bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparing Location Data From Smartphone and Dedicated Global Positioning System Devices: Implications for Epidemiologic Research
Authors: Thierry Benoit , Stanley Kevin , Kestens Yan , Winters Meghan , Fuller Daniel
Published: August 2023

In this study, we compared location data from a dedicated Global Positioning System (GPS) device with location data from smartphones. Data from the Interventions, Equity, and Action in Cities Team (INTERACT) Study, a study examining the impact of urban-form changes on health in 4 Canadian cities (Victoria, Vancouver, Saskatoon, and Montreal), were used. A total of 337 participants contributed data collected for about 6 months from the Ethica Data smartphone application (Ethica Data Inc., Toronto, Ontario, Canada) and the SenseDoc dedicated GPS (MobySens Technologies Inc., Montreal, Quebec, Canada) during the period 2017–2019. Participants recorded an average total of 14,781 Ethica locations (standard deviation, 19,353) and 197,167 SenseDoc locations (standard deviation, 111,868). Dynamic time warping and cross-correlation were used to examine the spatial and temporal similarity of GPS points. Four activity-space measures derived from the smartphone app and the dedicated GPS device were compared. Analysis showed that cross-correlations were above 0.8 at the 125-m resolution for the survey and day levels and increased as cell size increased. At the day or survey level, there were only small differences between the activity-space measures. Based on our findings, we recommend dedicated GPS devices for studies where the exposure and the outcome are both measured at high frequency and when the analysis will not be aggregate. When the exposure and outcome are measured or will be aggregated to the day level, the dedicated GPS device and the smartphone app provide similar results.
63 Analysis of the Intra and Post-Operative Complications of Minimally Invasive vs Open Adrenalectomy in Patients with Phaeochromocytoma: A Systematic Literature Review
Authors: Papaioannou C , Druce M
Published: August 2023

Aim

Phaeochromocytoma is a rare type of neuroendocrine tumour arising from the chromaffin cells of the adrenal medulla. The Endocrine Society suggest that minimally invasive (laparoscopic or robotic) adrenalectomy (MIA) should be performed unless the tumour is >6cm or invasive where open adrenalectomy (OA) is preferred. The aim of this review is to describe the intra and post-operative complications between the two surgical approaches.

Method

A thorough search was conducted on PubMed, EMBASE and Cochrane Library to find papers which analysed the intra and post-operative morbidity of adult patients with phaeochromocytoma. This review included only original studies written in English, after the year 2000. Our search strategy identified 10 papers which fulfilled our inclusion criteria. The PRISMA system was used for standardization.

Results

Haemodynamic instability was the major intra-operative complication. Patients having OA had significantly more frequent and greater fluctuations in their blood pressure during surgery. This was both in terms of hypertensive crises and hypotension too. Furthermore, significantly more patients required blood transfusion if they had an OA due to the higher degree of blood loss compared to the MIA (p<0.05).

The median number of days spent in the hospital post-operatively was significantly more for patients having OA (8.3 days vs 4.2 days). Finally, two papers analysing the number of patients having post-operative cardiovascular complications deduced that a higher proportion sustained such complications after OA than MIA (p = 0.002 and p = 0.041).

Conclusions

The results highlight the superiority of the MIA in terms of safety during and shortly after the procedure.
677 Amide Proton Transfer-Weighted Imaging Versus Diffusion-Weighted Imaging for Monitoring Treatment Response in Glioma Patients: A Systematic Review and Meta-Analysis
Authors: Chansiriwongs A , Welch A
Published: August 2023

Aim

Monitoring treatment response in glioma (GM) patients remains a challenge, as tumour recurrence (TR) and treatment-related injury (TRI) both appear similarly on standard magnetic resonance imaging (MRI). Although diffusion-weighted MRI (DWI) is gold standard, equivocal patients still undergo invasive biopsies for diagnosis. Amide proton transfer-weighted MRI (APTw) may more accurately differentiate TR from TRI, reducing surgical intervention rates. Hence, this systematic review and meta-analysis aimed to determine how APTw compares to DWI in the identification of TR from TRI.

Method

A search strategy was used to select studies investigating the diagnostic ability of DWI or APTw in detecting TR from Ovid MEDLINE ®, Ovid Embase, Web of Science, Cochrane Central Register of Controlled Trials, and Thai Clinical Trials Registry. Selection criteria were applied to retrieve studies and methodologies critically appraised according to the QUADAS-2 tool. Conclusions from studies were synthesised, and the sensitivity and specificity for TR detection pooled.

Results

18 studies were included in the analysis (11 DWI, 6 APTw, 1 both). For TR, APTw signal measured significantly higher, whereas apparent diffusion coefficients derived from DWI images were significantly lower. In DWI studies, combined sensitivity and specificity for TR was 84.4% (95% CI, 72.5%-91.7%) and 81.2% (95% CI, 67.9%-89.8%) accordingly. Meta-analysis was not performed for APTw due to limited study numbers. In general, studies had low methodological quality and were associated with a risk of bias.

Conclusions

Overall, though comparisons between DWI and APTw in monitoring GM treatment were inconclusive, this study supports the potential use of APTw in neurosurgery.
891 A Systematic Review and Narrative Synthesis on the Efficacy of Bisphosphonate Therapy in the Management of Diffuse Sclerosing Osteomyelitis
Authors: Nasri Elmi S , Van Der Lith S , Hawesa N , Abukhder M
Published: August 2023

Aim

Diffuse Sclerosing Osteomyelitis (DSO) of the mandible is a rare condition, characterised by recurrent severe pain, and functional disturbances such as trismus. Management of DSO through antibiotics, steroids, and analgesia has been generally unsatisfactory. Several articles have suggested the use of bisphosphonate therapy as an alternative treatment option to achieve long-lasting symptom improvement. We aim to summarise all evidence relating to the efficacy of bisphosphonate therapy in DSO.

Method

A systematic review protocol was registered with PROSPERO and reported in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses. Comprehensive electronic search strategies of six databases were developed. Studies were screened according to the inclusion and exclusion criteria by two independent reviewers.

Results

Eight articles were eligible for inclusion. A total of 102 patients with a confirmed diagnosis of DSO received bisphosphonate treatment following a trial of conservative management. All studies reported significant reduction in levels of pain and swelling, and a reduction in cumulative doses of analgesics. Majority of patients reported that bisphosphonate therapy provided long-lasting symptom improvement. Three studies reported improvements in maximal mouth opening, with one study reporting a mean increase of 9.6mm. Improvements in panoramic radiographs and cone beam CT scans were also observed in five studies, with four patients demonstrating almost normal-to-normal bone architecture. Finally, all studies reported no long-term complications.

Conclusions

Bisphosphonate therapy does appear to be a promising treatment option for DSO. It has shown to improve symptoms and radiological features, providing long-term benefits. Further prospective studies are required to finetune treatment protocols.
1247 A Vascular Surgeon's Dilemma - Biodegradable Versus Non-Biodegradable Drug Releasing Stents: A Systematic Review and Meta Analysis
Authors: Shah A , Kumar N
Published: August 2023

Aim

Vascular stents are the best-known interventional treatment for cardiovascular disease, and variation in available stents has increased significantly over time. Despite the rapidity of new prototype releases, critical cross-comparisons fail to maintain the same rate, therefore causing confusion for vascular surgeons. Research is most notably lacking between biodegradable-polymer sirolimus-eluting stents (BP-SES) and permanent-polymer sirolimus-eluting stents (PP-SES). Consequently, a systematic review with meta-analysis was conducted evaluating clinical outcomes.

Method

Medline, Embase, and Scopus databases were searched using relevant synonyms of “biodegradable”, “sirolimus” and “stent”, with the final search being conducted on the 4th of November 2022. Reference lists were also screened. The clinical outcomes investigated were stent thrombosis (ST), myocardial infarction (MI), target vessel revascularisation (TVR), target lesion revascularisation (TLR), and death. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.

Results

Five clinical trials directly comparing clinical outcomes between BP-SES and PP-SES were ultimately identified for inclusion. For all five outcomes investigated, no statistically significant difference (p>0.05) was found between the BP-SES and the PP-SES recipients. Pooled odds ratios of 0.86 (95% CI:0.44-1.65), 0.75 (95% CI:0.32-1.74), 1.12 (95% CI:0.54-2.32), 1.14 (95% CI:0.38-3.38) and 0.95 (95% CI:0.51-1.77) were calculated for ST, MI, TVR, TLR and death respectively.

Conclusions

Although there is some evidence to suggest BP-SES are noninferior to PP-SES, concrete conclusions cannot yet be drawn due to the paucity of research in this field. Further clarity from randomised control trials will aid additional examination and improvement in stent materials and outcomes.
15 Impact of Mentoring of Underrepresented Minorities in Undergraduate Medical Education: A Systematic Review
Authors: Feeley A , Feeley I , Sheehan E , Queally J
Published: August 2023

Aim

The aim of this review is to evaluate the impact of structured mentoring programs on underrepresented minorities in undergraduate medical education.

Method

A comprehensive search strategy was performed of electronic databases including PubMed, Ovid Medline, and EMBASE between January- September 2022 in accordance with PRISMA guidelines. Both qualitative and quantitative outcomes including characteristics of the mentoring structure explored within each study were collected, and differences in study outcomes analysed.

Results

In total 17 studies were included for analysis. Mentoring within underrepresented minorities resulted in an increase in research opportunities, exam performance, medical specialty applications and residency matching. Structured feedback yielded positive experiences by both mentors and mentees participating in programs, with both emotional and cultural competence issues explored across studies included for analysis.

Conclusions

Mentoring for medical students underrepresented in medicine across mentoring relationships including peer, senior, formal, and informal structures yield positive outcomes within research, academic modules, and career pathways. Future applications of mentoring programs should consider the use of tandem mentoring from both senior and peer mentors to optimise benefits URM students derive from each mentoring relationship.
526 Combining Sarcopenia and ASA Status to Inform Emergency Laparotomy Outcomes: Could It Be That Simple?
Authors: Karolewski J , Ming Y J , Howley P , Holmes M , Gani J , Pockney P
Published: August 2023

Aim

Emergency laparotomy mortality prediction tools are usually complex multipoint scoring systems. Our aim was to assess a 2 point system comprising radiological sarcopenia plus simplified ASA (PM;L3/sASA) as a potential predictor of 30-, 90- and 365- day mortality in Emergency Laparotomy patients, and compare this to current widely used tools such as NELA, P-Possum and ACS-NSQIP.

Method

A retrospective analysis was conducted across four hospitals, identifying 500 patients who underwent emergency laparotomies between 2016-2017 and had contemporaneous abdomino-pelvic CT scans. Radiological sarcopenia was measured using the PM:L3 ratio on a cross-sectional axial CT slice. PM:L3, NELA, ACS-NSQIP, and P-POSSUM, as well as simplified ASA (sASA) were retrospectively calculated and assessed as potential predictors of 30-, 90-, and 365-day mortality.

Results

ACS-NSQIP, NELA, P-POSSUM and PM:L3/sASA were each statistically significant predictors of 30-day, 90-day and 365-day mortality (p<0.001). Logistic regression models of 30-, 90- and 365-day mortality containing just the two predictors PM:L3 and simplified ASA exhibited AUCs of 0.838, 0.805 and 0.775 respectively, which are comparable with the best currently used predictors ACS-NSQIP and NELA.

Conclusions

Combining PM:L3 with ASA scores appears to be a significant predictor of 30-, 90-, and 365-day mortality in emergency laparotomy patients in Australia. The results are comparable with some of the best performing widely used risk assessment tools and provide a more time-efficient and accessible method of performing risk assessments in Emergency Laparotomy patients.
812 Decision Making in Emergency Laparotomy – Do Trainees and Consultants Take Decisions Differently? Preliminary Results of an International Quality Enhancement Initiative (DILEMMA Study)
Authors: Perin G , Bellio G , Ghirardo S , Favero A , Hormis A , Cresswell A
Published: August 2023

Aim

The aim of our study is to assess how professionals take decisions when evaluating suitability of patients for emergency laparotomy and compare judgement profiles between trainees and consultants.

Method

We created and validated a dataset of 90 short case vignettes based on real patients admitted with surgical pathology correctable only via an emergency laparotomy. We removed any information concerning real life outcomes. We submitted the vignettes to consultants and trainees in surgery, anaesthesia, and intensive care, asking them if they would or not offer an emergency laparotomy. The data was analysed using Judgement Analysis methodology (binomial logistic regression) to identify factors playing a role in the decision-making process. We then compared judgement profiles, accuracy scores (the lower the value the higher the likelihood of operating on patients that survived at 30 days), and inconsistency between trainees and consultants and between trainees of different grades.

Results

Twelve centres provided data (4 from Italy, 7 from the UK, 1 from Greece). 47 consultants, 9 SAS doctors, 28 higher trainees, 13 core trainees or equivalent took part in the study. Average concordance between decision makers and real life was 78.9%. Median accuracy was 16.5 (IQR 11-30.5). Median inconsistency score was 13% (IQR 7%-20%). Accuracy and inconsistency were better for consultants and worse for trainees. Judgment Analysis demonstrated differences between grades, specialities, and institutions.

Conclusions

Different clinicians, when faced with the same information, make different decisions. Accuracy and consistency differed between trainees and consultants.
227 Investigating the Use of Flavin Mononucleotide & Cell Free Mitochondrial DNA as a Biomarkers of Ischaemic Damage to Livers & Kidneys Before Transplant Surgery
Authors: Takyi C
Published: August 2023

Aim

Before accepting an organ for transplantation, it is important to ensure it is safe to use. Flavin mononucleotide (FMN) has been demonstrated to be an accurate predictor of 90-day graft loss in liver transplant surgery. Previous studies revealed that cell free mitochondrial DNA (cf mtDNA) is predictive of ischemic acute kidney injury in kidney transplantation.

There is no validated scoring system or biomarker in clinical use to aid the decision-making process before transplantation. Consequently, transplant surgeons accept or decline organs based on their clinical judgement. There is a need for an objective method to assess organ quality before transplantation.

Method

Patient consent and demographics were noted prior to transplant surgery. Perfusion solution was flushed through donor livers or kidneys. FMN concentration was measured by fluorescence spectroscopy and cf mtDNA concentration was measured by digital droplet polymerase chain reaction. The concentrations of FMN and cf mtDNA were correlated with donor age & BMI and total length of recipient intensive treatment unit (ITU) stay.

Results

Amongst 8 transplanted livers, the study showed a negative trend between donor BMI and both FMN & cf mtDNA. There was a strong correlation between FMN concentration and ITU duration (r = 0.7353, p = 0.0376). Amongst 14 transplanted kidneys, MT-ND6 subunit concentration strongly correlated with donor BMI (r = 0.8473, p = 0.0003).

Conclusions

Despite more research being required to consolidate the role of these biomarkers, the study reinforces the idea that FMN and cf mtDNA can play a role as point of care tests in assessing organ quality prior to transplantation.
224 Surgical Repair of Mitral Valve Prolapse: Hypertension and Other Determinants of Failure
Authors: Ashbridge T , Briffa N , Ali A , Begum M
Published: August 2023

Aim

It has been postulated that hypertension is associated with an increased likelihood of repair failure in patients with mitral valve prolapse. This study aims to assess whether there is a significant association between hypertension and disease recurrence and need for reoperation.

Method

A retrospective observational cohort study was conducted at a single centre in the United Kingdom. Patients who underwent surgical repair for mitral valve prolapse were identified between January 2011 and December 2020, with follow-up data collected to December 2021. Patients were classified as hypertensive if they had a pre- operative clinic blood pressure of 140/90 mm Hg or above. Treatment failure was confirmed by the presence of moderate or worse regurgitation on post-operative echocardiography and/or need for reoperation. Multivariate logistic regression and Cox regression were used for statistical analysis.

Results

A total of 278 patients were identified who had pre-operative blood pressure data available, of those 144 were hypertensive. By the conclusion of the study period, treatment failure occurred in 11.5% of the study sample. No significant association was identified between the presence of hypertension and treatment failure, or time to treatment failure. Concomitant atrial ablation was, however, found to be protective against treatment failure (odds ratio, 6.1; 95% confidence interval, 1.2 to 32.8) and associated with longer time to treatment failure (hazard ratio, 6.3; 95% confidence interval, 1.6 to 25.1).

Conclusions

There is insufficient evidence to demonstrate that hypertension is associated with treatment failure or time to treatment failure for patients undergoing surgical repair for mitral valve prolapse.
655 Survival and Quality of Life Following CSF Diversion in Adult Patients with Leptomeningeal Metastases-Associated Hydrocephalus - a Systematic Review & Meta-Analysis
Authors: Dhaliwal J , Ruiz-Perez M , Mihaela-Vasilica A , Chari A , Hill C , Thorne L
Published: August 2023

Aim

Leptomeningeal Metastases (LM) is associated with altered CSF flow dynamics (50-70%), and 1-5% of patients will develop communicating hydrocephalus, adversely impacting quality of life (QoL), functional status, and overall survival (OS). There is equipoise for CSF diversion in LM-associated hydrocephalus (LM-H). This systematic review and meta-analysis aims to assess the effect of CSF diversion on OS and QoL in this context.

Method

This systematic review was conducted in accordance with PRISMA guidelines. Pubmed/MEDLINE, EMBASE, Web of Science, and Scopus were searched for articles evaluating the role of CSF diversion in adult patients with systemic cancer LM-H. A meta-analysis was conducted using random effects models, mean differences, and 95% confidence intervals (CI). Bias was assessed using the ROBINS-I tool.

Results

Ten eligible studies with a total of 494 patients were included. Two studies reported multivariate hazard ratios for median OS, suggesting no significant effect of shunting on OS (pooled HR = 0.42; p = 0.27; 95% CI 0.09-1.94). A pre-operative and post-operative Karnofsky Performance Status (KPS) mean difference of 17.6 points (CI 10.44-24.68; p<0.0001) was calculated from 4 studies. Across all studies, a symptomatic improvement rate of 67-100% was observed, with high rates of improvement of headaches and nausea and lower rates for cranial nerve palsies. Complication rates across nine studies ranged from 0-21.1%.

Conclusions

The present findings prompt the generation of a standardised decision-making tool, a critical analysis of individual patient risk-benefit ratios, and systematic measurements for QoL for these patients. Implementation of these will facilitate and optimise surgical management for LM-H patients.
1188 The Effect of Bone Wax Application in Cardiac Surgery: A Systematic Review
Authors: Shah A , Kumar N , Raja S , Bhudia S
Published: August 2023

Aim

There is limited and conflicting evidence on whether bone wax usage in cardiac surgery increases infection risk. A systematic review was conducted to examine cardiac surgery postoperative outcomes following bone wax application.

Method

This systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The MEDLINE, EMBASE, and Scopus databases were searched for studies evaluating perioperative bone wax usage in the English language. All relevant synonyms of “Cardiac Surgery”, “Bone wax”, “Infection”, and “Healing” were used to identify papers. The outcomes of interest were wound infection, sternal dehiscence, postoperative sternal bleeding, postoperative chest drainage and mortality.

Results

From the 66 articles found, 5 were included following full-text screening. No statistically significant difference in infection risk between the bone wax (BW) and comparator groups existed. However, the evidence suggests bone wax significantly increases the risk of sternal dehiscence. Studies reporting postoperative bleeding showed a significantly greater mean volume in the BW group. All studies reporting postoperative chest drainage (n = 3) showed a greater mean volume in the BW group, of which two were significant. Of the three papers reporting mortality, two showed an increased risk in the BW group.

Conclusions

Current evidence indicates no significant association between bone wax and wound infection. Bone wax is associated with a greater risk of sternal dehiscence, postoperative sternal bleeding, postoperative chest drainage and mortality. Greater emphasis should be placed on bone wax alternatives in clinical practice. Limited data necessitates larger studies, and for clearer guidelines to be established around them.
944 Would You Like a Pus Swab Sent?
Authors: Hu K , Lingam G
Published: August 2023

Aim

The Association of Coloproctology of Great Britain and Ireland (ACPGBI) consensus guidelines in emergency colorectal surgery states that microbiology sampling is of limited value in the management of anorectal abscesses. Several centres continue to send intra-operative swabs routinely for microbiology. This study aims to identify (1) if sampling changed postoperative management and (2) quantify the financial cost of sending unnecessary swabs within a district general hospital setting.

Method

Retrospective study investigating intraoperative clinician use of microbiology swabs. Study sample included patients who underwent an incision and drainage of an anorectal abscess at Princess Alexandra Hospital from 1st October 2021 to 1st October 2022.

Results

A review of patient data obtained 59 patients who underwent an incision and drainage of an anorectal abscess. Swabs were taken in 54 (91.5%) cases. At 2 months, 40.7% of the swab results had not been reviewed by a clinician. 89% of swab results were reported after the patient was discharged. No documentation mentioned reviewing microbiology results in a follow-up clinic. There was no documented change of antibiotics nor management following the microbiology report. Each microbiology swab costs £3 and labour costs are a minimum of £10 per swab analysed by a band 6 biomedical scientist or senior. Total cost incurred per year was therefore estimated at £702.

Conclusions

Surgeons tend not to review microbiology results at follow-up appointments. Furthermore, there was no evidence that microbiology sampling resulted in change in patient management. Unnecessary use of swabs contributes to the NHS economic burden with no additional clinical benefit.
969 The Kara: Working Together Towards Active Inclusion Within Surgery
Authors: Sidki A , Panesar S , Sayeed S
Published: August 2023

Aim

During surgical scrubbing, Sikhs in healthcare are often expected to remove their kara, a religious metal bangle. This seems inconsistent with policies permitting rings. As some Sikhs feel they cannot do this, they are refused entry to theatres. The aim of this quality improvement project is to explore if and how this exclusion might affect Sikhs and propose an inclusive solution accordingly.

Method

Working with MedRACE (a student-staff EDI group), we reviewed local and national infection and surgical scrubbing policies. We also distributed a survey nationally to explore Sikh medical students’ experiences in theatres, sharing our findings with local Trust leadership.

Results

We found variations in the policies reviewed, some permitting the kara, and others proposing removal or impossible solutions (‘secured…above the elbow’). Of 11 survey respondents, 9 had been told to remove their kara before entering theatres; 7 felt that wearing a kara limited their opportunities. Students reported that some Trusts (or staff) allowed them to wear a kara, whilst others did not. On presenting these findings to our local Trust, they updated the policy to permit the kara, and communicated this update to staff.

Conclusions

The national variation on wearing a kara in theatres is excluding some Sikhs from theatres. This may impact attainment and deter Sikhs from pursuing surgical careers. It is also at odds with the Royal College of Surgeon’s vision of creating a more inclusive surgical environment. We are thus planning further work to ensure greater consistency on this matter across the UK.
630 Diversifying a Surgical Workforce Starts from Creation of an Inclusive Medical School Application Process
Authors: Asim N , Ravinthiran S , Sureshkumar A
Published: August 2023

Aim

The Royal College of Surgeons from England identified 20% of their surgical leadership were from BAME communities. This underrepresentation precedes core surgical training, stemming from unique barriers to medical school admissions encountered by students from widening participation (WP) backgrounds. Recent application data states only 12% of total medical applicants identified as BAME.

St George’s Medical Education Society aims to equalise the platform by supporting aspiring widening participation medics via the formal establishment of our ‘WP Zone’ in 2021.

Method

Over two years, we have taught these students over different elements of the medicine application through outlets such as social media, interview preparation webinars and an in-person mock multiple mini-interview (MMI).

Feedback forms using 5-Point Likert Scales measured changes in student confidence before and after sessions.

Results

Combined engagement on social media rose by 40% upon introduction of WP posts. There was an increase of 53% observed in the subsequent month during inauguration of interview webinars and the mock MMI.

The MMI webinar (n = 169) demonstrated a 20% mean increase in understanding. Furthermore, 57% of students found the support by our WP zone more helpful than individual school resources. The in-person mock MMI session (n = 68) displayed a 50% increase in students feeling more prepared for MMI interviews.

Conclusions

The above results demonstrate the WP zone making positive strides in creating an inclusive medicine application process. This has implications not only for increasing representation in surgery but strives to tackle structural injustices that prevent administration of optimal health care in minorities.
719 Barriers and Facilitators Towards People Experiencing Homelessness When Accessing Surgical Care: A Critical Review of the Literature
Authors: Javed M , Manchip G , Chiara Corriero A , Limbu T , Wellington J
Published: August 2023

Aim

People experiencing homelessness (PEH) are a vulnerable group in which physical health morbidities are much more common than the general population. Despite this, the inability to access healthcare remains a main concern. This literature review aims to identify the barriers and facilitators PEH face towards accessing safe surgical care, and to provide actionable strategies.

Method

A literature search was carried out on multiple databases. Thematic analysis of the included papers identified themes relating to barriers, facilitators, and actionable strategies.

Result

Twelve papers were identified. Eleven themes related to barriers and facilitators were identified and five for actionable strategies. The themes related to barriers included access to community care, fragmented follow-up care, transportation, lack of recovery shelters, infections, and post-operative complications. Themes related to facilitators included street medicine programmes and the utilisation of patient navigators. Actionable strategies identified for health workers included the improvement of education, enhancing existing social safety nets, improved screening, tailoring discharge and surgical plans with the view of unfeasible follow up.

Conclusions

Current papers are not based on UK data and there are limited data sources available. However, analysis of the available data has shown many barriers and limited facilitators towards surgical care, highlighting the need for further studies. With a rising population of PEH in the UK these findings highlight the need for further research to create strategies that allow for safe surgical care in this population.
503 Post-Pandemic Elective Surgical Activity: A Focus on Day-Case Laparoscopic Cholecystectomies Across England
Authors: Ayyaz F , Gray W
Published: August 2023

Aim

To investigate the association between post-pandemic activity levels and day-case rates for laparoscopic cholecystectomies in England.

Method

We examined data from HES (Hospital Episode Statistics) on adult elective laparoscopic cholecystectomies for the period January 2019 to September 2022 (inclusive). Activity levels in the first six months of 2022 were compared to activity levels for the whole of 2019 (the baseline). Day-case activity was identified where the length of stay record in HES was zero days. Data were summarised at an Integrated Care Board (ICB) level for analysis.

Results

Data were available for 168,811 patients across the 42 ICBs in England. By April–September 2022, activity levels had returned to 89% of pre-pandemic levels for the whole of England. The South West Region stood out as having recovered activity levels to the greatest extent, with activity at 102% of pre-pandemic levels by April–September 2022. The South West also had the highest post-pandemic day-case rate at 75% of all patients seen as day-cases during April–September 2022; this compares to an England average of 66%. All other regions had day case rates between 62 and 68%. At an ICB level, there was a significant correlation between day-case rates and post-pandemic activity levels (r = 0.327, p < 0.035).

Conclusions

Recovery of elective laparoscopic cholecystectomy activity has been better in South West England than in other regions. Day case rates may be important if ICBs in other regions are to increase activity levels.
553 Healing Patient, Harming Planet? Review of Waste Production and Recyclability of Surgical Instrument Packaging
Authors: Lee Y K , Hariri A , Ghedia R , Tikka T , Kim D
Published: August 2023

Aim

In November 2022, the three UK Surgical Royal Colleges had issued an Intercollegiate Climate Emergency Declaration acknowledging that “climate change and anthropogenic environmental degradation pose a major threat to both human health and planetary health”. We reviewed the waste production and recyclability of surgical instrument packaging used in a common ENT procedure (thyroidectomy) and suggest strategies to improve surgical waste and make surgery more sustainable.

Method

We prospectively audited packaging waste from 20 thyroidectomies performed at the Royal Marsden Hospital, UK between July and December 2022. All the packaging was weighted, categorised, and analysed after the operation. Recycling labels were recorded if present.

Results

On average, each thyroidectomy produced packaging waste of 183 g (34%) of plain paper / cardboard, 167 g (31%) of soft plastic film, 142 g (26%) of laminated paper, 37 g (7%) of hard plastic and 11 g (2%) of metal foil. Of all packaging items we have collected, only one item had a recycling label.

Conclusions

Despite only one item of packaging having a recycling label, in its current form, 41% of the packaging we collected is easily recyclable. Product manufacturers should place clear labels on packing that can be recycled, switch to recyclable materials where possible and remove unnecessary information booklets that can be easily accessed digitally. Local waste audit and analysis can be the simple steps to make surgery more sustainable and reduce the environmental impact whilst treating patients.
751 Incidence and Risk Factors of Postoperative Cardiac Complications: An International Prospective Cohort Study
Authors: Chaudhry D
Published: August 2023

Aim

Postoperative cardiac complications (PCC) after major surgery remain heterogeneously reported. This international prospective cohort study aimed to define incidence and risk factors for PCC after major abdominal surgery in Europe, Ireland, and UK.

Method

A prospective, international cohort study was performed between January 23 and May 1, 2022. Data were collected on consecutive patients undergoing major abdominal surgery in 446 hospitals from 28 countries of Europe. The primary outcome was postoperative cardiac complications (PCC) as defined by Standardised Endpoints and COMs for Perioperative and Anaesthetic Care (STeP-COMPAC) to 30-days after surgery. The secondary outcome was 30-day postoperative mortality.

Results

This study included 24,260 patients, of whom 611 (2.5%) developed PCC and 458 (1.9%) died within 30-days of surgery. Of patients who died, 123 (26.9%) were related to cardiac causes. Mortality rates were higher in patients who developed PCC than those who did not (19.8% vs 1.4%, p<0.001). On adjusted analyses, age >65 years (OR: 2.47, 95% CI: 1.99-3.06), ASA grade III-V (OR: 1.95, 95% CI: 1.58 - 2.40), emergency surgery (OR: 1.62, 95% CI: 1.31 - 2.00), and contaminated/dirty surgery (OR: 1.60, 95% CI: 1.15 - 2.23) were risk factors for PCC.

Conclusions

PCC are infrequent after major abdominal surgery, yet death from cardiac causes was higher than previously reported in adults undergoing major abdominal surgery. Targeting high-risk groups at risk of PCC and death warrant holistic interventional trials as future research focus.
1185 SADHemi Study: A Service Evaluation of Operative Treatment of Dislocated Hip Hemiarthroplasty in the UK – Initial Results
Authors: Brennan C , Haruna M , Simpson R , Kent B , Middleton R G
Published: August 2023

Aim

Hip hemiarthroplasty is a common orthopaedic procedure for intra-capsular neck of femur fracture. Dislocation is a rare but serious complication with a reportedly high mortality, but the literature and guidance for management is sparse. This study aims to evaluate the prevalence and determine the UK’s current management of dislocated hip hemiarthroplasty.

Method

A national collaborative was established to undertake a retrospective evaluation of patients aged ≥60 years with dislocation of a hip hemiarthroplasty carried out between January 2015 to December 2020. Eligible patients were identified by a site lead at each participating centre and data including patient demographics, management and mortality was entered on to REDCap for analysis.

Results

16 centres have been recruited and 137 patients entered: 65% female; average age 84 years and ASA grade 3. Median time to first dislocation was 22 days. Only 25.9% failed initial closed reduction. 57 patients re-dislocated (45.9%) and of these 64.9% had a successful closed reduction, and 46.4% had further dislocation episodes. Only 20% of patients were still alive at the time data entry.

Conclusions

The initial results show the rate of successful closed reduction of first time dislocation was higher, and the rate of re-dislocation was lower, amongst the SADHemi patients than previously estimated in the limited existing literature. There was more success with second closed reduction than previously reported. Early results suggest a high associated mortality. By expanding the national collaborative to gain more data we hope to further this evaluation and perhaps update the current protocols for management.
390 The Validity of Bench Top Simulators for Arthroscopic Surgical Skills Training: Does It Work?
Authors: Fennelly J , Hughes T , Patel R , Baxter J
Published: August 2023

Aim

The traditional model of surgical training has evolved significantly in recent years in response to the reduction in hours worked by junior doctors and the overall shortening in length of training. To compensate for the decreased exposure to surgical procedures, much has been done to develop techniques for skills training outside of the operating theatre. This paper aims to identify the current evidence for the use of bench top arthroscopic simulators and their validity for the purpose of surgical training.

Method

The PUBMED, MEDLINE via PUBMED and EMBASE databases were comprehensively searched for articles that described the investigation of bench top arthroscopic simulators and the methods for providing evidence to support their validity, from inception to April 2022. The search strategy employed the following terms: arthroscop* and valid* and simulat* or bench* or fundamentals. References of articles were searched for further studies.

Results

Twenty studies evaluating the use of bench top arthroscopic simulators and their validity for surgical training purposes were identified.

Conclusions

Evidence has been presented supporting the efficacy of low fidelity, bench top simulators in the training of basic arthroscopic skills, especially for those early in the training process. This includes evidence that such training on a bench top simulator combined with a stack viewing system, can indeed result in improved performance in real-life arthroscopic surgery. Further research to validate such a model in combination with a portable viewing system could facilitate increased access to arthroscopic skills training for surgical trainees and incorporation into the surgical curriculum.
670 Transition From Higher Surgical Training to Consultant Surgical Practice: What We Don’t Know but Need to Know
Authors: Kamran Siddiqui Z , Jayasuriya R , Lewis C , Tomlinson J
Published: August 2023

Background

Higher surgical training (HST) focuses on delivering clinical knowledge and technical skills to fulfil day-one consultant clinical competencies. Introduction of capabilities in practice (CiPs), shifts curricula to outcome-based assessment related to direct clinical care. To aid the transition into consultant surgical practice, we must identify deficiencies in HST related to wider professional capabilities outside of direct clinical care.

Aim

To identify deficiencies in HST by exploring challenges faced by recently appointed T&O consultants.

Method

The experience of T&O consultants, appointed in the last five years, was explored using a phenomenological approach. Field notes from unstructured interviews with five consultants (convenience sampling), was used to develop a topic guide for semi-structured interviews with six new consultants (purposive sampling). Interviews were transcribed and thematically analysed.

Results

Consultants transitioning into the new role emphasized comprehensive clinical knowledge, technical and non-technical skills as attributes required to be a good day-one consultant. Further identifying various deficiencies in their non-clinical training; categorised into two themes and further sub-themes:

Adapting identity

Practice management, Building a reputation, Leadership identity, Trainer identity, Awareness of limitations, Independence vs support

Discovering responsibilities

Job planning, Management structure, Service provision and procurement, Complaints and complications.

Conclusions

This study provides an in-depth account of deficiencies in professional capabilities outside of direct clinical care required by day-one consultants. Furthermore, highlighting the pressing need to equip trainees for transition to consultant-surgical practice. We make recommendations on how stakeholders such as surgical-trainees, newly appointed consultants and employing organisations can modify identified deficiencies at different training levels.
786 A Collaborative, Online, 'Near-Peer' Teaching Programme for Medical Schools with Short Breast Surgery Rotations
Authors: Tai J C J , Sangha M S , Ahmed M
Published: August 2023

Aim

The quality of teaching for breast surgery, a niche specialty that medical schools dedicate little placement time to, can vary from hospital to hospital. This single-centre cross-sectional study investigated whether a new near-peer teaching programme could improve this.

Method

An online teaching programme was created and executed by final year medical students (‘near-peers’) for penultimate year students rotating through a week-long Breast Surgery placement at a major teaching hospital in London, United Kingdom. It consisted of asynchronous pre-tutorial Single Best Answer questions and an online small group tutorial and was conducted every three weeks for a year. A mix of qualitative and quantitative data were collected using feedback forms.

Results

Thirty students opted in. The pre-tutorial SBAs were rated 4.07 out of 5, while the near-peer interactive tutorial scored 4.77 out of 5. Students’ self-reported confidence, on a scale of 1 to 5, increased significantly by an average of 1.5 points (p <0.001). Students also rated this programme either the same or more highly than all other teaching modalities available during these their clinical placements. Thematic analysis of free-text responses showed that students enjoyed the interactivity of the sessions, the exam relevance of the content covered, and the utility of this programme in consolidating information at the tail-end of their placements.

Conclusions

This novel interactive teaching programme was designed and executed relatively easily by near-peers, was received favourably in our pilot, and can be easily implemented for other 'short-rotation specialties' in medical school (e.g., urology, vascular surgery, ENT).
847 Risk Factors Related to Preterm Birth Among Mothers Who Gave Birth in Gynecology and Obstetrics Department of Services Hospital, Lahore, Punjab: A Case-Control Study
Authors: Khalid K , Hayat K
Published: August 2023

Introduction

Preterm labor remains one of the most important problems faced by obstetricians globally, because of the high rates morbidity and mortality in preterm infants. It is said to be caused by interplay of multiple factors that include inadequate nutrition, antenatal care, low income, lack of education, multiple gestations, chronic illnesses, hypertension, anemia, infections, and substance abuse. Thus, understanding of these factors is crucial for reducing morbidity and mortality due to complications of preterm birth.

Aim

To determine maternal, fetal, and socioeconomic factors leading to preterm birth in patients delivering in the Gynecology and Obstetrics Department of Services Hospital, Lahore.

Method

A case-control study was conducted on 226 mothers delivering in Gynecology and Obstetrics Department of Services Hospital, Lahore in November 2020. A well-designed structured questionnaire was used to collect data about the sociodemographic profile, past gynecological and obstetric history, history of current pregnancy, past medical history, and the newborn. SPSS version 25 statistical tool was used to enter and analyze data.

Results

Height of respondent ≤155cm, parity >3, previous preterm birth, twin pregnancy, hypertensive disorder in pregnancy, hospitalization during pregnancy, hemoglobin level <11g/dl during pregnancy, history of UTI during pregnancy, fetal distress, cephalopelvic disproportion, oligohydramnios, polyhydramnios, PROM, no use of iron and multivitamins during pregnancy use of alcohol or other drugs during pregnancy, psychological stress during pregnancy and history of dental problems were found to be statistically significant.

Conclusions

In our study it was found that characteristics of current obstetrical history were the most important factors contributing to preterm birth.
1319 Case Report: Volunteering Overseas with Medical Volunteers International
Authors: Cook H , Politis A
Published: August 2023

Background

Medical Volunteers International (MVI) is a non-government organisation (NGO) founded in Germany in 2016. Its mission is to provide medical care to asylum seekers and refugees in Europe. This is a volunteer case report from Athens, Greece. Scope of Practice: In Athens, volunteers work within three categories – triage – allocating patients to clinics and assessing for emergencies, street outreach – wound care and first aid to patients sleeping rough, and clinic – consulting room with diagnostic tools and translators.

Patient Story

Many patients do not have access to health cover from the Greek government or lack the language skills to access care. Patient A was an undocumented asylum seeker sleeping rough. He had a discharging dorsal foot abscess but refused to attend hospital for fear of cost or arrest. After persuasion he allowed MVI volunteers to clean his foot and express the abscess. With oral antibiotics and regular dressings, he improved. MVI helped arrange legal aid to assist with an asylum claim.

Impact of Volunteering: The main impact is directly from volunteers to patient care. Longer term, individuals can contribute by sharing skills with permanent members of NGO staff and helping write guidelines e.g., wound care.

How can this benefit the NHS and surgical trainees? MVI provides volunteer opportunities for doctors at all levels of training. Working with an international team provides opportunities to communicate and learn from others. Working in a less-economically-developed setting encourages resourcefulness and hones clinical diagnostic skills. Volunteers often report feeling part of a ‘bigger cause’.