bluuebunny/crossref_metadata_2025 huggingface dataset:
783 Do We Need Laminar Flow in Trauma?
Authors: Lewandowski D , Hussain A , Ahuja S , Matthew A
Published: August 2023

Aim

Laminar flow in theatres has become standard of care in orthopaedic implant surgery. Most of the evidence for laminar flow use is based on arthroplasty surgery, with early studies showing significant reduction in infections. We conducted a retrospective comparative study to assess Surgical Site Infection (SSI) rates in consecutive patients undergoing surgery for trauma in laminar and non-laminar flow theatres.

Method

Due to COVID restrictions our trauma care provision was restructured. This resulted in trauma surgery being performed in non-laminar flow theatres. We identified consecutive patients who had trauma surgery pre and post pandemic from February 2019 to June 2021 to avoid selection bias. There were 1010 in laminar theatre group and 1000 in non-laminar theatre group. SSI rates within the first 90 days. The two groups were statistically similar in terms of age and gender of the patients.

Results

28 patients developed surgical site infections in non-laminar flow theatres and 29 patients in laminar flow theatres. There was no significant difference between the SSI rate in laminar flow theatres (2.87%), as compared to non-laminar flow theatres (2.80%) (p = 0.92034). There was no link between infections and duration of surgery. 2 patients in the laminar flow group were MRSA positive and were excluded.

Conclusions

In our study, laminar flow theatres did not show a statistically significant reduction in surgical site infections. We conclude in the practical environment of trauma theatres; the theoretical advantage of laminar flow does not translate to an observable reduction of infections.
854 Paediatric Tracheostomy Decannulation: An Updated Protocol at Nottingham University Hospitals (NUH)
Authors: Hyland L
Published: August 2023

Introduction

Tracheostomy decannulation is an extremely important part of tracheostomy care in paediatric patients. Due to the increased risk of morbidity1 (bleeding, respiratory infection, airway plugging, accidental decannulation) and mortality2 (0.5-3.6%) associated with prolonged tracheostomies, it is strongly advised to decannulate the paediatric patient as soon as the underlying cause for tracheostomy placement is corrected or resolved3. A simple to navigate protocol is required in order to establish a safe and efficient way of decannulation as well as knowing when and how to decannulate. The literature varies widely in regard to an optimal method and the process leading to decannulation can often be different for each individual patient; as such, this may require review on a case-by-case basis.

Protocol

We have developed an NUH specific protocol in the format of a flow chart to act as a guideline in successfully decannulating paediatric tracheostomies. It provides the foundations in assessing each paediatric patient’s clinical readiness and subsequent progression of decannulation. We have incorporated Mitchell et al’s 2013 clinical consensus statement on tracheostomy care as the primary resource for the creation of this protocol. It is suitable for any member of staff looking after paediatric patients with tracheostomies, whether they be situated on a paediatric ward, PHDU or PICU. In addition to care from parent teams and nursing staff, it is important for each paediatric tracheostomy patient to have input from the long-term ventilation (LTV) team who can offer support in the timing and progression of decannulation.
948 The National Consultant Information Programme (NCIP) and Its Effect on Current Colorectal Surgical Practice, Specifically Looking at Exenteration of Pelvis for Lower Gastrointestinal Cancer
Authors: Galla A , Maxwell-Armstrong C , Young L , Booth M
Published: August 2023

Aim

Extract and contextualise relevant data from NCIP data set on exenteration of pelvis for lower gastrointestinal cancer. Identify and analyse trends to understand Covid's impact on surgical practice, understand any variations seen at trust and national level, and understand the importance and application of NCIP.

Method

Pseudonymised data extracted from NCIP dashboard as an Excel document by NHS England Improvement data analysts. NCIP data is primarily from Hospital Episode Statistics, and other relevant databases and registries. Data includes various metrics including demographics, length of stay (LOS), and anonymised provider codes.Visual aids created from analysed data to explain various metrics, and observed trends. Data contextualised by comparing observed data with previous literature, if possible.

Results

687 patient cases from April 2018-March 2022. All elective, all 17+ years.

340 cases between April 2018 to March 2020 and 347 cases between April 2020 to March 2022.

4 procedure types: 11 Lateral Lymphadenectomies, 20 Other Exenterations, 161 Posterior Exenterations, 495 Total Exenterations. Decrease observed in cases done post-covid for all procedure sub-groups except total exenteration (5% increase).

40 centers across England, 99.27% of cases performed at NHS trusts. Center variation observed with numerous providers doing <10 cases in the 4-year period.

Average LOS: 23.65 days, however maximum LOS of 154 days for 2 total exenteration procedures.

Conclusions

Impact of Covid pandemic not observed in the data. Significant variation observed at provider level for each procedure sub-group, possibly contributing to variation observed in metrics such as LOS. Data suggests the need for further exploration into observed variation.
1086 Improving the Use of Chest Drains in Trauma - Small but Perfectly Formed
Authors: Awadalla M , Marsden M , Bernard F , Sasikumar S , Mohammed M , Nikolopoulos I , Sorelli P
Published: August 2023

Aim

The Western Trauma Association (WTA) advocates using small-bore chest drains (e.g., 14Fr) in haemodynamically normal trauma patients for management of small Haemothoraxes (HTX) or Pneumothoraxes (PTX). This quality improvement project aimed to assess implementation of this guidance.

Method

We compared the use and outcomes of small-bore chest drains for management of HTX or PTX before (Cohort 1) and after (Cohort 2) adoption of WTA recommendations in a District General Hospital in London. We included all patients admitted under the General Surgeons with rib fractures.

Results

All patients were admitted with blunt chest injuries. Cohort 1: 60 patients [36 males, mean age 72 years (range 31-96)] admitted from May–December 2021. Cohort 2: 78 patients [42 males, mean age 73 years (range 23-102)] admitted from May–December 2022.

In cohort 1, 10 patients (16%) required chest drains, all were surgically inserted large bore drains (median size 28 Fr) there were no peri-procedural complications.

In cohort 2, 11 patients (14%) required chest drains; 5 were surgically placed large bore drains (median size 28 Fr) and 6 were small-bore drains inserted by Seldinger technique (median size 18Fr). Two large-bore drains had periprocedural complications and both required re-insertion. The mean age was 60 years. In the small-bore group, there were no peri-procedural complications, no drains occluded and the mean age was 75 years.

Conclusions

After the implementation of this policy, small-bore drain use increased and appeared safe. This audit supports recent literature suggesting small-bore drains are as effective as larger bore and better tolerated.
1158 Outcome of Hot Laparoscopic Cholecystectomy Service Evaluation in Morriston Hospital, SBUHB
Authors: Qadir R M A B , Gwilym B L , Yuksek A , Robine-Durnell L , Shingler G , Mortimer M
Published: August 2023

Aim

Symptomatic Gall Bladder disease is a common general surgery presentation. NICE guidelines recommend performing laparoscopic cholecystectomy (within 1 week of diagnosis) for patients with acute cholecystitis. Patients who had gall stone pancreatitis should have laparoscopic cholecystectomy on the index admission. Historically poor availability of theatre slots has resulted in unacceptable delays in our health board. The objective of this study was to evaluate adherence to these recommendations before and after an intervention to improve theatre access.

Method

A retrospective study of inpatient laparoscopic cholecystectomies between 20/06/2022 and 28/11/2022 was undertaken in Morriston Hospital. On 20/09/2022, dedicated theatre lists for laparoscopic cholecystectomy were moved from afternoon sessions to morning or all-day sessions with the intention of minimising delays. Baseline patient and operative details were captured from electronic health records. Outcomes were adherence to recommendations from NICE and time to procedure from booking and number of procedures done before and after the intervention.

Result

85 patients were included (42 patients before (Group 1) and 43 after the intervention (Group 2). 100% of patient from group 1 received cholecystectomy within a week of booking compared to 86% from group 2 (P = 0.09). Mean time to procedure was 2.5 days and 3.5 days for group 1 and group 2 respectively (P = 0.076). 3.5 patients received cholecystectomy per week in group 1 as compared to 4.4 in group 2.

Conclusions

Changing the timing of Theatre lists from Afternoon to Morning/all day resulted in more patients receiving cholecystectomies without compromising time from booking to procedure
1223 Physiotherapy’s Crucial Role in Early Elective Post-Operative Orthopaedic Discharge - One More Night?
Authors: Mills R , Sohail Z , Bansal M
Published: August 2023

Aim

Physiotherapy (PT) is essential post operatively in optimizing patient mobility. However, patients admitted to the wards in the evening may not benefit from same day post-operative mobilization. Subsequent overnight hospital stays are common.

We aimed to investigate whether same day mobilization with physiotherapy reduced length of hospital stay. We hypothesized that failure to reach mobility milestones delayed discharge and earlier physiotherapy intervention could reduce overnight stay/hospital duration.

Method

We retrospectively evaluated patient records and operating notes for all patients undergoing elective lower limb arthroplasty procedures under one operating hospital team, during April 2022. 38 patient records were analysed.

Results

Medical complications (particularly fatigue, wound issues, pain, and blood pressure control) commonly delayed discharge (31.6%) and affected engagement with physiotherapy. 55.3% experienced post operative pain affecting engagement with physiotherapy, blood pressure and fatigue being other factors. 92.1% of patients had same-day physiotherapy input of some form (such as pre-operative assessment), whilst 76.3% had same day post-operative PT assessment. Most patients required further PT assessments (92.1%) - of the patients who stayed overnight (92.1%), only 17.1% had same day post-operative physio assessment.

Conclusions

Optimising commonly encountered post operative complications is vital as medical complications often delayed discharge and affected engagement with physiotherapy.

Notably, the majority of patients (68.4%) were discharged from hospital less than a day after being discharged from inpatient PT, suggesting that patient mobility/PT engagement may be the limiting factor affecting discharge.
1238 Audit of Immediate Management and Self-Reported Confidence When Attending Tracheostomy Emergencies
Authors: Marples T , Nicely L , Kalyal N , Wang D , Hasegawa H , Selway R
Published: August 2023

Aim

To examine staff knowledge and confidence in the initial management of tracheostomy emergencies.

Method

Staff from six predetermined occupation groups within King’s College Hospital London, were identified and asked to complete a survey designed to test their knowledge of the initial management of tracheostomy emergencies and evaluate their self-reported confidence in doing so. As well as collecting role information for data stratification, the survey utilised a 1-10 scale for assessing confidence, fields for listing signs of airway obstruction and initial management of emergencies, and yes/no questions for having prior formal training and for awareness of the NTSP algorithm. Completed surveys were compiled and analysed.

Results

Seventeen members of staff completed surveys (Health care assistants n = 2, Nurses n = 7, nurse associates n = 1, Senior house officers n = 2, Physician associates n = 5, Specialty registrars n = 0). Responses to the immediate management question were accepted as appropriate if they included ‘call for help’, ‘apply oxygen’, ‘ABCDE approach’, or similar. Members from medical professional groups (SHO, PA, SpR) had an appropriate response rate of 71.4% (n = 5), whereas member of the healthcare professional groups (HCA, Nurse, Nurse Assoc.) had an appropriate response rate of 50% (n = 5). Self-reported confidence scored, on average, 3.6/10 for medical professionals and 7.4/10 for healthcare professionals.

Conclusions

According to the design of this survey, appropriate knowledge of the management of tracheostomy emergencies does not necessarily correlate to self-reported confidence. The next steps for this project are to implement MDT teaching at King’s, covering tracheostomy care and emergencies, promoting the algorithm, and encouraging confidence via reassessment.
1307 Infection After Surgical Fixation of Fractures – a Multidisciplinary Approach in the Prevention and Early Detection of Fracture-Related Infections
Authors: Quek F F
Published: August 2023

Aim

Infection after surgical fixation of fractures is a serious complication in Trauma and Orthopaedic surgery. A recent study has reported that the incidence of fracture related infections (FRI) may be as high as 30% in patients with open fractures post-surgical fixation. FRI can have significant and devastating impact on the patients as well as causing a huge financial burden on the national healthcare system in the United Kingdom. According to the British Orthopaedic Association (BOA) guideline, all patients with surgically managed fractures should have readily available guidance on how to respond in the event of suspected fracture related infection. The purpose of this audit was to evaluate the standard of practice in the prevention of FRI at a large teaching hospital.

Method

Patient notes and discharge documentation for all Trauma and Orthopaedic patients with surgically managed fractures between 01/10/2022 and 31/10/2022 were reviewed and results analysed.

Results

During this study period, 58 patients underwent surgery for surgical fixation of fractures. Among these 58 patients, only 5 patients (9%) had readily available information on how to respond in the event of suspected fracture related infection in their discharge documentations.

Conclusions

The results from this first cycle of audit shows that our current standard of does not meet the BOAST guideline. Actions must be taken to address this critical issue promptly. We are currently implementing interventions such as patient information leaflets and multidisciplinary approach with the aim to improve our standard of practice. We plan to reaudit the effectiveness of these interventions in January 2023.
244 Major Laparoscopic Versus Robotic Surgery – a Systematic Review of Randomised Controlled Trials
Authors: Kawka M , Fong Y , Gall T
Published: August 2023

Aim

To systematically review randomised controlled trials comparing robotic and laparoscopic surgical approaches in major surgery.

Method

Embase, Medline and Cochrane Library were searched from their inception to September 2022. Included studies were randomised controlled trials comparing robotic and laparoscopic surgery in major general surgical, urological and gynaecological procedures. Short-term, health-related quality-of-life, surgical ergonomics, and long-term outcomes were compared. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results

Forty-eight studies, across fifteen procedures, involving 7588 patients were included. All of the studies reported non-significant differences in mortality between robotic and laparoscopic surgery. In selected studies, robotic surgery was associated with a lower rate of complication (8.3%, n = 4), shorter length of postoperative stay (10.4%, n = 5), and lower conversion rate (6.3%, n = 3), while laparoscopic surgery was associated with shorter operative time (37.5%, n = 18) and lower total cost (20.8%, n = 13). Eight studies found robotic surgery to be associated with superior health-related quality-of-life outcomes. Only six studies included long-term outcomes, with no significant differences between groups, while two studies reported on surgical ergonomics, one each reporting benefits in laparoscopic and robotic groups.

Conclusions

Robotic surgery is at least non-inferior in terms of short-term mortality and morbidity when compared to laparoscopic surgery, with potential benefits in post-operative recovery, and patient-reported outcomes, especially apparent in complex resection procedures. Future studies should focus incorporate metrics of surgical ergonomics, long-term outcomes and formal quality-of-life assessment, to further elucidate where the robotic platform can lead to patient benefits, as its adoption increases.
42 Can Cross-Sectional Imaging Reliably Determine Pathological Staging of Right Sided Colon Cancers and Select Patients for More Radical Surgery or Neo-Adjuvant Treatment?
Authors: Shekleton F , Courtney E , Bunni J , Andreou A
Published: August 2023

Aim

Cross sectional imaging with CT scanning is the most commonly performed imaging modality to stage right sided colon cancers. There is increasing evidence for the use of neo-adjuvant chemotherapy in selected patients and debate about the role of complete mesocolic excision (CME) and central vascular ligation (CVL) in the management of locally advanced colon cancers. Predicted tumour stage and presence of nodal by CT is often used to select patients for neo-adjuvant chemotherapy and those that may benefit metastases from CME.

This study aims to compare predicted radiological T and N staging with final pathological T and N staging in elective patients having potentially curative surgery for right sided colon cancer.

Method

Retrospective analysis of a prospectively gathered database of all patients who had undergone (true) right hemicolectomy between 02/01/13 and 21/05/20. Sensitivity, specificity, positive predictive value, and negative predictive value for CT scanning with regards pathological nodal metastases were calculated and analysed.

Results

The sensitivity and specificity of radiology staging for predicating nodal status were 76.4% and 65.5% respectively. The positive predictive value of CT staging for correctly identifying nodal metastases was 55.3%, with a negative predictive value of 77.3%.

Conclusions

This large series adds further evidence that CT, even when reviewed by expert GI radiologists, has limited accuracy at identifying lymph node metastases in colon cancer.
188 Incidence and Root Causes of Surgical Site Infections After Gastrointestinal Surgery at a Public Teaching Hospital in Sudan
Authors: Hassan R , Osman S , Mohamed W , Hassan R , Mohamed S
Published: August 2023

Aim

Surgical site infections (SSIs) are common healthcare-associated infections and associated with prolonged hospital stays and additional financial burden. Patients undergoing gastrointestinal tract procedures carry a high risk of SSIs. This study aimed to determine the prevalence, associated factors, and causing microorganisms of SSIs among patients undergoing gastrointestinal tract surgeries.

Method

A hospital based, cross-sectional study conducted at Soba University Hospital in Khartoum, Sudan. We included all patients from all age groups attending the gastrointestinal tract surgical unit between September-December 2017. A Chi-square test was conducted to determine the relationship between the independent categorical variables and the occurrence of SSI. The significance level for all analyses was set at p < .05.

Results

80 participants were included in the study. (67.5%) did not have any chronic illness prior to the surgical operation. Most of them (46.3%) underwent large bowel surgery. 27.5% developed SSI post operatively and superficial SSI was the most common type of SSIs (81.8%). Occurrence of SSI was found to be associated with long operation time (p > .001), malignant nature of the disease (p > .001), intra-operative blood loss (p > .001), and intra-operative hypotension (p = .013). The most prevalent microorganism isolated was E coli (47.8%), followed by Enterococcus faecalis (13.0%) and combined Pseudomonas aeruginosa + E coli infection (13.0%).

Conclusions

The results showed a high prevalence of SSIs among patients attending the gastrointestinal tract surgical unit and the most prevalent microorganism isolated from them was E coli. Measures should be taken to reduce the magnitude of SSI by mitigating the identified associated factors.
408 Actinomyces Species Microbiology Proven Infection – an Increasingly Recognised Emerging Implicated Pathogen: An Observational Study
Authors: Kiang J , Venkatesha S , Sanghera A , Raja N , Ahmed J , Ayantunde A
Published: August 2023

Introduction

Actinomyces species, gram-positive filamentous anaerobic microaerophilic organisms, are commensals of the human oropharynx, gastrointestinal and urogenital tracts. Actinomycosis infection is rare and occurs when tissue integrity is compromised, typically in a polymicrobial fashion. There is an emerging rise in Actinomyces species associated infections with their therapeutic challenges.

Aim

To evaluate the pattern, presentation, and risk factors of Actinomyces species associated infections.

Method

Blood culture, tissue, fluids, bone, and swab samples with isolated Actinomyces species were evaluated between July 2016 and April 2021. The antibiotic susceptibility of the isolated Actinomyces was obtained as per EUCAST guidelines. Electronic medical records were retrospectively evaluated for demographic and clinicopathological data relating to the patients.

Results

145 patients were evaluated. The mean age was 49 years, 63 males and 82 females. 52.4% and 59.3% had co-morbidities and risk factors for Actinomyces species infection susceptibility respectively. The most common presentations were infected sebaceous cysts (25.5%) and pilonidal abscess (11.7%). Actinomyces species were isolated from swabs (78), pus(32), blood cultures(26), body fluids(6), soft tissues(2) and bone fragments(1). Eleven different Actinomyces species were isolated. The commonly isolated species were Actinomyces neuii(24.8%), Actinomyces turicensis(22.8%) and Actinomyces europaeus(13.8%). 57.2% of samples had mixed microorganisms isolated. 26/29 blood culture samples yielded Actinomyces and 6/29 yielded mixed microbial agents. 78.6% of patient received empirical antibiotics and 79% of antibiotic choice was appropriate.

Conclusions

Actinomyces species isolates, and infections are increasingly reported, potentially attributed to improved culture techniques. We recommend epidemiology and resistance surveillance in Actinomyces species associated infections.
283 The Impact of Augmented Reality Laparoscopic Simulator in Improving Performance Metrics in General Surgical Trainees
Authors: El-Bahnasawi M , Rawaf D , Street E , Luthra P
Published: August 2023

Aim

To assess the impact of simulated laparoscopic trainers on improving surgical trainees’ technical ability in completing a laparoscopic appendicectomy by measuring effect on completion time and distance travelled with standard instruments.

Method

Six CT1 (early-stage) trainees with little prior operative exposure were selected from the North-West of England Deanery to perform x10 appendicectomy simulated exercises with the Augmented Reality Laparoscopic Simulator (LapAR™), interspersed by x3 Lapass exercises. Metrics including ‘Time of completion’ and ‘Distance travelled’ were collected by the simulators and analysed.

Results

Repeated laparoscopic appendicectomies with the LapAR™ improved performance time for 100% of trainees, with an average of 55% (Regression coefficient -0.65) and improved distance travelled for 75% of the trainees with an average improvement of 39% (Coefficient -2.67). Improvement in instrument smoothness, acceleration and ambidexterity were also observed.

Conclusions

LapAR™ use has improved all performance metrics for most surgical trainees and proves to be an invaluable tool for surgical training.
657 Evaluating the Effectiveness of Virtual Reality for Arthroplasty Training in Orthopaedic Trainees: A Systematic Review
Authors: Adebayo O , Beedham W , Millward I , Gandhi M
Published: August 2023

Introduction

Virtual Reality (VR) provides high-fidelity simulation, enabling trainees to practice surgical procedures whilst reducing patient risk. The focus in orthopaedic literature has been on basic surgical skills and arthroscopic procedures. Research into arthroplasty simulation resources is under-represented.

This systematic review assesses current literature on the effectiveness of VR for arthroplasty training.

Method

A systematic literature search was conducted across all relevant bibliographic databases. Randomised controlled trials (RCTs) meeting the inclusion criteria were selected and assessed by three independent reviewers. The primary outcome was the standardised mean difference (SMD) in either the global rating score or task-specific checklists at pre/post-intervention. This outcome was extracted using a piloted data extraction tool. Studies were assessed for risk of bias using a piloted risk of bias tool.

Results

628 studies were identified, of which 624 did not meet the inclusion criteria. The four studies included in the meta-analysis displayed a trend that VR improved surgical competence more than existing methods (SMD 1.57, 95% CI [-0.45 to 3.59]; P = 0.13).

Secondary outcomes in all studies showed VR improved trainee confidence and provided a more enjoyable experience.

Conclusions

VR improved surgical competency and improved trainee confidence in performing arthroplasty procedures, therefore indicating that this training modality could benefit both trainees and patients in the future. However, there is a paucity of evidence for VR in arthroplasty training, making results less precise and creating significant inter-study heterogeneity. This highlights the need for further high-quality RCTs to be produced assessing the effectiveness of VR for arthroplasty training.
67 Surgical Foundation Doctor Placements: Does Team Structure Alter Training and Support?
Authors: Nadama H , Sullivan L , Mungroo S , Stephens N
Published: August 2023

Aim

Surgical foundation placements lay the groundwork for a surgical career. Many units run individual teams comprising consultants and trainees in the same subspecialty whilst others have adopted ward-based placements where foundation doctors are responsible for patients belonging to several teams.

Belonging to a ‘firm’ is said to increase trainees' access to professional and emotional support. To accommodate for COVID-19 pressures, foundation doctors in our unit became ward-based as opposed to team-based.

Our aim was to explore what impact this pandemic-enforced change in team structure had on foundation doctors’ training experiences.

Method

We conducted a single-center, cross-sectional study. We sent out a questionnaire to foundation doctors who had undergone both pre-COVID and COVID surgical placements. Domains such as training opportunities, support from seniors, and whether their experience impacted their interest in pursuing a surgical career were measured using Likert Scales (1 = low; 5 = high). Statistical analysis was conducted using Microsoft Excel.

Results

A total of 30 foundation doctors completed the survey. Foundation doctors felt that they were significantly more supported when team-based (p = 0.005) and found they had greater training opportunities (p = 0.002). Despite this, there was no impact on their interest in pursuing a surgical career (p = 0.255). Furthermore, for foundation doctors already interested in surgery, their COVID experience did not impact their career aspirations (p = 0.104).

Conclusions

Foundation doctors subjectively preferred individual team-based placements. The change to ward-based work led to perceived fewer training opportunities and less support. However, despite this negative impact on training, there was no impact on whether they would pursue a surgical career.
357 A Case-Control Study to Evaluate the Impact of Pet Cat or Dog Ownership on Medical Students’ Psychosocial Wellbeing
Authors: Wong R , Co M
Published: August 2023

Aim

This study aims to evaluate the impact of pet dog or cat ownership on medical students’ stress response and academic performance during the COVID-19 pandemic.

Method

This is a prospective case-control study. A validated questionnaire, COVID-19 Student Stress Questionnaire (CSSQ), was distributed to all final year medical students studying at University of Hong Kong in July 2021. Stress responses and academic performance between pet and non-pet owners were compared.

Results

A total of 110 medical students participated in the study, with non-pet owners accounting for 81 students (control group), and 29 students being pet-owners (case group). The baseline demographic characteristics were comparable between both groups. Non-pet owners demonstrated higher levels of stress compared to pet-owners, with 49.4% perceiving academic study experiencing being “very” or “extremely” stressful compared to 24.1% seen in pet owners (p = 0.0278).

13 (11.8%) students failed in the final examination in the medical school requiring supplementary examination. Of which, 1 (7.7%) were pet-owner while 12 (92.3%) were non-pet owner. However, statistically significant correlation cannot be demonstrated (p = 0.1778).

Conclusions

Pet ownership is associated with reduced stress levels among medical students during COVID-19 pandemic.
482 Is Collaboration the Key to Strength in Unity for Surgical Education?
Authors: Baskaran R , Vyas R , Naguib A
Published: August 2023

Aim

With the everchanging landscape of surgery, there is a paucity of surgical education courses focused on medical school finals examination. We examined the effectiveness of an eight-part specialty-doctor-delivered collaborative online teaching.

Method

The largest surgical education collaboration, SurgEazy, was organized between eight national/international organizations (NSTS, BIMA, NANSIG, ANTS, INCISION UK, WEDNS, BURST Urology). Finals-specific online teaching sessions were organized and delivered via zoom spanning eight surgical specialties. All sessions were delivered by session specialty-specific surgical trainees ranging from FY2 to ST3. 10-point Likert scales were used to measure the outcomes of sessions.

Results

A total of 433 students attended the eight sessions. All sessions demonstrated an increase in knowledge (8 ± 1.48), interest in pursuing surgery as a career (8 ± 2.17), commitment (8 ± 2.06), confidence (8 ± 1.60), and clarification of discrepancies in knowledge (8 ± 1.64). It also saw a decrease in concerns and worries (8 ± 1.89), and anxiety (8 ± 2.30). The majority of the students felt that the collaborative nature of the series increased its value (8 ± 1.79), their likelihood to attend (8 ± 2.13), and their awareness of all organizations (79.94%).

Conclusions

While online teaching has its merits of accessibility and convenience, collaborations have been shown to increase the overall merit of surgical education. Conducting such specialty-doctor-delivered focused collaborative online teaching is proven to be effective and should be considered by organizations in the future to increase the value, reach, attendance, and overall awareness of both the series and individual organizations.
605 Whose Operation Is It Anyway? Is There Consensus on Supervision Codes Use for General Surgical Procedures?
Authors: Cohen H , Simson R , Bamford R
Published: August 2023

Aim

Operative numbers are critical in applications to Core and Higher Surgical training, ARCP and CCT requirements. However, instructions for the use of supervision codes on the surgical eLogbook and ISCP are ambiguous. This study seeks to determine if there is a consensus for supervision coding for common general surgical operations.

Method

A survey of 10 operative vignettes was distributed to doctors who used the eLogbook. Participants were asked to indicate if they would code the operation Assisted (A) or Supervised Trainer Scrubbed (STS) from the vignette provided.

Results

The survey received 258 responses from doctors across all grades. In one appendicectomy vignette describing involvement at each key step but no dissection, 55% coded it as Assisted and 40% STS. For a laparoscopic cholecystectomy vignette which described dissecting the gallbladder off the liver and closing the ports, 59% coded it as Assisted and 37% STS. By including port insertion in this vignette 25% coded it as assisted and 72% as STS. Only 20% agreed with the statement “I find it easy to understand what supervision code I should record in my logbook”.

Conclusions

This study shows little consensus on supervision codes for general surgical operations and considerable ambiguity in the system. The description of the codes on eLogbook is not fit for purpose with minimal supporting guidance on ISCP. Clearer guidelines are required to enable trainees to use consistent coding to ensure validity in the use of indicative numbers in applications and as a marker of progress.
623 How Much Time Do Surgeons Spend Operating?
Authors: Fu K , Abdelrahman M , Walmsley J , Chan D
Published: August 2023

Aim

There is significant variation in the amount of time that surgeons spend performing elective surgery worldwide. The aim of this study was to assess this degree of variation.

Method

An anonymised survey was sent via email to members of The Upper Gastrointestinal Surgeons (TUGS). The questionnaire consisted of demographic details, scope of practice, experience, the average number of days spent performing elective surgery per week and what they would prefer.

Results

206 surgeons (174 males; most of whom were aged 35-64 years and were trained surgeons) from 46 countries completed the survey with the majority working as general surgeons with an upper gastrointestinal interest in the public sector. Worldwide, the median number of days that surgeons spend performing elective surgery in the public sector is 2 days per week. Surgeons in the UK spent the least amount of time performing elective surgery compared with surgeons in the rest of Europe, North America, Asia and Africa (1 day vs. 3, 2 and 2 days respectively, p<0.05). All surgeons preferred to spend at least 3 days performing elective surgery per week.

Conclusions

Surgeons in the UK spend the least amount of time operating electively. The reasons for this is multifactorial and should be explored further. The results of this study could improve public expectations of surgeons in different countries and inform trainee surgeons on ideal opportunities for training.
701 Designing a Transition Programme: From Higher Surgical Training to Consultant Practice
Authors: Kamran Siddiqui Z , Jayasuriya R , Lewis C , Tomlinson J
Published: August 2023

Background

Higher surgical training (HST) in the UK focuses on delivery of clinical knowledge to pass FRCS exams, technical skills to fulfil CCT requirements, and clinical preparedness for a day-one consultants.

Aim

To identify specific professional capabilities deficient in HST which may inform new training objectives to aid transition between HST and T&O consultant practice.

Study Design

PRISMA Scoping Review. Review of existing courses and interviews with course directors. Semi-structured interviews with newly appointed consultants (< 5 years) exploring non-clinical attributes necessary for new consultants. Interactive questionnaire with senior trainers and with post-FRCS trainees exploring timeframe for current trainees to gain non-clinical experience compared to the ideal timing of developing these skills.

Results

PRISMA-ScR papers identified n = 434, screened n = 276, eligible n = 105, included n = 50, of which surgical = 7, T&O = 0; demonstrating limited literature characterising the gap in preparedness during this specific surgical transition-point.

Specialities with dedicated courses include paediatrics and ophthalmology; programmes reviewed demonstrated a wide array of topics.

Interviews identified strong themes of lack of understanding of NHS structure, job planning, procuring specialist equipment, handling complaints and human factors.

The interactive survey undertaken by both senior trainers and post-FRCS trainees demonstrated a similar trend with a clear shift towards pre-FRCS delivery of skills.

Conclusions

Differences in trainees’ perceived needs and those identified by consultants pose a potential challenge in HST. Across all groups involved, deficiencies were identified in acquiring non-clinical skills and knowledge. This mixed methods approach identified key topics to cover in transition to consultant course to improve challenges during transition.
768 Exploring the Use of the HoloLens2 as a Tool in a Clinical Skills OSCE
Authors: Moore A , Moorjani U , Karunaratne D , Dasigan K , Bartholomew B
Published: August 2023

Aim

We explored the impact of examiners using mixed-reality headset (HoloLens2) on student performance/wellbeing, examination logistics, marking accuracy and examiner availability during a formative clinical skills OSCE.

Method

24 final-year medical students from Singapore were tested on clinical skills including catheterisation, suturing and arterial blood gas sampling. The first station had two in-person examiners, the second had an examiner using the HoloLens2 to live-stream footage to a remote examiner, the third had an examiner using the headset to view a virtual mark scheme. Quantitative and qualitative data were obtained using questionnaires and semi-structured debriefs.

Results

Qualitative data was analysed thematically, with impacts on examination implementation, student/examiner wellbeing and marking ability emerging as key themes that were discussed in depth. 83% of students denied any impact of the HoloLens2 on their performance and 75% denied experiencing any distractions. However, correctable technical challenges were highlighted by 75% of examiners, such as difficulty visualising finer details of suturing remotely. Despite this, all examiners felt this was an acceptable mode of examination and would improve their availability to examine.

Conclusions

This evaluation served as a useful pilot of how the HoloLens2 may be used for remote examination and virtual marking in OSCEs. Examiners and students highlighted the value of this technology on examiner availability, student wellbeing and potential use for external examiners to monitor each station remotely. The main limitations lie with technological issues impacting on implementation, making this currently unsuitable for high-stakes assessment. However, it poses significant advantages for formative assessment in medical education.
950 Optimising Remote Near-Peer Teaching for Undergraduate Clinical Orthopaedic Skills - a Series of Quality Improvement
Authors: McColm C , Williamson T , Kay R , Brennan J , Martinson E
Published: August 2023

Aim

Undergraduate medical education has changed significantly following the COVID-19 pandemic, necessitating the adaption of medical education to an online environment. The aim of this quality improvement project was to develop and refine a series of online orthopaedic teaching sessions to supplement history and examination teaching within the undergraduate curriculum.

Method

Near peer tutorials, led by final year students, were delivered to year 4 students at the University of Edinburgh Medical School. The series of interactive tutorials ran three times throughout the academic year. Qualitative and quantitative feedback was collected, and the tutorial content adapted and improved for future sessions. Attendees ranked their confidence to deal with orthopaedic pathology pre and post session on a Likert scale to quantify the value of these sessions.

Results

Attendees ranked their confidence in dealing with orthopaedic pathologies on a 1-10 Likert scale to quantify the effectiveness of the teaching sessions. Cycle 1 for the history and examination tutorials demonstrated a +2.75 (p = <0.001) and +3.15 (p = <0.001) mean improvement in overall student perceived ability. By cycle 3 this was increased to 2.64 (p = <0.001) for the history tutorial and +3.5 (p = 0.027) for the examination tutorial.

Conclusions

We have demonstrated that traditionally practical skills including history taking and orthopaedic examinations can be successfully implemented in a virtual environment. Online teaching methods can be utilised with great success within undergraduate trauma and orthopaedic teaching. Ensuring session interactivity, limiting session duration, and providing students with live feedback can greatly improve student satisfaction and thus improve the learning experience.
1209 Comparison of Competition in Recruitment into Surgical and Non-Surgical Specialties
Authors: Ridgley J , Vaidya A
Published: August 2023

Aim

Despite notoriety for strenuous training with significant out of hours commitments, surgical specialties maintain a reputation for competitive entry with rigorous portfolio requirements. This study aimed to compare recruitment data between surgical and non-surgical specialties to examine whether surgical specialties are more competitive for entry.

Method

Recruitment data from 2022 published by Health Education England was collated. Specialties included were those recruiting for registrar level training post (ST3/ST4 depending on specialty). Fill rates and competition ratios for all surgical specialties (with an ST3 entry-point) were compared with all non-surgical specialties for which there was data. Statistical analysis was completed using the Mann-Whitney U test.

Results

Median fill rates were 94.99% (IQR 23.81%) for non-surgical specialties and 100% (IQR 0%) for surgical specialties (p < 0.05). Median competition ratios were 3.17 (IQR 2.86) for non-surgical specialties and 3.92 (IQR 1.58) for surgical specialties (p < 0.05). Highest competition ratio overall was in immunology (46), with cardiothoracics having the highest surgical competitions ratio (23.5). Only genitourinary medicine and diagnostic neuropathology had a competition ratio <1.

Conclusions

All specialties at registrar level training had high fill rates and competition ratios, however this varied greatly between specialties perhaps due to lifestyle factors and exposure as students. Surgical sub-specialties demonstrated significantly higher competition ratios and fill rates, suggesting that despite discussion around quality of life and burnout in recent years, surgery continues to be an attractive career. It would be interesting to compare the rates of those leaving training posts with recruitment data.
748 Views of Theatre Staff Regarding Reusable Gowns and Sustainability
Authors: Wheeley E , Jenkins R , Curtis R , Narayanan D , Murray C , Barthelmes L
Published: August 2023

Aim

The three Colleges of Surgeons declared a climate emergency. Reusable gowns are suggested to improve sustainability in theatres.

Method

Reusable gowns were made available to explore the interest of staff in using them. Staff were encouraged to answer a questionnaire about their attitude towards sustainability, their view on the impact of using reusable gowns, and whether they would be prepared to approach a colleague wearing a single use gown for a non-clinical reason (feeling cold).

Results

30 staff members agreed with global warming being important to them, with 4 staff members being indifferent. The same proportion agreed with theatres being an important area of net zero opportunities. 10 staff members consider changes in theatres to only play a minor role in relation to the magnitude of global warming.

26 of 34 colleagues would voluntarily wear reusable gowns, 8 would prefer single-use gowns given a choice.

Replying to the scenario of a staff member not being scrubbed up wearing a single-use gown feeling cold 7 would do the same, 9 would disapprove and raise this to the staff member, 8 would disapprove but not raise this, 3 would disapprove and raise this if there was a hospital policy in place to challenge 'it is ok to ask'.

Conclusions

Most staff (30/34) recognise opportunities in theatre to become carbon neutral. A considerable proportion (26/34) would use reusable gowns if available. We have started work on a logo for a code of conduct of respectful conversations regarding wasteful behaviour (e.g. wearing disposable gowns for non-clinical reasons).
1117 The NHS in Crisis; Assessment of the Impact of Litigation Trends Over 20 Years in General Surgery
Authors: Wallace-King S , Musbahi A , Coates R , Mofidi R
Published: August 2023

Introduction

A rising proportion of the National Health Service (NHS) annual budget is being spent on medico-legal costs, with over 1.6% of total UK healthcare spending on litigation in the year 2018/19. This is a risk to both patient care and public opinion of the NHS and as per business definitions the system is in crisis. This paper aims to assess the scale of the litigation crisis to fuel further work into mitigating it to improve value for patients and staff alike.

Method

Data was obtained from NHS resolution for claims relating to General Surgery between January 2000 and December 2020 to include the following: number of claims, cost of settled claims with and without damages paid, age/sex of patients, and primary injuries/causes.

Results

Between 2000 and 2020, 17,542 claims were made against General Surgical units in England with an increase in claims per year. Successfully closed claims cost the NHS £1.3 billion. The three most common causes for claims were intra-operative problems, failure/delay of treatment and failure/delay of diagnosis.

Conclusions

The NHS is threatened by a litigation crisis, with case volume and cost rising out of proportion to surgical workload and inflation. The most common causes for claims are known complications discussed as part of a standard consenting process, indicating that current practice may fail to achieve adequate patient understanding of surgical risk. More research is required to improve the current consenting process and identify demographics that may increase an individual’s propensity to make a claim.
1149 Bringing Recycling to the Operating Department - a Sustainability Project in a DGH in London
Authors: Cho G , Yun J W
Published: August 2023

Aim

The Lancet Commissions report of 2015 suggested that tackling climate change could be the greatest global health opportunity of the 21st century. Both the Royal College of Surgeons of England and the Royal College of Anaesthetists have committed to sustainability task forces and have published guidance on improving care through small, sustainable practices including recycling waste.

Method

We conducted a theatre staff survey on SurveyMonkey in an operating department in an acute district general hospital without any recycling facilities on the attitudes towards recycling, and how this could be implemented.

Results

We received 103 responses, including a broad spectrum of the multi-disciplinary team including surgeons, anaesthetists, scrub nurses, operating department practitioners and healthcare assistants. Results showed that little to no recycling occurred (59%), 48% of respondents were not familiar with which material can be recycled, and 96% were agreeable to improving access to recycling in theatres. Two main areas identified as barriers to recycling were inadequate access to recycling bins and inadequate information on what can and what cannot be recycled. In terms of implementation, 75% of respondents indicated that posters around the department would be most useful in raising awareness and providing information on recyclable materials.

Conclusions

Currently, we are in conversation with the Trust and the waste management company to identify a list of recyclable materials and to incorporate recycling bins as part of the waste management pathway.