bluuebunny/crossref_metadata_2025 huggingface dataset:
982 Higher General Surgical Trainee preferences for Annual Review of Competency Progression during COVID-19 Pandemic
Authors: Khan K , Torpiano G , Galbraith N , McLellan M , Lannigan A
Published: October 2021

Aim

The COVID-19 pandemic has caused significant disruption in surgical training. We aim to explore the preferences of higher general surgical trainees for Annual Review of Competency Progression (ARCP) also compare the responses across different training grades.

Method

All higher general surgical trainee in a single deanery were invited to participate in an online voluntary anonymous survey. The respondents were divided in two groups: junior (ST3-ST5) and senior higher surgical trainees (ST6-ST8) and responses compared.

Results

Sixty-four of 88 trainees responded. Thirty-three (51.6%) were ST3–ST5, 24 (37.5%) were ST6–ST8 and 7 (10.9%) were out-of-training. More trainees in ST3–ST5 group preferred to defer the next rotation for 12 months (18.2% vs 0%, p = 0.034), repeat current sub-specialty (33.3% vs 4.2%, p = 0.009), or add 12 months to training and delay predicted CCT date by 12 months (18.2% vs 0%, p = 0.034). Most trainees in both groups preferred the option of prolonging training should be offered to all trainees with an option to decline extension if ARCP competencies met (66.7% vs 50.0%, p = 0.276).

Conclusions

The preference for ARCP and length of training was different between two training groups, hence the need of trainees should be considered by training committees when addressing the impact of COVID-19.
1004 Student Perspectives on Surgical Careers
Authors: Ramjeeawon A , Kungwengwe G , Ooi R
Published: October 2021

Aim

To investigate medical students’ understanding of skills needed as surgeons and how prepared they feel to pursue surgical careers, and to identify methods to support and prepare medical students who want to pursue surgical careers.

Method

A student-led National Surgical Conference (Cardiff, 2018) ran a consensus and debate session entitled ‘Are students adequately prepared for a career in surgery at medical school?’, including a questionnaire addressing elements of medical school curriculums relevant to surgery and the importance of developing technical skills and non-technical skills (NTS).

Results

60 delegates completed the questionnaire: Year1-3 (n = 38), Year4-6 (n = 15), intercalating (n = 4), foundation doctors (n = 3). Delegates most frequently stated specific surgical skills (20.1%), broader surgical skills (20.1%) and interpersonal skills (17.2%) as the most important skills to be a surgeon. 75% rated technical skills and NTS as equally important, 25% rated technical skills as more important. 12.5% felt unconfident in their NTS to be an efficient surgical team-member, 37.5% felt between confident and unconfident, and 50% were confident. 26.3% felt unprepared to pursue surgical careers following medical school, 70.2% felt between prepared and unprepared, and 3.5% felt prepared. More practical surgical skills sessions (35%), career pathway sessions (15%), surgically relevant teaching (16%) and theatre or surgical placements (19%) were the most frequently wanted improvements.

Conclusions

Prospective surgeons highly valued developing surgical skills and overall do not feel prepared to pursue surgery. Medical students would benefit from education on the surgical career pathway and the importance of the non-practical components of surgery, including patient safety and NTS.
1034 A Survey to Assess the Confidence and Knowledge of Foundation Year One Doctors to Perform A Digital Rectal Examination
Authors: Sahni D , Khan K
Published: October 2021

Aim

Digital Rectal Examination (DRE) is an essential component of comprehensive assessment of a surgical patient, both in acute and elective settings. Due to the intimate nature of the examination, this important examination is often not well taught. This study aims to assess the confidence and knowledge of the Foundation Year 1 (FY1) doctors in performing DRE.

Method

FY1 doctors were invited for online voluntary anonymous survey via Google forms. The survey consisted of 16 questions on the indications, findings, and interpretation of DRE. The purpose and aims of the study were explained in an invitation email and participants provided a declaration of consent, giving permission for their anonymous results to be used in the study.

Results

There were 24 responses, 79% had performed DRE (including on mannequins and simulations) less than 10 times. Two thirds of DRE were performed during the FY1 rotation and two thirds in the elective wards. Majority of respondents (83%) were moderately confident in performing and appreciating DRE findings. 63% respondents though that a chaperone is not mandatory if the gender of the doctor and patient was same. 58% respondents thought that hematuria is not an indication to preform DRE. Interpretation of DRE findings - approximately 80% respondents correctly interpreted the findings, however only 45% could formulate the correct initial management plan.

Conclusions

This study illustrates that FY1 doctors receive inadequate exposure to performing and interpreting DRE. Their teaching should be enhanced by providing them with more opportunities through simulation and dedicated teaching sessions.
1082 Are Trauma and Orthopaedics Consultant Posts Decreasing in Frequency and Increasing in Subspecialisation?
Authors: Ansari S A , Kennedy J , Irwin B , Rogers S
Published: October 2021

Aim

Changes to the configuration of the NHS Trauma Services in T&O and the level of subspecialisation are changing and could impact training and the number of consultant posts available at CCT. The aim of this study was to review the number of T&O Consultant posts and determine the frequency of the subspecialist requirements of these posts from 2011 to 2020, to assess the perceived reduction in advertised numbers and the increasing sub specialisation as a whole.

Method

451 volumes of the BMJ were reviewed over Jan 2011 - April 2020. The total number of jobs advertised were recorded. Additionally, for each post, sub-specialism, regional analysis and substansive or locum tenure were recorded.

Results

1141 jobs were advertised during this period. There has been a decreasing trend in the total number of advertised posts of 13% per annum. Proportion of specialty jobs remain constant yearly. However, jobs listing Trauma clearly decreased after 2012, when trauma centres were initiated. Clear decreases were present in North-west and Scotland in number of jobs. There has also been an increasing trend of advertisement of substantive posts, with locum posts forming less than 13% of total advertisements.

Conclusions

We found no significant increase in job specialism contradicting previous research. Overall, the total number of Consultant jobs in Trauma and Orthopaedics is decreasing, especially in the north-west and Scotland, two of the biggest employers. Questions must be asked for the future of training in T&O to meet service needs.
1107 Supplementing Orthopaedic Education outside of the Medical Curriculum: The Utility of a 1-Day Orthopaedic Revision Course for Medical Undergraduates
Authors: Argyriou A , Michael S , Nadeem K , Batra G
Published: October 2021

Introduction

Orthopaedic undergraduate education is both minimal and variable across UK medical schools. Furthermore, the clinical skills required to treat musculoskeletal injuries have been found inadequate by several studies assessing UK medical graduates.

Method

Orthopaedic revision courses organized by the student surgical society consisted of lectures and workshops covering clinical orthopaedic knowledge and skills required for university assessments. Five identical courses were run between December 2017 and December 2019 following the completion of fourth year’s musculoskeletal clinical block. Course tutors ranged from foundation year doctors (57%) to orthopaedic consultants and trainees (43%). An anonymous feedback form was handed out at each event and 5-point Likert scale questioning assessed participant perceptions prior to and following the course.

Results

This course led to a significant mean increase in students’ perceived knowledge levels with an average increase of 0.96 (19.2%) across all clinical examinations and lectures (p < 0.01). Tutor grade did not affect mean participant self-reported value of station, with stations taught by consultants and surgical trainees showing similar results to stations taught by FY doctors (p = 0.776).

Conclusions

The feedback revealed significant increases in student self-reported knowledge levels while poor pre-course scores reported might suggest inadequate coverage of orthopaedics in the undergraduate curriculum. The similarity in results when assessing the quality of tutorship suggests that FY doctors can be equally as valuable teaching tools for such courses as surgical trainees and consultants. These results suggest 1-day orthopaedic revision courses of this format can be highly beneficial in supplementing the undergraduate curriculum.
1131 The Integration of Cardiothoracic Practical Skills Workshop in The Undergraduate Medical School Curriculum and Its Impact on Promoting Interest in Cardiothoracic Surgery
Authors: Raja M S , Dhuga Y , Modi S , Nagasubramony A , Sood S , Ahmed I
Published: October 2021

Recently, a downward trend is seen in undergraduates wishing to pursue a career in cardiothoracic surgery(CTS). This is partly due to lack of clinical exposure and limited teaching during the undergraduate years; the focus being on cardiac ad vascular pathology.

Aim

Assess if WETLAB workshop encourages the engagement of medical students in CTS surgery

Method

We hosted a cardiac WETLAB workshop, led by a consultant cardiothoracic surgeon. Attendees were taught how to carry out an end-to-side anastomosis on animal tissue. We used pre-and -post exposure questionnaires composed of 10 items to assess the ability of the workshop to improve undergraduate interest in cardiothoracic surgery. The questionnaire included questions around students’ interest in the speciality, previous exposure to the speciality and whether students want to pursue a career in the speciality.

Results

Out of the 12 attendees, 10 completed both questionnaires. The workshop was well received with the overall satisfaction of 9.64 out of 10. It significantly increased respondents’ interest in CTS(z=-0.06, p = 0.01) but did not show any significant difference in encouraging them to pursue surgery. 100% of respondents agreed that specialised practical workshops should be incorporated within the medical school curriculum and that if the opportunity arises, they will attend another in the future.

Conclusions

Specialised practical workshops have the potential to play a significant role in the medical school curriculum in order to enhance exposure to the field of cardiothoracic surgery. This may lead to a positive impact on the number of doctors wishing to pursue this speciality in the future.
1167 A Cross-Sectional Study of Undergraduate Exposure and Teaching of Trauma and Orthopaedics in The UK
Authors: Choi S M , Ooi S Z Y , Carpenter E C
Published: October 2021

Aim

Research has shown exposure to specialities as a medical student can have a great influence in choice of career. Exposure to potential mentors during this time also has an additive effect on career shaping of medical students. It is important to encourage interest in trauma and orthopaedics (T&O) to ensure the best candidates are selected. Our aim was to establish the compulsory duration of T&O teaching provided by all (non-new) medical schools. This study also aims to identify which other specialities were taught alongside T&O.

Method

Surveys were distributed to medical students in all 33 (non-new) medical schools, through surgical societies and colleagues met through courses, between June 2019- February 2020. The survey asked the total length of compulsory teaching of T&O in days, and how this was divided into pre-clinical or clinical teaching.

Results

Data for all 33 UK medical schools were collected. Only 7 medical schools taught T&O as a standalone subject. The other 26 medical schools combined T&O with other specialities, most commonly with Rheumatology (n = 16). The average total length of days of T&O teaching across medical school was 17 days (range 3-60). Majority of this teaching was given in the clinical years of medical school (n = 30).

Conclusions

Research has shown medical students require enough exposure to increase their interest in pursuing a particular speciality. Currently there is a huge variance on the number of compulsory teaching days for T&O.
1183 Why Are Surgical Trainee Recruitment Rates Declining? A Cross-Sectional Study of Medical Students from Two English Medical Schools
Authors: Dawo S , Laloo R , Haughton S , Rangaraju M
Published: October 2021

Aim

To identify medical students’ career aspirations and describe their perceptions of pursing a surgical career at two English medical schools, in order to better understand declining surgical recruitment rates.

Method

Seventy-seven medical students consented to complete anonymous pre- and post-course questionnaires on career aspirations and promoting and deterring factors for a surgical career. Surveys were completed by medical students attending three one-day surgical revision courses organised and led by junior doctors.

Results

Seventy-seven medical students completed pre- and post-course questionnaires with a median age of 25 years (IQR 24-27). Respondents were 58.4% female and 58.7% were final year medical students. Their specialty career aspirations included medicine (27%), general practice (19.5%) and surgery (19.5%). Most students (68%) felt that time spent in the operating theatre was their most memorable surgical experience while 41.3% of students reported observing and assisting in theatres enhanced their interest in surgery. Only 20.5% of students spent extra time outside of their placements in surgery. The most common deterring factors for a surgical career included poor work-life balance (37.3%), high competition rates (28%) and a personality mismatch (12.9%) among students and surgeons.

Conclusions

One in 5 students was interested in pursuing a surgical career. Facilitating early hands-on operating theatre exposure for medical students and addressing the perceived issues with poor work-life balance may promote a career in surgery. This could help to tackle declining recruitment rates in surgical specialty training. Further research is required to determine how specific experiences at medical school, such as shadowing and mentorship, influence career choice.
1241 MaxSim, a Novel Simulation Based Education Course for OMFS Emergencies
Authors: Holden A
Published: October 2021

Introduction

For Oral and Maxillofacial Surgery (OMFS) Senior House Officers (SHOs), with no formal medical training, the first exposure to inpatient medical or OMFS emergencies will be the first time they are having to manage them, usually alone. Simulation based education has been demonstrated to increased experience and confidence when used in medical education 1, therefore an OMFS simulation-based education course was created to facilitate this learning in a safe environment.

Method

The course included stations on medical emergencies such as sepsis, and OMFS emergencies centred around scenarios that necessitate rapid response including retrobulbar haemorrhage and carotid artery blowout. A pre and post course questionnaire was given to all delegates to assess their change in confidence when managing the scenarios. Each was asked to score their confidence in managing the scenarios numerically from one to ten.

Results

Delegate numbers were limited due to the Covid-19 pandemic with all ten completing both questionnaires. There was an even distribution between first and second year SHOs. Two had received simulation training before however, very limited. In all ten simulation stations every delegate felt an increase in confidence on average by 4.5 (range: 3.8-5.6) on the ten-point scale, p < 0.05. Positive feedback was also given by all stating it was extremely useful.

Conclusions

Simulation based education has been shown to be invaluable method of training for clinical scenarios and needs to become more common place in Oral and Maxillofacial Surgery. This course is to be expanded post Covid-19 to become available nationally.
1476 North Wales Vascular Surgery Zoom Webinar Teaching Programme for Medical Students and Junior Doctors
Authors: Iqbal Z , Youssef A , Abdaldayem A , Shaikh F
Published: October 2021

Aim

Surgical Education is now more widely delivered on virtual platforms due to the COVID-19 pandemic. Due to centralisation of Vascular Surgery services in North Wales to Glan Clwyd Hospital (Central), Medical Students, Junior Doctors and General Surgical Registrars have reduced exposure to the speciality and the management of common cases in neighbouring hospitals (East and West). Subsequently, we developed a regional virtual teaching programme to help bridge gaps in knowledge and to instil confidence when providing a service.

Method

We developed a 4-part didactic webinar educational programme which covered parts of the medical undergraduate and MRCS curricula pertaining to Vascular Surgery. Under/Postgraduate educational leads from Central, East and West were contacted to promote our programme. Webinars were delivered on ZOOM video conferencing once weekly throughout December 2020. Feedback forms were collected on Google Forms™ and used 5-point Linkert scales to grade responses and analysis of data was carried out on Microsoft Excel®.

Results

186 feedback forms were collected and respondents reported significant improvements in knowledge in each of the subjects covered: [1] Abdominal Aortic Aneurysms - (2.59±1.07/5 to 4.23±0.65/5, p = <0.0001, n = 60), [2] Acute Limb Ischaemia – (2.55±1.11/5 to 4.21±0.72/5, p = <0.0001, n = 42); [3] Chronic Limb Ischaemia (2.57±1.03/5 to 4.23±0.77/5, p = <0.0001, n = 35); [4] Vascular Emergencies (2.94±1.28/5 to 4.37±0.63/5, p = <0.0001, n = 49). Overall topic interest, presentational skills and clinical usefulness was also rated highly.

Conclusions

Through this virtually delivered regional teaching programme, we successfully enhanced Vascular Surgery knowledge and addressed the educational needs of Medical Students and Junior Doctors across North Wales.
1496 Building Inclusivity and Diversity from our Foundations: A Cross-Sectional Study Identifying Barriers to Theatre Based Training for Foundation Doctors
Authors: Munro C , Minks W , Dowker F
Published: October 2021

Aim

Theatre experience is a powerful factor enabling trainees to determine whether they possess the enthusiasm and aptitude to undertake a surgical career. Removing barriers to theatre learning should allow a more meritorious and diverse cohort of surgical trainees.

Method

An 18 -point open and closed question Likert scale survey was distributed to Foundation Doctors in three hospitals within the Northern Deanery. The survey was designed via focus group and literature review, ascertaining perceived levels of preparedness, acceptance, enjoyment, and barriers to theatre access.

Results

The survey dichotomized respondents (n = 54) into those who attended theatre (n = 40) and those who did not (n = 14). Of those attending 38% (n = 15) reported intimidation and 15% (n = 6) cited a cultural barrier to attendance. Of those who did not attend 79% (n = 11) were interested in surgery. These respondents predominantly reported concerns around prohibitive ward workload and unfamiliarity with protocols. Covid restricted surgical rotations for some. There was a statistically significant difference (p fishers exact test = 0.001) between 83% of respondents who felt welcomed by the surgeons compared to just 45% made to feel welcome by the wider theatre team. Only 20% (n = 11) of respondents felt prepared for theatre by medical school. 50% (n = 27) were confident with theatre protocols.

Conclusions

The study raises concerns around apprehension surrounding the theatre environment and ward workload which appear to impede access to theatre. Adequate undergraduate surgical teaching, appropriate induction and allocation of theatre time are crucial to improve safety, diversity of applicants, confidence for trainees and compliance within the team.
1555 Comparison of Face-To-Face Versus Online Delivery of a Preparatory Course for First Year Clinical Students
Authors: Abdulhussein D , Luo R , Abou Sherif S , Aseem R , Pawa N
Published: October 2021

Aim

The coronavirus pandemic has had a huge impact on medical education, with increasing reliance on online delivery of teaching. Sound awareness of investigations available to clinicians is an essential skill, the foundations of which are built from the first clinical year. Our aim is to evaluate whether online teaching has the same efficacy as face-to-face teaching in the context of clinical investigations teaching.

Method

We designed a case-based course using active learning methods (by means of audience participation tools) to prepare first year clinical students in interpreting key investigations (bedside, laboratory and imaging tests) with focus on surgical conditions. This course was delivered face-to-face in November 2019 and subsequently re-delivered via an online platform in November 2020. We utilised a pre- (PR) and post- (PS) confidence questionnaire and a 13-part mock single best answer examination.

Results

32 students attended the face-to-face course; 27 (84.3%) completed the PR and 21 (65.6%) completed the PS. There was a significant improvement in examination scores (56.9% to 71.7%, P < 0.01) and a significant improvement in one of the 6 confidence domains tested (interpreting abdominal radiographs, P < 0.001). 80 students attended the online course; 46 (57.5%) completed the PR and 40 (50%) completed the PS. There was a significant improvement in examination scores (58.8% to 73.2%, P < 0.001) and a significant improvement in two of the 6 confidence domains (interpreting laboratory tests and abdominal radiographs, P < 0.001 for both).

Conclusions

Online teaching is as effective as face-to-face teaching in improving knowledge and confidence in clinical investigations for first clinical year students.
1585 The “6Pm Series” Addressing Medical Education for Final Year Medical Students During the Pandemic
Authors: Aslam Joiya S , Farquhar J , Buck J , Osman A
Published: October 2021

Aim

Free clinical teaching online delivered by NHS junior doctors to address a drop in face-to-face teaching.

Method

We created a block-based syllabus of topics that are commonly examined and created an SBA format series of online lectures. The lectures were delivered online and the lectures were carried out by NHS doctors. We delivered 30 continuous lectures in a 30-day period that covered a variety of topics. Each lecture lasted between 45 to 60 minutes and featured real time interactive mcqs which the students had a limited time to answer to simulate exam conditions. We also maintained a unique conference like format where the lecture provider would also be assisted by a ‘host' who would provide an environment that simulated a real-life lecture with a back-and-forth conversation. Lastly each session was reinforced with a feedback survey at the end which helped us improve our service but also provided key indicators on the needs of the audience.

Results

We were able to provide a series of lectures that on average had a viewership of 120-150 attendees per lecture and grew a social media following of 3500 people. Although the following on social media is not a full reflection of our reach. A good indication is our prescribing safety assessment series which attracted over 2000 people interested and 260 confirmed for one event.

Conclusions

We feel that the format we followed in delivering medical teaching provided a very effective format and we hope to continue this into the future.
1617 SOCS: Surgical On-Call Simulation
Authors: Castelhano R , Gurung P , Waters C , Win K , Coleman N , Schneiders H
Published: October 2021

Introduction

Simulation is a well-known method of effectively teaching Medical students. The majority of the simulation scenarios are related to Medicine. Surgical simulation is a gap within the curriculum, especially Surgical on-call simulations. To improve this, we ran simulation sessions designed to replicate a General Surgery themed on-call shift that junior doctors should be able to manage. We aimed to improve confidence in clinical prioritisation and confidence in being an on-call Junior doctor, managing the most common on-call surgical tasks.

Method

Groups of 3-4 final year Medical students participated in a 2 hour-long simulated “on-call” shift, throughout the hospital. There were 8 scenarios, which ranged from prescribing to acute clinical scenarios. Students were given bleeps and were called at set times. They had to receive/give handovers and prioritise tasks according to clinical importance. A debrief following the session focussed on prioritisation and highlighted key learning points. The students completed a pre- and post-session questionnaire as assessment.

Results

The percentage of students who felt confident or very confident in the following domains were compared pre- and post-simulation respectively: confidence in clinical prioritisation (17% vs 86%); confidence in prescribing medication (0% vs 14%); confidence in escalation to seniors (33% vs 71%). 87.5% of the participants felt the session was an effective way to learn how to prioritise clinical tasks, and 100% felt this an effective way to learn about common General Surgical queries whilst on-call.

Conclusions

This project demonstrates how simulation is effective in improving confidence in prioritisation and knowledge within clinical practice, especially surgery.
1627 We Are Donors: Redeveloping Educational Material for Schools in Response To COVID-19
Authors: Whitby J , Doshi P , Symington M , Battle J , Brathwaite-Shirley C , Whitter L , Adamou C , Green M , Critchley A , Ehrlich A , Byrne M
Published: October 2021

Aim

We Are Donors is a UK registered charity aiming to increase the number of organ and blood donors across the UK through student led education at schools and universities. Over the last two years we have spoken to over 4000 students and have shown that the program improves awareness of organ donation, facilitates discussion within families and increases the number of planned organ donor registry sign ups. In response to COVID-19 our educational sessions moved online, and we studied what impact this had on engagement with the students and how our material could be redeveloped to improve outcomes.

Method

We compared the feedback from 1514 children aged 11-18 years who received face to face presentations in August 2018 - May 2019 with that from a group of 141 children aged 14 -18 years from 5 schools who received live online sessions using the same powerpoint presentation between March 2020 - June 2020.

Results

The change to online delivery reduced recommendation of the talk to a friend from 88% to 69%. Moving to online sessions also resulted in reduced post session feedback. To tackle these issues, we re-developed our presentation in collaboration with Slido to feature interactive elements, a quiz (including a leaderboard) and a real-time question and answer session. We also incorporated an immediate feedback survey.

Conclusions

Our study highlights new challenges that educators are facing when moving to online platforms. While moving online allows more students to be reached, maintaining high levels of student engagement is challenging.
1677 Integrating Venepuncture Training Within the Curriculum for Oral and Maxillofacial Dental Core Trainees Within A Hospital in South Wales, UK
Authors: Aruede G , Mustafa S
Published: October 2021

Aim

The aim of this quality improvement project was to provide a solution to improve the confidence and skill of Oral and Maxillofacial Dental Core Trainees (DCTs) in venepuncture by attending phlebotomy training sessions. DCTs within the hospital where this project was undertaken are dentally qualified and are often not taught the principles of venepuncture during their undergraduate degree. Furthermore, they rarely gain hands-on experience to confidently apply these skills.

Method

Phlebotomy training sessions were held, each an hour and a half long and were completed within the first 4 weeks of the DCTs starting their job. A survey was completed by each of the DCTs prior to the training. The sessions consisted of a short introduction to phlebotomy and the different techniques, observing a phlebotomist taking blood, and then performing venepuncture on live patients attending the clinic who required blood investigations. The Vacutainer eclipse single needle was used with the single-use holder. Following the training, the DCTs completed a second survey.

Results

The mean confidence of the DCTs increased from 2.7 to 8.2 out of 10 following the phlebotomy training. 100% of the DCTs rated the quality of the workshop 10 out of 10, with 10 being excellent. The sessions had minimal disruption to the running of the phlebotomy and maxillofacial clinics.

Conclusions

This quality improvement project will have an overall benefit firstly to patients and also to the Health Board. The success of this programme lead to its permanent implementation within the curriculum for or each intake of new DCTs.
1700 Using Intra-Operative Imaging as A Tool to Provide Peer Review, Scoring, Feedback and Education for Hand and Wrist Trauma Cases - A Quality Improvement Project
Authors: Smith A , Thompson A , Stanier P , Rooker J , Lowdon I
Published: October 2021

Aim

To improve the efficiency of intraoperative hand trauma x-ray review, introduce a scoring system for quality of fixation achieved and use this as an education and feedback tool for trainees.

Method

A large QI project in 2019 demonstrated that intra-operative images taken using the mini C-arm were not being reviewed. In March 2020 the first QI cycle introduced an Access database to ensure that as cases were removed from the trauma board, they were added to a review list. Each x-ray was also scored in the trauma meeting (good, acceptable, poor) to assess the radiographic quality of fixation. The second QI cycle identified the named surgeon for each case, allowing surgeon specific feedback. Finally, we trained all qualified users of the mini C-arm to upload their own images after each case, reducing the mean time to upload.

Results

This QI project has improved the review rate of mini C-arm images from 30% to 100% and every x-ray is scored. The mean time to review images has reduced from 4 days to less than 24 hours. All trainees can access their scores for imaged hand and wrist trauma and receive written constructive feedback.

Conclusions

This project ensures appropriate and prompt review of all hand and wrist trauma cases allowing early identification of any concerns. All x-rays are scored, and this process acts as an educational prompt in the trauma meeting. A final report can be printed for each trainee which can be uploaded to their portfolio to document their surgical progress.
195 The Application of Radiomics in Laryngeal Cancer: The Forgotten Cohort
Authors: Rajgor A , McQueen A , Ali T , Aboagye E , Obara B , Bacardit J , McCuloch D , Hamilton D
Published: October 2021

Background

Radiomics is a novel method of extracting data from medical images that is difficult to visualise through the naked eye. This technique transforms digital images that hold information on pathology into high-dimensional-data for analysis. Radiomics has the potential to enhance laryngeal cancer care and to date, has shown promise in various other specialties.

Aim

The aim of this review is to summarise the applications of this technique to laryngeal cancer and potential future benefits.

Method

A comprehensive systematic review-informed search of the MEDLINE and EMBASE online databases was undertaken. Keywords ‘laryngeal cancer’ OR ‘larynx’ OR ‘larynx cancer’ OR ‘head and neck cancer’ were combined with ‘radiomic’ OR ‘signature’ OR ‘machine learning’ OR ‘artificial intelligence’. Additional articles were obtained from bibliographies using the ‘snowball method’.

Results

Seventeen articles were identified that evaluated the role of radiomics in laryngeal cancer. Two studies affirmed the value of radiomics in improving the accuracy of staging, whilst fifteen studies highlighted the potential prognostic value of radiomics in laryngeal cancer. Twelve (of thirteen) studies incorporated an array of different head and neck cancers in the analysis and only one study assessed laryngeal cancer exclusively.

Conclusions

Literature to date has various limitations including, small and heterogeneous cohorts incorporating patients with head and neck cancers of distinct anatomical subsites and stages. The lack of uniform data on solely laryngeal cancer and radiomics means drawing conclusions is difficult, although these studies have affirmed its value. Further large prospective studies exclusively in laryngeal cancer are required to unlock its true potential.
231 Outcomes of Cochlear Implantation in Patients with Waardenburg Syndrome: A Systematic Review and Narrative Synthesis
Authors: Lovett A , Eastwood M , Metcalfe C , Muzaffar J , Monksfield P , Bance M
Published: October 2021

Aim

This systematic review aims to establish outcomes of cochlear implantation (CI) in patients with a diagnosis of Waardenburg syndrome (WS).

Method

A systematic review and narrative synthesis were undertaken. Databases searched: Medline, PubMed, Embase, Web of Science, Cochrane Collection, and ClinicalTrials.gov. No limits placed on language or year of publication. A review conducted in accordance with the PRISMA statement.

Results

Searches identified 160 abstracts and 157 full texts. Of these, 22 studies met inclusion criteria reporting outcomes in 191 patients and at least 209 implants. Hearing outcomes of those receiving cochlear implantation were generally good. Five studies included genetic analysis of one or more of the participants. A total of 10 intra- or post-operative complications were reported. The methodological quality of included studies was modest, mainly comprising case reports and non-controlled case series with small cohort size. All studies were OCEBM grade III-IV.

Conclusions

Hearing outcomes following CI in Waardenburg syndrome are generally good with the majority of patients experiencing improvement in audiometry, speech perception, and speech intelligibility. Cochlear implant teams must use their clinical expertise to assess individual patients’ needs in order to perform cochlear implantation at the optimum age and provide thorough rehabilitation to maximise implantation benefits.
654 Outcome and Complications Following Revision Shoulder Arthroplasty. A Systematic Review and Meta-Analysis
Authors: Ravi V , Murphy R , Moverley R , Derias M , Phadnis J
Published: October 2021

Introduction

It is important to understand the rate of complications associated with the increasing burden of revision shoulder arthroplasty. Currently, this has not been well quantified. This review aims to address that deficiency with a focus on (i) shoulder outcome scores, (ii) complication and reoperation rates and (iii) comparison of anatomic and reverse prostheses when used in revision surgery.

Method

A PRISMA systematic review was performed to identify clinical data for patients undergoing revision shoulder arthroplasty. Data were extracted from the literature and pooled for analysis. Complication and reoperation rates were analysed using a meta-analysis of proportion and continuous variables underwent comparative subgroup analysis.

Results

107 studies (5,010 shoulders) were eligible for inclusion, although complete clinical data was not ubiquitous. Indications for revision included component loosening 20% (n = 584/2872), instability 20% (n = 577/2872), rotator cuff failure 18% (n = 528/2872) and infection 17% (n = 490/2872). Revision surgery resulted in a clinically important improvement in patient-reported outcome measures (PROMs). Intraoperative complication, postoperative complication and reoperation rates were 3% (n = 205/4919), 22% (n = 722/3474) and 15% (n = 533/3474) respectively. Intraoperative and postoperative complications included iatrogenic humeral fractures (n = 134/205, 65%) and instability (n = 209/772, 27%). Revision to reverse TSA, rather than revision to anatomic TSA from any index prosthesis resulted in lower complication rates (22% vs. 29%, p < 0.001 odds ratio 1.5) and superior Constant scores (59.9 vs. 53.8, p < 0.001), although no difference in ASES scores.

Conclusions

Satisfactory improvement in PROMs are reported following revision shoulder arthroplasty; however, revision surgery is associated with high complication rates and better outcomes may be evident following revision to reverse TSA.
843 Annular Closure Device for Disc Herniation: Meta-Analysis of Clinical Outcome and Complications
Authors: Ong C S , Choy W J , Phan K , Diwan A , Mobbs R
Published: October 2021

Aim

To assist surgeons to determine a potential approach to reduce incidences of recurrent lumbar disc herniation and assess the current devices regarding their outcomes and complications.

Method

Four electronic full-text databases were systematically searched through September 2017. All results were pooled utilising meta-analysis with weighted mean difference and odds ratio as summary statistics.

Results

Four studies met inclusion criteria. Three studies reported the use of Barricaid (ACD) while one study reported the use of Anulex (AR). A total of 24 symptomatic reherniation were reported among 811 discectomies with ACD/AR as compared to 51 out of 645 in the control group (OR: 0.34; 95% CI: 0.20,0.56; I2 = 0%; P < 0.0001). Durotomies were lower among the ACD/AR patients with only 3 reported cases compared to 7 in the control group (OR: 0.54; 95% CI: 0.13, 2.23; I2 = 11%; P = 0.39). Similar outcomes for post-operative Oswestry Disability Index and visual analogue scale were obtained when both groups were compared.

Conclusions

Early results showed the use of Barricaid and Anulex devices are beneficial for short term outcomes demonstrating a reduction in symptomatic disc reherniation with low post-operative complication rates. Long-term studies are required to further investigate the efficacy of such devices.
871 Liver Transplant for Colorectal Liver Metastases: A Systematic Review and Meta-Analysis of Proportions
Authors: Varley R , Tarazi M , Davé M , Mobarak S , Stott M , Baltatzis M , Satyadas T
Published: October 2021

Introduction

Colorectal liver metastases were historically considered a contraindication to liver transplantation, but dismal outcomes for those with metastatic colorectal cancer and advancements in liver transplantation (LT) have led to a renewed interest in the topic. We aim to compare the current evidence for liver transplantation for non-resectable colorectal liver metastases (NRCLM) with the current standard treatment of palliative chemotherapy reported in literature – 5-year survival rate <10%.

Method

A systematic review and meta-analysis of proportions was conducted following screening of MEDLINE, EMBASE, SCOPUS and CENTRAL for studies reporting liver transplantation for colorectal liver metastases. Post-operative outcomes measured included 1-, 3- and 5-year survival, overall survival, disease-free survival, and complication rates.

Results

Three non-randomised studies met the inclusion criteria, reporting a total of 48 patients receiving LT for NRCLM. Survival at 1-, 3- and 5-years was 83.3-100%, 58.3-80% and 50-80% respectively with no significant difference detected (p = 0.22, p = 0.48, p = 0.26). Disease free survival was 35-56% with the most common site of recurrence being lung. Thirteen out of fourteen deaths were due to disease recurrence.

Conclusions

Although current evidence suggests a survival benefit conferred by LT in NRCLM compared to palliative chemotherapy, the ethical implications of organ availability and allocation demand rigorous justification. Eight registered clinical trials will report on 300 more patients undergoing LT for NRCLM over the next 10 years: concomitant improvements in the management of patients following liver resection and of palliative chemotherapy regimens is paramount.
970 Age-related Differences in Acute Skeletal Muscle Atrophy After Immobilisation: A Systematic Review
Authors: Hodgson H , Wilkinson M , Howard A
Published: October 2021

Introduction

Muscle atrophy is a recognised cause of morbidity and mortality. Whilst the association between loss of muscle mass and age is well established, it is controversial as to whether older adults’ atrophy at a different rate or are more susceptible to atrophy in the acute setting. The aim of this systematic review is to identify if there are any age-related differences in the rate of atrophy between older and younger persons.

Method

A systematic search of Medline, Embase and Cochrane databases in December 2020 was carried out. All studies whose design involved a period of immobilisation and a comparison between older and younger cohorts were included. Studies must have direct pre-and-post immobilisation muscle mass measurements, and the percentage change in muscle mass was extracted from each study.

Results

Searching revealed 1007 records, of which six articles met the inclusion and exclusion criteria. 150 participants were included; 136 (90.7%) were male, and 14 (9.3%) were female. Studies used immobilisation periods between five and 14 days, and measured muscle volume by MRI, DXA or CT. Three studies reported greater atrophy in the older group, and three studies reported greater atrophy in the younger group.

Conclusions

There is no convincing evidence of any differences between the rates of atrophy in older persons in comparison to younger persons. We highlight that the current literature is inconsistent and overall, there is a lack of high-quality research on the topic, with particular concern regarding the significant lack of literature regarding atrophy rates in women.
1044 Impact of Obesity on Complications from Anterior Lumbar Interbody Fusion
Authors: Feeley A , Feeley I , Butler J
Published: October 2021

Aim

Anterior Lumbar Interbody Fusion is a procedure growing in popularity for conditions including degenerative disc disease, and discogenic back pain. Obesity is a significant risk factor in the development of back pain, with patients with raised BMIs at increased of complications using the posterior approach. This review aims to evaluate the risk profile of this patient cohort using the anterior approach for lumbar interbody fusion.

Method

A systematic review of the search databases Pubmed; google scholar; and OVID Medline was carried out between September 2020-November 2020. Studies evaluating the risks associated with obesity during Anterior Lumbar Interbody Fusion (ALIF) were identified and included for review according to PRISMA guidelines. Studies eligible for inclusion were agreed by two independent reviewers. Meta-analysis was used to compare intra- and postoperative complications in patients with increased BMI during ALIF.

Results

Search terms yielded 435 articles for evaluation. 13 studies were included in this review after applying inclusion and exclusion criteria. Meta-analysis of studies demonstrated a significantly increased risk profile for overall complications in the obese patient cohort (CI = 0.04-0.16, p = 0.002) with significant heterogeneity (I2=86%). Patients with increased BMI were not significantly more likely to develop Vascular complications (CI= -.03-0.02, p = 0.62). Simple pooling demonstrated significant association between increased BMI and blood loss.

Conclusions

Obesity was demonstrated to have an impact on overall complication rates in Anterior Lumbar Interbody Fusion procedures, with postoperative complications including wound infections and lower fusion rates more common in patients in increased BMIs.
1046 Anterior Lumbar Interbody Fusion Approaches: A Systematic Review
Authors: Feeley A , Feeley I , Clesham K , Butler J
Published: October 2021

Aim

Anterior lumbar interbody fusion (ALIF) is a well-established alternative to posterior-based interbody fusion techniques, with approach variations, such as retroperitoneal; transperitoneal; open; and laparoscopic well described. Variable rates of complications for each approach have been enumerated in the literature. We aim to elucidate the comparative rates of complications across approach type.

Method

A systematic review of the search databases Pubmed; google scholar; and OVID Medline was made in November 2020 to identify studies related to complications associated with anterior lumbar interbody fusion. PRISMA guidelines were utilised for this review. Studies eligible for inclusion were agreed by two independent reviewers. Meta-analysis was used to compare intra- and postoperative complications with ALIF for each approach.

Results

4575 studies were identified, with 5728 patients across 31 studies included for review following application of inclusion and exclusion criteria. Meta-analysis demonstrated the transperitoneal approach resulted in higher rates of Retrograde Ejaculation (RE) (p < 0.001; CI = 0.05-0.21) and overall rates of complications (p = 0.05; CI = 0.00-0.23). Rates of RE were higher at the L5/S1 intervertebral level. Rates of vessel injury were not significantly higher in either approach method (p = 0.89; CI=-0.04-0.07). Laparoscopic approaches resulted in shorter inpatient stays (p = 0.01).

Conclusions

Despite the transperitoneal approach being comparatively underpowered, its use appears to result in a significantly higher rate of intra- and postoperative complications, although confounders including use of BMP and spinal level should be considered. Laparoscopic approaches resulted in shorter hospital stays, however its steep learning curve and longer operative time have deterred surgeons from its widespread adaptation.
1510 Percutaneous Coronary Intervention vs Coronary Artery Bypass Grafting in Left Main Coronary Artery Disease. A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Hennessy C , Henry J A
Published: October 2021

Aim

There is still no consensus whether percutaneous coronary intervention (PCI) is as safe and effective as coronary artery bypass grafting (CABG) for left main coronary artery (LMCA) disease. Recent updates from key clinical trials necessitated an updated examination of the literature on this topic.

Method

A systematic search was performed of the MEDLINE (via PubMed), EMBASE, Cochrane and clinicaltrials.gov databases from inception to December 20th, 2020. Selected studies were analysed using the random effects model. Outcomes measured included all-cause mortality, MACCE, myocardial infarction (MI), stroke and revascularization. Follow up points were 30 days, 1 year, 5 years and 10 years.

Results

Six RCTs with a total population of 4700 were included in the analysis. For all-cause mortality PCI was non-inferior to CABG at all time points. MACCE favoured PCI at 30 days, and CABG at 5 years. No difference was seen at 1 year and 10 years. MI favoured CABG at 5 years follow up, with no difference seen at 30 days, 1 year or five years. For stroke, PCI was favourable to CABG at 30 days and 1 year, with no difference at 5 years and 10 years. Revascularisation favoured CABG at 1 year and 5 years, with no difference at other time-points.

Conclusions

PCI may be considered as an alternative to CABG for uncomplicated LMCA disease. More complex lesions may still benefit from CABG. CABG may be of benefit where future revascularisation would rather be avoided. Further clinical trials examining this research question are needed.