bluuebunny/crossref_metadata_2025 huggingface dataset:
1086 Tetanus Bedside Immuno-Assay. A Quality Improvement Study
Authors: Gkorila A , Nicola A
Published: July 2024

Aim

ProTetanus immunoassay is a bedside test used to determine if a patient has tetanus antibodies. It has been proven to be sensitive and specific at determining tetanus vaccination status. Although it is available on NHS Supply Chain, it is not widely used. Our aim was to prevent unnecessary Revaxis booster administrations as well as reduce the associated cost.

Method

Using a visual protocol based on trust and NICE guidelines, we determined which patients with tetanus prone wounds would otherwise require vaccination due to uncertainty of their previous immunisation. ProTetanus test was used to assess their immune status. If no immunity was shown, a booster was administered. A simple questionnaire was used to collect data on the test result, ease of use, and time required to perform the test.

Results

18 responses were recorded over 2 months. 2 patients were unnecessarily tested but all patients were treated correctly. In terms of cost efficiency, Revaxis costs £10.16 per vial and ProTetanus £4.15 per test. Therefore, a negative test costs £14.31 and a positive test costs £4.15. In our unit, without ProTetanus, 17 doses of Revaxis would have been administered, costing £172.72. With ProTetanus, 8 doses were prevented, dropping the cost to £161.99.

Conclusions

The introduction of ProTetanus, prevents unnecessary tetanus booster administrations for our patients, improves the level of clinical care, and provides a cost reduction. We have demonstrated that the use of the immunoassays becomes easier with use and minimise reliance on registered nurses. We strongly advocate its use into other departments and units.
910 MIND THE BUMP - a Multi-Site Initiative Promoting Allyship for Pregnant Colleagues in Theatres
Authors: Brown R , Rogers M , Jenkins L , Marino S , Gibby M , Dunkerley S , Graham S , Hristova K , Pentlow A , Vipulendran I , Pearce K , Schmuel E , Pavlova K , Cyclewala S , Roope J , McNish A , Lyons M , Ryan E , English C , Rushton F , Thomas O , Bolchover L
Published: July 2024

Aim

Awareness of considerations to keep pregnant colleagues safe in theatres is crucial for equity and diversity. National orthopaedic guidance exists for radiation, cement exposure, gas induction, scrub, and managing symptoms. Lack of knowledge of guidance can cause anxiety for pregnant staff and friction between colleagues. This multi-centre initiative assessed and improved awareness of pregnancy considerations amongst theatre staff, promoting allyship and a supportive environment,

Method

A questionnaire assessing knowledge of published guidance on pregnancy considerations was completed by orthopaedic theatre staff (surgeons, anaesthetists, nurses, allied health professionals and students) at eight trusts. Educational posters were displayed in theatres and changing areas. The questionnaire was then repeated.

Results

290 pre-poster (49.1%:50.2%:0.7% Male:Female:Non-Binary) and 220 post-poster (37.8%:62.2%:0.0% M:F:NB) questionnaires were completed. Pre-poster, the average percentage of correct questionnaire answers was 22.4%, with a significant 47.3% increase post-poster to 69.8% (95%CI 43.8%-50.8%, p=0.0000). Knowledge varied widely across domains, increasing across all topics (radiation 9.0% to 61.4%, scrub 17.2% to 74.5%, cement 30.3% to 72.3%, gas induction 10.7% to 57.7% and symptom management 45.2% to 82.7%). There was a significant post-poster difference of 21.9% (95% CI 16.3%-27.5%, p=0.0000) between female and male scores (females scoring higher), compared to a non-significant pre-poster difference of 4.2% (95%CI -0.4% to +8.8%, p=0.0783).

Conclusions

This study revealed a low pre-existing knowledge of important pregnancy considerations amongst theatre staff. A simple poster campaign transformed awareness in all staff groups and should be expanded across specialties and nationwide to promote allyship and support for our pregnant colleagues.
1276 Creating Safer Theatres. Tackling Religious Headwear Discrimination Nationally
Authors: Okocha M , Giorga A ,   ASGBI Moynihan Academy
Published: July 2024

Aim

To identify and challenge discriminatory EDI practices. To improve adoption of national policies on surgical headwear in theatre.

Method

Freedom of information requests were sent to 124 hospitals with emergency general surgery theatres. Data requested included total staff number, BAME staff percentage, theatre staff percentage, Muslim theatre staff (including ODPs, porters, medical, nursing staff, surgeons, junior doctors), female Muslim staff number, and copies of uniform policies, especially on religious headwear. Two senior trainees reviewed policies.

Results

100 of 124 trusts responded to the FOI request. Percentage of BAME staff ranged from 5% to 47%. 12 trusts had no BAME members of staff working in theatres or could not release this data for risk of their few personal being identified. 97 policies were reviewed. 80% of the policies reviewed adhered or replicated the national guidance. Potentially discriminatory practices included necessitating disposable head wear be always worn, lack of specific guidance on the wearing of hijabs, and one policy which appeared to request they would not be worn.

Conclusions

This project highlights significant disparities in EDI policies within hospital theatre teams, especially regarding religious headwear. The lack of specific accommodations for religious garments creates an exclusionary environment. This can lead to increased stress and lower sense of belonging amongst minority staff. The findings emphasise the need for hospitals to re-evaluate and reform their policies, those with poor practices have been contacted. We aim to foster a more inclusive, equitable workplace.
939 A Comparison of the Short-Term Outcomes Following Robotic-Assisted and Computer-Navigated Total Knee Replacements
Authors: Chen G A
Published: July 2024

Aim

Total knee replacements (TKR) remain as one of the most effective procedures for restoring quality of life. Computer-navigated TKR (CN-TKR) have been consistently used for the last two decades whereas robotic-assisted TKR (RA-TKR) have been recently introduced into practice.

The primary outcome of this study was to compare the early outcomes following RA-TKR and CN-TKR.

Method

This retrospective, single-centre, cohort study identified all the patients who underwent a TKR in the Golden Jubilee National Hospital by a single primary hip and knee replacement surgeon between 12th January 2021 and 22nd April 2022. Results were analysed for statistical significance.

Results

111 patients underwent a TKR between January 2021 and April 2022. 26 patients underwent a RA-TKR using Stryker’s MAKO SmartRobotics and 85 patients underwent CN-TKR using B. Braun’s OrthoPilot®. Patients who had an RA-TKR were younger, with the average being 64 compared to 69. They also had a greater ROM pre-operatively, with an additional 9 degrees of movement on average.

However, post-operatively there was no difference in ROM. There was no change in the mean length of stay (LOS), operation length, blood loss, Oxford score, EQ5-D score, and Forgotten Joint Score. At the 6-week follow-up, 96% of RA-TKR patients were either satisfied or very satisfied compared to 91% of CN-TKR patients.

Conclusions

This study found no significant difference in short-term clinical outcomes between RA-TKR and CN-TKR. However, a small sample size and a relatively short time frame in which data was collected limits this study to some extent and further research is recommended.
107 Should All Medical Students Receive Clerking Simulation Teaching?
Authors: Bretherton K , Hinton A , Charles-Rudwick M , Tidd C
Published: July 2024

Aim

Simulation-based teaching for clerking hospital admissions is not routinely offered in medical school curricula. The Advanced Clinical Reasoning (ACR) course was developed to improve confidence and clinical proficiency in managing surgical and medical patients by allowing students to work through simulated cases in a safe environment.

Method

The ACR course was optional and face-to-face, consisting of six surgical and six medical simulated cases. The session was divided into practice forming management plans, simulated referrals, and discussion of answers. Students completed pre-course, immediate post-course and six-week post-course questionnaires and knowledge tests.

Results

Qualitative confidence forming management plans significantly increased post-session and at 6 weeks (p <0.00001), as did preparedness for an acute surgical shift (p <0.00001). The mean knowledge test score pre-session was 64%, which increased significantly to 77% immediately after the course (p = 0.0003) with a significant increase from baseline sustained at 6 weeks (p = 0.0012). 100% of students would recommend the course to another student, with 88% keen to repeat the course with a different case.

Conclusions

There was statistically significant qualitative and quantitative improvement in both confidence and knowledge after the course, which remained six weeks later. This supports previous research that simulation teaching has excellent outcomes and should be utilised more widely in medical school curricula. The future of this project is to conduct a remote course with a similar sample size to compare outcomes for face-to-face and remote teaching.
610 The Effectiveness of Adipose Tissue Derived Mesenchymal Stem Cells Mixed with Platelet Rich Plasma in the Healing of Inflammatory Bowel Anastomoses: A Pre-Clinical Study in Rats
Authors: Geropoulos G , Psarras K , Papaioannou M , Geropoulos V , Niti A , Nikolaidou C , Koimtzis G , Symeonidis N , Pavlidis E T , Koliakos G , Pavlidis T E , Galanis I
Published: July 2024

Aim

Anastomotic leak is a detrimental complication following bowel surgery leading to prolonged hospital stay, increased healthcare costs and significant increase in morbidity and mortality. The aim of this study is to investigate the effect of adipose derived mesenchymal stem cells (MSCs) mixed with platelet rich plasma (PRP) in the healing of bowel anastomoses, in an inflammatory environment .

Method

Thirty-five male Wistar rats were divided into five groups of seven animals: normal controls, colitis controls, PRP, MSCs, and PRP + MSCs. All groups underwent laparotomy, segmental colectomy and anastomosis in situ. Colitis was previously established by transrectal administration of 2,4,6-trinitrobenzene sulfonic acid (TNBS) except for the normal controls. Post-mortem histopathological, tissue hydroxyproline and anastomotic bursting pressure (ABP) assessments were performed.

Results

Tissue hydroxyproline and ABP were significantly increased in the group of PRP+MSCs compared to colitis controls (p=0.0151 and p=0.0104, respectively). Inflammatory cell infiltration was lower and fibroblast activity higher in PRP + MSCs group, but not statistically significant. Neoangiogenesis (p=0.0073) and anastomotic area epithelialization (p=0.0182) were significantly higher in PRP + MSCs group compared to colitis controls.

Conclusions

The synergic effect of the PRP and MSCs is shown to significantly improve healing in bowel anastomoses even on a background of inflammation. These results give hope for primary anastomosis and potentially avoiding stoma and its complications, especially in immunocompromised or malnourished patients undergoing bowel resection. Clinical studies should follow in order to support the clinical application of PRP and MSCs combination in gastrointestinal anastomoses.
1040 Morphometric Study of Human Aortic Valve Along with a Case of Bicuspid Aortic Valve in Cadaver
Authors: Borthakur D , Dhawan V , Kumar R , Nomani K , Singh S
Published: July 2024

Aim

The morphometric data pertaining to the aortic valve is very relevant for aortic valvular diseases and prosthetic valve transplant thereof, but such data is variably described in autopsy studies which prompted us to study the same in cadaveric hearts of Indian population. We also present a case of symmetrical bicuspid aortic valve (BAV).

Method

Thirty formalin fixed cadaveric hearts of both genders, aged between 58 -83 years were taken. Guidelines for using cadaver for teaching and research were followed. Various attributes of the aortic valve viz. number, width and height of cusps, number and depth of aortic sinuses, number of coronary ostia were recorded. All measurements were made with Vernier callipers and statistical analysis was performed with Microsoft Excel version 2019.

Results

The mean cusp heights were 18.28±0.54 mm, 19.52±0.34 mm and 20.91±0.46 mm respectively for the right, left and the non-coronary cusps. The mean depths of the aortic sinuses were 17.3±0.68 mm, 16.8±0.74 mm and 15.9±0.32 mm respectively for the right, left and the non-coronary sinus. We also observed symmetrical BAV in 1 (2.5%) out of the 30 specimens but the death of the individual was unrelated to the presence of the anomaly.

Conclusions

The morphometric parameters obtained in the study would help in transplanting prosthetic aortic valve with greater compatibility. The chance of encountering congenital BAV even in individuals with no cardiac ailment should be borne in mind.
1096 The African Surgical Outcomes Study in Paediatric Patients (ASOS-Paeds) and Global Paediatric Perioperative Mortality - a Meta-analysis
Authors: Taylor E , Tesfaye E , Ramakrishnan R , Abdulwahed E A , Bittaye M , Elhadi M , Torborg A , Biccard B
Published: July 2024

Aim

There is little data for surgical outcomes of children in Africa. This is of particular importance as children constitute 40% of the African population, compared to a global average of 25%. As part of ASOS-Paeds - a prospective cohort study of children undergoing surgery in African countries, we undertook a meta-analysis to synthesise the evidence on global paediatric perioperative mortality.

Method

We searched MEDLINE, Embase and WHO Global Index Medicus for studies published within the last decade, reporting paediatric perioperative mortality. We included studies with ≥200 children that reported perioperative mortality for multiple surgical specialties and procedures. Perioperative mortality was defined as death within 30 days of surgery. For meta-analysis, proportions were combined using a random effects model.

Results

After screening 13,258 s and reviewing 158 full-text reports, data from 9 studies were eligible for synthesis along with data from ASOS-Paeds. The meta-analysis included 579,733 children from Africa, Europe, and North America. The pooled perioperative mortality rate per 1,000 children (95% CI) was 17.91 (9.78, 26.04) in Africa compared to 2.18 (0.95, 3.42) in Europe and North America. This equates to excess paediatric perioperative mortality in Africa between 6 (in the best-case scenario) to 25 (in the worst-case scenario) per 1,000 children.

Conclusions

Perioperative mortality for children undergoing surgery in Africa is 8-fold higher than in Europe and North America. Access to safe and affordable anaesthesia and surgery should be a public health priority and urgent action is needed to improve surgical outcomes for children in Africa.
756 Impact of Hands-on Laparoscopic Simulation on Confidence and Skills in Medical Trainees: A Prospective Study
Authors: Khan H , Zilani N
Published: July 2024

Aim

The growing significance of minimally invasive procedures necessitates a shift in the traditional surgical training model towards a more apprenticeship-based approach. This requires the introduction of simulation training in surgical education to be more prominent. This study aimed to explore the effectiveness of a hands-on laparoscopic simulation on confidence in laparoscopic and surgical skills, giving insight into its use of teaching for doctors & medical students, as well as the correlation between confidence and practical skills.

Method

83 medical students and foundation year doctors attended a laparoscopic simulation hands-on session and completed pre- and post-event questionnaires using a 5-point Likert scale assessing their confidence in practical skills and ability to perform laparoscopic surgical procedures. Attendees also rated how important they believe laparoscopic simulators are for improving surgical skills. Statistical significance & normality were determined using the one-tailed Shapiro–Wilk test and a follow-up T-test was conducted.

Results

Attendees had demonstrated a significant increase in confidence in the practical skills required in laparoscopic surgery after having done the simulation (average pre-event & post-event 2.11, 3.69 respectively, p = p = 2.99 10-19); as well as confidence in the ability to perform the procedures (average pre-event & post-event 1.71, 4.16 respectively, p = p = 2.99 10-23).

Conclusions

The study has shown that laparoscopic simulations are effective in increasing the confidence of attendees in the practical ability of laparoscopic simulations and skills required for laparoscopic surgery, showing a positive impact of introducing laparoscopic simulation into surgical training. Further studies are required with long-term follow-up in order to measure sustainability.
809 A Systematic Review of Quality Assurance Processes in Simulated Surgical Training Programmes
Authors: Campioni-Norman D , Mavroveli S , Boshier P , Robb H , Walsh C , Hanna G
Published: July 2024

Aim

To provide a comprehensive overview of quality assurance processes implemented within published simulated surgical training programmes, identifying areas of deficit.

Method

A systematic review was conducted according to PRISMA guidelines. Databases were searched from 1947 until April 2023 to identify studies reporting structured simulation programmes undertaking qualitative assessment of laparoscopic technical skills. The assessment had to be procedural (e.g., appendicectomy) versus tasks (e.g., bean drop). Simulation had to be physical modalities (synthetic/cadaveric). Virtual and augmented reality modalities were excluded.

Data was extracted against an existing quality assurance standards framework for simulation-based education, developed by the Association for Simulated Practice in Healthcare (ASPiH) in partnership with Health Education England. Study quality was appraised using the Medical Education Research Study Quality Instrument (MERSQI).

Results

39 studies were included, with 17 from USA and 3 from UK simulation programmes. Range of participants was 6-256, with 7 studies reporting >50 participants. Faculty: 40% (n=15) of studies reported no description of faculty expertise or selection. 60% (n=24) of studies implemented no assessor training. 90% (n=35) described no faculty evaluation or feedback. Activity: Variability was seen in assessment methods including number of stations, assessors, and assessment tools. 60% (n=24) of studies sought no feedback on their programme. 90% (n=35) of the programmes were not aligned to curricula or learning needs analyses.

Conclusions

This review highlights deficits in the implementation of quality assurance processes including faculty selection, training, and programme feedback. It also highlights the variability of assessment methods, reiterating the need for individualised robust validation processes.
271 Effects of Bariatric Surgery on Metabolic and Hormonal Balance: A 10-Year Retrospective Study
Authors: AlSaket L , Figura K , Bentley Ribot H , Thomas A , Sufi A , Lo S
Published: July 2024

Background

The increasing demand on Gastric bypass and other weight-loss surgeries known collectively as bariatric surgery is well documented but the long-term effects on some parameters have not been satisfactorily analysed over the years. Surgeons are dealing with a level of uncertainty regarding the most likely reason behind this metabolic derangement following such procedures in the follow up clinics.

Aim

To study the long-term effects of bariatric surgery and weight reduction procedures on Parathyroid function, calcium levels, Vitamin D and determinants of bone health.

Method

10-year retrospective study looking at patients underwent bariatric surgery between the years 2006 – 2008 within the Yorkshire area and their follow up data.

Results

We found that the median calcium levels have decreased significantly compared to its level prior to the operation, even though the absolute value of calcium remained within the normal reference range, it was lower than that of the baseline for each individual, resulting in an increased PTH and ALP levels to a low statistical significance and important clinical significance.

Conclusions

Calcium levels being lower than the baseline but still within the normal reference range is affecting both PTH and ALP leaving the patient at increased risk of bone weakness complications and other hormonal disturbances.

Recommendation

During the post-operative follow up plan, calcium levels should be adjusted to mimic the levels of the individuals’ pre-operative values, and the baseline should be the reference range rather than the actual lab reference assuming Calcium levels preoperatively were within the normal range.
366 A Case Study: Application of Personalised External Aortic Root Support to Overcome a Failing Ross Procedure
Authors: Chan-A-Sue T , Karsan R , Lockhart C , Ball P , Austin C , Austin C
Published: July 2024

Aortic root aneurysms are traditionally treated by aortic root replacement surgery alone or in combination with aortic valve replacement in a Modified Bentall procedure. We present a novel surgical approach using a Personalised External Aortic Root Support (PEARS) in the management of an aortic root aneurysm in a 24-year-old male, initially presenting in infancy with mixed aortic valve disease who underwent a free root Ross procedure in 2010 aged 11. Follow-up cardiac magnetic resonance imaging and transthoracic echocardiography showed mild aortic and pulmonary valve regurgitation with aortic root dilatation (51mm). In 2022, Computerised tomography (CT) exhibited dilation of the Sinus of Valsalva (43mm) and ascending aorta (56 mm). MDT review deemed redo valve-sparing root replacement appropriate as the ascending aorta was >55mm with an approximate 8mm increase over three years. As the young patient wished to avoid warfarinisation and the autograft valve maintained good function, a reduction PEARS was considered. In September 2023, a reduced aortic PEARS graft (80% reduction) was implemented along with a redo of the right ventricle to pulmonary artery conduit. Whilst applying the PEARS it was noted that there was a retroaortic circumflex artery, care was taken to mobilise this aberrant vessel to avoid compression by the graft. Cardiopulmonary bypass and cross-clamp times were 180 and 116 minutes respectively. Intraoperative transoesophageal echocardiography confirmed good bi-ventricular function with no pulmonary regurgitation additionally on postoperative CT the aortic diameter was 38mm. In conclusion, application of a reduction PEARS is a potential alternative to a valve-sparing aortic root replacement method in young patients.
1287 Timing of Surgery for Operable Non-Small Cell Lung Cancer and Concordance Between Clinical and Pathological Staging: The Aftermath of the Covid-19 Pandemic
Authors: Qamar A , Qamar Y , Shazly A , Abouelea Y , Yonis H , Islam H
Published: July 2024

Aim

The present study assessed the concordance between clinical and pathological staging of non-small cell lung cancer (NSCLC) in patients who were referred with operable tumors.

Method

We retrospectively reviewed case records of 123 consecutive patients with operable NSCLC, who underwent curative surgery and whose pathology was evaluated at our institution between January 1, 2021, and December 31, 2021. Histopathology reports, imaging information, and multidisciplinary (MDT) team notes were retrieved from hospital digital records.

Results

The cohort included 73 (59%) women and 50 (41%) men in the age range of 46-88 years (median age 73 years [IQR 67-77]). Median time interval between staging CT and surgery (91 days [IQR 76.5-117.5]), and PET and surgery (70 days [IQR 57.5-92.0]) indicated that UK guidelines of <62 days between initial referral and commencement of definitive treatment were not being met in the majority of cases. EBUS-TBNA was performed for 15 (12%) patients and the median interval between EBUS-TBNA and surgery was 44 days (IQR 41.0-66.5). Discordant clinical and pathological TNM staging was evident in 65% of cases, including 45% of clinically understaged cases; and four patients with undetected pT4 disease. Six tumors staged postoperatively as N1 had been staged clinically as N0. For five cases with unforeseen N2, clinical staging was N0; surgery might not have been necessary for these patients.

Conclusions

Discordance between clinical and pathological staging of NSCLC is associated with treatment delays. Reduced time interval between staging CT/PET and surgery may have avoided inappropriate resections.
1004 Urgent Explant of Infected Aortic Stent Graft in a Patient with Kidney Transplant Using Biological Aortoiliac Reconstruction and a Temporary Axillo-Femoral Perfusion Shunt: 6-Year Follow-Up and Literature Review
Authors: Yiu J , Biasi L , Khan T , Taylor D , Price N , Bell R , Sallam M
Published: July 2024

Background

Written consent obtained for case report. A 59-year-old male who was 3-months post-EVAR repair under immunosuppression for kidney transplantation and anti-retroviral HIV treatment presented to ED in 2017 with abdominal pain and fever. CTAP revealed pyelonephritis in renal allograft. Blood cultures were positive for staphylococcus epidermidis. PETCT showed high-intensity uptake around endograft. Urgent explant of endograft and insitu biological aorto-biiliac graft reconstruction with bench prepared bilateral long saphenous veins were performed.

Results

The predicted challenges were locating source of infection, immunosuppressed state, and allograft preservation. Dacron graft was used as temporary perfusion shunt (left axillary artery to right superficial femoral artery) for renal allograft on right external iliac vessels. Endograft was removed via rooftop incision with visceral rotation. Supra-celiac and supra-superior mesenteric artery clamping times were 15 and 35 minutes. The source of infection was from infected appendix proximal to graft with erosion of right external iliac artery resulting in appendectomy in the same operation. Following 12-weeks of OPAT antibiotic-therapy, repeat PETCT revealed low-grade uptake around aortic graft and inflammatory markers were back to baseline. At 6 years in 2023, patient remains clinically well with ∼20% allograft function. Maintaining kidney allograft perfusion in the setting of elective non-infected aortic graft explant was previously reported, but with ENROUTE system (Rasheed et al., 2018).

Conclusions

The satisfactory long-term outcomes discussed here demonstrated with MDT planning involving vascular surgery, infectious diseases, renal medicine and patient, explant of infected graft with insitu biological graft reconstruction in renal transplant patients presenting with complex aortic-graft infection is feasible.
1166 Thymoma and Good's Syndrome: Analysing the Role of Surgery in a Case Series
Authors: Singh C , Anderson R , Hawari M , Jadoon M
Published: July 2024

Background

Good’s syndrome is a rare paraneoplastic phenomenon with unknown pathogenesis in patients with thymoma. The incidence is 0.15 cases per 100,000 population per year. Patients typically have hypogammaglobulinemia, reduced B cell and CD4+ T cell count, and present with recurrent infections and autoimmune manifestations.

Case Summary

This case series highlights two patients with Good’s syndrome who underwent thymectomy in a United Kingdom Thoracic Surgery Unit. Patient 1, a 57-year-old female, presented with a history of recurrent infections (including Pneumocystis jiroveci), dysphagia, and dyspnoea. The subsequent discovery of a thymoma led to a diagnosis of Good Syndrome. Patient 2, a 61-year-old male, exhibited recurrent infections and immunological abnormalities, eventually leading to the identification of a thymoma.

Both patients were diagnosed in their 5th decade, and shared similar clinical profiles with absent B cells, reduced NK cells, hypogammaglobulinemia, and an anterior thymoma. Preoperatively, they received IVIG transfusions. The surgical intervention involved robotic-assisted thymectomy for both patients. Histopathological assessments classified Patient 1 as T1bNxMxR1 and Patient 2 as T1aNXMXR1 providing insights into the extent of the thymomas. Post-operatively they continue to have prophylactic antibiotics and IVIG and have been reportedly well.

Conclusions

Patients with Good Syndrome are at significant risk of opportunistic infections and may present repeatedly to medical specialties. Thymoma and its associated symptoms can precede immunodeficiency. Consequently, thorough consideration of this diagnosis, interdisciplinary collaboration, and preoperative planning is vital for the effective management of this extremely rare syndrome. Successful outcomes are achievable through timely IVIG and full surgical resection.
1215 Cardiovascular Compromise and Hypertensive Crisis Secondary to Phaeochromocytoma
Authors: Fetuga L , Shkoukani Z , Houghton N
Published: July 2024

Phaeochromocytoma is a rare tumour of the chromaffin cells in the adrenal medulla, which secretes catecholamines. While associated with genetic disorders e.g., MEN-2, they tend to occur sporadically, and are often initially asymptomatic, found incidentally on imaging. Classical symptoms of Phaeochromocytoma include headaches, sweating, and palpitations, with sustained or paroxysmal hypertension which is refractory to a cocktail of antihypertensives.

A variety of presentations have been reported in the literature including, but not limited to colitis, intracerebral haemorrhage, and PRES syndrome.

We present a case of a 64-year-old man with an incidental left adrenal nodule. This radiologically indeterminate lesion was initially asymptomatic. Secretion studies revealed elevated metadrenaline levels, and an MIBG scan with positive avidity unveiled the lesion's pheochromocytoma nature.

Whilst awaiting surgical intervention, the patient required emergency admission with a hypertensive crisis, presenting with left-sided flank pain and a blood pressure peaking at 220mmHg systolic. ECG findings were consistent with a myocardial infarction-like picture, and echocardiogram demonstrated regional wall motion abnormalities. CT coronary angiography revealed no significant coronary arterial disease – confirming that the patient’s presentation was in fact secondary to the pheochromocytoma.

Pre-operative optimization is crucial for safe surgery. After the crisis, surgery was delayed by 6 weeks for cardiac rehabilitation. The patient was admitted a week before the procedure for optimal haemodynamics. Adrenalectomy proceeded as planned after alpha-blockade.

A structured endocrine surgery clinic follow-up was established to assess the patient's ongoing recovery, and cardiovascular status. This case highlights cardiovascular implications of phaeochromocytoma, stressing a multidisciplinary approach for hypertensive crises and optimising outcomes.
854 Bridging the Communication Gap in Surgery: A Quality Improvement Initiative to Improve Surgical Juniors’ Confidence in Navigating Difficult Conversations and Documentation
Authors: Kamal T
Published: July 2024

Aim

In response to the challenges faced by surgical juniors in communicating with critically ill patients and their families, particularly after emergency surgery, we initiated a comprehensive two-pronged QIP. Our aims were 1) to enhance skills and confidence of surgical juniors in navigating difficult conversations, and 2) to improve documentation of post-operative patient and NOK discussions after ITU step-down to ward, in-line with NICE guidelines (CG83-1.13).

Method

A retrospective analysis of 14 laparotomy patients in September 2023, revealed that only 36% had documented NOK discussions 3-5 days post-operatively, falling short of best practice guidelines recommending documentation within 12 hours. Only 33% of the 10 patients requiring ITU admission, received documented NOK updates post-step-down to the ward. Interventions to address this included developing a communication skills workshop and implementing colored cards in notes folders to visually identify patients needing NOK discussions.

Results

Pre- and post-workshop surveys, utilizing a 1-to-5 scale, measured confidence levels of junior doctors for difficult discussions, with 13 and 9 respondents, respectively. High confidence scores (4 or 5) for different discussion types showed substantial improvement post-workshop: DNACPR (31% vs. 89%), end-of-life (31% vs. 55%), emotionally charged (31% vs. 78%). Furthermore, 100% of participants post-workshop were highly likely (4 or 5) to utilizing communication frameworks e.g., SPIES.

Conclusions

Our interventions have demonstrated a significant improvement in the confidence of surgical juniors when navigating challenging conversations. Our ongoing efforts include expanding our ‘communication in surgery’ workshop series, which we hope to present, and a re-audit of NOK discussion documentation to objectively measure positive changes post-intervention.
145 Arthroscopy Combined with Platelet-Rich Plasma Injections in Temporomandibular Joint Disorders: Impact on Patients' Quality of Life
Authors: Zar Rab K , Komath D
Published: July 2024

Aim

Temporomandibular joint disorders are associated with pain, dysfunction, and reduced quality of life. Emerging treatments, such as arthroscopy combined with platelet-rich plasma (PRP) injections, offer promise in managing these conditions. This study aims to assess the impact of this combined approach on patients' quality of life. The study outlines a detailed surgical procedure for level 2 arthroscopy, as well as the specialized method for preparing PRP, step by step.

Method

This retrospective cohort study included 80 patients who underwent unilateral or bilateral TMJ arthroscopy with PRP injection between 2019 and 2023. Inclusion criteria involved radiological and clinical evidence of TMJ disorders and failed non-operative treatments. Patients completed the TMJ-S-QoL questionnaire, evaluating pain, diet, speech, and psychosocial aspects postoperatively.

Results

Arthroscopy with PRP injection led to significant improvements in patients' quality of life. The TMJ-S-QoL questionnaire revealed positive outcomes in pain relief, functional improvement, and psychosocial well-being. Statistical analysis confirmed the significance of these improvements (p < 0.05).

Conclusions

Arthroscopy combined with PRP injections represents a promising therapeutic approach for TMJ disorders. This study demonstrates its positive impact on patients' quality of life, encompassing pain reduction, improved function, and enhanced psychosocial well-being. These findings contribute to a comprehensive understanding of treatment efficacy, paving the way for improved patient care and outcomes in TMJ disorder management.
208 Head and Neck Surgical Oncology Handover Audit Using ‘RAAAIDDSS’ Method
Authors: Jamalludin A , Elegio G , Abu Shamat H , Haxhiaj E
Published: July 2024

Background

Patient handover is vital in ensuring patient safety and quality of patient care, in line with Royal College of Surgeons Guidance of Safe Handover (2007). ‘RAAAIDDSSS’ method stands for resection (surgery), airway, anticoagulant, antibiotics, intake, drain, Doppler, serology, scans, structure (plans). It shows comprehensive clinical updates for planning best management, ensuring smooth flow of activity and reducing morbidity. This method is ideal as our surgical patients often have altered airway anatomy and airway plans and consequently variable feeding routes.

Aim

To audit the compliance of RAAAIDDSSS method.

Method

This is a prospective audit in Head and Neck Surgery Department of University College London Hospital (UCLH), done within 4 weeks across June-July 2023, with sample (n=100) for first cycle and (n=81) for second cycle. The format was implemented in handover sheet and case presentation was run according to this method.

Results

First cycle showed good compliance to RAAAIDDSSS handover method. The least compliant component is ‘structure’ which showed only 62%. Results were presented in grand ward round. Second cycle showed significant improvement. Almost all components showed 100% compliance, except for the ‘intake’, which was 90%. Overall shows positive compliance to this handover method.

Conclusions

UCLH Head and Neck Surgery has strict compliance with the RAAIDDSSS method. This audit brings significant positive impacts and changes to clinical practice in terms of patient safety, service efficiency and quality of patient care. This audit also holds valuable clinical value and opens doors for further audits as well as project expansion regionally and nationally.
540 Outcomes of Laparoscopic Common Bile Duct Exploration and Laparoscopic Cholecystectomy; a Single Centre Review from a District General Hospital in Northern Ireland
Authors: Winter J , Ainley P , McGuinness E , Gudyma J , Eltayeb O
Published: July 2024

Aim

Laparoscopic cholecystectomy and common bile duct exploration is a one-stage therapeutic option for patients presenting with choledocholithiasis. This is a review of outcomes for patients who underwent this procedure in a district general hospital setting in Northern Ireland over a two-year period.

Method

This is a retrospective review of prospectively collected data concerning all patients who underwent laparoscopic cholecystectomy and common bile duct exploration between October 2021 and October 2023. Data were reviewed to include pre-operative liver function, pre-operative imaging, rate of conversion to open procedure, length of stay, and readmission rate due to complications.

Results

106 patients were included in the review. The average length of stay was 2.7 days (with a median of 1 day). 87.7% of patients had deranged liver function tests on the morning of surgery, and 100% had proven choledocholithiasis on cross-sectional imaging prior to proceeding to theatre. Only two patients required conversion to open cholecystectomy. No patients developed post-operative pancreatitis. The complication rate was 11.3%, with most complications being of Clavien-Dindo Grade I or II. The readmission rate was 7.5%.

Conclusions

Common bile duct exploration at the time of laparoscopic cholecystectomy represents a safe and effective method for management of choledocholithiasis. It can be considered as an alternative to endoscopic retrograde cholangiopancreatography as a therapeutic option in an appropriately selected patient group.
1195 The Outcomes of Liver Resection for Metastatic Liver Disease from Melanoma: A Systematic Review and Meta-Analysis
Authors: Ravulapalli K , Tijare C , Al-Mukhtar A
Published: July 2024

Aim

There remains controversy in the literature regarding the choice of treatment of melanoma metastases to the liver. This systematic review aims to compare the survival and morbidity rates of patients undergoing liver metastasectomy with patients undergoing medical treatment.

Method

A literature search was conducted from inception until June 2022 using Ovid, Medline, Embase and the Cochrane library. Snowball and hand searches were also carried out. Included studies compared survival outcomes between patients undergoing metastasectomy to those undergoing medical management. Meta-analyses were performed comparing the survival at 6 months, 1, 3 and 5 years as well as overall survival. A sub-analysis was performed comparing the overall survival between surgically and medically treated patients which exclusively uveal melanoma hepatic metastases.

Results

25 studies with a total of 2990 participants were included in our study. All studies were found to have some degree of risk of bias. Mean Overall survival was 44.31 (SD 46.25) and 21.59 (SD 24.31) in surgically and medically treated patients respectively. Meta-analysis showed a statistically significant benefit overall in favour of surgically treated patients (OR = 1.33, 95% CI 0.29 to 2.3, p =0.01, I²=0). This was also the case at 6 months, 1, 3 and 5 years. Meta-analysis showed no significant differences in survival between surgically and medically treated patients which exclusively uveal melanoma metastases.

Conclusions

This review demonstrates improved survival in patients undergoing hepatic metastatectomy for melanoma metastases compared to those undergoing medical treatment, but this may not be the case for those with uveal metastases.
294 Does the Initial Antibiotic Choice Affect the Incidence of Post-Operative Collections in Paediatric Appendicitis?
Authors: Manoharan M , Alrasad R , Chatterjee-Woolman S , Peeraully R , Shepherd G , Shenoy M
Published: July 2024

Introduction

In appendicitis, antibiotics are routinely commenced prior to consideration of operative management. The choice of initial regimen depends on local antimicrobial guidelines. The presence of resistant organisms risks development of post-operative collections.

In our tertiary paediatric surgery unit, antimicrobial guidelines were changed in September 2022 to recommend co-amoxiclav instead of cefuroxime/metronidazole. This study compares incidence of post-operative collections before and after the policy change.

Method

Patients who underwent appendicectomy between September 2021 and October 2023 were identified and contemporaneous data collected. Patients who had initial surgery elsewhere, interval/incidental appendicectomies or penicillin allergy were excluded. Comparison was made between patients receiving cefuroxime/metronidazole (Group 1) or co-amoxiclav (Group 2).

Results

Over the 26-month period, there were 104 patients in Group 1 (after excluding 47) and 104 in Group 2 (after excluding 46). 4 (3.8%) developed collections in Group 1 versus 13 (12.5%) in Group 2. In Group 1, 2 (50%) were treated with antibiotics alone, 1 (25%) required drain insertion and 1 (25%) had a laparotomy. In Group 2, 7 (54%) were treated with antibiotics alone, 5 (38%) required drain insertion and 1 (8%) had a laparotomy. The relative risk of developing a post-operative collection was 3.3 (p=0.023) in Group 2 versus Group 1.

Conclusions

The change in antimicrobial policy resulted in a significant increase in post-operative collections in our unit. This provides evidence that a regimen of cefuroxime/metronidazole is more effective at preventing collections and we are liaising with our Microbiology department with a view to amend the guidelines.
71 Stereotactic Ablative Radiotherapy Is a Safe and Feasible Treatment Option for Patients with Hepatocellular Carcinoma
Authors: Wagner B , Falk S , Callaway M , Abbadi R , Appanna G , Rees J , Skipworth J , van Laarhoven S
Published: July 2024

Aim

Stereotactic ablative body radiotherapy (SABR) is a highly focused radiation treatment that delivers an intense dose of radiation to a tumour whilst limiting exposure of surrounding tissues. SABR has been associated with improvement in survival and good rates of local control in non-surgical candidates with hepatocellular carcinoma (HCC). The aim of this study was to evaluate the outcomes of HCC patients treated with SABR after its introduction in a tertiary referral hepatobiliary centre.

Method

A total of 32 patients (median age 73 years {47 to 85}, 78% male) who received SABR for HCC liver lesions between July 2020 and August 2022 were retrospectively analysed. Patient, treatment, and follow-up details were obtained from online patient records and imaging.

Results

Overall Survival rate was 78% at a median follow-up of 12 months (range 4 to 30). Local control was achieved in 72%, while progression occurred in 31%. Median time to progression was 6 months (range 3 to 31). The rate of progression-free survival at 12 months was 62.5%. Only 31% reported toxicities. No patients in the study group experienced any Grade ³ 3 toxicities.

Conclusions

Our experience following the introduction of SABR for patients with HCC is that SABR is a viable, well-tolerated and effective treatment option in this patient group. Further research is warranted to examine the clinical benefits of combination treatment with SABR and other treatment modalities to maximise disease control in patients with both early and advanced HCC.
399 Cancer Recurrence in Positive Margin Partial Nephrectomies: 5-Year Results from the West of Scotland
Authors: Wrobel A , Durai P , Qureshi K , Umez-Eronini N , Hendry J , Oades G
Published: July 2024

Aim

Provide insight into the incidence of disease recurrence following a positive margin partial nephrectomy in Renal cancer patients. Allowing the analysis of the current surveillance protocols for early detection of disease recurrence.

Method

A retrospective review of all patients undergoing Partial Nephrectomies (PN) within a single centre between 2016 and 2021 was performed. Demographic data including age and sex, as well as tumour-specific data of histology, RENAL score, tumour margin, surveillance, and disease recurrence was recorded. Follow-up was performed as per WOSCAN guidance.

Results

255 patients underwent PN: 79 (31%) open (OPN) and 176 (69%) robotic-assisted procedures (RALPN). OPN was performed in higher risk cancers with a higher risk of positive margin compared to RALPN (10.1% vs 6.25%). The median follow-up time was 35 months. 3 patients with positive margins had recurrence; all were pT3 cancer following OPN of which 2 had metastatic and 1 patient had local recurrence. 18 positive margin patients (95%) were compliant with WOSCAN surveillance guidelines.

Conclusions

OPN was performed for more complex tumours which had a higher risk of positive margins and thus recurrence. Regional data can be used to better counsel patients, however further work should assess any evolving change in RALPN positive margin rates as more complex tumours are attempted robotically.
Red carpet moments: recognition of neuroscientists by election to UK national academies
Authors: Spires-Jones Tara L
Published: July 2024

Our editor discusses recognition of achievement in translational neuroscience and the wider issues around incentivization of research.
Political Partisanship and Economic Outcomes: Canada, 1870–2020
Authors: Voia Marcel-Cristian , Ferris J Stephen
Published: July 2024

This paper examines the role of partisanship at the provincial and federal levels in relation to the functioning of the Canadian economy. At the provincial level (1976–2019), we find no evidence of a traditional partisan effect but do find evidence weakly consistent with a rational partisan cycle a′ la Alesina. At the federal level (1870–2020), we also find no evidence consistent with a distinctive expansion in output arising when the government is controlled by the left-leaning (Liberal) political party although we again find evidence of a weak rational partisan effect. The former result is reinforced by finding the absence of evidence of partisan changes in federal spending and/or taxation. But while the data do not support a theory of left-right partisan policy over the entire post-Confederation (1867) period of Canada’s history, the data do support distinctive periods of partisan influence on aggregate output. The first is consistent with Sir John A. MacDonald’s post-Confederation conservative government’s adoption of a policy of nation-building based on the railway, immigration, and tariffs. The second is the period between 1885 and 1933 where traditional left-right partisanship is evident and the third is the period following the Great Depression where a distinction between the outcomes arising under left- versus right-leaning parties is no longer apparent.