bluuebunny/crossref_metadata_2025_split huggingface dataset:
1670 The 50 Most Cited Manuscripts in Paediatric Robotic Surgery: A Bibliometric Analysis
Authors: Schaffer S , O'Neill P , Thomas M C , Randev J K 
Published: October 2021

Abstract

Introduction
Robotic assisted surgery is increasingly utilised in paediatric surgery. The purpose of this study was to establish a ranking of the 50 most frequently cited articles addressing this subject and analyse their bibliometric characteristics.

Method
Articles related to paediatric robotic surgery were searched in The Web of Science citation indexing database utilising defined search terms. Results were filtered to include only English language and full manuscripts. The dataset was then ranked by the absolute number of citations and analysed by the journal of publication, impact factor of the journal, title of publication, article type, year of publication, first and senior author, geographic origin, and level of evidence.

Results
The search yielded a total of 352 papers which were ranked in order of citations. The 50 highest cited articles had 2669 citations cumulatively. The most cited article by Lee, RS et al had a citation count of 207. The publication years spanned from 2002 to 2018. 2013 saw the greatest number of publications on this topic. Most articles were of the ‘’Clinical science’’ type. Geographically the USA accounted for most of these publications. All published articles demonstrated a high level of evidence.

Conclusions
The 50 articles identified in this study are clearly influential in this new and evolving field of surgery. Identification of these seminal papers is intended to assist clinicians and scientists in formulating an overview of current and developing trends in this cutting-edge discipline as well as providing a foundational basis for further discussion and future research.
127 Electronic Collection of Patient-Reported Outcomes Following Discharge After Surgery: A Systematic Review
Authors: Tsang C , Lee K S , Richards H , Blazeby J , Avery K 
Published: October 2021

Abstract

Aim
Little is known about the electronic collection and clinical feedback of patient reported outcomes (ePROs) post-surgical discharge. This review summarised the evidence on the collection and uses of electronic systems to collect PROs after discharge from hospital following surgery.

Method
Systematic searches of Medline, Embase, PsycINFO, CINAHL and Cochrane Central were undertaken from database inception to July 2019 using terms for “patient reported outcomes”, “electronic”, “surgery” and “at home”. Primary research of all study designs was included if they used electronic systems to collect PRO data away from formal health care settings. Only studies in adult patients admitted for surgery then discharged from hospital were eligible.

Results
From 9,474 records identified, 15 studies were reviewed including three randomised controlled trials. Seven studies were in orthopaedic surgery. Most studies used commercial ePRO systems (n = 9/12). Six studies reported types of electronic devices used to collect data: tablets or other portable devices (n = 3), smartphones (n = 2), combination of smartphones, tablets/portable devices and computers (n = 1). Systems had limited features or functions such as real-time feedback to clinicians (n = 6) and messaging service for patients to communicate with care teams (n = 3). No studies described integration of the ePRO system with electronic health records to support clinical feedback.

Conclusions
There is limited reporting of ePRO systems in the surgical literature. ePRO systems lack integration with hospital clinical systems. Future research should describe the ePRO system and ePRO questionnaires used, and challenges encountered during the study, to support efficient upscaling of ePRO systems using tried and tested approaches.
987 Braidlock - The Evolution of a Novel Drain Securing Device
Authors: Byrne C , Ali E , Qureshi R , Cheng L 
Published: October 2021

Abstract

Introduction
The use of drains in Oral and Maxillofacial Surgery is widespread and the securing method using a silk suture laddering along the drain in a standard ‘roman sandal’ pattern is well established. Other methods include tie-lock with sutures and adhesive dressings. We describe the use of a braided device (Braidlock®) without using sutures, based on the concept of a Chinese finger trap, to secure the drain onto patients' skin using tissue adhesive. We report the evolutionary changes of Braidlock.

Device Evolution
Braidlock® is a Class I non-invasive disposable medical device which provides securement of lines, drains and catheters to a patient using tubing from 3.5Fr to 36Fr. The diameter of the Braidlock® expands when the device is compressed, similar to a ‘Chinese finger trap’. A line can then be inserted through the device and into the body. When decompressed, the Braidlock® squeezes the line tightly and securely. The initial Braidlock® device was hook & loop which required suturing to secure onto skin. Integrated adhesive is a recent invention.

Advancement
With advances in adhesive dressing and ultrasonic wielding between the plastic casing and adhesive pads, Braidlock® drain securing device appears to be a safe medical device that enables successful securement of drains. Braidlock® may represent a cost saving relative to the conventional suture pack for drain securement.

Conclusions
This new drain securing device offers a cost effective and reliable alternative to the standard suture fixation. This will eliminate the risk of sharps injury and allow shortening of the drain by ward staff with minimal training.
1165 Reporting Patient Selection in Robotic Cholecystectomy: Less than IDEAL? A Systematic Review
Authors: Biggs S , Dixon L , Brankin-Frisby T , Dewi F , Torkington A , Olivier J , Kirkham E 
Published: October 2021

Abstract

Introduction
Laparoscopic cholecystectomy is the gold standard definitive treatment option for benign biliary disease. There has been increasing interest in novel robotic surgical techniques; robotic cholecystectomy (RC) represents the most recent innovation in the management of gallstones. The IDEAL Collaboration has provided guidance for the rigorous and comprehensive reporting of surgical innovations, despite this, transparency in patient selection has been limited. We aimed to assess the reporting of patient selection in studies reporting RC.

Method
A collaborative, systematic review was conducted in accordance with the PRISMA guidance to identify all published studies reporting RC. Study specific inclusion and exclusion criteria were detailed in a protocol.

Results
Searches identified 1425 abstracts; 90 papers were included for data extraction. Inclusion criteria were reported in 38 (42%) studies. The most frequently cited were age (20%), aetiology (20%), presence of symptoms (16%) and comorbidities (10%). Forty-nine (54%) studies reported exclusion criteria. Numerous and variably reported exclusion criteria were reported; acute cholecystitis (26%), previous abdominal surgery (25%), comorbidity (17%), pregnancy (13%), common bile duct stones (13%) and pancreatitis (10%) among others. Seven reported no exclusion criteria. Three reported numbers of patients who declined RC.

Conclusions
Patient selection criteria were inconsistently reported and when present lacked standardisation. Concern persists around patients being “cherry picked” for inclusion in studies reporting innovative robotic surgical procedures, making interpretation and applicability of results impossible. Standardised inclusion criteria are needed to enable greater transparency and reproducibility to ensure the safe adoption of new technologies into clinical practice.
943 Beyond the Adenoma Carcinoma Sequence
Authors: Daniel S , Iype S 
Published: October 2021

Abstract

Introduction
Looking beyond the adenoma carcinoma sequence researchers have discovered alternate morpho-genetic routes, and tumour biomarkers in colorectal cancer. This has caused a paradigm shift in the management, resulting in improved diagnosis, prevention, and delivery of tailored treatment aiming at specific molecular pathways.

Aim
This review summarises

Method
PubMed, Google Scholar, NLM searches based on aims and key words were conducted. Further, academically, and clinically relevant searches were made if more information was required. When required, references of articles were also retrieved.

Results
The two main theories regarding the morphological origins of colorectal cancer are the adenoma carcinoma sequence and the De-novo origins. The underlying genetic models are the (i) chromosomal instability pathway (CIN), (ii) the microsatellite instability pathway (MSI) and (iii) the CpG Island methylator phenotype (CIMP) pathways. Though unique, the pathways communicate with each other. The genetic fingerprinting of colorectal cancers has an impact on their tailored management and consequently a through grounding in the basics are essential for those in gastrointestinal subspecialties.

Conclusions
Two morphologically distinct pathways and three unique genetic mechanisms have been described. There are significant interactions between them. Behaviours of sporadic and inherited colorectal cancer, their treatment and prognosis depend on our understanding of these mechanisms and the availability of targeted therapies to assist surgical resection.
228 Outcomes of Gallstone Complications During the COVID Pandemic
Authors: Isherwood J , Karki B B , Chung W Y , AlSaoudi T , Wolff J , Malde D , Bhardwaj N , Garcea G , Dennison A 
Published: October 2021

Abstract

Background
The Intercollegiate General Surgery Guidance on COVID-19 recommended either non-surgical management or cholecystostomy drains for the management of acute biliary disease replacing gold standard practice of early laparoscopic cholecystectomy within 1 week of index admission with drainage reserved for high-risk patients where surgery is not appropriate.

Method
This is the retrospective study presenting the impact of gallstone disease in our unit during five months of the COVID- 19 pandemic (March 2020-August 2020) compared with the equivalent period in 2019.

Results
Patients presenting to the HPB unit with a coded diagnosis of gallstones were included and during the study period 1447 patients presented compared with 1413 in 2019. In 2020 compared with 2019 there was a significant decrease in patients presenting with cholecystitis (240 vs 313; p = 0.031) but no significant difference in patients presenting due to gallbladder perforation (44 vs 51). Interestingly the numbers of cholecystostomies were comparable, with 11 in 2020 and 15 in 2019 representing significantly less than the 7.2% figure published by Peckham-Cooper et al.

Conclusions
In our study there was a decrease in patients with cholecystitis and perforation and there was an increase in patients with gallstone pancreatitis, increase waiting lists with increase in the incidence of serious complications. In our trust we currently have 656 patients awaiting cholecystectomy compared to 280 in august 2019. With the recent elevation of the alert level to 4 and increased government restrictions, a consistent National approach is required to mitigate these risks.
632 Analysing Laser Doppler Images - A Modified Approach to the Assessment of Burn Depth
Authors: Shahid S 
Published: October 2021

Abstract

Aim
To establish a method of quantifiably determining burn depth from Laser Doppler (LD) images of burns.

Method
NICE advises for LD scanning to be utilised for the assessment of intermediate depth burns, where there is doubt about burn depth following experienced clinician examination. However, these scan images do not provide a quantifiable measure of burn depth. LD determines burn perfusion, with deeper burns appear blue, and superficial burns appearing red. We retrospectively studied LD images from 110 patients over the course of 2019. Using Adobe Photoshop, Histogram software, we highlighted the burns using the selection tool, and determined the proportion of the burn that was deep/poorly perfused. We then correlated these results with time till recovery.

Results
Burns with a poorly perfused region of larger than 20%, had a proportional increase in time till full recovery. This proportional increase was also reflected in burns with a 30% and 40% poor perfusion. Burns with less than 20% of poor perfusion were found to recover at the same rate as superficial burns. This novel method for the measurement of burn depth will allow for the examining plastic surgeon to make a decision on treatment based on concrete and quantifiable burn depth data.

Conclusions
We have demonstrated the initial validity of a novel method for the quantifiable measurement of burn depth. Further study is required, to establish the validity of this novel approach to the quantifiable detection of burn depth.
751 Improving Engagement with Home-Based Surgical Skills Simulation
Authors: Falconer R , Semple C , Cleland J , Walker K , Watson A 
Published: October 2021

Abstract

Introduction
Surgical simulation has been repeatedly shown to facilitate technical skill acquisition. However, trainee engagement with self-directed practice remains variable, despite access to resources. Understanding the motivators and barriers to participation is crucial to develop modules which can effectively meet the learning needs of current, and future, surgical trainees. The aim of this qualitative study was to examine factors which influence trainee engagement with home-based surgical skills simulation.

Method
A series of one-to-one semi-structured interviews were conducted remotely with ST3 vascular trainees who had previously consented to take part in a national programme of home-based technical skills simulation. Interview data was transcribed and thematically analysed.

Results
12 trainees were interviewed during a 4-week period. Overall, trainees valued simulation but found it difficult to balance against clinical commitments and mandatory training requirements, particularly if there were limited opportunities for skill transfer to the real-world environment. Although simulation was acknowledged to be a safe environment for experiential learning, trainees alluded to an underlying culture of perfection which limited willingness to learn from mistakes, even within a simulated setting. In addition, traditional attitudes about the apprenticeship model of surgical training prevail, with simulation often viewed as inferior to learning “on the job” in theatre.

Conclusions
Trainee engagement with home-based surgical skills simulation may be influenced by a range of systemic factors. In future, formal certification of simulation modules, mandating simulated competencies and curricular integration may help improve participation, as well as supporting cultural shift towards recognition of simulation as a vital component of modern surgical training.
79 Remote Delivery of an International Surgical Education Webinar Series for Medical Students During COVID-19
Authors: Zaver V , Ahari D , Jayawardena P , Sayed M A 
Published: October 2021

Abstract

Aim
The 2019 novel coronavirus (COVID-19) pandemic caused the cancellation of lectures and clinical placement-based education for medical students across the UK. With resumption of university teaching, remote delivery via online platforms has seen increased implementation to prevent overcrowding and comply with social distancing measures. This article explores the efficacy of an internationally delivered online surgical webinar series to facilitate undergraduate surgical education on a long-term basis.

Method
The University of Manchester undergraduate surgical society, Scalpel, in collaboration with three Junior Surgical Trainees designed and organised an online surgical teaching programme aimed at medical students. The syllabus was constructed in accordance with the Royal College of Surgeons England’s (RCSEng) National Undergraduate Curriculum in Surgery. Multiple-choice questionnaires (MCQs) were used to evaluate knowledge during the sessions and Likert scales were utilised to assess subjective improvement of knowledge. The teaching programme was delivered remotely using Zoom (Zoom Video Communications, Inc.).

Results
he average attendance for the lectures was 68. The reach of the webinar series was international. The average increase in correct answers between pre and post lecture MCQs was +78.7% (+72.4, +18.6, +76.6, +43.5, +161, +100). Likert scale analysis demonstrated 100% improvement of knowledge.

Conclusions
This study demonstrates a positive outcome to remote, extra-curricular surgical education in the time of COVID-19. The methodology outlined herein has the potential for easy replication on a more widespread scale to provide routine supplementation for medical student and surgical trainee education during the ongoing pandemic.
245 An Introduction to Surgery: Effectiveness of An Online, Lecture-Based Programme in Providing Surgical Career Guidance for Pre-Clinical Students
Authors: Kelada M , Kawka M , Komor J 
Published: October 2021

Abstract

Aim
Early exposure to surgery has been found to impact medical students’ decisions to pursue a career in surgery. Despite this, students are often not exposed to surgical specialties until senior years of medical school. The aim of this study was to determine if a student-led, three-month online lecture series can facilitate early exposure to surgical careers.

Method
Participants volunteered to complete pre- and post-lecture questionnaires. The four domains discussed across the lecture series included: what a surgical career entails, the day-to-day life of a surgeon, advances in surgery and surgical portfolio. Participants self-rated confidence in the knowledge of each of the four domains was measured on a five-step Likert scale. Changes in perceived confidence were measured using a paired Student’s t-test. Data were analysed using R 4.03 (Vienna, Austria). The threshold of significance was &lt;0.05.

Results
A total of 45 respondents completed both pre- and post-lecture questionnaires. Most respondents (57.8%) were first- or second-year students. Following the course, there was a significant increase in confidence across all four domains investigated (mean rating 2.64 vs 4.07, p &lt; 0.001). More than 9 out of 10 respondents (99.3%) gained new knowledge and (95.2%) agreed that an online event format did not hinder their learning.

Conclusions
Student-led online lecture series can increase knowledge of core concepts pertaining to a career in surgery for pre-clinical students. The findings provide a basis for further large-scale investigation of surgical education during early years of medical school and for the potential value of extracurricular, student- or trainee-led courses.
681 Increasing Representation in Surgical Careers – the First Cut Mentorship Programme for Medical Students
Authors: Tulloch A , Aghanenu O , Mutlib I , Ahmed A , Gomez D , Hagan P , Lymath D 
Published: October 2021

Abstract

Background
Surgical specialties in the medical literature are described as having low workforce diversity. Classically underrepresented groups among surgeons include women, trainees from Black, Asian and Minority Ethnic (BAME) backgrounds and those possessing visible or hidden disabilities. As advocates for underserved communities, increasing the representation of these groups is vital to ensure that their values and perspectives influence the progression and practice of surgery. A mentorship programme was created to address this need and help break down the reported barriers which often deter medical students from pursuing surgical careers.

Method
A 6-month mentorship programme for students from underrepresented groups in surgery was designed and co-developed by four medical students and three university faculty members: a consultant HPB surgeon, a professor of medical education and an educational enhancement manager.

Results
30 medical students received one-to-one mentorship from consultant surgeons. All participants (mentors and mentees) were from underrepresented groups in surgery. Students were provided with exposure to the life of a surgeon, personal development, and careers advice by their mentors. Opportunities for professional development in academic, educational and management roles were also offered to go beyond the scope of the standard clinical responsibilities of surgeons. This descriptive case study offers an approach to implementing this within a large medical school.

Conclusions
The First Cut project is currently in its pilot phase. Feedback will be collected and analysed at the end of the programme for evaluation and improvement. These results will demonstrate the value of mentorship programmes to students from underrepresented groups.
737 Supporting Surgeons in Their Return to Training
Authors: Richardson R , Siddiqui S , Little Z , Pollard R , Chan S 
Published: October 2021

Abstract

Aim
t any one time, approximately 10% of the junior doctor workforce (∼5000 doctors) take time out of training. Following the Bawa Gaba case, and with trainees shielding during the COVID pandemic, there is greater scrutiny and demand to support trainees returning to the frontline. Supported Return to Training (SuppoRTT) is a Health Education England Program designed to improve the Return-To-Training (RTT) experience. For surgical specialties there are additional challenges of reintroducing trainees to practical skills.

Method
e designed and facilitated the first regional SuppoRTT course for Orthopaedic Specialist Registrars, which consisted of peer and consultant-led clinical updates, forum discussions and externally commissioned professional coaching. A pre-course survey established participants’ concerns and expectations about RTT and formed the basis of discussions. A post-course survey assessed value of the course and impact on participants.

Results
Eight participants (6 female) attended. Grade of training on return ranged from ST3 to ST8. Main areas of concern related to colleague perception, reduced confidence with decision-making, operative skill fade, and frustrations with organisational elements of managing work-life balance. There was an overwhelmingly positive response to the support offered on our course, particularly to the discussions around RTT concerns and returning to on-calls. All respondents strongly agreed that sharing their concerns and hearing about peer experience was valuable.

Conclusions
High numbers of trainees take approved time out of training. RTT is associated with anxiety around performance and safety. Surgical trainees can be supported with a targeted course that offers clinical update, peer support and professional coaching.