bluuebunny/crossref_metadata_2025_split huggingface dataset:
242 Maintaining Surgical Training During the Covid-19 Pandemic; A Novel Use of Surgical Simulators
Authors: Aung M , Obakponovwe O , Raymond A , Apostolidis K , Bahadori S , Wainwright T , Middleton R 
Published: May 2021

Abstract

Introduction
During Covid-19 pandemic, operation theatres limit the number of staff during each session, which causes a decrease in training opportunity. To counteract this lapse, the Orthopaedic Research Institute (ORI) designs an innovative training session. During the nationwide lockdown, the closure of the Institute allowed for the transfer of the VirtaMed ArthrosTM (VA), to our NHS facility. VA is a surgical simulator which enables the participant to practise knee arthroscopy.

Method
Participants with little arthroscopic experience were included in the study. Three fellowship-trained surgeons conducted daily teaching sessions. Participants were taught necessary arthroscopic skills before undertaking training modules on diagnostic arthroscopy. 90% of the participants attended the session at least three times.
At the end of every module, VA generates a score based on parameters which include procedure duration, visualisation of key structures and iatrogenic chondral damage. Structure questionnaires were also used to analyse feedback.

Results
The overall confidence and module scores progress with each subsequent session. A keystone of success is the location and ease of access to the simulator.

Conclusions
Surgical simulators are a useful tool for surgical education and training. We should encourage their use in the future, especially in the UK surgical training programme.
267 Ascertain Impact of Using Low-Fidelity Simulation Scenarios in Preparation for Practical Surgical Finals
Authors: Awan M 
Published: May 2021

Abstract

Introduction
Simulation has become the new way of preparing doctors to deal with medical emergencies, we investigate it using in managing ward-based surgical emergencies.

Method
Final year medical students completed pre- and post-session questionnaires related to themes of preparedness, anxiousness, and confidence in management of acute surgical presentations versus post-operative complications.
The intervention was divided into classroom based teaching and common surgical scenarios enacted using Sim-Man.

Results
Preparedness increased by a third following participation in surgical simulation scenarios among participants. Anxiousness related to surgical finals decreased by 9%. Confidence in managing acute patients increased by 25% compared to pre-session results. Moreover, 35% of participants felt more confident in managing post-operative complications after the session. On average, participants scored 8/10 for usefulness of the sessions in highlighting areas to concentrate focus upon during revision.

Conclusions
Simulation is slowly becoming a staple in undergraduate training and our results emphasise positive impact of using this as a revision tool. Kinaesthetic learning is more memorable during simulation which serves as a confidence boost in self-perception of managing both acute and post-operative surgical patients. Anxiety associated with exams and managing real-life emergencies can be dampened by rehearsing scenarios and following a structured approach as championed by medical simulation.
457 Survey of Perceived Barriers to Medical Students for Progression into Surgery
Authors: Toh S , Jayawardena O , Fowler H , Fok M , Clifford R 
Published: May 2021

Abstract

Introduction
Applications for surgical training have been decreasing despite higher numbers of medical school graduates. We sought to explore the perceived barriers to medical students for progression into surgery.

Method
An online anonymised SurveyMonkey® questionnaire aimed at medical students was disseminated in May 2020, with survey invitations advertised through social media.

Results
A total of 271 responses were obtained, with 95% of respondents being undergraduates and a 7:3 female to male ratio. Approximately one-fifth (19%) were considering pursuing a career in surgery. 82% of students had observed in an operating theatre. 54% of respondents agreed that their surgical rotation was a positive experience, 21% neutral, 8% negative.
Most frequent perceived barriers included lack of work-life balance (77%), surgical culture (67%), lengthy post-graduate training pathway (63%), and competitive entry of surgical specialties (63%). Others included a lack of understanding of surgical career pathways (52%), limited exposure to surgery (47%), and lack of interest (37%). Notably, gender bias was a barrier for many (35%). Most wanted more exposure to surgery through surgical skills teaching (85%), theatre experience (67%), surgical placements (59%) and didactic teaching (33%).

Conclusions
Modifiable barriers need to be addressed in undergraduate and postgraduate training to boost the number of applications into surgical training.
562 Home Microsurgical Method: A Zero-Cost, Accessible, Simulator Using Home-Based Technologies
Authors: Tullie S , Abdaal A 
Published: May 2021

Abstract
Microsurgery is an advanced practice that demands a steep learning curve. Skill acquisition is reliant on repetition which is challenging with decreased trainee operating hours. Evidence indicates early skill acquisition in low-fidelity simulation is of equal efficacy to operating time. Our aim was to create a zero-cost, low-fidelity, microsurgery simulator using home-based technology.
The simulator has five components; a smartphone (iPhone/Android), laptop/computer, USB/lightning wire, ruler, and two supports of equal height. The ruler creates a platform between the supports on which to place the phone, camera focused downwards. The phone camera captures the surgical field between the supports, projecting the image onto the laptop screen via the USB connection.
The trainee operates in a ‘hands down, eyes up’ fashion, looking forwards at the laptop/computer screen whilst operating below in the field of the camera. Latest smartphones achieve magnifications equivalent to a microscope, preserving image quality whilst allowing recording of sim tasks for technical review.
Initial verbal feedback in informal advisory groups has been resoundingly positive. There is clear educational benefit with potential to work with consultant surgeons to develop free, accessible, online training modules. These would provide structured, remote, platforms for both qualitative and quantitative tracking of skill development.
621 Impact Of COVID-19 On Surgical Training at A District General Hospital in London
Authors: Kesharwani D , Buksh M M , Rawashdeh M , Arumainayagam N 
Published: May 2021

Abstract

Introduction
COVID 19 affected surgical training owing to changes in rotations, moving trusts/departments, surgical skills acquisition and new guidelines/protocols during unprecedented times. Aim was to infer how redeployment impacted surgical skills via an objective and subjective study.

Method
A retrospective observational study comparing lead surgeons in Laparotomy and Appendectomies between 23rd March- 31st July (2019/2020). A subjective survey was done to elucidate perspectives on skill, academic advancement and trust/deanery support. A focussed group discussion was also done to gain insight on physical and psychological well-being.

Results
Laparotomy 2019 (n = 75) had 59%; 41%; 0% - Consultants/Registrars/ fellows respectively as lead surgeons. 2020 Laparotomies (n = 50) had 40% consultants; 41% registrars; 20% fellows
Similarly, Appendectomy 2019 (n = 94) had 8.5% consultants; 71.3% registrars; 3.2% clinical fellows, whereas 2020 Appendectomies (n = 67) had 18% consultants; 71.6% registrars and 10.4% fellows.
The Likert questionnaire showed 42.86% had mental exhaustion, less confidence/skills due to lesser opportunities/procedures. 57.14% expressed COVID 19 extremely affected surgical training while 28.14% believed in a reduction of 81-100% operative log book entries from before.

Conclusions
Although, the results were not significant in number of cases managed by trainees; many reported perceived loss of training( log book/portfolio), less teaching/training opportunities and mental exhaustion.
759 Maintaining Surgical Education and Team Morale During A Pandemic – Can A Virtual Educational Platform Deliver Effective Engagement and Personal Development of Non-Technical Skills?
Authors: Sambhwani S , Al-Shahwani A , Sheikh N 
Published: May 2021

Abstract

Introduction
The COVID 19 pandemic has brought unprecedented challenges in healthcare, leading to a dramatic change in service provision and impacting surgical training.
We developed a new educational timetable to maintain an ethos of education safely; focusing on providing an opportunity to develop non-technical skills and maintain reflective practice.

Method
Microsoft Teams was used in our department with two separate streams of weekly education; journal club with focus on developing critical evaluation skills, and a case based in depth discussion forum to develop presentation skills and evidence based management. A questionnaire was sent out after 10 weeks to evaluate the effectiveness and engagement.

Results
From 53 responses, 72% felt that their engagement in teaching increased with a virtual platform with an overall satisfaction of 88%. Reflective practice increased and 40% felt their non-technical skills improved. Overall, 68% preferred to continue learning virtually and 88% would recommend this to their peers. 92% felt that the platform played a pivotal role in helping maintain team morale during this period.

Conclusions
There has been good engagement with positive reflection and learning at a time of great change in the NHS benefiting training and non-training doctors. We recommend incorporating virtual platforms to provide education in all surgical departments.
929 Not Another Abscess - A Case of Streptococcal Myositis Misdiagnosed as a Right Axillary Abscess
Authors: Oyende O , Jackman J 
Published: May 2021

Abstract

Introduction
Streptococcal myositis is a rare form of infectious myositis caused by Lansfield A beta-haemolytic streptococci. It is characterised by rapidly spreading inflammation that can result in severe systemic toxicity and necrosis of the affected tissue if not diagnosed and aggressively treated.

Presentation
We report a case of a 42-year-old male who presented with a one-week history of worsening right axillary swelling that progressed to painful swelling of his arm. Inflammatory markers were significantly elevated with a white cell count of 17 ×109/L and C-reactive protein of 212 mg/L. On examination, a fluctuant axillary swelling was appreciated, and a decision was made for incision and drainage under general anaesthetic. Intraoperative aspiration of his arm revealed copious purulent fluid prompting intraoperative orthopaedic consult and exploration of the anterior compartment in which there was extensive involvement of the biceps muscle. The microbiological analysis revealed gram-positive cocci in chains, and microbiology advice sought for tailoring of antibiotic regimen. He has recovered well.

Discussion
Though uncommon, the emergency general surgeon should have a high degree of suspicion when evaluating soft tissue infections to avert potentially disastrous outcomes.

Conclusion
Early diagnosis, aggressive management with high-dose intravenous antibiotics, and surgical debridement are principles to treat this rare, life-threatening infection.
935 Stridor in Multiple System Atrophy: An Otolaryngologist Perspective
Authors: Cameron M , Al M , Jain A , De Silva R 
Published: May 2021

Abstract

Background
Bilateral vocal cord paralysis is a rare emergency presentation for Parkinson's disease (PD) but an acknowledged complication of an atypical rarer form of PD called Multi system atrophy ( MSA). MSA is a neurodegenerative disorder comprising of autononic failure, cerebellar ataxia and parkinsonism. An early occurence of stridor can indicate a shorten survival and quality of life remains uncertain. Airway definitive management of this patient group can pose a dilemma for the Otolaryngologist who may be asked to provide a specialist opinion.
Case: We present a case of a 73 year old female who developed mild stridor, hours after an emergency right sided hemiarthroplasty. On day 23 of her admission, there was a sudden airway deteoriation. The otolaryngology and anasthetic emergency team stablised her conservatively with an option of non invasive ventilation. Bilateral vocal cord palsy was observed on nasendoscopy On day 27, she was eventually diagnosed with MSA and showed partial response to a trial of madopar. Both options of a tracheostomy and laser cordotomy were avoided. She was safely discharged with follow up.

Conclusions
There remains gaps in the literature towards an unaminous consensus on stridor management in MSA patients. However, raising awareness of this patient groups will strenghten decision making processes.
962 COVID-19 And ST3 National Selection in Surgery: What Happens to Core Surgical Trainees When We Remove the Face-to-Face Interview?
Authors: Leiberman D , Trivedy M , Kausar A 
Published: May 2021

Abstract

Introduction
The 2020 ST3 recruitment year for Higher Surgical Training (HST) did not have a face-to-face interview due to COVID-19. Candidates were solely scored on portfolio self-assessment alone. We have assessed the impact on Core Surgical Trainee progression into ST3 by comparing the 2020 recruitment year with 2019.

Method
Total numbers of applicants to ST3 for all 7 surgical sub-specialties that recruit at ST3 level were obtained via Freedom of Information requests from Health Education England (HEE). These were sorted by those who were in CST, had completed CST or had an alternative equivalence certificate.

Results
Overall applicant numbers were up in 2020, mainly from an increase in applicants with a Certificate of Readiness to Enter Higher Surgical Training. Overall ST3 positions appointed to were down. CST progression rate was down slightly, with an increase in appointees &gt;10 years since graduation.

Conclusions
The 2020 recruitment year for ST3 HST had a higher number of applicants and lower places available than 2019. The majority of the extra applicants were trainees who have not completed CST in the UK. CST progression rate to HST was down slightly. The lack of face-to-face interview may benefit some candidates graduating &gt;10 years ago.
136 Intraoperative Neuromonitoring in Spinal Surgery: A Systematic Review and Meta-Analyses
Authors: Ang W W , Boutong S , Shetty N 
Published: May 2021

Abstract

Introduction
Intraoperative neuromonitoring (IONM) is widely used in spinal surgery as it has been shown to be highly sensitive and specific for detecting neurological injuries, although recent evidence has been conflicting in its cost-utility. The authors aim to determine whether the use of IONM during spinal surgeries significantly improves patient outcomes in terms of neurological events, and whether IONM is cost-effective.

Method
Literature search of studies looking at use of IONM for spinal surgeries from 2009 to 2020 was performed across several databases, following PRISMA guidelines. Quality of articles was assessed using MINORS criteria.

Results
The random effects model was used to evaluate the 5 studies comparing neurological events with and without IONM use. There was a higher incidence of neurological events without IONM, at 44 compared to 11 with IONM. However, pooled odds ratio was 0.56 (p = 0.11), indicating no significant difference. IONM was also found to be associated with longer operative times and costs, which is not cost-effective based on NICE recommendations.

Conclusions
- This study corroborate previous studies; there is no significant difference in patient outcome of neurological events with the use of IONM. There is, however, a higher incidence of neurological events without IONM.
436 Remote Surgical Education for Medical Students at UK Universities in the Time of COVID-19
Authors: Zaver V , Ahari D , Jayawardena P , Sayed Md A 
Published: May 2021

Abstract

Background
The novel coronavirus pandemic caused the cancellation of lectures and clinical placement-based education for medical students across the UK. With phased resumption of University teaching, remote delivery via online platforms has seen increased implementation to prevent overcrowding and comply with social distancing measures. This study explores the efficacy of a nationally delivered online surgical education programme to facilitate undergraduate surgical education.

Methods
An undergraduate surgical society in collaboration with two Core Surgical Trainees designed and organised an online surgical teaching programme. The syllabus was constructed in accordance with the Royal College of Surgeons England’s (RCSEng) National Undergraduate Curriculum in Surgery. Remote delivery was facilitated by Zoom (Zoom Video Communications, Inc.). Multiple-choice questionnaires were used to evaluate knowledge during the sessions and Likert scales were utilised to assess subjective improvement of knowledge.

Results
The average attendance for the lectures was 100. The average increase in correct answers between pre- and post-lecture multiple choice questions was +55.87% (+72.4, +18.6, +76.6). 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 to be adopted by other Universities to facilitate undergraduate surgical education.
16 Re-Do of Laparoscopic CBD Exploration Through Cystic Duct Remnant Following Laparoscopic Cholecystectomy; A Case Series
Authors: Jardine R , Abdelmabod A , Habib M , Ghazanfar M 
Published: May 2021

Abstract

Introduction
Common bile duct (CBD) stones are detected in approximately 10-15% of patients with gallstone disease. They can be formed in the absence of gallbladder stones or in patients who underwent previous cholecystectomy. Laparoscopic common bile duct exploration has been documented since 1999, with increasing evidence illustrating the effectiveness of the transcystic approach. There is no review of re-exploration of the CBD, due to retained stones, following laparoscopic cholecystectomy (LC) via this approach. Four cases are presented detailing need for initial intervention, and intra-operative findings.

Method
Review of four cases in 2020 in Aberdeen Royal Infirmary. Each underwent re-do laparoscopic transcystic common bile duct exploration for retained stone, following previous laparoscopic cholecystectomy.

Results
Each case had successful stone clearance and resolution of symptoms.

Conclusions
With increasing laparoscopic technology and surgical skill, re-exploration of the CBD following previous LC due to emergency surgical presentations should be performed. This is feasible and safe. We recommend the transcystic approach due to reduced morbidity and high success rates of stone extraction.
97 What Are the Main Delays to Surgery After A Patient Presents with An Acute Type A Aortic Dissection?
Authors: Surendran A , Bleetman D , Whitaker D 
Published: May 2021

Abstract

Introduction
Acute-aortic-dissection (AAD) represents a serious cardiovascular emergency, with an associated mortality of 1-2% per hour after symptom onset. It is known that the relative infrequency of AAD and plausible differentials can negatively impact on a timely diagnosis. Female sex, absence of typical features and high-risk examination findings (hypotension/pulse deficits) shown to delay diagnosis. In UK, services for AAD are centralised, working on established volume/outcome relationships. However, this has the potential to introduce delays in rapidly diagnosing patients without on-site specialist support and in the logistics of transferring patients across large distances. This study aims to report on time taken for patients to receive surgery after first presentation at local hospital and identify points that contribute to maximal delay.

Method
Retrospective analysis of all operated type-A-aortic-dissections at our hospital in 2019. Hospital database used to identify patients, and local/referring hospital documentation reviewed to establish times.

Results
Mean time from A&E presentation to surgery is 8-hours-and-30 minutes (4:16–13:43). Largest contributor to delay is time from A&E admission to CT scan.

Conclusions
Our findings suggest greatest impact on improving times from presentation to surgery is to increase awareness of AAD in regional, non-specialist hospitals and to encourage rapid imaging.
160 Applying the Free Energy Principle to Surgical Robotics
Authors: Asad S Al , Khan S , Friston K 
Published: May 2021

Abstract

Introduction
In an effort to build intelligent, autonomous systems, robotics has repeatedly used neuroscience as a source of inspiration for perception and control. This corresponds well with advances in neuroscience, particularly the free energy principle; a unified theory of the brain, integrating together notions of action, perception, and learning. Crucially for robotics, it provides a simple recipe to synthesise autonomous agents under the framework of active inference.

Method
We conducted a literature search assessing the practicality of autonomous agency within surgical robotics, and to understand the potential of applying the free energy principle to surgical robotics in a bid to optimise locomotion, spatial awareness, planning, and artificial curiosity.

Results
Numerous real-life examples demonstrate the feasibility of applying bayesian inference to humanoid robotics. Here we demonstrate a similar approach to adapting surgical robotics through the representation of sensory data through a probability density function over a group of unknown variables. In this manner, surgical robotics will be able to utilise sensory signals and can provide different weights to sensory cues, thereby efficiently integrating sensory input over space and time.

Conclusions
The free energy principle may be applied to surgical robotics to provide additional feedback, and control to improve patient prognosis.
352 A Retrospective Audit to Determine the Appropriateness of Antibiotic Use in Surgical Patients in MKUH
Authors: Stone H , Khanna A , Keeler B 
Published: May 2021

Abstract

Introduction
This audit’s aim is to determine the appropriateness of antibiotics dispensed in Emergency Surgery Clinic (ESC) for a two-month period in 2020. Antibiotic stewardship promotes appropriate antibiotic use in clinical settings whilst limiting unnecessary use. Appropriate antibiotic use is important in reducing the risk of antibiotic resistance.

Method
We extracted the following details from 801 patients’ electronic notes who attended MKUH ESC: diagnosis, prescription of antibiotics, hospital admission, and re-attendance at the ESC. Prescriptions were analysed as to whether they were in accordance with our microbiology guidelines. Patients were analysed as a collective and within diagnosis sub-specialities (appendicitis, wound infection, gallstones/cholecystitis, testicular pathology, UTI, diverticulitis, renal stones and abscesses).

Results
218 (27%) patients were given antibiotics, 180 (22%) patients re-attended ESC and 111 (14%) were admitted. Only 77 patients (35%) receiving antibiotics were prescribed appropriately. Outcomes also varied by diagnosis. All patients presenting with UTI (n = 15) were treated correctly. In contrast, only 71% of patients with renal stones (n = 68) were incorrectly treated with antibiotics.

Conclusions
Two-thirds of patients receiving antibiotics were inappropriately prescribed. This together with the variation by diagnosis would suggest further measures be introduced to support antibiotic stewardship and mitigate the risk of antibiotic resistance.