bluuebunny/crossref_metadata_2025 huggingface dataset:
304 Scar Assessment of Elliptical Versus Punch Biopsy Excision for Epidermoid and Pilar Cysts
Authors: Mayer F , Daniels R
Published: August 2024

Aim

The aim of this study was to compare the scars of patients who had epidermoid cysts removed using conventional elliptical excision versus removal using a 7.0mm punch biopsy.

Method

Patients were selected from a medium-sized GP practice that offers elective cyst removal. Scars were assessed using the Patient and Observer Scar Assessment Scale (POSAS) 3.0 and photographs were taken. Statistical significance was analysed using the Mann-Whitney U test.

Results

The elliptical excision group included 13 patients and the punch biopsy group included 6 patients. Overall, there was no statistically significant difference in any of the POSAS 3.0 items between both groups. Average patient satisfaction with the scar was 4.85 out of 5 (very satisfied) in the excision group, and 5.0 in the punch biopsy group. Scar size was larger in the excision group (0.70 cm2 [SD 0.81] v. 0.38 cm2 [SD 0.28]) despite cyst volume being similar in both groups (6.88cm3 [SD 6.13] v. 6.47cm3 [SD 4.17]. There was no recurrence in the excision group but one recurrence in the biopsy group.

Conclusions

While this study has relatively few patients, it gives insight into real-world outcomes in a GP practice. The results suggest that the scars from epidermoid and pilar cyst removal are generally well rated by both patient and observer. While removal with 7.0mm punch biopsy resulted in smaller scars, patients did not rate the appearance and function of the scar significantly differently. This information can help patients and operators decide on which method of removal may be most suitable.
486 Disease and Economic Burden of Plastic Surgery-Related Diseases in the United Kingdom: Results From the 2019 Global Burden of Disease Study
Authors: Wong Z Y , Ou K Q , Wong Z N , Faderani R , Kanapathy M , Mosahebi A
Published: August 2024

Background

This study aims to assess the burden and economic impact of disease associated with plastic and reconstructive surgery in the United Kingdom (UK) as it has remained unclear to inform policy and research funding decisions.

Method

Data on the burden of disease were extracted from the Global Burden of Disease 2019 results tool for all available and relevant plastic surgery diseases. The economic burden of disease in UK pounds was calculated based on prior studies. A VSLY of £60,000 per person in the UK was sourced from ‘The Green Book’ published by HM Treasury and inflated using the UK Health Consumer Price Index (CPI). Data are presented as rate or counts with the associated uncertainty interval.

Result

In 2019, the estimated age-standardized incident rates (ASIRs), age-standardized death rates (ASDRs), and age-standardized DALYs (ASDALYs) of plastic surgery related conditions were 361.47 per 100,000, 19.5 per 100,000 and 551.0 per 100,000 respectively. Burn emerged as the leading contributor to the overall disease burden, accounting for 32%, followed by decubitus ulcer (21%) for, breast cancer (17%). The economic burden of plastic surgery-related diseases in the UK amounted to £34.3 billion in 2019, exhibiting a steady increase from £19.6 billion in 2010.

Conclusions

Plastic and reconstructive surgery-related diseases, primarily breast cancer, thermal burns, and malignant melanoma, impose a substantial burden on the UK healthcare system. These findings hold significant implications for national healthcare policy, funding allocation, and research prioritisation.
685 The MISHAP Trial: Managing Injuries - a Study of Hand Appearance and Psychosocial Dysfunction
Authors: Marinescu I , Phoenix E , Geary E , Aljohmani L , McLaughlin D , Dolan R
Published: August 2024

Aim

Over 24 million hand injuries occur globally every year. Patients suffer chronic pain, functional impairment and loss of income, causing significant psychological distress. This study aimed to investigate the functional and psychosocial impact of hand injuries and their association with injury severity.

Method

A single-centre, prospective, observational study was conducted over a six-month period in St.Vincent’s University Hospital. Patients with traumatic hand injuries were assessed for inclusion. Patient-reported outcome measures were collected at two and six weeks postoperatively using the Disabilities of the Arm, Shoulder, and Hand (DASH) scale, Derriford Appearance Scale-24 (DAS-24), Conor-Davidson Resilience Scale-25 (CD-RISC-25), Post Traumatic Growth Inventory-Short Form (PTGI-SF), Hospital Anxiety and Depression Scale (HADS) and Short Form-36 (SF-36). The hand injury severity score (HISS) and demographic data were obtained from medical records. Paired samples t-test and correlation analyses were performed to analyse data.

Results

Data was collected from 62 patients at baseline and 44 (71%) at follow-up. The mean age was 44 (range 20-72) with a male preponderance (89%). The mean HISS was 38 (range 2-204), with 21% scoring severe injuries. HADS, DASH, SF-36 and CD-RISC-25 scores were less favourable than the general population means. Ten and fourteen percent of participants had above-average DAS-24 scores at baseline and follow-up, respectively. HADS, DASH and SF-36 scores significantly improved at the second time point. Scores were not significantly correlated with HISS.

Conclusions

Our patient cohort demonstrated higher-than-average psychological distress and functional disability, irrespective of injury severity, highlighting the need for psychological input in the multidisciplinary management of hand trauma.
698 A Case Series of Limb Reconstruction in the Non-Concordant Patient
Authors: Jageer P , Kiely J , Day S , West C , Bhat W
Published: August 2024

Aim

Substance misuse is common in patients undergoing limb reconstruction secondary to open fractures and fracture related infection. This group risk breaching the social contract with their treating team through reduced engagement with peri-operative care. Potential problems include limited social support, intravenous access, analgesia and withdrawal. These factors may negatively influence the range of treatments offered to this group. We aimed to establish the prevalence and outcomes of the problematically non-concordant cohort in our limb reconstruction population, who we aim to treat equitably even where non-concordance is suspected pre-operatively.

Method

A retrospective study was performed using our prospectively collected free flap limb reconstruction database from December 2021-October 2023. Patient electronic health records were reviewed for demographics, peri-operative details and outcomes.

Results

80 patients were identified, with 8 identified as problematically non-concordant (10%). All patients had a background of substance abuse; smoking (100%), alcohol (75%), IVDU (63%). Pre-operative non-concordance included absconding (43%), staff abuse (57%) and refusal of care (57%). Post-operative non-concordance included smoking (75%), mobilisation against instructions (75%), absconding (63%). No patients had free flap failure. Inpatient stay varied from 8-83 days, average 28. 50% of patients did not attend follow-up.

Conclusions

The expanding horizon of microsurgery means complex reconstruction is offered to a greater range of patients. Surgical teams should ensure that this service is offered equitably, individualising treatment plans to achieve the best outcomes. Risk of non-concordance is usually evident pre-operatively. We advise early involvement of substance misuse teams, discharge support and an understanding team to achieve good outcomes.
751 Efficacy of Liposomal Bupivacaine (Exparel) for Post-Operative Analgesia in Plastic Surgery: A Systematic Review
Authors: Erotocritou M , Krishna V , Khajuria A
Published: August 2024

Aim

This systematic review aimed to identify new evidence from randomized controlled trials on the post-operative applications of Liposomal Bupivacaine (Exparel) in patients undergoing plastic surgery.

Method

An extensive literature search was performed using PubMed, MEDLINE, Embase and Google Scholar to identify studies published between November 1st 2015 and July 31st 2021, investigating the efficacy of Exparel for postoperative pain management in patients undergoing Plastic Surgery procedures. Data on opioid use, patient satisfaction, patient outcomes, hospitals costs and length of stay were collected.

Results

A total of 22 studies were selected out of 5651 identified in our initial search. The data for a total of 2505 patients are included in this review across various plastic surgery procedures (including abdominal reconstruction, breast reconstruction, hand, skin and oromaxilofacial surgery). Liposomal bupivacaine was shown to be safe and led to a reduction in post-operative opioid requirements compared to controls.

Conclusions

LB is a long-acting non-opioid analgesic that has become increasingly more available and more popular for post-operative pain control. The data from this review have demonstrated that it is effective at reducing the opioid requirements post plastic surgery and this is not limited by anatomical site. It appears to be safe and well tolerated by patients. It’s effect on pain scores, treatment costs and length of stay remains controversial. In view of the well-recognised opioid epidemic, LB can be used to reduce opioid analgesia use and revolutionise post-operative analgesia protocols especially in the setting of Enhanced Recovery After Surgery protocols.
200 Outpatient Transurethral Laser Ablation (Tula) of Bladder Tumours: Our Initial Experience
Authors: Mendonca J , Bright E , Mantle M
Published: August 2024

Background

Transurethral laser ablation (TULA) is a safe and cost-effective treatment for non-muscle invasive bladder cancer. We report our experience of establishing an outpatient TULA service at a DGH.

Method

Retrospective review of attendances to the TULA clinic from May 2022 to May 2023. Data were analysed using EZR.

Results

Ninety-seven TULA procedures were performed on 87 patients (45-95 years; median age 79 years; 70.1 % male; median ASA grade 2). Fifty-three lesions were unifocal and 44 were multifocal. Ablations were performed in 79 cases (81.4%), enucleations in 15 cases (15.5 %) and 3 patients (3.1%) underwent both. Of the 66% of patients with recurrent cancer, 62.5% had previously been diagnosed with high-grade cancers. Biopsies were performed in 66% of cases, with muscle present in 9.4% of specimens. Transitional cell carcinoma was confirmed in 21 of 64 biopsies with the commonest stage being G2pTa (45.5%). Two patients were re-admitted within 30 days due to haematuria and 3 patients developed a urinary tract infection within 2 weeks. Eleven attendances were not amenable to TULA either due to tumour size (n=10) or position (n=1). The median pain score reported by 45 patients was 1 (IQR 3). Of the 38 patients who had previously undergone a GA resection, 95% preferred TULA due to reduced pain (52.6%), shorter procedure time (84.2%) and avoidance of inpatient stay (57.9%).

Conclusions

TULA provides a safe alternative for treating superficial bladder cancer with high patient satisfaction rates, thereby reducing demand on inpatient and operative services. Future work involves assessing recurrence rates after TULA.
535 Improving the Quality of Consent Forms and Operation Notes for Laparoscopic Appendectomies Using the Best Practice Standards Outlined in Getting It Right First Time (GIRFT)
Authors: Spurring E , Naqvi M , Wright C , Hatch E , Prys-Jones S
Published: August 2024

Aim

This study aimed to enhance compliance with the Getting It Right First Time (GIRFT) best practice initiative to standardise documentation of consent process and operation notes for laparoscopic appendicectomies.

Method

The documentation of laparoscopic appendicectomy was reviewed to assess compliance with GIRFT's 32 standards (n=15). The initial overall compliance rate was found to be 42%. Haemostasis and estimated blood loss was not documented (n=0). In response, templates were developed based on GIRFT standards, incorporating pre-filled consent form stickers and a digital operation note for electronic upload to patient records. The templates aimed to enhance accessibility and security of patient information by reducing reliance on handwritten notes.

Results

Following the intervention, the overall compliance rate increased to 63% (n=15). Notably, when the GIRFT template was utilised, compliance increased to 98% and haemostasis and EBL was documented in 100% of cases (n=5). However, the incorporation of pre-filled consent form stickers showed limited impact, with only 2 out of 15 cases utilizing them. Despite this, discussions regarding blood transfusion increased from 27% to 36% (n=15).

Conclusions

The implementation of standardised templates significantly improved compliance with GIRFT best practice standards for laparoscopic appendicectomies, particularly when utilizing the provided template. Challenges remain regarding the adoption of pre-filled consent form stickers. Future directions will explore the development of a patient information leaflet to enhance risk communication and promote the consistent use of template-based documentation. The study highlights the importance of tailored interventions to address specific components of GIRFT standards for optimal impact on patient care and outcomes.
587 Preventing Post-Operative Orthostatic Hypotension in Orthogeriatric Neck of Femur Fracture Patients by Encouraging Oral Fluid Intake
Authors: Tsang F S L , Perera T , Solomonsz A
Published: August 2024

Aim

This quality improvement project aims to reduce the length of hospital stay in orthogeriatric neck of femur (NOF) fracture patients by preventing orthostatic hypotension during post-operative patient mobilisation through encouraging post-operative, pre-mobilisation oral fluid intake.

Method

Orthogeriatric NOF fracture patient notes and fluid charts were retrospectively reviewed to establish the pre-intervention baseline post-operative pre-mobilisation fluid intake. A separate cohort of newly admitted geriatric NOF fracture patients were followed prospectively, with an intervention administered one day post-operation to encourage fluid intake. This intervention consisted of a verbal reminder and leaflet encouraging oral fluid intake, along with a verbal explanation and patient information sheet on orthostatic hypotension. Adequate fluid intake was defined as ≥500 ml fluid intake before mobilisation, and a prolonged hospital stay was defined as ≥20 days. This was carried out at the Royal Derby Hospital from July to November 2023.

Results

A total of 41 patients were reviewed. 21 patients were in the pre-intervention group and 20 in the intervention group. The pre-intervention group had 23.8% (5/21) patients with adequate fluid intake prior to mobilisation. This was increased to 95% (19/20) in the intervention group. The pre-intervention group also had 61.9% (13/21) patients with a prolonged hospital stay which was reduced to 10% (2/20) in the intervention group.

Conclusions

Encouraging oral fluid intake post-operatively reduces the risk of postural hypotension, empowering patients to mobilise and recover post-operatively, contributing to earlier discharge. Additionally, it may reduce the risk of post-operative acute kidney injury, an avenue which should be further explored.
703 Elevating Documentation Practices: Examining the Longitudinal Impact of an Electronic Operation Note Proforma in a District General Hospital
Authors: Mushtaq M , Mushtaq Y , Zuberi S , Gurprashad R
Published: August 2024

Aim

This study aimed to enhance the standard of operation note documentation at a district general hospital, in accordance with the guidelines established by the Royal College of Surgeons of England (RCSEng). A new electronic operation note proforma was developed, implemented, and assessed for both its influence on compliance with guidelines immediately after enactment, and for sustaining affects in the following years.

Method

A retrospective review of 50 operation notes was conducted between December 2019 and March 2020, and quantitatively compared to RCSEng guidelines. Another 50 notes were then assessed between August 2020 and December 2020, following implementation of a new electronic proforma. An additional 100 operation notes were then analysed between August 2022 and November 2023.

Results

A total of 200 operation notes were reviewed and each awarded a score out of 19 based on RCSEng guidelines. Implementation of the new proforma showed significant improvement to the average score both immediately after its execution (15.64 vs 17.94; p<0.0001), and in the years following (15.64 vs 17.39; p<0.0001). The latest audit cycle revealed that surgeons who joined the trust after October 2021, scored lower on average than those present during the proforma's introduction (15.43 vs. 17.71; p < 0.0001).

Conclusions

The implementation of a new electronic operation note proforma, designed in accordance with RCSEng guidelines, resulted in a sustained improvement in documentation over a significant time period. The slight discrepancy in scores between old and new members of the team could emphasise the importance of effective communication in ensuring the continuity of quality improvement projects.
938 Prospective Interviews to Comprehend Patient Perspectives on the Digitisation of Ophthalmology Clinics: A Quality Improvement Project
Authors: Papaioannou C
Published: August 2024

Introduction

Artificial intelligence (AI) has revolutionized medicine, enhancing efficiency and patient care. Moorfields, in collaboration with Google Health and DeepMind, employs AI algorithms to swiftly and accurately diagnose retinal diseases from scans and photographs. This improves treatment timelines and optimizes NHS resource allocation. While widespread AI integration is a few years away, it's crucial to gauge patient awareness, trust, and acceptance. This quality improvement project aims to assess patients' understanding of AI and their attitudes towards it.

Method

We surveyed 30 patients at Moorfields Eye Hospital's Medical Retina clinic between December 2022 and January 2023. The questionnaire included ten questions covering demographics, prior AI knowledge, trust in future AI implementation, and factors enhancing confidence and patient experience.

Results

In the cohort, 83.7% were aged 50-79, 60% female, and 40% male. White ethnicity dominated (50%), followed by Black or Black British (20%) and Asian or Asian British (16.7%). While 53.3% felt not confident about AI understanding, 26.7% were very likely to trust AI in treatment. Income correlated significantly with trust (p = 0.015; r = 0.605), showing lower trust in AI among those from deprived backgrounds. Over 80% preferred pre-appointment AI explanations through leaflets/videos for an improved patient experience.

Conclusions

Patients generally lack confidence in understanding AI, yet they express trust in its use in their treatment. Educating patients about AI is crucial for building trust, and this can be achieved through explanatory leaflets and videos.
962 Simplifying Spines: Updating a Tertiary Centre Spinal Admissions Proforma
Authors: Marei O , Anderson C , D’Aquino D
Published: August 2024

Aim

It has been widely shown that admissions proformas improve the quality of documentation, which is important not only for patient safety but funding secondary to coding within the NHS. The admissions proforma in this busy Tertiary centre was 16 pages long, and frequently not filled out. Therefore, we investigated just how underutilised it was with a view to restructure it, in line with RCSEng Guidance.

Method

Study completed during November and December 2022. 31 proformas identified, and data collated within 46 possible sections over the 16-page document. Analysed using Excel. The document was then changed, using verbal feedback from spinal fellows, junior doctors, and nursing staff.

Results

Average completion rate of 41% over all sections. Admission date and time completed in 15% and 36% respectively. Past medical history completed in almost 90% of patients. Allergies and drug history completed 90% and 100% respectively. Physical examination was recorded in 66% of patients. Imaging and ECGs reviewed in 6% of patients. Registrar reviews were documented in 12% of cases and Consultants on 2%.

Conclusions

There is a clear lack of documentation using the current proforma, and instead senior reviews are recorded on continuation sheets. This leads to difficulty in continuation of patient care, reduced communication and increased time spent on discharge summaries. The new 8-page document will allow clearer documentation, with tick boxes and checklists incorporated to allow easy use for even for doctors providing temporary cover on the spinal unit and will provide a more environmentally sustainable solution.
1038 DrEaMing- a QIP Project for Enhanced Recovery Programme in Post Operative Patients
Authors: Khan N , Singh A , Alnabhan A , Adhya S , Janakan G , Hodge S
Published: August 2024

Aim

Dreaming is a simplified version of an enhanced recovery programme expected to reduce the length of stay and decrease the risk of complications. The Aim of this quality improvement project was to assess the adequate implementation of DrEaMing project in colorectal surgical inpatients.

Method

Twenty-one patients underwent elective colorectal surgery and are candidates for an enhanced recovery programme for July, August, and September 2023 at a tertiary care centre. were selected randomly between June 2023 and August 2023 under the general surgery department. Patient notes, nursing notes and operation notes for each patient were analysed to identify the inadequacy in each of the three limbs.

Results

Free fluids were ordered for 21/21 (100%) patients and were administered for 17/21 (81%). Food was ordered for 16/21 (76%) and was administered on 12/21 (57%) of the patients. Lastly 16/21 (76%) patients were advised for mobilisation and mobilisation was supported in 10/21 (48%) of the patients. The results were discussed in the clinical governance meeting and interventions were advised for better implementation of the DrEaMing project.

Conclusions

There is a deficiency in effective implementation of the DrEaMing project, and this can be rectified with better communication among the nursing staff and the surgeons. Also, in case a patient is not suitable for the DrEaMing project, it needs to be documented by the operating surgeon. By adopting such measures, we can improve the effectiveness of the DrEaMing project and will repeat the cycle of this QIP to confirm our findings.
1185 Improving the Time Between TURP and TWOC: A Quality Improvement Project
Authors: Jones A , Nettleton J
Published: August 2024

Aim

To achieve time between TURP to TWOC of four days or less.

Background

Most trans-urethral resection of prostate (TURP) operations is now done as day case procedures. Catheterisation is standard post TURP, to avoid clot retention and allow bladder irrigation if required. Currently, as patients are being discharged the same day, they are discharged with their catheter in situ. The catheter can be in-situ for longer than necessary, due to long waiting lists of the TWOC clinic.

Method

I performed a quality improvement project with the aim to achieve mean time between TURP and TWOC of four days or less. I reviewed the records 100 patients who underwent TURP between 21/07/2022 and 2/11/2022 in a district general hospital. For each patient, I calculated the time between TURP and TWOC.

Results

The average elapsed time was 9.49 days. The method of organising a TWOC post TURP is to email the urology nurses on the day of the TURP, stating that the patient requires a TWOC. My intervention was to therefore ask the bookings team that when they book in a TURP procedure, they also email the urology nurses to tell them in advance of the patients’ TURP date, that this patient will need a TWOC. Post intervention data was collected: the medical notes of 45 patients post intervention were reviewed.

Conclusions

The average time between TURP and TWOC had decreased to 6.61 days. This is an improvement but has not met the aim of less than or equal to 4 days.
859 RoboticFoundations: A Quality Improvement Programme Developing Robotic Surgical Skills in Foundation Doctors
Authors: Asif A , Floros G , Kaparounaki E , Paine H , Luangsomboon A , Bull A , Walker R , Madhavan A , Singh P , Abbassi-Ghadi N , Preston S
Published: August 2024

Aim

Although many surgical specialties have adopted robotic surgical techniques as standard, basic surgical skills training amongst early-career doctors neglects this paradigm shift. Our tertiary centre has pioneered a longitudinal quality improvement programme focused on integrating Foundation Doctors into robotic surgical teams, such that they are exposed to these skills early rather than during their registrar years. This approach is particularly relevant in preparing Foundation Doctors for a future that is increasingly reliant on robotic surgery, thus addressing immediate and long-term demands in surgical education, as well as leading the extended surgical workforce in this domain.

Method

The programme commenced with an Intuitive platform-based course, which introduced newcomers to being a robotic-bedside assistant. Foundation Doctors progressed from supervised sessions to independent simple tasks, under the guidance of both registrars and consultants. This programme is currently in its data collection phase, focusing on both quantitative and qualitative aspects, such as skill progression, number of procedures performed, and feedback from participants of all stages.

Results

We identified three primary benefits: Foundation Doctors gain hands-on, future-oriented experience, and feel more empowered; senior registrars accrue more console time; and consultants engage in meaningful mentorship — shaping future surgeons of every stage. Preliminary results indicate increased procedural involvement and more motivated trainees.

Conclusions

This novel and structured educational programme offers a beginner-friendly approach to training in robotic surgery, addressing key gaps in the current NHS climate. This model offers a viable and scalable solution for other institutions to further surgical training, aligning with the evolving demands of a robotic future.
1150 The Use of Artificial Intelligence in the Detection of Chondrosarcomas: A Scoping Review
Authors: Ogunmwonyi I
Published: August 2024

Aim

Chondrosarcoma is a challenging primary bone tumour to diagnose radiographically. This review investigates the role that artificial intelligence (AI) may have in improving the diagnostic accuracy of chondrosarcoma.

Method

A review of public databases, including PubMed, Scopus, and IEEE Xplore was performed. Predefined search terms, including but not limited to "chondrosarcoma," “bone tumour” "artificial intelligence," and "diagnosis." were used. The inclusion criteria were research articles and reviews focusing on the application of AI in the detection of chondrosarcoma as applied to various imaging modalities including X-ray, CT scans, and Magnetic Resonance Imaging. Details on the types of algorithms used, dataset characteristics, performance metrics, and any comparisons to traditional diagnostic methods were captured.

Results

The review highlighted that there is a growing body of literature and increasing potential for AI in the identification of chondrosarcomas across different imaging modalities. AI algorithms, including machine learning and deep learning models, showed promising results with improved sensitivity and specificity compared to conventional diagnostic methods.

Conclusions

The Integration of AI in chondrosarcoma detection holds promise for enhancing diagnostic accuracy. Standardised methodologies, larger datasets, and prospective validation studies are needed for robust application. Collaborative efforts between clinicians, radiologists, and AI developers are crucial for translating these advancements into clinically meaningful tools, ultimately improving early detection and management of chondrosarcoma.
546 Effects of Different Weight Loss Programs on Oncological Outcomes Following Curative Resection of Digestive Tract Cancers
Authors: Razzaq A , Niaz O , Seabrook M , Niaz T , Parrott R , Ahmed I , Rao A
Published: August 2024

Aim

The review aimed to investigate the impact of weight loss programs on the long-term oncological outcomes of overweight and obese patients following curative gastrointestinal (GI) cancer resections. Given the association between obesity and heightened risks in cancer patients, the study sought to assess the effectiveness of various weight loss interventions, including lifestyle modifications, pharmacological agents, bariatric surgery, or their combinations.

Method

A comprehensive search strategy utilising MeSH and free-text terms was employed across multiple electronic databases, without language or publication status restrictions. Inclusion criteria focused on randomised controlled trials involving any type of weight loss intervention for overweight or obese patients following curative GI cancer resection. The GRADE approach was intended for risk of bias assessment and primary outcomes encompassed overall mortality, local recurrence, and distant recurrence. Secondary outcomes included quality of life, disease-free survival, overall complication rate and time to recurrence.

Results

Despite the systematic search, no randomized controlled trials meeting the specified inclusion criteria were identified. As a result, the review lacked empirical data to draw conclusions regarding the outcomes of weight loss programs in this patient population following curative GI cancer resection.

Conclusions

The absence of conclusive evidence highlights a critical gap in understanding the impact of weight loss interventions on the oncological outcomes of overweight and obese patients after GI cancer resections. Given the increasing survival rates post-resection with advanced surgical treatments, there is a pressing need to comprehend the potential influence of weight loss programs on recurrence. Large multicentre randomised controlled trials are required to assess these outcomes.
29 Comparisons of Operative Exposure in UK Core Surgical Training a Generation Apart: A Father/son Logbook Comparison in Kent, Surrey & Sussex
Authors: Karanjia R , Karanjia N
Published: August 2024

Aim

Operative exposure during current core surgical training is considered by many to be significantly less than a generation ago. To evaluate this, we compared the logbooks of a father and son, who both completed their core surgical training in the same deanery of Kent, Surrey and Sussex (KSS), 35 years apart.

Method

Nariman Karanjia (NK) and Rustam Karanjia (RK)’s logbook numbers in 1985-1987 and 2020-2022 respectively over 24 months were analysed. NK completed core surgical training at the Royal Surrey Hospital in Guildford and RK at St. Peter’s Hospital, Chertsey, and Worthing Hospital. Only procedures performed as the primary surgeon were included. Total procedure number and core procedure numbers for each specialty were compared. RK’s numbers were adjusted to ensure the same placement length when using direct comparison.

Results

Overall, NK performed 703 procedures vs. RK’s 398, with greater numbers in Trauma & Orthopaedics (T&O) (261 vs. 12) and General Surgery (314 vs. 47) but fewer in Urology (128 vs. 339). When adjusted for placement length, Urology numbers were comparable (128 vs. 127) but NKs numbers for T&O (261 vs. 18) and General Surgery (314 vs. 141) remained far greater. Core procedures were greater or equal in NKs logbook for all three specialties when adjusted for placement length.

Conclusions

Operative numbers were much greater overall and across General Surgery and T&O 35 years ago. Urology numbers were equivalent and likely represent the benefit of a themed core surgical training program.
386 Introduction of a Surgical Mentoring Scheme for Undergraduate Medical Students
Authors: Delaney M , Whiting E
Published: August 2024

Aim

Due to increasing difficulty getting into surgical training and a perceived lack of surgical mentorship for medical students, we established the Surgical Early Mentoring Scheme (SEMS). We aimed to improve surgical opportunities for medical students interested in a career in surgery.

Method

Medical students at a single university teaching hospital were invited to partake. The scheme ran twice, across two different semesters. Students were matched with a surgical mentor, ideally in their speciality of interest. Meetings were determined by the student and mentor. Surveys were distributed before and afterwards, assessing the impact of the scheme and to guide improvements.

Results

Prior to participation, 6.9% of students felt they had a surgical mentor. Students stated that they would benefit from exposure to theatres and clinics, audit involvement, careers advice and application guidance. 44 students participated in the first round of the scheme. The mean number of times they met with their mentor was 0.86. The students reported that the scheme should have started earlier in the term to maximise the opportunities given.

In the second round, 28 students participated. Following previous feedback, the scheme began earlier in the semester. The mean number of times that students met with their mentors was 1.2. Overall satisfaction, usefulness for theatre exposure, audit opportunities, general career advice and training application advice improved from the first round.

Conclusions

The introduction of SEMS has demonstrated improved surgical opportunities for medical students. Through responding to feedback, the scheme has developed between cycles. SEMS can easily be continued for future student cohorts.
50 Tie-Over Dressing in Split-Thickness and Full-Thickness Skin Grafts: A Systematic Review and Meta-Analysis
Authors: Nam R , Fung E , Pang C
Published: August 2024

Aim

Skin grafting is a common procedure used in plastic surgery to repair skin defects. Tie-over dressings are often used in conjunction with skin grafts, but their benefits are debated, and have been associated with limitations and adverse effects. A systematic review is needed to evaluate the effectiveness and safety of tie-over dressings in skin grafting.

Method

Major clinical databases (MEDLINE, Embase, Cochrane, ClinicalTrials.gov, EU Clinical Trials Register and ISRCTN registry) were systematically searched from its inception to 24th October 2022 for studies describing subjects who received skin grafts and subsequently received tie-over or non-tie-over dressing in plastic surgery. Risk ratios of graft take rate, wound infection rate, and haematoma are calculated to compare tie-over and non-tie-over dressing with random-effect model.

Results

A total of 892 entries were retrieved. Of these, 8 met the inclusion criteria and were included for analysis. Full graft take is high in both groups (89% in tie-over vs 95% in non-tie-over). Risk ratio of graft take is 0.95 (95% CI = 0.89-1.02, p = 0.118, I 2 = 0%). Risk ratio of graft failure is 1.41 (95% CI = 0.72-2.74, p = 0.235, I 2 = 0%). Risk of causing complications is higher in patients who received tie-over dressing (RR=1.61, 95% CI =1.03-2.54, p = 0.271).

Conclusions

The results indicate that the additional tie-over dressings may not be beneficial. However, no existing evidence looked into the health economics between tie-over and non-tie-over groups.
133 Gender Differences in Mortality of Hospitalised Stroke Patients: A Systematic Review and Meta-Analysis
Authors: Abdel-Fattah A R , Pana T , Smith T , Pasdar Z , Aslam M , Mamas M , Myint P
Published: August 2024

Aim

Gender differences in mortality after stroke remain unclear in the current literature. We therefore aimed to systematically review the gender differences in mortality up to five-years following ischaemic (IS) or haemorrhagic stroke(HS) to address this evidence gap.

Method

The literature was systematically searched using Ovid-EMBASE, Medline, and Web-of-Science databases, from inception to November-2021. The quality of evidence was appraised using the CASP Cohort-study checklist. Unadjusted and adjusted odds and hazard ratios were meta-analysed separately for IS and HS.

Results

Forty-one studies were included (n=8,128,700; mean-age: 68.5 years; 47.1% female). Thirty-seven studies were included in meta-analysis (n=8,8008,110). Compared to men, women who had IS had lower mortality-risk in-hospital (RR: 0.94; 95%CI: 0.91–0.97), at one-month (RR: 0.87; 95%CI: 0.77–0.98), 12-months (RR: 0.94; 95%CI: 0.91–0.98) and five-years (RR: 0.93 95%CI: 0.90–0.96). Nevertheless, analysis of crude data showed women were at higher risk of mortality in-hospital, at 12-months and five-years (in-hospital, RR: 1.05; 95%CI:1.03–1.07; 12-months, RR: 1.10; 95%CI: 1.06–1.14; five-years, RR: 1.06; 95%CI: 1.02–1.10). After HS, women had higher mortality-risk in-hospital (RR: 1.03; 95%CI: 1.01–1.04) however, no gender differences were found post-discharge.

Conclusions

The gender differences in post-stroke mortality differ by stroke type, age-group, and follow-up. Crude stroke mortality in women is higher than in men and this appears to be driven by pre-existing comorbidities. In adjusted models, women have a lower mortality-risk following IS, independent of duration of follow-up. After HS, women had higher mortality in hospital however, no gender differences after hospital discharge were found.
850 Streamlining Patient Care: Developing an Integrated Proforma for Neck of Femur Fracture Patients Across Multidisciplinary Teams
Authors: Choudhry H , Thiagarajan J , MacDowell A
Published: August 2024

Aim

To create a comprehensive Neck of Femur (NOF) fracture proforma that includes sections for the wider multi-disciplinary team (MDT) such as Physiotherapy, Nursing, Orthogeriatric, Emergency Department (ED) and Orthopaedic teams. To assess the extent of completion of the Integrated care pathway (ICP) by profession. To assess the documentation of Key Performance Indicators (KPI) of a single centre.

Method

57 NOF proformas were collected and analysed to evaluate compliance of each section. Qualitative feedback was obtained from the wider Multidisciplinary team to gauge the practicality of the proforma. Each section underwent scrutiny to assess the documentation of key information relevant to the respective MDT.

Results

Certain aspects, such as time to surgery, nerve block documentation, and NICE-compliant surgery, could not be thoroughly assessed due to insufficient information (less than 50% availability). Documentation scores; ED 5.8/13, Orthopaedic clerking 8.9/13, Nursing 22/29, Physiotherapy 3.5/4. For each KPI; Physio score was 96%, MUST score 89%, mobilising the next day after surgery 86%, Orthogeriatric ST3+ r/v 72 hours after presentation 82%, falls assessment 77%, pre-Op AMTS 75%, surgery the following day of presentation 49%, 4AT post-op score 11%.

Conclusions

A single place proforma for all patient needs can save significant administrative time when it comes to assessing key documentation of the ICP. However, this is only useful if there is adequate compliance to proforma documentation. Education is key as simple factors such as documentation of delirium post-operatively can limit Best Practice. A proforma must be practical, and easily accessible to encourage compliance.
1076 Stop Before You Bier's Block- a Major Trauma Centre's Experience of Improving Intravenous Regional Anaesthesia Safety
Authors: Murdeshwar H
Published: August 2024

Aim

Intravenous regional anaesthesia (IVRA) offers a safe and cost-effective means to perform short procedures on an extremity. Local anaesthetic systemic toxicity may occur if the anaesthetic is infiltrated prior to inflating a tourniquet. This project aims to improve Bier’s block safety in the Orthopaedic department at a major trauma centre.

Method

Root cause analysis performed after a patient safety incident involving the Bier’s block indicated a knowledge gap among Orthopaedic junior doctors, breakdown in communication between the Plaster room team and need for training in managing adverse outcomes. A survey assessing block providers’ understanding of the indications, associated risks and competence in undertaking the procedure was conducted. A poster with an aide memoire highlighting the key steps of the procedure was created and a demonstration was provided. The widely successful “STOP before you BLOCK” approach was applied to encourage a 2-person check of tourniquet inflation and local anaesthetic before proceeding.

Results

The post session survey demonstrated an increase in self-reported confidence levels in performing the block from 3 to 5 on a 5-point scale with 88% reporting a better understanding of the signs and symptoms of local anaesthetic toxicity and its management. 70% responders attributed their increased confidence to the poster intervention and 84% to the “STOP before you BLOCK approach.” The Plaster room technicians reported improved communication among the team with better involvement of individual members.

Conclusions

Procedural competency in IVRA can be improved through adequate training, induction, use of visual cues and effective communication.
176 Rare Case of Spontaneous Renal Artery Rupture Secondary to Wegner Granulomatosis A Case Report
Authors: Shaker G
Published: August 2024

Background

Wegener's granulomatosis (now known as Granulomatosis with Polyangiitis, GPA) is a rare autoimmune disorder primarily affecting small-to-medium-sized blood vessels. Renal involvement is a well-recognized complication, often leading to glomerulonephritis. However, spontaneous renal artery rupture, a life-threatening event, is an exceptionally rare manifestation of this disease.

Case Presentation

We present the case of a 58-year-old male with a long-standing history of GPA, who developed end-stage renal disease (ESRD) and required dialysis despite immunosuppressive therapy. He presented with sudden-onset severe abdominal pain, hypotension, and tachycardia. Imaging revealed a ruptured right renal artery aneurysm, ultimately diagnosed as spontaneous renal artery rupture secondary to GPA.

Investigation: Laboratory tests showed elevated inflammatory markers and deteriorating renal function. A CT scan with contrast confirmed the ruptured renal artery aneurysm.

Differential Diagnosis: While considering other causes of retroperitoneal haemorrhage, the patient's medical history and characteristic imaging findings led to the diagnosis of spontaneous renal artery rupture related to GPA.

Treatment, Outcome, and Follow-up: Emergency endovascular embolization successfully controlled the haemorrhage, stabilizing the patient's condition. Continuous immunosuppressive therapy was maintained, and regular follow-up evaluations were initiated to monitor disease activity and possible complications.

Discussion

This report underscores the rarity and life-threatening nature of spontaneous renal artery rupture in the context of GPA. Early recognition and intervention are pivotal to preventing fatal outcomes. Endovascular embolization emerges as a viable treatment option, particularly in cases where surgical intervention carries higher risks.
367 Flexible Cystoscopy Audit in Patients with Recurrent Urinary Tract Infections (rUTI) / Lower Urinary Tract Symptoms (LUTS): A Path to Clinical Excellence and Cost Savings
Authors: MacDonald-Nethercott M , Pereira M , Pai A
Published: August 2024

Aim

To minimize unnecessary flexible cystoscopy in patients with rUTI and LUTS, thereby enhancing patient care and optimizing the utilization of resources.

Method

Comprehensive data collection from the outpatient cystoscopy clinic, including demographics, indications (rUTI/LUTS), red flag symptoms and outcome.

Results

In October 2023, our DGH outpatient clinic performed 240 flexible cystoscopy procedures, with 24.1% (58 cases) for rUTI (32) and LUTS (26). Only 37.9% of patients exhibited one or more risk factors, necessitating flexible cystoscopy according to European Urological Association (EUA) guidelines. Additionally, over 13% of patients were under 40 years old with symptoms of rUTI/LUTS. Through collaborative efforts with the consultant body, we derived local consensus criteria for flexible cystoscopy, leading to the introduction of a new referral pathway. Departmental education may further contribute to a significant reduction in unnecessary procedures. Cost analysis, based on private clinic pricing, revealed a substantial predicted monthly saving.

Conclusions

The complex landscape surrounding the investigations and management of rUTI/LUTS, coupled with the decision on cystoscopy, often introduces uncertainty. By establishing a local consensus and implementing new criteria within our referral pathway, we have successfully brought clarity to the utilization of this procedure, which may result in enhanced and efficient patient care. Our adherence to EUA guidelines demonstrates our commitment to best practices. The predicted substantial cost savings emphasize the financial advantages of our interventions. Our collaborative and locally driven initiatives underscore our dedication to excellence in patient care and healthcare efficiency.
508 The Introduction of Daycase HoLEP in a Peripheral Hospital
Authors: Hughes J
Published: August 2024

Aim

To describe the introduction of daycase HoLEP in a geographically remote, peripheral hospital. Establish the safety of this compared to published data.

Method

Daycase protocol developed for bladder outflow obstruction surgery, including HoLEP. Special considerations were given to the challenges of introducing this in a remote hospital, with no ITU support and which may have a single anaesthetist and surgeon. Retrospective analysis of prospectively collected data from June 2022 to August 2023.

Results

Patient eligibility for daycase surgery include living within one hour of hospital; ASA 1-2; prostate volume <150cc and able to manage a catheter. Patients are placed on the morning list and leave theatre with a 22Ch 3 way catheter with irrigation running, which is switched off in recovery after 1 hour (if clear). They are reviewed by the surgeon at 4 hours post-op. Daycase discharge is completed if: urine was clear/rose, patient mobilising, eating and drinking, BP within 10% of pre-op level. 17 patients underwent daycase HoLEP (median age 69). 100% of patients were daycase. Mean pre-op prostate size 100cc (n=13), mean enucleated volume 51cc (range 3-95). One patient returned to theatre for haemostasis on the day. No patients required transfer to main hospital. One re-admission within 30 days (5.96%, compared to 5.5%-8% in literature). One patient failed TWOC at day five then passed at two weeks.

Conclusions

Daycase HoLEP in a remote hospital is safe and effective. This is a credible method of providing the service whilst taking strain of the main distract general hospital.