bluuebunny/crossref_metadata_2025_split huggingface dataset:
P10 A systematic review of current literature on interventions among first-year university students and how this may influence current policy on child obesity strategies within the UK
Authors: Priestman Elena 
Published: April 2021

Abstract

Background
With the steady rise of obesity within the UK, the Government has been increasingly developing policy to curb these figures. Great focus has been put on early implementation of a wide range of interventions in educational settings, but results show little improvement.

Aim
To evaluate health interventions amongst first-year university students with the intention of influencing current policy on obesity prevention amongst children.

Methods
A literature search, utilising PRISMA reporting guidelines, was carried out on health intervention studies that focus on first-year university students. To formulate the search strategy, UK obesity policy was input into a PICO Framework.

Results
Eight studies met the inclusion/exclusion criteria. Results showed that when measuring weight-related outcomes, no significant improvement was found; secondary outcomes, especially those regarding physical activity demonstrated greater benefit but the link to obesity prevention proved to be relatively weak.

Discussion
Due to differing demographics between where the studies were based as well as cultural differences regarding views on leisure and diet led to lack of applicability to UK students.
Environmental factors between compulsory and higher education must also be considered as it may be a case of creating new strategies rather than re-applying a pre-established policy.
Ultimately, the lack of comparable studies reflects on the lack of understanding of the overall issue of childhood obesity and thusly its prevention.

Conclusion
With evidence-based policy increasing in popularity, it is questionable as to whether the target population for child obesity strategies could widen to include first-year university students.
P12 A systematic review of the reporting of surgical quality assurance and learning curve in robotic oesophagectomy
Authors: Ramirez Jozel , Jones Conor , Sellers Grace , Kiandee Miraen , Abbas Aya , Pathak Samir , Blencowe Natalie ,   on behalf of the ROBO-SURG collaboration
Published: April 2021

Abstract

Introduction
There is an increasing trend in novel robotic-assisted oesophagectomy in place of standard techniques, potentially due to its perceived technical benefits and improved post-operative outcomes. However, safety and efficacy remain uncertain and little is known about surgeons’ expertise in this complex procedure. This review aims to summarise the reporting of surgeons’ expertise in studies evaluating robotic oesophagectomy.

Method
Systematic searches of OvidSP, MEDLINE and Cochrane Library were conducted using key words for robotic surgery and oesophageal cancer. Searches were limited to human studies published up to February 2020. Studies reporting any type of outcome for robotic oesophagectomy were included. Data on quality assurance measures (e.g. type of centre, surgeons’ experience, study entry criteria) and learning curve assessments were recorded.

Results
Of 954 abstracts screened, 226 full texts were reviewed and 103 included. Two studies were clinical trials. There were 85 (82.5%) single and 6 (5.8%) multi-centred institutions. Forty-four (43%) stated the type centre(s) involved: general (n = 1), specialist (n = 41) or mixed (n = 2). Thirteen (13%) reported centres’ caseload of robotic and non-robotic oesophagectomies within a defined period. Seven described surgeons’ prior experience in robotic oesophagectomy, and 5 described experience in open/laparoscopic surgery. Two stipulated entry criteria for surgeons (training qualification and number of robotic oesophagectomies performed). Eighteen (17%) assessed the learning curve through changes in operating time, complications and conversion rates.

Discussion
There is currently inadequate reporting on surgeons’ expertise in robotic oesophagectomy, making comparisons with standard techniques challenging. This highlights the need for better transparency when reporting surgical innovation, as outlined by the IDEAL framework.
P14 Acute management of traumatic anterior shoulder dislocations during COVID-19: are we meeting published national standards for treatment during the pandemic?
Authors: Donovan Richard L , Abdelmalek Amir , Crowther Mark A A , Packham Iain 
Published: April 2021

Abstract

Background
BESS/BOA Patient Care Pathways provide national guidelines for acute management of traumatic anterior shoulder dislocations with respect to emergency reduction and clinic follow-up. COVID-19 posed challenges in terms of analgesia choice for reductions and altered follow-up arrangements. This study aimed to assess variance from the care pathway.

Methodology
We performed a retrospective case note analysis of all emergency presentations with acute traumatic anterior shoulder dislocations at the MTC in Bristol. We compared 01 Apr to 31 May in 2019 to the same period in 2020 to analyse the effects of the COVID-19 pandemic on the management of these injuries. Data parameters collated included examinations and imaging pre- and post-reduction, choice of analgesia, follow-up rates, referral to physiotherapy, and further imaging requested.

Results
We identified 32 patients in 2019, and 24 in 2020. Use of Entonox fell during the pandemic in favour of Penthrox. Use of conscious sedation (requiring full PPE) remained around 20%. Pre- and post-reduction orthogonal radiographs was near 100% in both cohorts. Referral to follow-up was 88% in 2019 but fell to 38% in 2020. Of those assessed in clinic during COVID-19, fewer were mobilised early or referred to outpatient physiotherapy compared to the previous year.

Conclusions
The acute management of anterior shoulder dislocations during the early COVID-19 pandemic faced two main challenges: choice of suitable analgesia whilst minimising AGPs; and limiting access to ’face-to-face’ follow-up to minimise hospital attendances. A key concern was a significant decrease in patient follow-up, thus limiting the access to optimal aftercare such as physiotherapy and further imaging.
P15 Admission avoidance in acute epistaxis: a prospective national audit during the initial peak of the COVID-19 pandemic
Authors:   INTEGRATE (The UK ENT Trainee Research Network)
Published: April 2021

Abstract

Introduction
In March 2020, UK epistaxis guidelines were issued incorporating major shifts in standard practice, namely the recommended use of dissolvable products and discharge of patients with non-dissolvable packs.
The aim of this audit was to assess patient outcomes following epistaxis care during the initial COVID-19 peak, exploring factors relating to unscheduled re-presentations.

Methods
A UK-wide prospective multicentre national audit was performed over 12-weeks from 6th April 2020 at ENT departments treating adults with epistaxis. The primary outcome was re-presentation within 10-days. Univariable binary logistic regression analysis was used to identify significant determinants of the primary outcome measure.

Results
83 centres from all four UK nations submitted 2,631 cases, the majority of which were Emergency Department (ED) referrals (89.7%). ENT clinicians used a dissolvable intranasal product in 34.7% of patients overall (n = 816/2,351), and in 61.1% of those receiving an intranasal product (n = 816/1,336). 54.6% were discharged from the ED following ENT review. The overall re-presentation rate was 19.5% for ED discharges (n = 245/1,259) and 9.9% for ED admissions (n = 104/1,046). 6.8% of ED discharges and 5.7% of ED admissions were admitted following their re-presentations (n = 86 and 60 respectively). Not being packed by ED clinicians, antiplatelet medications, failed cautery and recent epistaxis treatment were predictors of re-presentation within 10-days.

Discussion
Re-presentation data were similar to the 2016 UK Epistaxis Audit, however, there was a notable shift towards alternative packing techniques and reduced admission. This highlights that many patients who would previously have necessitated admission may be safely discharged from ED.
P22 Are Elderly Patients at Increased Perioperative Morbidity and Mortality from Oesophagectomy for Oesophageal Cancer? A Systematic Mapping Review and Meta-Analysis
Authors: Gujjuri Rohan R , Elhadi Muhammed , Umar Hamza , Subramanya Manjunath S , Evans Richard P T , Kamarajah Sivesh K , Griffiths Ewen A 
Published: April 2021

Abstract

Introduction
Oesophagectomy is being increasingly performed in an ageing population that is observing a concomitant growth in the life expectancy. However, the risks are poorly quantified, and this study aims to review current evidence to further quantify the postoperative of oesophagectomy in the elderly population compared to younger patients.

Methods
A systematic electronic search was conducted for studies reporting oesophagectomy in the elderly population. Meta-analysis was performed using random-effects modelling to compute odds ratios (OR) and 95% confidence intervals (CI). Primary outcome was overall complications and secondary outcomes included anastomotic leaks, cardiac complications, pulmonary complications, overall and disease-free survival. Meta-regression was performed to identify study-, hospital- and patient-level factors confounding study findings.

Results
This review included 37 eligible studies involving 61,723 patients. Increasing age was significantly associated with increased rates of overall complications (OR: 1.67, CI 95%: 1.42 – 1.97), cardiac complications (OR: 1.62, CI 95%: 1.10 – 2.40), pulmonary complications (OR: 1.44, CI 95%: 1.11 – 1.87) and decreased 5-year overall survival (OR: 1.36, CI 95%: 1.11 – 1.66) and 5-year disease-free survival (OR: 1.66, CI 95%: 1.40 – 1.97). Rates of anastomotic leaks showed no difference between elderly and younger patients (OR: 1.06, CI 95%: 0.71 – 1.59).

Conclusion
Postoperative outcomes such as overall complications, 5-year overall survival and disease-free survival appear to significantly worse in all age cut-offs in this meta-analysis. Sarcopenia and frailty act as better predictors of postoperative outcomes than chronological age. This study confirms the preconceived suspicions of increased risks in elderly patients following oesophagectomy and will aid future pre-operative counselling and informed consent.
P27 Bedside teaching from a distance; surgical education in the COVID era, a randomised control trial
Authors: Feeley A , Carroll A , Hehir D 
Published: April 2021

Abstract

Introduction
The COVID pandemic resulted in a shutdown of facilities and resources globally. With drastic changes in the provision of services available in the health sector, so too were medical students’ provision of learning. With the onslaught of COVID and the need for ongoing learning resources for students, novel methods to maintain adequate surgical patient exposure and student interaction on a platform amenable to the interactive format required was devised using a virtual platform to compliment current pedagogical approaches.

Methods
This was a randomised control trial to evaluate the perceived use of remote learning in place of surgical bedside teaching in the COVID-19 era. Medical students in a regional hospital were recruited and randomised to undergo the bedside teaching in person or receive the teaching virtually through a Xpert eye, smart glasses to facilitate connections remotely. Feedback questionnaires and exit interviews carried out following each session. Content analysis of transcripts was performed to evaluate the presence and quality of perceived learning, benefits and limitations.

Results
Feedback demonstrated greater engagement, satisfaction, involvement and learning (p &lt; 0.01) in the bedside teaching group. Content analysis yielded three main themes; Interpersonal content, technological features, and provision of content. Students reported the virtual teaching was an acceptable alternative in the current climate of social distancing and reduced patient access.

Conclusion
The current pandemic poses a risk to adequate patient exposure to patient centred learning. Teaching sessions received remotely are an acceptable alternative in the current climate of reduced clinical access, however bedside teaching remains the preferred method of learning.
P30 Can non-allergy health workers safely delabel reported penicillin allergies using an antibiotic allergy assessment tool? - A multicentre study
Authors: Owens Rhys , Sandoe Jonathan , Whyte Andrew , West Robert , Slatter Mandy , Stonell Rebecca , Powell Neil 
Published: April 2021

Abstract

Background
False penicillin allergy labels can be potentially hazardous to patients. Most penicillin allergy labels can be safely removed following risk stratification and formal drug challenge. These de-labelling strategies have been limited to specialist allergy and infectious disease services.

Aims
To determine whether non-allergy specialist health-care workers can use an antibiotic allergy assessment tool (AAAT) to correctly phenotype and manage reported penicillin allergy.

Method
Non-allergy health-care workers in three UK hospital were emailed online questionnaires and asked to assign the allergy phenotype and management recommendation for eight vignettes of real cases reporting a penicillin allergy using the AAAT. In one hospital participants were randomised into two groups: one group was directed to use the AAAT whilst the second group had no decision tool. Participants were assigned an average score for correct allergy phenotype, management and a major error rate.

Results
Use of the AAAT across the eight vignettes significantly improved the average score for assigning correct phenotype (6.7 vs 5.2 p &lt; 0.001), management choice (7.1 vs 5.7 p &lt; 0.001), and major error rate (0.6 vs 1.6 p &lt; 0.001). Participant performance with the AAAT was generalizable across all three hospitals. Despite use of the AAAT 35-40% of participants made at least one major error.

Conclusion
The AAAT significantly improved health worker performance in phenotyping and choosing correct management for reported penicillin. However, even with the AAAT, there remains a risk of potentially hazardous management choices highlighting the need for formal allergy training to expand penicillin allergy assessment services.
P32 Changes in medical education due to COVID-19
Authors: Kabbani Jade , Kabbani Jamil 
Published: April 2021

Abstract

Introduction
The Coronavirus pandemic (COVID-19) has greatly impacted medical education, resulting in changes to teaching, examinations and research opportunities. We explored changes across these areas, evaluating their impact on medical education.

Methods
Pubmed was searched using the terms “medical education”, “COVID-19”, and “changes”, yielding 174 results. Relevant results were assessed to determine perceived impact on medical education, categorised as changes to teaching, examinations, and research opportunities.

Results
Changes to teaching included the introduction of virtual learning, with in-person lectures replaced by recordings or livestreams to facilitate remote teaching. Perceived advantages included increased flexibility, although drawbacks include increased reporting of loneliness. With social-distancing measures limiting the number of individuals allowed in theatre, opportunities for surgical experience have been greatly reduced. Online assessments have largely replaced traditional written examinations, with the introduction of new mediums in order to assess “soft-skills”, as demonstrated by virtual OSCE examinations. However, the efficacy of such mediums has yet to be demonstrated. Despite large volumes of COVID-19-related studies, research as a whole has been negatively affected by restrictions in both funding and research-related hiring, as well as pauses on many clinical trials.

Conclusion
COVID-19 has resulted in significant changes to medical education, including greatly accelerating the incorporation of technology in medical teaching. These novel adaptations may be permanently incorporated into curriculums due to possible benefits in flexibility. However, these changes are not without drawbacks, including reduced opportunities for research and surgical experience.
P35 Co-producing surgical patient information during COVID-19
Authors: Venn Mary L ,   on behalf of CovidSurg Collaborative
Published: April 2021

Abstract

Introduction
Patients preparing for surgery are understandably fearful due to the threat of COVID-19. With rapid release of surgical research, we wanted to ensure patients can access the right evidence to make informed decisions. We describe an innovative, digital, patient and public involvement (PPI) strategy designed to engage surgical patients with COVID-19 research as it is released, by producing accessible resources.

Methods
We established a Patient Advisory Group (PAG) to co-produce patient information about having surgery during the pandemic, and the risks of perioperative SARS-CoV-2, using information from the CovidSurg international surgical cohort studies.

Results
The PAG were keen for patients to understand the high risks of mortality and serious breathing complications associated with perioperative SARS-CoV-2. They wanted detailed information about what patients can do to stay safe and about the measures hospitals are taking to keep them safe. What patients wanted to know was not always what surgeons presupposed.
We co-produced patient resources with separate versions for dyslexia and learning disabled patients. We published 18 translations within a few weeks and hosted them in purpose-built web pages. We generated PAG-approved lay summaries to share our original research findings with patients.

Conclusion
Patients quickly adapted to engage in digital PPI activities during pandemic lockdown conditions. Collaborative working via teleconferencing and shared screens is a productive, inclusive and convenient way to rapidly develop patient information. Clinicians should invite critique and can expect patient engagement to enhance the content and acceptability of patient resources.
P41 Development of a Montgomery compliant consent discussion aide memoire leading to the establishment of a 'remote consent clinic'
Authors: Priestman Elena , Anderson Joseph , Curtis Alex , Kelly Andrew 
Published: April 2021

Abstract
In response to the Montgomery ruling and increasing costs due to improper consenting, specialties such as spinal surgery have implemented consent clinics performed between the conventional initial consultation and day of surgery. However, as this new process can be cost and labour intensive, providing the clinic remotely has been proposed as a way of streamlining this service.
This review aims to develop a Montgomery-compliant checklist that provides practical considerations on conducting a remote consent clinic, with scope to integrate this initially into orthopaedic practice.
Two literature searches were conducted with the first establishing previous study in remote consent clinics and the second determining the feasibility and financial viability of providing a remote clinic against a face-to-face clinic.
The initial analysis revealed remote consent clinics as a relatively novel area of research. However, both literature searches suggested improvements in both patient recall and understanding in remote consenting, further enhanced by additional resources. Moreover, remote clinics are more efficient and cost-effective while still maintaining high patient satisfaction; outcomes are further improved by delegating this service to alternative staff members. Patients also benefit from the complete erasure of travel times and associated costs. Additionally, in the era of COVID-19, it limits patient exposure allowing hospitals to provide safer services.
Consent clinics, when performed remotely, are a cost-effective and efficient tool to minimise negligence claims while maximising patient satisfaction. In line with the digitisation of healthcare, it also allows for a COVID-appropriate service. Nevertheless, to ease the transition, a practical checklist has been developed.
P44 Direct and Combined Revascularization Versus Indirect Revascularization in the Treatment of Moyamoya Disease: A Systematic Review and Meta-Analysis
Authors: Lee Keng Siang , Zhang John J Y , Teo Mario , Steinberg Gary K 
Published: April 2021

Abstract

Introduction
There is currently no definite consensus regarding the surgical treatment of moyamoya disease (MMD). This study aimed to compare direct and combined versus indirect bypasses with regard to perioperative complications in pediatric and adult patients with MMD.

Methods
Systematic searches of Medline, Embase and Cochrane Central were undertaken. Primary outcome measures analyzed included perioperative complications defined as any major adverse events within 30 days after bypass surgery.

Results
2490 studies were identified. 20 reporting 2982 patients were eventually included in our meta-analysis. Pooled mean age was 37.5 years (95%CI:33.5–41.5) and 7.4 years (95%CI:4.1–10.7) in adult and pediatric patients respectively. For adult patients, perioperative stroke rate was comparable between direct/combined bypass and indirect bypass (OR = 1.26 [95%CI:0.81–1.96], p = 0.300 for indirect bypass). For pediatric patients, perioperative stroke rate was comparable between direct/combined bypass and indirect bypass (OR = 2.43[95%CI:0.74–7.94], p = 0.143 for indirect bypass). No difference was found in perioperative mortality between direct/combined bypass and indirect bypass for adult patients (OR = 1.16[95%CI:0.07–19.00], p = 0.915 for indirect bypass). There was no difference in perioperative mortality between direct/combined bypass and indirect bypass (OR = 1.39 [95%CI:0 –Inf], p = 1.00 for indirect bypass) in pediatric patients. There was no significant difference in perioperative neurological deficit rates between direct/combined bypass and indirect bypass (OR = 1.27[95%CI:0.68–2.39], p = 0.451 for indirect bypass).

Discussions/Conclusions
Our meta-analysis provides statistical evidence suggesting that both direct and indirect bypasses can be equally effective in preventing stroke, with similar rates of perioperative complications in pediatric and adult patients.
P48 Exploration of variation in Management of Acutely Symptomatic Hernia – results from the MASH practice survey
Authors: Spence O , Proctor V , Sayers A , Green S , Burns F , Smart N , Lee M 
Published: April 2021

Abstract

Introduction
There is minimal evidence to guide the emergency management of groin and abdominal wall hernia. The aim of this project is to understand current variations in clinical practice across the UK when managing common types of acutely symptomatic hernia.

Methods
A survey of clinical practice was developed to explore the management of acutely symptomatic abdominal wall hernia (ASH) including groin (GH), umbilical (UH), and incisional hernia (IH). The survey captured respondent characteristics. It explored preferences in the management of each type of ASH, including factors related to treatment and repair strategy. Surgeons at ST3+ level with a UK practice were invited to participate through Twitter and collaborative networks.

Results
In total, 144 responses were received (response rate 26%). Of these, 62 (43.1%) were Consultant Surgeons, 105 (72.9%) did not have a specialist hernia practice, and 95 (66%) did not follow specific guidelines for emergency hernia repair. There was variation in investigations used e.g. CT required for IH (91%) but less for GH (34.7%) and UH (47.2%). Open repair was preferred in all settings. For GH with ischaemic bowel 76 (52.8%) would suture repair vs. 67 (46.5%) who would use a mesh (64.2% permanent synthetic) this is similar for IH, where 59 (41%) chose suture vs. 71 (49.3%) mesh, although 61.9% favoured biologic mesh for IH. Suture repair was preferred for UH with ischaemic bowel (69.4%).

Conclusion
The survey demonstrates variation in treatment of ASH. Areas which require further exploration include use of mesh and laparoscopy in the emergency setting.