bluuebunny/crossref_metadata_2025_split huggingface dataset:
665 Surgical teaching in times of COVID-19 - The Forth Valley Royal Hospital Experience
Authors: Dearie L , McGivern K , Wilson M 
Published: May 2021

Abstract

Introduction
The COVID-19 pandemic has threatened all aspects of society. Medical education has not been immune to this. Clinical educators have had to enact creative solutions to ensure continued departmental learning and development. We describe our experience in the General Surgery department of a District General Hospital of transitioning to webinar-based teaching.

Method
7 tutorials were delivered virtually from April-May 2020. A database was created to store presentations alongside supporting material. An online questionnaire canvassed attendee responses (n = 28) to individual teaching sessions and the methodology of the teaching.

Results
71% of staff responded. 100% of respondents were “very,” or “extremely,” satisfied with the quality of teaching. 79% thought remote access encouraged attendance. Attendance rose from 45-65% to 60-75% through the use of the learning database. 92% wanted this teaching methodology to continue.
Specific reference was made in free text responses to the quality, convenience, and utility of the learning database. Maintenance of responsible social distancing was also given as a positive aspect of this teaching method.

Conclusions
We report a successful transition from traditional teaching to a virtual platform as a result of COVID-19 restrictions. Our experience is that high quality teaching can be delivered virtually while encouraging attendance and maintaining social distancing.
667 Virtual Learning During The COVID-19 Pandemic Amongst Medical Students in The United Kingdom
Authors: Jayawardena O , Toh S , Fowler H , Fok M , Clifford R 
Published: May 2021

Abstract

Introduction
Throughout the COVID-19 pandemic medical education has predominantly been delivered through virtual learning (VL). This survey was conducted to evaluate the effectiveness of VL amongst medical students in the UK.

Method
An online anonymised SurveyMonkey© survey was distributed through social media amongst UK medical students.

Results
There were 142 completed surveys, 96.5% of students engaged in some form of VL during the pandemic, compared to 57.8% prior to the pandemic. The most frequently used method to deliver teaching was interactive online lectures (74.7%). The students perceived small group online teaching sessions to be the most effective delivery method (weighted average 7.4/10) followed by interactive online lectures (7.4/10). The least effective teaching method was online lecture notes (5.3/10).
Accessibility to coursework (8.6/10) and enhanced flexibility (8.4/10) were considered to be the biggest advantages of VL. Overall, 44% of students felt VL had a negative impact on their learning, with 23% of students considered to have failed to meet the learning objectives set out in these sessions.

Conclusions
Beyond the COVID-19 pandemic VL will continue to play a role in medical education. However, there is room for improvement in both delivery and engagement to improve student experience and satisfaction.
681 How Much Can Medical Students Benefit from A Student-Led Surgical Mentorship Scheme?
Authors: Ghazal-Aswad K , Hamakarim T , Pook C , Iyer P , Kum F 
Published: May 2021

Abstract

Introduction
Mentorship programmes enable students to explore different specialties, observe surgeries and participate in audits, whilst helping trainees develop leadership and teaching skills. We developed such a scheme and asked participants to fill out several questionnaires, to assess its benefits and restrictions.

Method
We set up a student-led mentorship scheme, pairing 54 medical students with surgeons around London. Students completed questionnaires before, during and after the scheme and mentors completed a post-mentorship scheme feedback questionnaire, with the purpose of measuring the participants’ experience on Likert scales from 1 to 5. Quantitative data analysis was performed to assess trends.

Results
In the cohort of students who answered all three questionnaires (n = 34) the biggest improvements seen over the duration of the scheme were ‘exposure to surgery so far in medical school’ and ‘understanding the steps required to improve a surgical portfolio’, with mean values increasing by 1.653 and 1.733, respectively. The main challenges faced were mainly related to time restraints and communication issues.

Conclusions
Mentors and mentees can both benefit from a mentorship scheme, but certain variables, such as time constraints and goal-setting, need to be clearly established for both parties. In the future, the scheme would benefit from more guidance and stricter ruling.
687 The Effectiveness of a Two-Day Conference in Improving Plastic Surgery Knowledge and Skills of Medical Students and Junior Doctors
Authors: Dawidziuk A , Ngadimin C , Kwasnicki R , Jallali N 
Published: May 2021

Abstract

Introduction
Reconstructing the Stereotype is a student-led conference organised by Imperial College Plastic, Reconstructive and Aesthetic Surgery Society providing holistic outlook on plastic surgery with lectures, tutorials, and practical workshops. The aim of this event-evaluation study was to assess the effectiveness of the conference in improving reported knowledge, skills and awareness of the specialty.

Method
25 delegates (21 medical students, 4 junior doctors; mean age 23.2 years; 14 women) volunteered to complete pre- and post-intervention online questionnaires comprising 26 five-step Likert scale questions on knowledge, skills, and career in plastic surgery. Significance of comparisons was established with Wilcoxon signed-rank test using IBM SPSS V26 (p &lt; 0.05).

Results
Post-conference, there was a significant increase in participants’ self-ratings across all domains investigated (p-values 0.000-0.001). Understanding of the reconstructive ladder showed largest improvement in knowledge (mean±SD: 1.96±1.27 vs 3.80±1.08), performing Z-pasty in skills (1.72±1.17 vs 3.72±1.06) and portfolio development in career category (2.28±1.17 vs 4.08±1.04). Two more participants declared considering career in plastic surgery after the conference.

Conclusions
A two-day student-organised conference significantly improved plastic surgery knowledge and skills of medical students and junior doctors. It also provided them with a realistic idea of what a career in the specialty entails.
771 Shaping the Virtual Learning Environment: Emojis As A Novel Feedback Modality for Content Delivery in Postgraduate Medical Education
Authors: Rajdev K , Watts E , Eastwood M , Goh S , Ahmed U , Bowyer D 
Published: May 2021

Abstract

Introduction
Postgraduate medical education in the wake of a pandemic has sparked creativity, evolving novel platforms concordant with socially distanced learning. Inevitably, evaluation is critical in navigating improvements in content delivery. However, as culture continues to shift away from didactic teaching, students are at risk of ‘feedback overload’. We propose a novel emoji scale to facilitate rapid appraisal.

Method
A three-point emoji scale was developed within the novel virtual learning environment for core surgical training in the West Midlands. Engagement with the emoji system was assessed and correlated with conventional post-course questionnaires.

Results
The novel emoji system provided a rapid mechanism for trainees to express opinion on individual modules immediately following completion. Parallels to social media meant this modality felt familiar to trainees. Simplification of feedback permitted prompt, targeted review of modules for improvement, as opposed to laborious collection and analysis of standard post-course questionnaires. Literature review revealed limited research regarding similar emoji-based responses, or the validity of Likert or free-text based feedback systems.

Conclusion
As virtual learning evolves following COVID-19, feedback systems help guide evolution. Emoji-based feedback may provide the key to prompt, accessible evaluation of VLE platforms.
930 Impact of the COVID-19 Pandemic on Higher General Surgical Training – A West of Scotland Experience
Authors: Khan K S , McLellan M , Galbraith N J , Lannigan A , Mahmud S , Stewart B 
Published: May 2021

Abstract

Introduction
COVID-19 pandemic has caused significant disruption in all aspects of training. Our aim was to explore the degree of impact caused by the pandemic on higher general surgical trainees.

Method
All higher general surgical trainees in a single UK deanery were invited to participate in an online, voluntary, anonymous survey via SurveyMonkey.

Results
64 (72.7%) of the trainees responded. 39.1% were ST3/4, 29.7% were ST5/6, 20.3% were ST7/8 and 10.9% were out of training (maternity & research). Thirty-five (55.6%) worked in district general hospitals. Forty (68.9%) trainees felt that they had fewer opportunities to be primary surgeon. Forty-two (67.7%) trainees did not have access to laparoscopic simulation trainers. Fifty-two (88.1%) trainees had their courses and 2 (3.4%) had their FRCS part 2 exam postponed. 16 (27.1%) trainees reported they had been off-sick, with a median of 7 days off (range 3-35 days). Thirty-three (55.9%) trainees felt more stressed due to the pandemic and 35 (59.4%) had symptoms of burnout.

Conclusions
The COVID-19 pandemic has had an unprecedented impact on all aspects of higher surgical training. The most noticeable impact has been on the reduction in the confidence in laparoscopic and endoscopic skills.
940 Mesenteric Haematoma Complicated by A Perforated Sigmoid Diverticulum Following Extracorporeal Shockwave Lithotripsy
Authors: Sorooshian P , Luangsomboon A , Al-Robaie B 
Published: May 2021

Abstract
A 78 year old female presented with sudden onset lower abdominal pain, vomiting and fresh rectal bleeding. She had undergone extracorporeal shockwave lithotripsy (ECSL) for a left renal stone two weeks earlier and was taking Rivaroxaban for atrial fibrillation. A CT Abdomen & Pelvis revealed a large mesenteric haematoma and a contained sigmoid perforation secondary to compressive forces of the haematoma on the sigmoid artery, resulting in ischaemia. While mesenteric angiogram-guided embolisation initially controlled the active sigmoid artery bleed, the patient clinically deteriorated the following day warranting a laparotomy. This revealed an ischaemic sigmoid colon with contained faeculent material within the mesentery. An extended left hemi-colectomy with end-colostomy was performed. Despite optimal critical care input, the patient developed multi-organ failure and passed away one week later. Mesenteric haematoma should be considered as a rare complication in patients with sudden onset abdominal pain following ECSL; especially with concurrent anti-coagulation use.
165 A Review of The Current Literature on LMWH Administered at Different Times in Relation to MOS (Major Orthopaedic Surgery): Assessment of The Safety and Efficacy of The Different Proposed Strategies
Authors: Placella G , Pace V , Antinolfi P , Salini V 
Published: May 2021

Abstract
Nowadays venous VTE represents an important perioperative and postoperative complication in patients undergoing elective Major Orthopedic Surgery (MOS). There are significant discrepancies between clinical practice, international recommendations, and published guidelines. Although thromboembolic events may be less common these days than in the past, they can still lead to serious medical complications. Therefore, most patients undergoing MOS procedures are provided with one of the thromboprophylactic treatments. The optimum timing of LMWH administrations remains debated.
Customized structured electronic searches in PubMed and Cochrane database. Meta-Analysis, Randomized Controlled Trials, Systematic Reviews on different strategies of the use of LMWH for MOS.
Studies on prophylactic regimens showed that subcutaneous LMWH plays a key role in the management of thromboprophylaxis in MOS. However, some controversies still stand. Among those most relevant, it remains unclear whether to start thromboprophylaxis before or after MOS to better balance the risks of clotting and bleeding.
With regards to different times of LMWH administration, there is no convincing evidence that starting prophylaxis 12 hours preoperatively is associated with lower risks of VTE compared to prophylaxis started 12 to 24 hours postoperatively. Furthermore, it seems that the most safe and efficient LMWH regimen is the one called “Just-in-time” (LMWH started 6 hours post-op).
295 Radiotherapy for Curative-intent Metastatic Rectal Cancer: A Systematic Review and Meta-Analysis
Authors: Nistala K R Y , Yeo J W , Ow Z G W , Ng C H , Law J H , Wong K Y , Soon Y Y , Chong C S 
Published: May 2021

Abstract

Introduction
The role and optimal regimen of radiotherapy in curative-intent treatment of metastatic rectal cancer is unclear and hence a single arm meta-analysis was performed.

Method
Medline, Embase and Cochrane Library databases were searched up to 16 May 2020. A Meta-analysis of binomial data was performed using a Freeman-Tukey double arcsine transformation, and pooled estimates were used to construct risk ratios and confidence intervals via the Katz-logarithmic method. Additionally, comparative meta-analysis was performed with the Mantel Haenszel model.

Results
18 studies were included. Rectal pathological complete response (pCR) was observed in 14% of tumours treated with radiotherapy (n = 57/388, CI 0.07 to 0.23). Comparative meta-analysis of cohort studies showed that treatment regimens including radiotherapy were associated with higher pT1 tumour and better oncological outcomes compared to regimens without radiotherapy. Katz-logarithmic method showed that neoadjuvant radiotherapy had a higher proportion of pN0 staging (RR = 1.81, 95% CI 1.06 to 3.09, p = 0.029) and better oncological outcomes compared to adjuvant radiotherapy, and that short course radiotherapy (SCRT) had a lower proportion of pT3 tumours (RR = 0.778, 95% CI 0.609 to 0.994, p = 0.044) and similar oncological outcomes compared to long course radiotherapy (LCRT).

Conclusions
This study supports the evidence that radiotherapy should be used in curative intent metastatic rectal cancer.
169 Literature Review on Efficacy of Manual Therapy in The Conservative Treatment of Adolescent Idiopathic Scoliosis (AIS)
Authors: De Larrea E A , Pace V , Caraffa A , Rinonapoli G 
Published: May 2021

Abstract
AIS is a common condition whose conservative options usually involve physical therapy. Manual therapy can be part of an adequate conservative strategy due to his ability to improve range of motion and decrease muscle tone and pain. However, his indications and efficacy remain controversial. What is the current evidence on indications and efficacy of manual therapy in the treatment of AIS?
Customized structured electronic searches: PubMed, Cochrane. Key terms: AIS manual therapy, AIS manipulative therapy, AIS mobilization exercises. 17 works included.
5 case reports, 3 case series, 2 group-control studies, 3 narrative reviews, 4 systematic reviews. Complications:0. Reviews suggested that manual therapy is a promising option if in adjunct to physical therapy exercises. Prevention of curve progression and better spine flexibility are often achieved. It remains unclear whether this should be attributed to physical therapy, manual therapy, or combination of both. Lacks in methodology leave room for uncertainty.
Only few papers analyse the indications and efficacy of manual therapy in treatment of AIS. The current evidence suggest that manual therapy is a promising beneficial treatment strategy for AIS with conservative indications, especially if in conjunction with physical therapy. This is further supported by absence of reported complications. Further research with better methodology is needed.
337 Barriers to Laparoscopic Surgical Training for Abdominal Conditions in Low- and Middle-Income Countries (LMICS): A Systematic Review
Authors: Wilkinson E , Aruparayil N , Gnanaraj J , Jayne D 
Published: May 2021

Abstract

Introduction
Resource-deprived low-and-middle-income countries (LMICs) can benefit from the reduced perioperative morbidity of laparoscopic surgery. However, utilisation is low, partly due to paucity of appropriately trained staff. This study aims to explore the barriers to the training of healthcare professionals in laparoscopic techniques in LMICs.

Method
Medline, Embase, Global Health and Web of Science databases were searched, using the key terms ‘LMIC’, ‘Laparoscopy’ and ‘Training’. Eligible papers were in English, focused on abdominal laparoscopy and addressed barriers to training qualified health professionals. Papers focusing on advanced surgeries, paediatrics, and training in high-income countries were excluded. PRISMA guidelines for systematic reviews were followed.

Results
Funding was the first of seven key barriers identified, but feasible low-cost methods have been developed in some settings. Equipment limitations and lack of local trainers were highlighted, and expatriates may provide limited quality training opportunities. Stakeholder dynamics can create barriers, as can lack of knowledge on effective training curricula. Surgical departmental structure can limit the practical opportunities of trainees.

Conclusions
Themes are apparent across LMICs, but local factors reduce their generalisability, highlighting the need for larger-scale studies focusing on specific barriers. National investment in training programmes with research-backed curriculums and increased availability of local trainers and equipment is needed.
452 Exploring the Merits and Availability of Smartphone Applications Related to Bariatric Surgery
Authors: Kabbani J , Kabbani J 
Published: May 2021

Abstract

Introduction
Smartphone applications transcend healthcare specialties, with applications related to bariatric surgery widely available on mainstream application stores. We reviewed published literature regarding bariatric surgery-related applications, and the number and types of applications available for download.

Method
A literature search of “bariatric surgery” and “smartphone” was used to find publications assessing such applications. “Bariatric surgery” was searched in Apple’s (iOS) “App Store” and Google’s “Google Play” to analyse application purposes, pricing, and ratings.

Results
22 articles explored smartphone usage in relation to bariatric surgery, describing benefits to patient self-management and wellbeing. However, concerns include a perceived lack of involvement of healthcare professionals in application development, and further investigation of application benefits to diet prior to bariatric surgery is needed. Searches on the App Store and Google Play identified 33 and 250 apps respectively. 85% of iOS results were categorised as clinical and weight management tools, 9% as educational, and 6% as recreational. The corresponding figures for Google Play were 60%, 6%, and 34%.

Conclusions
The results demonstrate the widespread availability of applications related to bariatric surgery aftercare, particularly for patient support. Input from healthcare professionals during application development, and assessment of impacts on physical outcomes, are important aspects to consider.
622 Potential Application of Electrocardiographs (ECG) to Diagnose Breech Presentations of Fetuses
Authors: Murugan R , Hastie C , Narayanan N , Wong S 
Published: May 2021

Abstract
Breech presentation, i.e. the abnormal lie of a foetus longitudinally with the buttocks closest to the mother’s cervix, is a common issue affecting up to 5% of women during delivery resulting in poor outcomes such as traumatic labour, infection and increased neonatal mortality.
Currently, abdominal palpation is the screening method of choice for breech presentation; however, 15,000 breech presentations remain undiagnosed across England annually. While routine ultrasonography has been suggested, its cost-effectiveness and scalability remain concerning, especially in low/middle-income countries.
Various algorithms have been applied to maternal trans-abdominal ECGs to obtain foetal ECGs, but current applications only allow heart rates, congenital heart defects, hypoxia, and foetal distress to be identified. The use of ECG is proposed to determine foetal position as breech foetuses tend to display QRS complexes in a similar pattern to the maternal trace, whereas cephalic foetuses would demonstrate inverted QRS complexes.
ECGs are cost-effective, safe and do not require highly skilled technicians to operate, which makes it an ideal starting platform for the development of a device with high sensitivity and reasonable diagnostic speeds to identify breech foetuses. Future considerations include the use of artificial intelligence to increase diagnostic accuracy and development of a patient-facing mobile application.
710 A Novel Ventriculoperitoneal Shunt Design Aiming to Reduce Shunt Failure Rates
Authors: McColm L , Asbalaili E E , Khandakar T , Razak N A , Yuyi A T , Yau J D 
Published: May 2021

Abstract

Introduction
Ventriculoperitoneal (VP) shunt insertion is the most common surgical treatment for hydrocephalus. While shunt obstructions are frequent and subsequent revision operations carry significant morbidity, there is limited advancement in shunt design to address this problem.

Method
A literature review of aetiology and mechanism of shunt blockage was performed. Design concepts of current medical and non-medical grade devices were studied. Design improvements to VP shunt were focused on the proximal catheter and lumen configuration. Concept dimensions and computer flow simulations using different diameters were generated.

Results
An improved prototype VP shunt design was proposed. It has multiple lumens and communicating channels between neighbouring lumens to provide alternative routes for cerebrospinal fluid drainage in the event of individual lumen obstruction. Our design also features a novel cone-shaped proximal end to minimise occlusion by nearby choroid plexus.

Conclusions
By targeting common causes of VP shunt blockage through proposed novel design, the mean service-life of shunts can be extended, necessitating fewer revision procedures and reducing both patient health and financial burdens. Further investigation, optimisation, and validation of this proposed shunt design is required before further product development.
920 Long Term Outcomes After Resection of A 'Normal' Appendix
Authors: Hammett F , Ali S , Adair R , Peter M , Dobbins B , Saha A 
Published: May 2021

Abstract

Introduction
Recent studies have suggested that there should be diagnostic confirmation of appendicitis prior to surgical resection to reduce the rate of negative (normal) appendicectomy. There are few long-term analyses of morbidity after negative appendicectomy.

Method
All appendicectomy specimens removed for suspected appendicitis from June 2010 to August 2015 at a single-centre surgical unit were identified. Patients with a histologically 'normal' appendix were analysed. Demographics, pre-operative and operative details and post-operative outcomes (Clavien-Dindo system) were recorded. Minimum follow-up was 5 years.

Results
There were 1977 patients. Most (1938 patients, 98%) had a laparoscopic procedure. There were 241 normal specimens (12.1%); none of these patients had pre-operative CT imaging. Thirty-two patients had at least one re-admission in the 5 years after surgery; 12 of these patients had multiple re-admissions (range, 2-5 re-admissions). 22 patients (69%) had a re-admission within 30 days after primary surgery. 4 patients (&lt;1%) required further surgery and mortality was 0%. 6 patients (2%) had a Grade III complication, and none had a Grade IV complication.

Conclusions
There was low long-term morbidity after negative appendicectomy in this study. The cost of confirming a normal diagnosis by way of mandatory pre-operative CT does not represent a cost-effective method of management.