bluuebunny/crossref_metadata_2025 huggingface dataset:
1140 Antibiotic Stewardship in Treating Glandular Fever Tonsillitis
Authors: Sood M , Elmarghani M , Misirovs R , Ganesh V
Published: August 2024

Introduction

Glandular fever is caused by Epstein-Barr virus. Antibiotics are not indicated in viral infections. A large number of patients who are hospitalised with sore throat will have Glandular fever with positive IM serology and be incorrectly treated with antibiotics without evidence of superimposed bacterial infection.

Aim

To assess the use of antibiotics in EBV positive patients with no signs of bacterial infection in NHS Lothian.

Method

A retrospective audit of 75 adult patients hospitalised with tonsillitis between August 2020 and July 2021. Data on diagnosis, inflammatory markers, EBV serology, and antibiotic use were collected and analysed. This was compared to previously reported NHS Tayside 4-year data between 2017 and 2020.

Results

Of the 75 tonsillitis admissions, 28% were IM Positive. Of these, 86% were discharged on antibiotics despite no evidence of concomitant bacterial infection. Similar figures were noted in NHS Tayside.

Conclusions

Glandular fever seems to be managed with antibiotics which goes against current best practice. Local and national ENT guidelines need to be updated and created, respectively.
1280 The Role of Antibiotics in Diverticular Bleeding
Authors: Al-Hashemi S , Davis C , Heneghan H , Fearon N
Published: August 2024

Aim

Diverticular disease is a leading cause of lower gastrointestinal bleeding. The management of diverticular bleeding varies between surgeons. Evidence has shown that omission of antibiotics for the first presentation of uncomplicated acute diverticulitis is sometimes safe. We sought to identify trends that may suggest the same is true in patients presenting with diverticular bleeding.

Method

This was a retrospective cohort study. The Hospital Inpatient Enquiry coding system was used to identify patients presenting to our hospital with diverticular bleeding without colonic perforation requiring hospitalisation between the period. Data were then collected regarding demographics, initial blood results, inclusion or omission of antibiotic therapy, need for inpatient endoscopy, length of stay, need for surgery and readmission within 30 days with re-bleeding.

Results

34 patients were identified, roughly 3/4 of whom were female. The average age was 75 years old (Standard Deviation +/- 13) and the median duration of bleeding before presentation was 24 hours. The mean haemoglobin was 11.5 grams/decilitre (SD +/-2) and mean white cell count was 10.4 (SD +/- 4). Median C reactive protein was 8.2 (range 1 - 209) 18/34 patients were prescribed antibiotics and had a mean length of stay of 4.8 days. Those in whom antibiotics were omitted had a mean length of stay of 3.7 days. There were 19 inpatient endoscopies undertaken, none of which resulted in any endoscopic intervention. Only 1 patient was readmitted within 30 days with rebleeding.

Conclusions

This study suggests omission of antibiotics in patients presenting with diverticular bleeding may be safe in select circumstances.
422 Does Surgeon Age Influence the Outcome of Emergency Laparotomies? a Single Centre Retrospective Study
Authors: Behera K , Hargest R
Published: August 2024

Aim

In the United Kingdom, over 20000 emergency laparotomies are performed annually and reported in the National Emergency Laparotomy Audit (NELA). Although the mortality rate after emergency laparotomy has fallen recently, it is still significantly higher than elective surgery. Many studies have assessed the correlation between patient factors and institutional provisions against emergency laparotomy outcomes. However, there is limited evidence for the influence of surgeon related factors. To assess the influence of surgeon age on mortality rate for patients undergoing emergency laparotomy.

Method

Data was collected from NELA (2014–2018). Operations performed by surgeons who were locums, non-consultants or from a speciality outside of general, vascular or transplant surgery, and those with missing data were excluded. Surgeon age <50 or >50 years were compared to 30-day, 60-day, 90-day and 1-year mortality.

Results

In total, 1147 patients were included and 264 (19%) excluded for the reasons listed above. There was no significant difference in the mean 30-day, 60-day, 90-day and 1-year mortality between the groups. The mean mortality rates for <50 years (>50 years) were 11.60% (11.80%), 14.70% (14.60%), 15.00% (14.80%) and 15.20% (15.00%) respectively (p=0.44). Surgeons aged >50 years had a 10% decrease in overall mortality rate compared to 4% for the <50 group. There was a significant difference in patient demographics between the two groups as the >50 group had a higher risk caseload (p=0.02).

Conclusions

Overall mortality after emergency laparotomy was not related to surgeon age but older surgeons undertook higher risk cases.
383 Assessing Knee Pain Following Intramedullary Nailing for Tibial Shaft Fractures: Retrospective Analysis of Patient Outcomes at Single High Volume Major Trauma Centre
Authors: Dangata K , Murphy L , Rooney B
Published: August 2024

Aim

The primary objective of this study is to use proven patient reported outcome measurement (PROM) tools to compare knee pain and function between the two approaches.

Method

This single centre retrospective study identified all patients who underwent IM nailing of the tibia between January 2020 – February 2023 in the Queen Elizabeth University Hospital Glasgow. The patient cohort was divided into those who received an SPN versus an IPN. The outcomes were assessed using the Oxford Knee Score and Kujala scores.

Results

After applying exclusion criteria, our study comprised 93 patients, from whom we obtained 50 responses (23 IPN vs 27 SPN) and the mean patient age was 47. No statistically significant disparities in patient demographics were observed between the 2 groups. The mean Oxford Knee score in the SPN group was 34.5 compared to 38.3 the IPN group. The mean Kujala score was 67.6 in the SPN group versus 73.3 in the IPN group. Using a two-tailed student’s T test we concluded that the pain scores from both Oxford knee score and Kujala Knee were not significantly different between the SPN and IPN group.

Conclusions

Based on our analysis the outcomes in anterior knee pain between the IPN and SPN group are comparable. It is recommended to continue using suprapatellar tibial nailing technique for treating tibial shaft fractures at our institution. A larger scale powered study is required assess its superiority over the IPN procedure for anterior knee pain.
652 Inspiring Future Surgeons - Exploring Influences on Year 3 UK Medical Students' Interest in Surgical Specialties: A Thematic Analysis
Authors: Kaur H K , Alakus C A , Elsherbiney S , Khera G
Published: August 2024

Aim

UK surgical training is recognised for its demanding nature, extensive working hours, stressful environment, and prolonged training. We aimed to identify positive factors influencing medical students in considering a surgical career, to shape surgical educational placements.

Method

An optional, anonymous, single-question, open-text survey was administered to 190, year 3 UK medical students, after completing a 11-week surgical clinical placement, comprising Breast, Emergency Department, Interventional Radiology, Orthopaedics, Peri-op anaesthetics, Plastics, Vascular, Upper/Lower GI and Urology. The specific question asked was, 'Would you contemplate pursuing a career in surgery?' Subsequently, a qualitative analysis focused on responses from participants expressing interest in a surgical career, utilizing a thematic approach to categorize and identify common patterns.

Results

102 responses were received of which 35 were not suitable for analysis. Among the remaining 67 students, 37 (55.2%) demonstrated a positive inclination towards a surgical career. Following thematic analysis four main themes were identified:Encountering positive role models within field of surgeryHands-on practical nature of surgeryPositive influence of recent surgical placementPre-existing surgical interest

There was also evidence that some student’s had changed their minds, reporting they were ‘inspired and pleasantly surprised, despite being apprehensive about surgery before starting placement’.

Conclusions

To increase recruitment to surgical specialities and improving surgical placement satisfaction requires positive engagement with diverse surgical specialties, gaining hands-on experience in a supportive environment, with inspiring surgical role models. Our study sheds light on the areas where medical schools and surgeons should tailor educational strategies to inspire future surgeons.
1070 Intraoperative Identification of Glioblastoma Multiforme Using Label-Free Optical Biosensors and Refractive Index Sensing
Authors: Balaji A , Suvarna R , Ovalekar R , Musa M , Chauhan M
Published: August 2024

Aim

Glioblastoma multiforme is the most prevalent brain tumour, with a high recurrence rate due to the lack of quality and cost-effective imaging techniques. Thus, our study aims to explore application of biosensors as a potential non-invasive, low-cost and highly specific means of identifying GBM cells intraoperatively utilising differences in refractive indices of tissue imprints obtained.

Method

A literature search was performed on Medline OVID, PubMed and Google Scholar with keywords including ‘glioblastoma’, ‘biosensor’, ‘refractive index’ and ‘glutamate’.

Conclusions

Splicing pattern alterations and downregulation of canonical isoforms of Glial Fibrillary Acidic Protein (GFAP) are pivotal in glioma progression. Glutamate dysregulation in glioblastoma (GBM) is emphasised by GLAST (glutamate aspartate transporter) activity. GLAST, vital for extracellular glutamate homeostasis, is dependent on the Na+/K+-ATPase electrochemical gradient. GBM cells exhibit compromised glutamate uptake due to GLT-1 absence, influenced by oncogenes such as AEG-16, and aberrant GLAST localization in the nucleus. Neurophotonics and spectroscopy methods show promise in distinguishing between GBM and healthy brain parenchyma, however they are limited by cost. A prospective study revealed high specificity with gold imprinting biosensors in identifying GBM tissue with refractive index 1.350, warranting investigation into the differences in the interaction of GFAP and GLAST proteins with light via spectroscopic techniques which could provide better intraoperative guidance. A potential methodology could involve refractive index sensing with “label-free optical sensors to detect biomolecular interactions” with GFAP and GLAST proteins using transmitted diffraction patterns.
716 Analysis of Routine Endoscopy Referrals in NHS Greater Glasgow and Clyde
Authors: McElvaney J , Irving A , Lawton A , Sabir S , Glen P
Published: August 2024

Aim

Routine (category 3/4) upper gastrointestinal endoscopies (UGIE) constitute a significant proportion of endoscopy workload in NHS Greater Glasgow and Clyde (GGC). Referrals are varied and there are opportunities for service improvement to reduce clinician burden and patient outcomes. This is with particular relevance to early detection and prevention of cancer. This work aimed to analyse routine UGIE referrals and subsequent scopes within GGC to identify quality improvement opportunities, potentially including endoscopy-saving alternatives such as Cytosponge.

Method

Referral indications for 299 males over 50 years awaiting routine UGIE in GGC on 02/03/2023 were reviewed. Referrals were categorised into 6 groups based on primary presentation. Data on findings, biopsy and follow-up were gathered where UGIE was subsequently performed.

Results

299 patients were analysed; 197 received UGIE (4 had no available scope report), 77 remained waiting, 25 had died/not attended/declined UGIE. Primary referral presentations were 13% Oesophageal; 29% Gastric; 10% Anaemia; 28% Liver/variceal; 14% Dysphagia; 6% other (n=299). At UGIE, 10% (n=193) identified pre-/malignancy across all groups; there were 3 cases of new malignancy. 75% (n=193) received medical/conservative management following their scope and 22 cases could have been reassured using Cytosponge.

Conclusions

There are opportunities for improved routine UGIE delivery in GGC which may reflect nationally. These include altered vetting practices and potential UGIE-saving procedures. Notably, there was no Barrett’s oesophagus rich group within this cohort.
36 The Duration of Postoperative Antibiotics in Autologous Breast Reconstruction: A Systematic Review and Meta-Analysis
Authors: Aldarragi A , Farah N , Warner C , Ghasemi A , Ekakitie O , Jabr Y , Rahman S
Published: August 2024

Although prophylactic antibiotic use following autologous breast reconstruction post-mastectomy is a common practice, there is no consensus in the literature regarding its duration. Antibiotic stewardship is important to minimise multi-resistant organisms as well as mitigate the associated side effects. Currently, there are no published guidelines regarding the duration of prophylactic antibiotics in autologous breast reconstruction surgery following mastectomy. The authors searched the online literature regarding the administration of antibiotics for autologous breast reconstruction surgery post-mastectomy. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. The primary outcome measure was the incidence of surgical site infections (SSIs). Three studies met the inclusion criteria and included a total of 1,400 patients. Overall, 101 (7.2%) SSIs were observed. There was no significant difference in the rate of SSIs when comparing the use of antibiotics for less than or longer than 24 hours postoperatively (odds ratio = 1.434, p = 0.124). There is no significant difference between SSIs with the use of antibiotics for longer than 24 hours when compared to less than 24 hours. Further studies in the form of randomised controlled trials are required to assess the effects of prophylactic antibiotic duration in autologous breast reconstruction following mastectomy.
335 Investigating of the Utilisation of Botulinum Toxin Type-a in of Breast Reconstructive Surgery: A Literature Review
Authors: Cui X M , Lim J S , Wai J , Mosahebi A
Published: August 2024

Aim

Breast malignancy remains a serious and debilitating disease, with numbers increasing every year. Previous research found that botulinum toxin type A (BoNT-A) can be used in various aspects in plastic and reconstructive surgery, and that BoNT-A can be applied in many non-aesthetic surgeries. This review aims to investigate the efficacy of BoNT-A on improving outcomes for flap reconstruction of the breast in women in the past 5 years.

Method

A systematic review approach of Medline, Embase, PubMed and Cochrane Register of Controlled Trials (CENTRAL) identified 5 publications after the application of selection criteria.

Results

The literature was assessed based on pain attenuation, scar prevention, muscular contracture and muscle spasms. Only scar reduction was clinically relevant, with mean total POSAS scores between the intervention (15.17±7.6, p=0.034) and control (13.04±5.44, p=0.034) at the 9-month follow-up.

Conclusions

There is evidence supporting the use of BoNT-A in scar reduction for breast reconstruction, however, no additional benefits were identified.
429 Does Time to Definitive Treatment Have Influence on the Clinical Outcomes of Open Hand Injuries? a Systematic Review
Authors: Chee S Y , Quinlan C
Published: August 2024

Aim

Hand injuries pose a significant financial burden due to medical expenses and occupational disability. They constitute about 20% of emergency department attendances. Minimal evidence exists to confirm that the rate of complications of open hand injuries is not increased by waiting to perform definitive operative repair. The study’s aim is to collate existing evidence to investigate the influence of surgical timing on the outcomes of open hand injuries.

Method

A systematic literature search of Medline and Embase computerised literature databases and manual bibliography searches were conducted using the PRISMA 2020 guidelines and the SWIM criteria. Descriptive/ quantitative data were extracted, and we grouped the results obtained to enable a clear and transparent interpretation of our findings. Eligible articles included adult subjects (>16 years old), open hand injuries distal to the radius and ulna, reported clinical outcomes and were published in English.

Results

13 studies were included in the qualitative synthesis. Our studies involved patients aged 26 to 87, predominantly male. 13 studies examining the time to definitive treatment assessed various clinical endpoints: infection rates (n=12), total active motion/ extension (n=1), length of hospital stays, (n=1) revision surgery rates (n=1), non-union rates (n=1) and functional outcomes (n=1). Overall, the findings showed that time to definitive treatment did not result in adverse outcomes for open hand injuries.

Conclusions

These findings support the idea of managing open hand injuries in an ambulatory, semi-urgent setting, which could potentially contribute to improved healthcare service planning and enhance the quality of patient care.
644 Advancements in Biofabrication of Human Skin and Its Microvascularity
Authors: Seraj S S
Published: August 2024

Aim

Bioengineered in-vitro human skin substitutes with reliable “take” has been the aspiration of clinicians and bioengineering researchers when tackling compromised skin in chronic wounds, burns, malignancy and trauma. Microvasculature of these artificial models is key for maintaining hold into the recipient site. The purpose of this review is to outline the current body of literature regarding skin substitutes and innovations in bioengineered vascularity.

Method

A narrative literature review using a systematic approach was performed by using a search strategy and MESH terms: "((3D Bioprinting) OR (Biofabrication) OR (tissue engineering)) AND ((skin tissue) OR (skin substitutes) OR (human skin))". MEDLINE (PubMed), Embase (OVID) and CENTRAL (cochrane library) databases were examined. Inclusion and exclusion criteria were applied.

Results

Previous developments in 3D bioprinting involved forming multilayered scaffolds, hydrogel/gelatine bioinks, preset moulds with tissue-engineered keratinocytes and fibroblasts. Artificial angiogenesis in-vitro models have included lining biofabricated microtubules or pores with human placental pericytes or endothelial cells. Extrusion-based bioprinting has been popular either in a "top-down" or "bottom-up" approach to construct scaffolds. Pore size diameters of these substitutes have adhered to >100µm. Autologous fat grafting has provided a viable microvascular option.

Conclusions

Only a few studies and clinical trials have managed to tackle the vascularity issue of human skin substitutes. Exploration into integration 3D bioprinted scaffolds, fat grafting with a bottom-up approach using micropores lined with endothelial cells provides promise for future research. Further studies must be undertaken to assess feasibility, cost and "take" of such grafts initially in human subjects with industry support.
731 Profiling United Arab Emirates Aesthetic Botulinum Toxin Practitioners: A National Cohort Analysis
Authors: Zargaran A , Zargaran D , Sousi S , Al-Khafaji M , Mohamed F , Al-Khafaji M , Davies J , Mosahebi A
Published: August 2024

Aim

The global aesthetic Botulinum Toxin market has been growing yearly, with concomitant concerns over lack of regulation and oversight. Whilst robust laws are in place in UAE regarding who is licensed to practice, practitioners remain largely unknown. This study aims to quantitatively evaluate practitioners and their professional background in the UAE.

Method

A comprehensive search was performed on internet search engines and social media in Abu Dhabi, Dubai, Fujairah and Sharjah. Clinics were then contacted via WhatsApp to corroborate online information. The list of practitioners was cross-referenced with professional regulatory bodies, as well as year of qualification and country of qualification.

Results

A total of 694 practitioners were identified from 310 clinics. 50.7% were male, while 49.3% were female. The most common practicing specialty were dermatologists (48.3%), followed by plastic surgeons (39.4%). Only one non-medical practitioner was identified. Practitioners qualified from a total of 51 different countries with the most common one being Syria (n=76), followed by Egypt (n=71). The modal year of qualification was 2016.

Conclusions

This paper is the first to describe the range of aesthetic Botulinum Toxin practitioners in UAE, their professional backgrounds and experience. Knowledge of professional background is an important consideration when introducing regulation and monitoring public health impact, and this provides a foundation for further regional and international public health studies.
1285 Evaluation of Post-Operative Outcomes for Peripheral Nerve Injuries to the Hand: A Single-Centre Study
Authors: Panikkar M , Elfaki A , Izadi D
Published: August 2024

Aim

This study aims to investigate all adults who suffered peripheral nerve injuries to the hand over a one-year period to assess adherence to The British Society for Surgery of the Hand (BSSH) guidelines for nerve trauma. It also aims to assess clinical outcomes and provide strategies to optimise patient care.

Method

This is a single-centre retrospective analysis of 76 adult peripheral nerve injuries between November 2022 and November 2023. Data was collected and analysed regarding patients’ time from predentation to repair, mechanism and nature of injury, intra-operative practices and post-operative recovery and management.

Results

60% of nerve injuries were repaired by consultant plastic or orthopaedic surgeons. On average, nerve injuries were repaired within 3.3 days of referral. 83% of nerve injuries were to digital nerves of the hand. The infection rate reported at the time of patients’ first clinic appointment was 8%. 10% of patients underwent secondary procedures including full-thickness skin grafts and further washouts. 84% of patients were referred to hand therapy following surgery.

Conclusions

This data highlights high rates of adherence to the BSSH guidelines with regards to the time from presentation to repair, in addition to the availability of competent hand therapy services and experienced microsurgeons to facilitate satisfactory post-operative outcomes. It also identifies areas for improvement including documentation of intra-operative equipment and the use of pharmacological aids.
113 R-E-S-P-E-C-T: A Closed-Loop Audit Increasing the Quality of ReSPECT Documentation in a Tertiary Surgical Centre in the United Kingdom
Authors: Wagner B , Flint M , Jenkins B , McNish A , Rutland T , van Laarhoven S
Published: August 2024

Aim

Resuscitation Council UK guidelines suggest Recommended Summary Plans for Emergency Care and Treatment (ReSPECT) must be considered for all patients at risk of deterioration or cardiac arrest or who want to have their wishes documented. This quality improvement project aims to evaluate the use of ReSPECT forms in acute general surgical admissions and improve compliance with the ReSPECT process.

Method

The audit was registered with the local audit department (REF: GENSUR/CA/2023-24/03). Data was collected in the form of random spot-checks, quantitatively and qualitatively evaluating the completion of ReSPECT forms for all patients admitted via the general surgical ‘take’ at a large inner-city hospital. The first intervention was the addition of ReSPECT forms to the surgical admissions proforma. Second-cycle intervention involved educating clinical teams about the importance of ReSPECT completion by delivering a teaching session and producing a novel poster to be displayed in the unit.

Results

The initial completion rate of accurate ReSPECT forms was 8%, with 30% counter-signed by the responsible consultant. Re-audit following the first intervention showed ReSPECT form completion rate of 27%, with 50% of forms counter-signed by a consultant.

Conclusions

The addition of ReSPECT forms to the surgical admission proformas is a simple and effective way of increasing compliance. Overall quality of ReSPECT documentation improved with our interventions, however, there remains scope for further improvement and ongoing education of clinical teams is paramount to improving compliance with the ReSPECT process long-term.
464 ENT Handover Audit Using ‘RAAAIDSSS’ Method: Initial Step in Excellent Patient Care
Authors: Jamalludin A N Binti , Sahu B
Published: August 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, 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 otolaryngology patients often have altered airway anatomy and airway plans and consequently variable feeding routes.

Aim

To audit the compliance of RAAAIDSSS method.

Method

This is a prospective audit in ENT Department Imperial College Hospital NHS Trust, done in August and October 2023, with sample (n=100) for each cycle. The format was implemented in handover sheet and case presentation was run according to this method.

Results

First cycle showed good compliance to RAAAIDSSS handover method. The least compliant component is ‘structure’ which showed only 62%. Results were presented in local teaching. 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

The department has showed improved compliance with the RAAIDSSS 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.
757 Rapid Deployment of a Virtual Fracture Clinic (VFC) at a London District General Hospital: Safely Building on a Pragmatic Measure to Bring About Lasting Service Impact
Authors: Erotocriou M , Chammaa R , Mellet S , Berber O , Overton A
Published: August 2024

Aim

We report our experience of rapidly deploying a Virtual Fracture Clinic (VFC) at our institution as a safe alternative to a traditional fracture clinic and demonstrate how innovation can be built upon to enact lasting change.

Method

The VFC was assessed using 3 PDSA cycles. Initially, a paper referral system was established along with detailed injury management pathways. In the 2nd PDSA cycle an electronic referral system was introduced. The 3rd PDSA cycle involved ED staff training sessions, alongside a patient webpage. At each stage the number of VFC referrals, clinic follow-ups and patient satisfaction were measured.

Results

There was a statistically significant (p-value<0.01) reduction in the number of new face-to-face follow-up appointments between pre-VFC (4083) and post-VFC (713); an increase in patient satisfaction (p-value<0.05) and a reduction in non-attendance (p-value<0.01). Recent executive review demonstrated ongoing success and sustainability with the creation of 1600 face-to-face clinic slots which could be used for elective or post-op patients, reducing the pressure on orthopaedic services.

Conclusions

We have demonstrated that a VFC model can be deployed rapidly and safely as an emergency measure and subsequently refined into a permanent and effective service thereby dramatically improving efficiency and cost effectiveness over a short period. Rapid, bold innovation is possible in the NHS but requires short-term pragmatic changes which can then be nurtured to amplify their lasting effect. Our work highlights that key to success are strong clinical leadership, the meaningful engagement of all stakeholders and senior managerial/operational support.
824 Assessing the Quality of Surgical Operation Notes in the General Surgery Department at a District General Hospital (QI Project)
Authors: Sherafat A , Alhammali T , Ali A , Kamath S , Marcu V
Published: August 2024

Aim

assessing the current adherence to Royal College of Surgeons (RCS) guidance on the standards of documenting operation notes. There are 18 elements that must be present on operation notes including date and time of operation, name of surgeon and anaesthetist, type of anaesthesia, findings of operation, potential complications, closure technique, information on implants and signature of the surgeon.

Method

The present audit was a retrospective study of patients' notes to review their operation notes. 93 operation notes that were recorded August-September 2022 were reviewed in the first cycle. The second cycle reviewed 46 operation notes in May 2023.

Results

The outcome of the audit showed satisfactory adherence to majority of the RCS recommendations. Time of the operation was only recorded in 9% of operation notes in the first cycle which improved to 76% in the second cycle. Only 46% of operation notes in the first cycle were signed by a surgeon which improved to 67% in the second cycle.

Conclusions

Areas that mainly required improvement were identified to be recording time of the operation and signature of the surgeon in the first cycle. The result of the first cycle of audit was communicated to surgeons. The electronic operation note templates were also updated. The second cycle showed a significant improvement in the quality of operation note documentation in May 2023. A continuous cycle of audit should be implemented to ensure the documentation standards are maintained.
1046 IV Maintenance Fluids Prescribing in General Surgery Patients
Authors: Tan J X , Tan H M , Sasapu K
Published: August 2024

Aim

Identify if DPOW general surgery team is meeting NICE guidelines for IV fluids prescribing and offer solution for quality improvement.

Method

NICE guidelines 2013 states that patients should receive 25-30ml/kg/day of water and 1mmol/kg/day of sodium, potassium, and chloride with regards to maintenance fluid therapy. We conducted a retrospective audit on surgical patients. Post-operative emergency laparotomy patients were chosen randomly from surgical inpatient wards in DPOW hospital over the course of one month. Maintenance IV fluids prescribed over 24 hours were collected, adjusted according to the patients’ weight, with the exclusion of individuals with AKI and heart failure. Microsoft excel was used to calculate the average weight, fluid volume and electrolyte administration.

Results

Over the specified time frame, 21 patients were identified. The mean weight among these patients was 72kg. The typical daily intake of total fluid volume amounted to 2.5L. During the 24-hour post-operative period, the mean electrolyte concentration administered were as follows: 249mmol Sodium, 12mmol potassium, 228mmol chloride. Taking into account the average patient weight, there is a net administration of +177mmol sodium, -60mmol potassium, +156mmol chloride.

Conclusions

The electrolytes administered were inappropriate with too much sodium, chloride and too little potassium. Patients on average received 246% excess sodium, 83% less potassium and 217% chloride than the recommended daily requirement. Interventions including teaching sessions and posters to foundation doctors to improve the appropriateness of intravenous maintenance fluids prescription in the hospital has been done. The next data collection after intervention will be done by the end of December 2024.
1250 Literature Review: Revolutionizing Emergency General Surgery; Harnessing the Power of Robotics and Pioneering the Future Landscape of Artificial Intelligence
Authors: Al Maawali S S
Published: August 2024

Aim

This review embarks on two critical fronts: firstly, an exploration of the integration of robotic surgery in emergency general surgery, and secondly, a forward-looking anticipation of the role of artificial intelligence (AI). The objective is to provide profound insights into the potential applications of robotics in urgent surgical scenarios, endorsed by a meticulous systematic review supported by the World Society of Emergency Surgery (WSES)1. Concurrently, the review evaluates the future trajectories of AI, accentuating its potential within healthcare.

Method

The study meticulously conducts a PRISMA-compliant literature search encompassing PubMed and the Cochrane Library, spanning from 1980 to 2022. Fifty-two studies, enveloping urgent conditions undergo meticulous scrutiny2. The parallel review on AI delves into major advancements, dissecting advantages, obstacles, and potential implications according to the WSES methodology1.

Results

Robotic assistance in urgent general surgery, predominantly utilising the Da Vinci® system, demonstrates feasibility across surgical emergencies2. Simultaneously, the review on AI illuminates a promising trajectory for robotic technologies, emphasising their potential to revolutionise healthcare through improved patient outcomes, and precise solutions for challenges1.

Conclusions

This study envisions a landscape where robotic surgery emerges as a formidable ally in emergency settings, showcasing not only feasibility but also safety. Simultaneously, it underscores the role of AI in reshaping healthcare. It creates a balanced approach that integrates technology while preserving the human touch. This synthesis heralds a future where robotics and AI seamlessly converge, delivering enhanced patient care.
480 RCS Good Surgical Practice Consent Guidelines: An Audit of Compliance After the Introduction of Digital Consent
Authors: San N T , Martin J , Rahman K , Brahmbhatt K , Mahmood A , Lister G , Bowrey D
Published: August 2024

Background

Informed consent is an ethical and legal obligation of modern-day clinicians. It protects patients from harm and doctors from litigation. Digital consent may enhance patients’ satisfaction and understanding, whilst also facilitating shared decision making. At our institution, digital consent (Concentric®) was introduced to the General Surgery department in May 2022.

Aim

To evaluate whether electronic consent forms on Concentric® followed RCS Good Surgical Practice Guidelines.

Method

A retrospective review was conducted on all patients consented using Concentric® by the General Surgery team for the calendar month of August 2023. Endoscopic procedures, blood transfusions and duplicate consent forms were excluded. Data was collected based on current RCS Good Surgical Practice Guidelines. Additional information was extracted from the theatre management software (ORMIS), correlating the time of consent with the date of the procedure.

Results

Over the month, 398 consent episodes were evaluated. Compliance with RCS standards was as follows: benefits and risks of procedures (100%), clinicians involved (100%), indication for procedure (87%), alternative treatment (62%), and patient information leaflet with follow-up information (37%).

Among elective procedures (186 episodes), only 32% of patients were consented prior to the day of surgery. Where there was a significant interval (>24 hours) between the original consent signing and the operation, only 52% had consent reconfirmed.

Conclusions

This audit identified areas of good practice and areas for improvement in relation to digital consent in general surgery. Making fields on the form mandatory would likely improve compliance with current RCS standards.
826 Does Prehabilitation Improve Quality of Life After Gastrointestinal Cancer Resection?
Authors: Razzaq A , Niaz O S , Seabrook M , Rao A
Published: August 2024

Aim

This study aims to evaluate the effects of prehabilitation on the quality of life (QoL) of patients undergoing gastrointestinal cancer resection, addressing the existing gap in knowledge regarding this specific population.

Method

A systematic search of relevant terms was independently conducted by two authors across multiple databases. Selection criteria were applied rigorously, with conflicts resolved through consultation with senior researchers. From the initial pool of 33 articles, 6 studies were chosen for inclusion. Data extraction and analysis were performed to assess the significance of prehabilitation interventions on post-resection QoL.

Result

The selected 6 studies, despite displaying noticeable heterogeneity in methodologies and outcomes, consistently indicated a positive impact of prehabilitation on the role functioning aspect of QoL, as measured by the C30 QoL survey. The studies collectively involved a substantial number of patients.

Conclusions

The evidence from the reviewed studies suggests a favourable influence of prehabilitation on the post-resection QoL of gastrointestinal cancer patients, particularly in the domain of role functioning. However, limitations such as heterogeneity in Randomised Controlled Trials (RCTs) and a lack of long-term follow-up data, should be acknowledged. To provide more definitive conclusions, future RCTs should employ standardised QoL questionnaires like the C30 QoL and extend follow-up periods. This would enhance our understanding of the role of prehabilitation in improving patient outcomes following gastrointestinal cancer resection.
101 "Why Is This Person a Surgeon if They Can't Keep Their Hands Still?"- the Experience of Enhanced Physiological Tremor in Surgical Trainees
Authors: Greenlees G , O’Hanlon M
Published: August 2024

Aim

All humans experience a degree of physiological tremor which may be exacerbated by anxiety, fatigue, or caffeine. Physiological tremor visible to the naked eye is termed enhanced physiological tremor (EPT). The effect of tremor on surgical trainees has been explored in laboratory conditions but there has been limited exploration of the effect of anxiety on EPT. There is increasing recognition that surgical performance anxiety is a common phenomenon and we therefore set out to explore trainees experience of EPT, particularly its relationship with performance anxiety.

Method

Twelve surgeons in training were recruited to participate in semi-structured interviews on surgical performance anxiety and EPT. Interviews were conducted using Microsoft Teams and an inductive content analysis of transcripts was performed.

Results

All participants had experienced or witnessed EPT. EPT was felt to be common in surgical trainees and driven by surgical performance anxiety. Perceived evaluation by supervisors and other staff was a common trigger for surgical performance anxiety. Trainees outlined a variety of coping mechanisms such as using humour and physiological explanations for their tremor. EPT was generally described as improving with experience but could provoke negative emotions such as shame in trainees who experienced tremor.

Conclusions

Our findings add to a growing body of evidence on surgical performance anxiety and provide one of the first descriptions of trainee’s experiences of EPT. Further research, particularly to determine the prevalence of EPT in surgical trainees and explore the experience of supervising surgeons is warranted to gain a deeper understanding of the phenomenon.
347 Perspectives of Surgical Simulation Training in Medical Students: A Narrative Synthesis
Authors: Singh A , Baskaran R
Published: August 2024

Aim

Simulation serves as a crucial instrument for replicating authentic surgical environments. The acquisition of proficiency in surgical skills is a mandated criterion for medical students, as articulated by the General Medical Council. There is a paucity of data pertaining to the efficacy of simulation training in both acute and chronic surgical contexts. The objective of this study is to assess the effectiveness of simulation in training medical students and to consolidate insights into innovative methodologies for surgical education.

Method

A literature search was performed on Embase, Medline and Global Health using the search terms: medical student* AND surgical simulation AND (United Kingdom OR UK OR England), including data from 1947 to 2023. The inclusion criteria were: (i) Surgical simulation (ii) Medical student training (iii) United Kingdom. 8 studies were included and appraised by 2 blinded individuals. The results and conclusions were constructed into a narrative synthesis.

Results

Studies have highlighted the lack of adequate surgical skills training in British medical schools. Cross-sectional and survey-based research underscores the positive outcomes of simulated learning by implementing virtual reality and simulated surgical patient pathways. Significant improvement in students’ awareness, confidence, performance, and learning standards has been demonstrated across studies.

Conclusions

Simulated training emerges as a valuable approach for instructing medical students. Within British medical institutions, there is an imperative to accentuate the emphasis on surgical pedagogy. The deployment of innovative techniques not only endows the prospective healthcare workforce with heightened surgical competencies but also augments the exposure of medical students to surgery as a potential discipline.
359 The Ebbs and Flows of Empathy: A Qualitative Study of Surgical Trainees in the UK
Authors: Yannamani P , Gale N K
Published: August 2024

Background

Empathy is widely recognised as an important element of medical practice contributing to patient outcomes and satisfaction. It is also an important element of collaborative work in a healthcare team. However, there is evidence to suggest that empathy towards patients declines over time, particularly in surgical specialities. There is little qualitative research on this decline in surgical trainees, particularly in the UK. Therefore, the aim of this study was to explore how trainee surgeons experience empathy over the course of their career, both towards patients and colleagues and how they perceive it in others.

Method

10 semi-structured interviews were carried out with surgical trainees of different grades and specialties in January and February 2022. Framework analysis was used to interpret the data.

Results

Participants experienced an evolution in empathy over their career as their personal and professional experience was added to. They drew a distinction between desensitisation and actual decline in empathy and identified more with experiencing the former in their careers. Participants also felt interprofessional relationships require empathy, and this could be improved upon. Finally, they highlighted specific impacts of the COVID-19 pandemic upon their training, including reduced theatre time.

Conclusions

Participants felt training could be improved in regard to accessing training opportunities and relationships with colleagues, although many felt empathy between colleagues is better than it has been in the past. This project highlighted areas for future research, such as with surgeons in later stages of their careers, or mixed-methods projects.
528 Leicester SCRUBS Surgical Mentoring Scheme for Medical Students
Authors: Bowerman K , Martin J , Agarwal R
Published: August 2024

Background

Surgically themed mentoring schemes for medical students are critical in inspiring the next generation of surgeons. With surgical skills not classically taught as much compared to other aspects of the medical curriculum, alongside the ever-building NHS backlog, other avenues must be utilized to inspire and train future surgeons. The University of Leicester surgical society, alongside clinicians at University Hospitals of Leicester, therefore, have run a surgically themed mentoring programme for clinical medical students to address this.

Method

Clinical year medical students sign up to the scheme annually and are assigned a registrar or consultant mentor, matching preferences in specialty, gender, and ethnicity where possible. The scheme has now run for three years, with data collected post-scheme annually via a mixed methods survey.

Results

In the 2022-23 cohort, 81 Leicester medical students enrolled into the scheme. Students’ pre-scheme expectations were met, including increasing surgical opportunities, developing a surgical portfolio, and increasing research and audit opportunities. An increase in the quantitative likelihood of pursuing a surgical career was observed, rising from 3.48 to 3.65 (Likert scale 1-5). However, students said they would prefer more structure to the scheme and a mock agenda to aid meetings with their mentors.

Conclusions

Overall, there is a clear benefit in surgical mentoring for medical students and may contribute to increasing numbers entering surgical training. Further work needs to be done to generate a structure to guide frequency and content of meetings with mentors. This is currently being developed for the fourth cohort.
695 Simulated Multidisciplinary Team Meeting: A Novel Approach to Vascular Trainee Education
Authors: Boyce R
Published: August 2024

Aim

The multidisciplinary team (MDT) meeting is well recognised for its utility and role in facilitating the harmonisation of management approaches across multiple specialties for the delivery of quality care and improved patient outcomes. The discussion of complex and highly nuanced clinical cases lends itself to excellent educational opportunities and improved clinical decision-making. While vascular MDTs are routinely conducted across centres nationally there is currently no formal integration of this activity into the training curriculum for vascular trainees. This simulated vascular MDT was predicated upon this premise and was piloted at the recently concluded 5th East of England Regional Endovascular Skills Course for a cohort of 16 regional vascular trainees on 6th October 2023 which took place at Colchester Hospital.

Method

A series of peripheral vascular cases of varied complexity were presented to the vascular trainees who were then tasked with formulating management plans. A consultant radiologist and senior anaesthetic trainee was present to provide input related to imaging and preoperative assessment and perioperative planning.

Results

Pre-MDT questionnaires were distributed which assessed the trainees’ stage of training, experience, and comfort level with the various types of cases which were presented. Post-MDT questionnaires were used to assess the trainees’ opinions on this exercise and obtain feedback.

Conclusions

The responses obtained revealed overwhelming support for including this exercise in future training courses and regional teaching days. A strong recommendation can be made for incorporating simulated vascular MDTs into the vascular training curriculum.