bluuebunny/crossref_metadata_2025_split huggingface dataset:
694 The Impact Of COVID-19 On Trauma Referrals to a National Neurosurgical Centre
Authors: Horan J , Duddy J , Gilmartin B , Nolan D , Corr P , Husien M B , Bolger C 
Published: May 2021

Abstract

Objective
To investigate the impact of COVID-19 on trauma referrals to a National Neurosurgical Centre.

Method
Retrospective analysis of a prospectively maintained database of all trauma referrals to the National Neurosurgical Centre at Beaumont Hospital, during the period March 1st – May 31st, 2019 and 2020. Patient characteristics including age, sex, alcohol use, anticoagulant/antiplatelet use and initial Glasgow Coma Scale were recorded. Patients were grouped by trauma aetiology and diagnosis.

Results
There were 527 and 437 trauma referrals in 2019 and 2020, respectively. Overall, there was a 17.1% reduction in trauma referrals between years. Traumatic brain injury, spinal injury and cranial fractures referrals reduced 25% (375 vs 283), 59% (32 vs 13) and 18% (39 vs 32) respectively from 2019 to 2020. Low energy falls below 2 metres were the most common mechanism of injury and accounted for 60 and 61% of referrals in 2019 and 2020. No reduction in road traffic collision (33 vs 34) and assault (40 vs 40) referrals were observed between years.

Conclusions
COVID-19 has had a significant impact on the volume and mechanism of trauma referrals to the National Neurosurgical Centre in Ireland, with falls below 2 metres the most common mechanism of trauma referral across both years.
709 Covid-19 Pandemic: Audit on The Management of Acute Cholecystitis
Authors: Asarbakhsh M , Lazarus N , Lykoudis P 
Published: May 2021

Abstract

Background
The definitive management of acute cholecystitis is laparoscopic cholecystectomy on the same admission if the patient is fit. As the Covid-19 pandemic emerged, evidence suggested adverse outcomes for asymptomatic Covid positive patients undergoing surgery, including increased mortality risk. Risks to theatre staff were also highlighted. This prompted changes in acute cholecystitis management guidelines.

Method
The audit aim was to assess the impact of guideline change on clinical outcomes and readmission rate for acute cholecystitis. The revised Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS) guidelines were the gold standard. All inpatient admissions for acute cholecystitis during the 4-week peak of the pandemic (17/04/2020 – 14/05/2020) were included.

Result

24 patients were admitted with acute cholecystitis. 10 patients (41.7%) were managed with antibiotics alone, 4 patients (16.6%) underwent cholecystostomy. 12 patients (50%) were discharged within 3 days. Lack of clinical progress/ongoing symptoms was the indication for laparoscopic cholecystectomy in 5 cases (20.8%). 5 conservatively managed patients (20.8%) were readmitted with ongoing cholecystitis or pancreatitis.

Conclusions
19 patients (80%) were managed non-surgically in accordance with AUGIS guidelines. However conservative management was not always appropriate. We recommend that laparoscopic cholecystectomy should remain a management option for acute cholecystitis during the ongoing Covid-19 pandemic.
755 Elective Surgery in the COVID-19 Pandemic: Outcomes of 100 Consecutive Cases
Authors: Fisher R , Hadjittofi C , Ali Z , Antonas P , Parekh K , Seraj S , Thomas L , Uddin A , Lovett B 
Published: May 2021

Abstract

Introduction
The COVID-19 pandemic halted elective surgical activity. Basildon University Hospital established an elective Green Zone for COVID-19 swab negative patients who isolated for 14 days. This study reviewed the outcomes of the first 100 patients.

Method
A single-centre study was performed. Demographic and perioperative electronic data were supplemented with telephone follow-up for the first 100 Green Zone patients and analysed in Microsoft Excel.

Results
One hundred Green Zone patients underwent surgery between 21/05/2020 and 16/06/2020. The median age was 55 (14-88) years. 52% were female. Their operations were performed by General Surgery (39%), Gynaecology (17%), Vascular Surgery (14%), Oral Surgery (12%), ENT (9%), Urology (8%), and Pain Management (1%).
Preoperatively, 100% had a negative SARS-CoV-2 swab and one had CT evidence of mild resolving COVID-19. Two patients had postoperative SARS-CoV-2 swabs, both negative. Median length of stay was 0 (0-7) days. 84% responded to telephone follow-up at a median 25 (13-54) postoperative days, 69% of whom were asymptomatic There were no 30-day major complications (&gt;Clavien-Dindo IIIa) or 90-day mortality.

Conclusions
Elective surgery can be safe during the COVID-19 pandemic, with appropriate measures in place. This has significant implications in the context of an ever-expanding NHS waiting list during a pandemic of uncertain duration.
822 Lessons Learnt During the COVID-19 Pandemic on Emergency Surgical Admissions in A District General Hospital
Authors: Ahn K , Khan N , Desai N , Abdu M , Hiddema L , Odogwu S , Cheetham M , Pande R 
Published: May 2021

Abstract

Introduction
Coronavirus disease (COVID-19) is an acute severe respiratory distress syndrome which resulted in an unprecedented impact on NHS service provision. We aimed to assess the impact of COVID-19 on general surgical services in a district general hospital.

Method
Electronic health care record data was retrospectively collected from 6th of April to 6th of May for both 2019 and 2020.

Results
Despite fewer referrals and admissions in 2020 (133 vs 177 admissions in 2019), there were more failed discharges (29 vs 17 in 2019) and higher associated costs. Higher numbers of biliary related pathologies and pancreatitis (50 in 2020 vs 25 in 2019), and fewer complaints of non-specific abdominal pain (10 in 2020 vs 22 in 2019) were observed. The use of outpatient investigations decreased by approximately 40% in 2020; however, utilisation of inpatient investigations was comparable.

Conclusions
Better utilisation of outpatient investigations and virtual clinic services may surmount pressures from further peaks of COVID-19. The increase in biliary related cases and pancreatitis may be consequent upon lifestyle changes during lockdown. This merits further investigation and if appropriate, public health intervention. In the absence of an efficacious vaccine, further research would be essential to streamline general surgical services based on clinical risk stratification.
828 Is Isolation Before Elective Surgery the Way Forward During The COVID-19 Pandemic?
Authors: James S , Lafaurie G , Hafeez R 
Published: May 2021

Abstract

Introduction
The COVID-19 pandemic is here to last, and services must adapt to enable elective surgery to continue. Surgery involves high-risk aerosol generating procedures, potentially harmful to staff and patients. The current NICE guidance is for the patient to self-isolate for 72 hours prior to surgery. A question persists: Is 72-hour isolation the way forward in elective general surgery?

Method
In a DGH centre, using an anonymous questionnaire, we prospectively collected data on isolation for 36 elective general surgery patients during the 72h isolation period. The data was analysed to assess the concordance with isolation as well as patient's satisfaction with the process.

Results
75% of patients were concordant with 72 hours of isolation pre-operatively. This was an increase from 35% when compared to patients questioned during the 14 day isolation period. The main factors contributing to isolation breech were visitors to the house and the mode of transport used to attend hospital.

Conclusions
The protocol is now for a COVID swab 72 hours pre-operatively followed by isolation until the operation. Our results show that still significant breaches in isolation remain and patients welfare is adversely affected during that period. Further research and consideration is needed to optimise the COVID isolation protocol.
841 The psychological impact of Foundation Interim Year 1 Placements on Final Year UK Medical Students Transitioning to Foundation Year One During the COVID Era
Authors: Durand-Hill M , Ike D I , Nijhawan A N , Shah A B , Dawson A , Awad W I 
Published: May 2021

Abstract

Introduction
During the COVID pandemic, the 2019-2020 cohort of final year students were invited to participate in Foundation interim Year 1 placements (FiY1). FiY1 aimed to ease transition to Foundation Year 1 doctor (FY1). We assessed the psychological impact of FiY1 on final year medical students.

Method
A cross-sectional survey was distributed to final year medical students in the UK between June 4th and July 4th, 2020. The survey contained the following domains: participant demographics, rationale for FiY1 participation, a checklist of the key safety principles for FiY1s, the Hospital Anxiety and Depression Scale and the Perceived Stress scale-4.

Results
107 final years responded to the survey. 72.0% (n = 77) of final year students surveyed were working as FiY1s. Final year students participating in FiY1 postings had reduced rates of anxiety (29.9% vs 43.4%, P = 0.186), depression (5.2% vs 20.0%, P = 0.018) and lower perceived stress levels (5.0 vs 7.2, P &lt; 0.001). 19.5% (15/77) FiY1s reported working beyond their competency, 27.3% (22/77) felt unsupervised, but 94.8% (73/77) of FiY1s felt the post prepared them for FY1.

Conclusions
Students participating in FiY1 postings felt less stressed and depressed than those not participating in the scheme and the majority felt it was preparing them for FY1.
984 Hospital Transmission of COVID-19 in Trauma Surgery
Authors: Emerson H 
Published: May 2021

Abstract

Introduction
A single-site retrospective study identified a suspected cluster of hospital-acquired COVID-19 in trauma patients. The study aims to identify contributing factors in order to minimise future risk to patients and staff.

Method
A single-site retrospective cohort study including all T&O patients who underwent surgery with confirmed peri-operative COVID-19 infection. The primary outcome was 30-day mortality. Exposures investigated included diagnostic timing and theatre designation.

Results
92% of participants were not tested pre-operatively. 75% met the criteria for hospital acquired COVID-19. Only 2 patients were operated on in designated COVID-19 theatres. Two lists accounted for 50% of the T&O COVID-positive patients. Remaining patients on both lists were discharged without further testing. Local 30-day mortality rate (25%) was in line with the findings of the international COVIDSurg Study (23.8%). No further COVID-positive T&O cases identified since the introduction of blanket admission swabbing.

Conclusions
The majority of patients did not meet criteria for pre-operative testing. Thus, were not operated on in appropriately designated theatres despite unknown COVID status, increasing risk of cross-contamination. Complacency due to designation of “clean” and “dirty” wards, atypical presentation and bay nursing may have contributed to hospital transmission. Findings emphasise the importance of treating patients as COVID positive until proven otherwise.
21 Suture School: A Socially Distanced Surgical Education
Authors: Galloway R , Amar H , Panchalingham V 
Published: May 2021

Abstract

Introduction
Limited theatre exposure, cancelled practical teaching and placements abandoned due to COVID-19, has potential to damage the learning opportunities and experiences of medical students within surgery. We aimed to create and deliver an emergency small group teaching programme throughout the pandemic, targeted at increasing medical student confidence in basic surgical skills and inspiring interest in surgery.

Method
Multiple small-group teaching sessions were delivered to a cohort of 14 medical students recruited for work during the pandemic, whilst adhering to social distancing and sanitary measures. On completion of the programme and informal assessment of 11 surgical competencies, participants completed a follow up questionnaire to assess their improvement.

Results
70% reported improvement in 10 competencies and 30% across all 11 competencies. The greatest improvements were in abscess drainage and knot tying. 30% relayed increased interest in pursuing a surgical career. 80% were ‘more likely’ to attend theatres in future.

Conclusions
The teaching series facilitated increase in self-perceived confidence of students in basic surgical skills, whilst inspiring surgical interests. During challenging times, we must support learners to undertake activity that drives improvement in training for the wider benefit of health services. Innovative teaching programmes may reduce the impact of similar adversity in the future.
133 Neurosurgery Education in The Medical School Curriculum: A Scoping Review
Authors: Lee K S , Zhang J J Y , Alamri A , Chari A 
Published: May 2021

Abstract

Introduction
Worldwide, there is no specific medical school curriculum in neurosurgery despite a high burden of neurosurgical disease that is often assessed, investigated and managed by generalists. This scoping review was carried out to map available evidence pertaining to the provision of neurosurgery education in the medical school curriculum across the world.

Method
This review was conducted in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews.

Results
Ten studies were included. Six were from the United Kingdom, two from the United States, and one each from Canada and Ireland. Two studies evaluated perceptions of both medical students and practicing clinicians, five studies evaluated the perceptions of medical students and three studies reported perceptions of clinicians only. Three main themes were identified. Neurosurgery was perceived as an important part of the general medical student curriculum. Exposure to neurosurgery teaching was varied but when received, deemed useful and students were keen to receive more. Interest in a neurosurgical career amongst medical students was high.

Conclusions
There is a lack of a specialty-specific medical school curriculum and variability of medical students’ exposure to neurosurgery teaching exists. Our findings highlight the need to systematically assess specialty-specific teaching and determine adequacy.
189 Preliminary Results from an Innovative Surgical Research Group for Medical Students
Authors: Ng C H , Chin Y H , Nistala K R Y , Jain S R , Ow Z G W , Wong N W , Tham H Y , Lim W H , Chong C S 
Published: May 2021

Abstract

Introduction
Learning research in medical school can be daunting and difficult with many lacking appropriate guidance. Particularly, research in surgery can be difficult with most clinicians tied to long hours from clinical duties, leaving medical students lost to learn the ropes for medical research.

Method
We started a surgical research group in January of 2020 under a shepherd sheep model. Shepards were senior medical students who had previous experience in research and were provided resources from consultants on statistics and research designs. Thereafter, each Shepard were paired with junior medical students (sheep) and a resident to provide clinical background. Research was then carried out small teams with minimal guidance from consultants.

Results
To date, the group has published 11 articles (median impact factor: 2.41, range: 1.89 - 3.42), 3 articles in revision and 9 articles in review.

Conclusions
We provide preliminary evidence of a successful model for building medical student research in surgery. While current analysis was limited to meta-analysis and systematic review due to the availability of data, current expansion is currently underway to expand to observational studies.
379 The Critical Care Experience of Irish Surgical Non-Consultant Hospital Doctors, Are We Equipped to Assist During the Covid-19 Outbreak and Beyond?
Authors: Burke E , Balfe P 
Published: May 2021

Abstract

Introduction
The ongoing COVID-19 pandemic has presented unforeseen threats and stresses to healthcare systems around the world, most notably in the ability to provide critical care.

Aim
To assess surgical NCHD experience in providing critical care and working in an intensive care environment.

Method
An electronic survey was distributed amongst surgical trainees and then amongst individual surgical departments. Ten questions were included in the survey assessing the NCHD’s experience with aspects of critical care.

Results
39 respondents including 16 specialist registrars, 3 senior registrars, 11 registrars and 9 senior house officers. 18% of respondents had previous experience in anaesthetics or intensive care. 23% self-reported being competent in performing endotracheal intubation. 15% self-reported being competent in the use of CPAP and BiPaP, 5% did not know what these were. 20% self-reported being competent in the use of AIRVO. 15% self-reported being competent in placing central and arterial lines. 15% self-reported being competent in starting and adjusting inotropes/vasopressors. 49% reported completing a CCRISP or BASIC course. 85% felt that a rotation in anaesthesia should be a routine part of surgical training.

Conclusions
Whilst there is critical care experience amongst the surgical NCHD cohort there remains room for further development.
448 The Impact of Noise in the Operating Theatre: A Review of the Evidence
Authors: Mcleod R J W , Wilks L , Davies S , Elhassan H A 
Published: May 2021

Abstract

Background
Noise has been recognised to have a negative impact on performance and wellbeing in many settings. Average noise levels have been found to range between 51-79 dB in operating theatres. Despite this, there is little research investigating the effect of noise on surgical team functioning.

Method
A literature review to look at the impact of noise in the operating theatre was performed on MEDLINE which included the search terms ‘noise’ OR ‘distraction’ AND ‘technical skill’ OR ‘Surgical skill’ OR ‘Operating Room’. 10 of 307 articles identified were deemed relevant.

Results
8 of 10 studies found noise to be detrimental to communication and surgical performance, particularly regarding total errors and time to task completion. No studies found noise to be beneficial. Two studies found case irrelevant verbal communication to be a frequent form of noise pollution in operating theatres; this is both perceived by surgeons to be distracting and delays patient care. Noise was most harmful to trainees.

Conclusions
Noise and irrelevant verbal communications were both found to be harmful to surgical performance, surgeon experience and team functioning. The worsened effect on the trainee exposes an urgent need to address noise pollution in the training environment.
557 A Novel Peer-Led Anatomage-Based Teaching Programme for Medical Students
Authors: Banjoko A , Boylan C , Kumar H , McCabe H , Morris S 
Published: May 2021

Abstract

Introduction
Anatomical knowledge is an essential part of surgical practice. However, its delivery lacks a standardised approach across medical school curricula. A student-led anatomy programme was implemented at a single institution, using near-peer teaching and Anatomage virtual dissection. This study aims to describe the methodology of this programme and determine the benefit of a near-peer taught anatomy course.

Method
The programme was organised by senior medical students, utilising Anatomage virtual dissection and techniques in line with Bigg’s constructive alignment. Attendees were asked to complete questionnaires with Likert scales (0-10) and open answer text to determine learners’ benefit. Both quantitative and qualitative analyses are presented.

Results
73 students attended eight sessions from January to March 2020. Students reported a statistically significant (p &lt; 0.01) increase in confidence after the sessions of 3.74±1.83. The quality and relevance of the teaching also scored highly (9.32±0.89 and 9.47±0.86 respectively). Qualitatively, students praised the "informal learning environment”, the structure of the sessions, the handout provided, and the interactivity of anatomage technology.

Conclusions
This study demonstrates how virtual dissection technology and near-peer teaching can derive significant benefit to undergraduate students, in line with previously published data.
572 Virtual Reality Operative Simulation in Orthopaedic Surgical Training During Periods of Restricted Clinical Hours: Systematic Review
Authors: Salaja B , Feeley A , Feeley I , Merghani K 
Published: May 2021

Abstract

Introduction
The public health response to the coronavirus pandemic-imposed limitations upon orthopaedic surgeon’s scheduled care practice, with a consequential diminution of training time for residents. A potentially viable option for maintenance of operative competency is the use of virtual reality (VR) simulation. This review looks at the effectiveness of (VR) as a pedagogical method of learning for orthopaedic trainees.

Question
Can VR be a viable method of learning and skill retention for orthopaedic trainees during periods of diminished operative time?

Method
A systematic search using Google Scholar, EMBASE and PubMed was conducted in July 2020.

Results
Following the PRIMSA guidelines; initial search revealed 779 studies. 35 full text articles were analysed by two reviewers with a final total of 30 articles used in this review. A thematic analysis revealed three broad categories: quality and validity of VR teaching simulations studies (n = 8); learning curves and subject performance (n = 14) and VR simulators utility in orthopaedics reviews (n = 8).

Conclusions
We demonstrated that VR has the capacity to help trainees maintain their technical skills, enhance their precision, and retain rudimentary competency during this pandemic. Additional improvements are necessary to ensure its safety as a training tool.
643 Near-Peer Surgical Teaching for Junior Doctors: A 16-Month Retrospective Analysis
Authors: Hussain S F , Toi T , Laurent E , Seraj S S , Haque S 
Published: May 2021

Abstract

Introduction
Surgical departments across the UK are having to mitigate service demands, budget constraints and changes to work patterns with their statutory duty to provide high-quality training and education. Securing consultant-led teaching has also become increasingly difficult leading to the rise of near-peer teaching. We evaluate the long-term effectiveness of near-peer surgical teaching for junior doctors.

Method
We developed a rolling 12-week trainee-led didactic surgical education programme for Foundation doctors and Core Surgical Trainees. Junior doctors delivered teaching to peers with registrar input; session and supervision feedback was recorded using 5-point scales and free-text responses.

Results
42 junior doctors responded to our end-of-programme feedback surveys covering December 2018 to April 2020. The overall programme (8.83±1.08/10), relevance (4.62±0.58/5), presentation quality (4.60±0.50/5) and supervisor knowledge (4.81±0.40/5) were rated highly by respondents. Attendees also reported significant improvements in subject knowledge (3.72±0.92/5 to 4.50±0.56/5, P &lt; 0.0001), clinical confidence, presentation and teaching skills.

Conclusions
Our near-peer teaching programme addressed the educational needs of junior doctors and developed their presentation and organisational skills. Supervision and input from registrars facilitated discussion and reinforced key concepts. The success of this programme highlights the role that trainees can play in designing, developing, and leading an effective surgical teaching programme.