both pre- and post-lecture questionnaires. Most respondents (57.8%) were first- or second-year students. Following the course, there was a significant increase in confidence across all four domains investigated (mean rating 2.64 vs 4.07, p < 0.001). More than 9 out of 10 respondents (99.3%) gained new knowledge and (95.2%) agreed that an online event format did not hinder their learning.

Conclusions

Student-led online lecture series can increase knowledge of core concepts pertaining to a career in surgery for pre-clinical students. The findings provide a basis for further large-scale investigation of surgical education during early years of medical school and for the potential value of extracurricular, student- or trainee-led courses.
681 Increasing Representation in Surgical Careers – the First Cut Mentorship Programme for Medical Students
Authors: Tulloch A , Aghanenu O , Mutlib I , Ahmed A , Gomez D , Hagan P , Lymath D
Published: October 2021

Background

Surgical specialties in the medical literature are described as having low workforce diversity. Classically underrepresented groups among surgeons include women, trainees from Black, Asian and Minority Ethnic (BAME) backgrounds and those possessing visible or hidden disabilities. As advocates for underserved communities, increasing the representation of these groups is vital to ensure that their values and perspectives influence the progression and practice of surgery. A mentorship programme was created to address this need and help break down the reported barriers which often deter medical students from pursuing surgical careers.

Method

A 6-month mentorship programme for students from underrepresented groups in surgery was designed and co-developed by four medical students and three university faculty members: a consultant HPB surgeon, a professor of medical education and an educational enhancement manager.

Results

30 medical students received one-to-one mentorship from consultant surgeons. All participants (mentors and mentees) were from underrepresented groups in surgery. Students were provided with exposure to the life of a surgeon, personal development, and careers advice by their mentors. Opportunities for professional development in academic, educational and management roles were also offered to go beyond the scope of the standard clinical responsibilities of surgeons. This descriptive case study offers an approach to implementing this within a large medical school.

Conclusions

The First Cut project is currently in its pilot phase. Feedback will be collected and analysed at the end of the programme for evaluation and improvement. These results will demonstrate the value of mentorship programmes to students from underrepresented groups.
737 Supporting Surgeons in Their Return to Training
Authors: Richardson R , Siddiqui S , Little Z , Pollard R , Chan S
Published: October 2021

Aim

t any one time, approximately 10% of the junior doctor workforce (∼5000 doctors) take time out of training. Following the Bawa Gaba case, and with trainees shielding during the COVID pandemic, there is greater scrutiny and demand to support trainees returning to the frontline. Supported Return to Training (SuppoRTT) is a Health Education England Program designed to improve the Return-To-Training (RTT) experience. For surgical specialties there are additional challenges of reintroducing trainees to practical skills.

Method

e designed and facilitated the first regional SuppoRTT course for Orthopaedic Specialist Registrars, which consisted of peer and consultant-led clinical updates, forum discussions and externally commissioned professional coaching. A pre-course survey established participants’ concerns and expectations about RTT and formed the basis of discussions. A post-course survey assessed value of the course and impact on participants.

Results

Eight participants (6 female) attended. Grade of training on return ranged from ST3 to ST8. Main areas of concern related to colleague perception, reduced confidence with decision-making, operative skill fade, and frustrations with organisational elements of managing work-life balance. There was an overwhelmingly positive response to the support offered on our course, particularly to the discussions around RTT concerns and returning to on-calls. All respondents strongly agreed that sharing their concerns and hearing about peer experience was valuable.

Conclusions

High numbers of trainees take approved time out of training. RTT is associated with anxiety around performance and safety. Surgical trainees can be supported with a targeted course that offers clinical update, peer support and professional coaching.
738 Lessons from the National Patient Safety Agency Alerts
Authors: Lee Rachel , Hatt Jacob , Mahawar Kamal , Bansal Mohit , Goyal Amit , Madhok Brijesh
Published: October 2021

Aim

The National Patient Safety Agency (NPSA) reviews incident reports from all NHS trusts, and reports deemed critical are issued as NPSA alerts. We aim to highlight important learning points from NPSA alerts to facilitate wider dissemination and prevent similar incidents, and overall improve patient safety.

Method

All patient safety alerts obtained from NPSA since inception (2008) till June 2020 were screened. We identified safety alerts that could be relevant to surgical practice, and further details of each alert were obtained from the Central Alerting System (CAS) website. Information obtained from CAS website was reviewed by consultant surgeons to identify specific learning points.

Results

1857 alerts were reported by NPSA of which 94 were relevant to surgical practice. Alerts were grouped into four themes: pre-operative(N = 4), intra-operative(N = 34), post-operative(N = 29), others(N = 8), and no specific learning point identified(N = 19). Pre-operative alerts focused on safety checks to avoid errors and improve patient safety e.g., WHO checklist. Majority of the intra-operative alerts were due to difficulty with use of specific equipment(n = 22) e.g., advanced haemostatic devices. Post-operative alerts highlighted specific issues with implants especially in breast and orthopaedic surgery(N = 23), and patient review following procedures(N = 6).

Conclusions

In spite of alerts occurring in a specific speciality, there is wider applicability to all surgical specialities e.g., pre-operative risk assessment in elderly patients requiring urgent surgery or confirming pregnancy status in immediate pre-operative period. Emphasis should be laid on staff training on using specialist equipment including troubleshooting. Raising awareness of these NPSA alerts may help prevent similar incidents.
828 STITCH And B**** - A Novel Programme Combining Pastoral Support and Surgical Skills
Authors: Lochab S , Stanier P , Rooker J
Published: October 2021

Aim

Foundation training can be a challenging time for Junior doctors; though help and support is offered, it is not always taken up. This programme aims to create a safe environment to facilitate discussion and provide pastoral support alongside teaching them new surgical skills.

Method

Four different sessions were organised over the period of four months (August 2020 – November 2020) and FY1/FY2 doctors working in the Orthopaedic department at the GWH, Swindon were invited to attend. Each session focussed on assorted suturing techniques and knot tying. In addition, the facilitator directed conversation towards opportunities to discuss frustrations, challenges, queries as well as positive occurrences. A questionnaire was distributed at the final session to evaluate participant experience.

Results

100% of attendees agreed or strongly agreed that they found their FY1 rotation challenging so far. 100% also scored 9/10 when asked how comfortable they were talking about concerns, worries or issues at these sessions. All the participants recorded ‘yes’ when asked if the session provided them with a listening ear, helpful advice, feeling supported, understanding/empathy and reassurance. 100% of the attendees scored that their confidence at suturing had improved (average: 4 points on a scale of 1-10).

Conclusions

Through these sessions, practical changes and improvements were achieved in the running of the Trauma and Orthopaedic department. Placement feedback was obtained, suggestions on things to improve or change and key issues were escalated to supervisors. There do not appear to be any similar programmes run that combine directed pastoral support and surgical skills teaching.
913 Near-Peer Teaching for Surgical Foundation Year Doctors During COVID-19 Pandemic
Authors: Olabisi O , Choi S , Hughes A , Torkington J
Published: October 2021

Introduction

Literature has shown near-peer teaching to be an effective method of improving learning. There is little data on surgical teaching initiatives of this kind. Nationally and locally, teaching sessions and courses have been cancelled due to the pandemic. A new surgical lunch-time virtual course was created to fill this gap.

Method

FY1 doctors from University Hospital Wales were invited to participate in a survey exploring the need and topics for surgical teaching. Results were used to create a surgical teaching course. Near-peer, core surgical trainees were recruited to teach. A post-course questionnaire was distributed to FY1 doctors who attended the teaching to assess the success of the course.

Results

15 FY1 doctors completed the initial questionnaire. 33% (5) were currently on a surgical placement. 60% (9) had an upcoming surgical placement. 73% (11) felt they did not have sufficient teaching on surgical specialties during medical school. 93% (14) felt they did not have sufficient teaching on how to manage surgical patients as a FY1. 100% (15) responded they would be interested in surgical teaching delivered by core surgical trainees. Eight topics were suggested, and lunchtime sessions were created. Post-course feedback was completed by 12 FY1 doctors. 88% (10) of respondents found the course ‘extremely useful’ and relevant to their surgical jobs.

Conclusions

There is a demand for surgical teaching for FY1s. Near-peer education designed by FY1s and delivered by CSTs is an effective way for teaching relevant surgical knowledge. Lunch-time virtual teaching is a good way to continue teaching sessions through the pandemic.
1644 Trainee Perspective in Sarcoma Care
Authors: Leong S , Clancy R , Jessop Z , Bragg T
Published: October 2021

Aim

Soft tissue sarcomas (STS) are rare and aggressive tumours. Appropriate multidisciplinary management requires robust knowledge of best practice and understanding of current guidelines. Plastic surgery trainees must therefore be proficient in the assessment, investigation, and treatment of patients with STS. We aimed to evaluate trainee education, confidence, and competence in managing patients with STS.

Method

All plastic surgery trainees in Wales completed an online questionnaire and written assessment. This was designed by the lead for STS and TPD. Formal training, knowledge of national guidelines and excision margins for different types of STS and skin cancer was assessed using short answer questions. A five-point Likert scale was used to assess trainee confidence in STS and skin cancer management and follow-up. Volume and type of teaching in sarcoma and skin cancer was also quantified.

Results

Trainees received less sarcoma training and were less confident in STS assessment and follow-up, in comparison to skin cancer. More senior trainees or those with formal sarcoma training were more confident in skin cancer management (mean confidence rating 4.4 vs 2.2) and performed better in the written assessment of excision margins (mean score 100% vs 61.45%)

Conclusions

Trainees receive less training in sarcoma with a significant impact on their competence and confidence in sarcoma care. We believe this is consistent across the United Kingdom as evidenced by just two sarcoma webinars held during the COVID-19 pandemic. Formal national evaluation of sarcoma teaching should be carried out to inform ongoing efforts to improve educational resources on this important topic for trainees.
1041 A Systematic Review of the Reporting Quality of Surgical Randomised Controlled Trials in Head and Neck Cancer using the CONSORT Statement
Authors: Canagarajah N A , Porter G J , Mitra K , Chu T S M
Published: October 2021

Introduction

Randomised controlled trials (RCTs) are considered the gold standard for evaluating the efficacy of an intervention. However, previous research has shown that surgical specialities poorly report RCTs, making it difficult to ascertain if various biases have been appropriately minimised. This systematic review assesses the reporting quality of surgical head and neck cancer RCTs.

Method

A literature search of PubMed and Embase was performed. Papers were included if they reported RCTs which assessed a surgical technique used to treat or diagnose head and neck cancer published during or after 2011. Therefore, the CONSORT 2010 checklist was used to evaluate the reporting quality of these trials.

Results

41 papers were included. The mean CONSORT score was 16.5/25 (66% adherence) and the scores ranged from 7.5 (30%) to 25. The most common omissions were full trial protocol (found in 14.6%), participant recruitment method (22%) and effect size with precision estimate for all outcome measures (29.3%). The full design and implementation of the randomisation method was reported in 6 (14.6%). Papers published in journals which endorsed CONSORT had significantly higher scores (p = 0.02) and journal impact factor was significantly correlated with CONSORT score (p = 0.01).

Conclusions

We have identified several pieces of information that are underreported in surgical head and neck cancer RCTs. These omissions make understanding and comparing the methodologies and conclusions of RCTs more difficult. The endorsement of CONSORT by journals improved adherence, suggesting that wider adoption of the checklist may improve reporting.
1109 Artificial Intelligence in Urological Oncology
Authors: Brodie A , Dai N , Teoh J Y C , Decaestecker K , Dasgupta P , Vasdev N
Published: October 2021

Aim

A comprehensive review of the literature on the current and future applications of artificial intelligence (AI) in the context of urological oncology.

Method

Four key areas of urological oncology were identified, and a comprehensive literature review was carried out in each area looking at the current and future applications of AI. These four areas included: Prostate cancer, Renal cancer, Bladder cancer, Robotic Surgery.

Results

In total, 63 primary research articles were reviewed across these four areas. For prostate, renal and bladder cancer, AI has already shown great promise in the areas of imaging and histopathology interpretation, predicting tumour grade, reducing inter-observer variability and identification of genomic biomarkers. For robotic surgery, AI has already demonstrated value in the assessment of operator skill and using this to predict surgical outcomes. However, some common limitations to the applicability of AI into clinical practice include an overwhelming predominance of small retrospective studies, concerns over the datasets and methodology of AI training, the complexity of AI algorithms being such that they become un-interpretable and the technological requirements and ethical considerations with so much confidential “big data.”

Conclusions

The potential for AI to improve clinical care is clearly unparalleled but there remain significant challenges to adoption into clinical practice. Future research will need to focus on the establishment of multi-institute open access databases and improved data collection and integration for improved training of AI algorithms and ultimately, for clinical applicability to be realised, there needs to be high-quality prospective randomised multi-institute studies.
1363 Oesophago-Pleural Fistula After Pneumonectomy; A Systematic Review
Authors: Phelan L , Layton G R , Lee E H , Liampas E , Bishay E , Griffiths E A
Published: October 2021

Introduction

Oesophago-pleural fistula (OPF) is an infrequent but highly complex complication of pneumonectomy with a mortality of up to 63%. There is a paucity of data on the optimal treatment strategy.

Method

Systematic review was conducted in line with PRISMA guidance concerning OPF following pneumonectomy. Demographic, operative and management data were analysed.

Results

30 full manuscripts of the 76 abstracts were included in the analysis. Data was limited to case reports or small series. In total, information for 58 patients was included. Median age was 59 years, with a median follow up time was 18 months. Most authors adopted sepsis control with chest drainage and pleural lavage and the mean number of interventions was 1.6. Overall mortality was 31% (18/58). There was no significant difference between the time to presentation following left (29.2+/-39.28 months) and right pneumonectomy (66.24+/-110.62) (p = 0.2271) nor any significant difference between successful outcomes following intervention for OPF after left (11/14) compared to right pneumonectomy (31/41) (p = 0.8219) or 90-day mortality (p = 0.4571). However, 26% of patients had synchronous broncho-pleural fistula and 90-day mortality was significantly higher in these patients (6/15 vs 6/43. p = 0.0395). 25 patients who underwent additional pericardial, oesophageal or a nodal resection or intervention at the time of pneumonectomy had a significantly reduced mean time to presentation with OPF (21.49+/-60.15 vs. 84.99+/-114.31. p = 0.0148) and a higher 90-day mortality (8/25 vs 3/32. P = 0.0414).

Conclusions

Major heterogeneity of management hinders the introduction of standardised guidance of post-pnuemonectomy OPF. An MDT approach involving Oesophago-gastric and Cardio-Thoracic Surgery is vital.
1459 Intravesical Chemohyperthermia Versus Bacillus Calmette-Guerin Instillation for Intermediate- And High-Risk Non-Muscle Invasive Bladder Cancer: A Systematic Review and Meta-Analysis
Authors: Zhao H , Chan V W S , Castellani D , Chan E O T , Ong W L K , Peng Q , Moschini M , Krajewski W , Pradere B , Ng C F , Enikeev D , Vasdev N , Ekin G , Sousa A , Leon J , Guerrero-Ramos F , Tan W S , Kelly J , Shariat S F , Witjes J A , Teoh J Y C
Published: October 2021

Introduction

Traditional intravesical chemotherapy instillations under room temperature post trans-urethral resection (TUR) of non-muscle invasive bladder cancer (NMIBC) have lower efficacies than maintenance BCG installations. Intravesical chemo-hyperthermia (CHT) at higher temperatures is developed to improve the efficacy of chemotherapy instillation. This systematic review aims to compare the use of CHT and BCG instillation post-TUR.

Method

The protocol of this review is registered on PROSPERO(CRD42020223277). A comprehensive literature search was performed on Medline, EMBASE, and Cochrane CENTRAL to identify studies comparing CHT and BCG post-TUR for intermediate- or high-risk NMIBC. Primary outcomes include recurrence-free survival (RFS) and progression-free survival (PFS). Secondary outcomes include adverse events (AE).

Results

From 2,375 identified records, four randomised control trials incorporating 327 patients were included for meta-analysis. The use of CHT was found to be non-inferior to BCG in RFS, PFS and AEs (Grades 1-3) (p > 0.05). Sensitivity analysis, excluding patients with BCG failures, show 24-36 months recurrence rate to be significantly lower in CHT group (RR 0.64, 95% CI 0.42-0.98, p = 0.04) compared to the BCG group. In patients without carcinoma in situ (CIS), RFS is also significantly better in CHT patients (HR 0.52, 95% CI 0.32- 0.85, p < 0.01). Safety profile remains non-inferior to the BCG group in sensitivity analyses. Quality of evidence across all outcomes ranged from moderate to low.

Conclusions

In well-selected patients, intravesical CHT has superior oncological outcomes and non-inferior safety profile when compared to BCG maintenance therapy for patients with intermediate- and high-risk NMIBC. CHT is a possible alternative treatment during BCG shortage.
Implantable brain–computer interface for neuroprosthetic-enabled volitional hand grasp restoration in spinal cord injury
Authors: Cajigas Iahn , Davis Kevin C , Meschede-Krasa Benyamin , Prins Noeline W , Gallo Sebastian , Naeem Jasim Ahmad , Palermo Anne , Wilson Audrey , Guerra Santiago , Parks Brandon A , Zimmerman Lauren , Gant Katie , Levi Allan D , Dietrich W Dalton , Fisher Letitia , Vanni Steven , Tauber John Michael , Garwood Indie C , Abel John H , Brown Emery N , Ivan Michael E , Prasad Abhishek , Jagid Jonathan
Published: October 2021

Loss of hand function after cervical spinal cord injury severely impairs functional independence. We describe a method for restoring volitional control of hand grasp in one 21-year-old male subject with complete cervical quadriplegia (C5 American Spinal Injury Association Impairment Scale A) using a portable fully implanted brain–computer interface within the home environment. The brain–computer interface consists of subdural surface electrodes placed over the dominant-hand motor cortex and connects to a transmitter implanted subcutaneously below the clavicle, which allows continuous reading of the electrocorticographic activity. Movement-intent was used to trigger functional electrical stimulation of the dominant hand during an initial 29-weeks laboratory study and subsequently via a mechanical hand orthosis during in-home use. Movement-intent information could be decoded consistently throughout the 29-weeks in-laboratory study with a mean accuracy of 89.0% (range 78–93.3%). Improvements were observed in both the speed and accuracy of various upper extremity tasks, including lifting small objects and transferring objects to specific targets. At-home decoding accuracy during open-loop trials reached an accuracy of 91.3% (range 80–98.95%) and an accuracy of 88.3% (range 77.6–95.5%) during closed-loop trials. Importantly, the temporal stability of both the functional outcomes and decoder metrics were not explored in this study. A fully implanted brain–computer interface can be safely used to reliably decode movement-intent from motor cortex, allowing for accurate volitional control of hand grasp.
Conduction disorders as the first hallmark of isolated cardiac sarcoidosis in a highly active individual: a case report
Authors: Muccioli Silvia , Albani Stefano , Mabritto Barbara , Musumeci Giuseppe
Published: October 2021

Background

Cardiac sarcoidosis (CS) is an inflammatory disease with various clinical presentations depending on the extension of cardiac involvement. The disease is often clinically silent, therefore diagnosis is challenging.

Case summary

We discuss the case of a middle-aged highly active individual presenting with an occasional finding of low heart rate during self-monitoring. The electrocardiogram shows a Mobitz 2 heart block; thanks to multimodality imaging CS was diagnosed and corticosteroid therapy improved cardiac conduction.

Discussion

To our knowledge, this is one of the first documented cases of occasional, early findings of CS in a middle-aged highly active individual who presented with cardiac conduction involvement. Despite the very early diagnosis, multimodality imaging suggested an advanced disease with no oedema detection at the cardiac magnetic resonance. Nevertheless, prompt corticosteroid therapy was able to improve clinical conduction. Although non-sustained ventricular arrhythmias were detected, electrophysiological study allowed to discharge the patient safely without implantable cardioverter-defibrillator implantation. Light-to-moderate physical activity was allowed at mid-term follow-up. A multidisciplinary evaluation should be considered to resume a high-intensity training.
Intergenerational Educational Mobility and Life Course Economic Trajectories in a Social Democratic Welfare State
Authors: Hällsten Martin , Yaish Meir
Published: October 2021

We test a prediction of cumulative advantage theory about enduring life cycle effects of educational mobility on earnings. We identify four mobility groups by cross-classifying parental education (degree/no degree) by their offspring (degree/no degree) and study the long-term economic consequences of intergenerational educational mobility. Data for this study come from Swedish population registers covering birth cohorts between 1953 and 1955. We analyse earnings trajectories of Swedish men and women, in each educational mobility category, over most of their working-age life course. We find that the earnings trajectories cluster in two groups that reflect each’s educational destination, not their educational origin. These results suggest that mobility trajectories in the Swedish labour market do not follow any strong advantage pattern but instead are explained by the attainment of human capital. By contrast, complementary analyses of mid-life wealth, not necessarily derived in the labour market, suggest more support for cumulative advantage since those with high-educated parents have much higher levels of wealth. We argue that these contrasting results, between earnings and wealth, highlight the Swedish welfare regime’s effectiveness, particularly in regulating and suppressing inequality in the labour market.