bluuebunny/crossref_metadata_2025_split huggingface dataset:
804 Using Simulation as A Platform to Prepare for ENT Emergencies in The COVID-19 Era
Authors: Li L , Hopkins M , Oliver N , Wet D T Du , Hathorn I , Mellanby E 
Published: May 2021

Abstract

Introduction
At the onset of COVID-19 crisis, our ENT department was allocated five interim foundation (FiY1) doctors to help support the clinical team at a time of extreme pressure within the NHS. An ENT emergency simulation programme was-established in order to improve the skills, knowledge and confidence of the new doctors, with the course being subsequently incorporated into departmental induction for the new first-on-call-ENT-doctors.

Method
Five FiY1 doctors attended a simulation study day, comprised of a “skills and drills” workshop followed by two interactive scenarios. An interactive SimMan3G-mannequin, technician utilizing a Mask-Ed™, trained confederate nurse and a video flexible laryngoscope trainer were used to provide high-fidelity simulation. Participants rated how prepared-they felt in managing the relevant condition before and after on a Likert scale (1–strongly disagree, 5–strongly agree). The session was repeated for the new nine first-on-call ENT doctors.

Results
Participants in the pilot session felt more prepared in managing both tracheostomy emergencies (1.2vs4.2)-and-epistaxis (2.0vs5.8). Participants in the subsequent session also felt-more-prepared in managing stridor (2.1vs4.6) -and-epistaxis-(3.1vs4.7). All-14-attendants stated that they would recommend the session to others.

Conclusions
Despite-the-simulation-course-being-originally-established-to help support newly qualified-FiY1 doctors during COVID-19, the success of the programme has resulted in its formal incorporation-into departmental ENT induction.
845 Flattening the Learning Curve: The Evaluation of Extended Laparoscopic Simulation Training for Novice Surgeons
Authors: Joiya S A , Hamid M , Siddiqui Z 
Published: May 2021

Abstract

Introduction
Associated with faster postoperative recovery, reduced length of hospital stays and scarring; laparoscopy has become the favoured approach for many surgical procedures across a range of specialties. However, due to its challenging learning curve, it has also been associated with increased theatre time and higher complication rates.

Method
A prospective, observational study with box trainers was carried out by novice medical students and trainees to evaluate the efficacy of long duration courses on skill acquisition. The novice group undertook a 5-week curriculum composed of lectures, demonstrations and spaced timed-assessments involving 3 tasks: hoop placement, stacking of sugar cubes and surgical cutting.

Results
Time taken for novice participants to complete a task individually and collectively improved markedly from the first to the third attempt, with an overall 44% reduction in time observed over the 5-weeks. We invited back 6 novice participants and 6 core surgical trainees after 4-weeks to complete the same tests. There was a further 18% time improvement in the novice group, with 44% faster task completion.

Conclusions
Given the success of this study and other simulation courses reported in the literature, we recommend more courses adopt a spaced-out approach; and a simulation curriculum for surgical trainees to cultivate greater skill acquisition.
889 A Window to Individual Surgical Training Plans
Authors: Hardie J , Page P , Fleming S 
Published: May 2021

Abstract

Introduction
A recent publication in the Plastic and Reconstructive Surgery journal (Rohrich et al., 2020) has attracted controversy for its generalised approach to “millennial” plastic surgeons. We suggest that surgeons in training, trainers and colleagues need to adjust their focus from the group to the individual in order to maximise clinical performance, quality of working life and quality of care delivered to patients.

Method
We outline a simple model, adapted from the Johari window tool, with the aim of delivering a job and training plan with which all parties are content. It considers individual ability to process scenarios and perform tasks (bandwidth), and the resources available to the individual trainee, to assess each aspect of the role.

Results
No two clinicians have the same strengths and weaknesses, and no two posts are identical. The Johari-like matrix allows trainers and trainees to identify which activities are firmly within the bandwidth and resources of the trainee, those which are clearly not, and those which may cause some concern and require further discussion or modification.

Conclusions
In this model, we suggest a framework which may help surgeons in training and trainers alike and provide a means of recording this longitudinally as individuals or roles evolve.
909 Modern Integrated Surgical Teaching for Junior Doctors: Local Workshops and Online Webinars
Authors: Kamble R , Scantling-Birch Y , Larsson E , Samarth G , Maden C 
Published: May 2021

Abstract

Introduction
Reforms in the postgraduate and undergraduate curriculum have resulted in a lack of surgical teaching. By tailoring educational objectives to learning needs of junior doctors, we assessed the perceptions and knowledge transfer of our 2-phase surgical teaching programme.

Method
A perception questionnaire was distributed amongst junior doctors to establish confidence levels in surgical topics. Junior doctors were invited to attend (1) a local surgical techniques workshop and (2) an online national webinar. Perception questionnaire and knowledge tests were delivered before and after each session.

Result
87.5% (n = 14) participants were not confident assessing an unwell surgical patient when on-call. Mean confidence gain before and after the practical session was 4.18 (W = 91.0, p = 0.0002). 106 participants attended the online webinar. 61.3% (n = 65) were quite confident in assessing a sick surgical patient and 56.6% (n = 60) were quite confident managing a sick surgical patient. The majority (97.2%, n = 103) deemed the session to be useful to very useful. Mean knowledge gain before and after the session was 32.8% (t = 4.67, p = 0.009).

Conclusions
Improvement in confidence and knowledge in surgical topics amongst juniors can be feasible by implementing blended learning tools, such as online webinars.
934 Remote one-to-one virtual surgical skills training: Evolving the delivery of operative skills training in the UK
Authors: Asher Christian , Ibrahim Ibrahim , Katsarma Eyfrossini 
Published: May 2021

Abstract

Introduction
COVID-19 has had an unprecedented effect on surgical training, including prerequisite entry-level courses to speciality training. We describe the implementation of a virtual, one-to-one training programme aimed at the acquisition and retention of operative skills.

Methods
Enrolment commenced 8th May 2020 for wound closure techniques or an extended programme including tendon repairs, delivered by Specialist Registrars in Plastic Surgery using Zoom® (v. 5.0.5) via mobile device. Participant feedback was collected retrospectively using a 5-point scale following course completion.

Results
5 participants completed the wound closure programme, and 3 the extended programme, over an average of 5 weeks, with 2 sessions per week. 5 participants were male, 3 female and were of the following grades: 2 CT2, 4 FY2, 1 FY1 and 1 medical student. A total of 103.5 hours of training was recorded to 7 September 2020.
Participants reported that all virtual skills taught were readily transferable to the theatre environment. Following the course, all participants felt confident to complete the skills learnt independently, rating the course as excellent.

Conclusions
The COVID-19 crisis has placed insurmountable obstacles in the face of surgical training. With further validation, we aim to develop surgical skills training with virtual, easily reproducible, cost-effective, trainee centred programmes.
939 Enterovaginal Fistula; Could It Be Gallstones?
Authors: Kapoor S , Boshnaq M , Wright C 
Published: May 2021

Abstract
This is a rare presentation of an impacted gallstone leading to a ileovaginal fistula. A 76-year old female presented with a 4 week history of faecal vaginal discharge and weight loss on a background of endometrial cancer treated with chemotherapy and radiotherapy 9 years ago. She was initially investigated with a pelvc MRI which showed a collection in the vaginal stump. A further abdominal and pelvic CT scan revealed a cholecystoduodenal fistula complicated by an ileovaginal fistula at the point of impaction. The patient underwent a laparotomy with small bowel resection and anastomosis. She was admitted to the intensive care unit post operatively and recovered well. There are no previous reports of a vaginal fistula caused by gallstone ileus. This case highlights a rare complication of gallstones in a patient who has undergone pelvic radiotherapy.
944 ‘A Series of Unfortunate Fractures’: Utilising Opportunities Brought About By COVID-19 To Create A National Online Educational Series
Authors: McCann C , Powell-Bowns M , Molyneux S 
Published: May 2021

Abstract

Background
The Covid-19 pandemic has disrupted the training and education of Junior Doctors. Physical restrictions have highlighted the potential use of remote online platforms to deliver teaching. We aimed to create and deliver a free educational series for Junior Doctors, delivered by Orthopaedic Registrars and Consultants through an interactive online platform.

Method
Teaching material, learning aims, and advertisement tools including mailing lists were developed. Advertisement was arranged on national scale via the British Orthopaedic Association (BOA) and the British Orthopaedic Trainees Association (BOTA). Six sessions were delivered via the ‘Blackboard Collaborate’ platform.

Results
Six sessions were held over six weeks with 546 total attendees, averaging 92 per session. Foundation Doctors and Medical Students accounted for 39.7% and 54.0% of attendees respectively. Attendees were primarily from the UK (90.1%). Average attendee rating for ‘enjoyment of session’ and ‘relevance to education’ was 9.11/10 and 8.66/10 respectively. Of those surveyed, 100% of attendees reported they would recommend this series to a colleague.

Discussion:
This lecture series was created in response to the restrictions on physical meetings and reduced teaching opportunities during the Covid-19 pandemic. High attendance and overwhelmingly positive feedback from this series supports the use of online teaching for the future of Post-graduate education.
959 Undertaking Core Surgical Training Less Than Full Time: A Qualitative Study of Experiences
Authors: Kelly M , Chiang Y , Corte-Real Houlihan M , Haylock-Vize P , Larsen C , Lilis L , Maki S , Milt K M , Shee J , Spoone L , Warre M 
Published: May 2021

Abstract

Introduction
The Royal College of Surgeons identifies Less Than Full Time Training (LTFT) as a key factor in attracting excellent candidates at Core level. Previous evaluations of LTFT have, however, focused on ST3 and beyond. This study focuses on Core Surgical Training (CST), to determine how well it is delivering for LTFT trainees.

Method
Participants undertaking any part of CST LTFT were eligible. An electronic, self-administered questionnaire was accessed by participants.

Results
There were 11 participants. The majority (55%) rated the information available, which often related to more senior trainees, as poor. A third reported it ‘very difficult’ to arrange a LTFT training post. A significant proportion felt their access to operative experience was decreased and 45% reported feeling less confident. Positive aspects were improved work-life balance and being able to maintain a surgical career with a family. Suggestions for improvements included normalising LTFT in surgery to reduce stigma, having dedicated LTFT TPDs, clear pathways, and longer rotations.

Conclusions
Training LTFT offers many benefits – not least, increasing workforce diversity. However, for many, training LTFT at Core level produces additional stress, work and stigma. If the surgical community is serious about maintaining an excellent, diverse workforce, these issues should be tackled sooner rather than later.
1012 Surgical Trainee Satisfaction Variations with Seniority and Region: An Evaluation of General Medical Council National Training Survey
Authors: Fan K S , McKenna J , Chan J 
Published: May 2021

Abstract

Aim
The General Medical Council (GMC) National Training Survey invites all doctors in training and this study evaluates satisfaction in surgical training and variations with speciality, seniority, and training region.

Method
All survey results were obtained from the GMC website. Responses of trainees, ranging from foundation training to registrar, were collected and categorised by speciality, training stage and location.

Results
9465 surgical trainees completed the study in 2019. The highest indicators were Educational Supervision (97.68), Clinical Supervision (87.42) and Clinical Supervision (out of hours) (87.28). The lowest were Workload (44.60), Rota Design (56.00) and Local Teaching (59.31). Highest and lowest ranking specialities were oral and maxillofacial surgery (84.25) and vascular surgery (73.95).
Satisfaction varied significantly across training stages, with speciality trainees highest (82.58) overall and foundation year 1 lowest (70.03). London scored highest (77.95) and Northern Ireland, Scotland and Wales collectively scored 77.13. Within England, South England ranked highest in five specialities but only orthopaedics and neurosurgery showed significant national variations.

Conclusions
Our data show variations in training satisfaction across many training cohorts. Satisfaction increases with surgeon seniority. Trainers and educational boards should target interventions to improve the quality of training for all grades of trainees and ensure appropriate curriculum coverage and address specific concerns.
1019 The Surgical Skills Club: An Adaptable and Sustainable Model for Surgical Teaching
Authors: Chia D , Choo A M H , Dar T , Joshi K S , Seah K T M 
Published: May 2021

Abstract

Introduction
The General Medical Council (GMC) stipulates that medical graduates should obtain competency in basic wound care. In a national review, only 24.7% of UK medical schools provided suturing training. Newly qualified doctors may be less prepared in performing basic surgical skills independently. Hence, Cambridge University Surgical Society initiated a weekly teaching programme, Surgical Skills Club (SSC).

Method
SSC covered instrument handling, knot-tying and various suturing techniques (interrupted, continuous, mattress and subcuticular), with 32 student participants. Trainees led these sessions, with tutor:student ratios at 1:5. SSC was designed to be cost-effective (£8/student); both reusable suturing pads and animal tissue were used. Glass jars were repurposed into knot-tying trainers. Participants completed questionnaires pre- and post-programme, rating confidence in skills on Likert scales; 1 (not confident) to 5 (very confident), alongside qualitative feedback.

Results
SSC was well-subscribed; most participants (88%) would highly-recommend it to peers. Receiving individualised feedback was highly valued. Students were more confident (scores 4 or 5) in skills post-programme compared to pre-programme (instrument handling: 21.9% vs 92.0%; basic knot-tying: 28.1% vs 88.0%; interrupted suturing: 50.0% vs 100%).

Conclusions
We demonstrated the effectiveness of a regular skills-teaching programme, where learning is consolidated through spaced repetition. This sustainable and accessible format can be widely adapted and implemented
503 Clinical Frailty Score (CFS) Vs Antibiotics, Time to Surgery and Time to Computerised Tomography (CT) Scan in An Emergency Surgical Population
Authors: Palaniappan S , Soiza R , Moug S , Myint P 
Published: May 2021

Abstract

Introduction
Frail patients have increased mortality after surgery. However, it is not known if pre-operative process measures such as antibiotic administration, time to CT and time to surgery are influenced by patient frailty.

Method
The Emergency Laparotomy and Laparoscopy Scottish Audit (ELLSA) assessed outcome after emergency surgery across Scottish hospitals (November 2017 – October 2018). Frailty was measured using the 7-point Clinical Frailty Score (CFS). Outcome measures were antibiotic provision for sepsis, admission to CT time, admission to surgery time, CT request to performance time and CT request to surgery time.

Results
1302 patients (median age 63 years [IQR 49-74]; 49% male) with complete data were included. Median time from admission to CT and surgery increased between those with CFS 1 to 6/7 from 597 to 1724 minutes (p &lt; 0.0001) and 1556 to 4120 minutes (p &lt; 0.0001) respectively. Time from CT request to surgery also significantly increased with CFS (p &lt; 0.042). There was no significant association between CFS and antibiotic administration or CT request to performance.

Conclusions
Frail patients have to wait longer for CT scan requests and surgery, but frailty was not associated with antibiotic administration or delays in CT request to performance time. Possible explanations include frailty-related challenges making correct diagnoses and optimal management plans.
813 Risk of Death Following Pulmonary Complications After Surgery with And Without SARS-Cov-2 Infection: A Pooled Analysis of Individual Patient Data from Pre-Pandemic and Pandemic International Cohort Studies
Authors:   STARSurg Collaborative,   COVIDSurg Collaborative
Published: May 2021

Abstract
Risk of death following pulmonary complications after surgery with and without SARS-CoV-2 infection: a pooled analysis of individual patient data from pre-pandemic and pandemic international cohort studies

Introduction
Diagnostic haematuria services have been reduced due to the COVID-19 pandemic, compromising patient care, and necessitating a more pragmatic pathway.

Method
The IDENTIFY study was an international, prospective, multicentre cohort study of over 11,000 patients referred to secondary care for investigation of haematuria. Using this data, we developed strategies using combinations of imaging and cytology as triage tests to maximise cancer detection within a pragmatic pathway.

Results
8112 patients (74·4%) received an ultrasound or a CT urogram, with or without cytology. 5737 (70·7%) patients had visible haematuria (VH) and 2375 (29·3%) had non-visible haematuria (NVH). Diagnostic test performance was used to determine optimal age cut-offs for four proposed strategies. We recommended proceeding directly to transurethral resection of bladder tumour for patients of any age with positive triage tests for cancer. Patients with negative triage tests under 35-years-old with VH, or under 50-years-old with NVH can safely be discharged without undergoing flexible cystoscopy. The remaining patients may undergo flexible cystoscopy, with a greater priority for older patients to capture high risk bladder cancer.

Conclusions
We suggest diagnostic strategies in patients with haematuria, which focus on detection of bladder cancer, whilst reducing the burden to healthcare services in a resource-limited setting.
158 Oral Submucous Fibrosis in A 2-Year-Old Girl Due to Chewing BIDI Stubs
Authors: Sahni D S , Desai D , Prasad G , Ramsaha S 
Published: May 2021

Abstract
A 2-year-old girl, complaining of a gradual increase in the restriction of the mouth opening for 3 months, was referred to the Otolaryngologists based on background history of recurrent oral ulcers. The local examination showed the presence of oral ulcers on the cheek in addition to abnormal oral mucosa which appeared blanched, opaque and fibrotic. This was clinically diagnosed as Oral Submucous Fibrosis, owing to classical presentation and the lack of systemic features. A detailed social and family history revealed that the father of the child used to smoke BIDI, a traditional form of nonfiltered cigarette. The child used to play with the burnt stubs and keep them in her mouth, chewing them for long durations. This was assumed to be the aetiological factor behind the development of the pathology, in absence of any other contributing factors. The patient was treated conservatively, and symptomatic improvement was noted on follow-up. This is the youngest reported patient with OSMF, and this case history brought an unusual aetiological factor to the fore.
168 Interprosthetic Fractures of The Femur: A Literature Review
Authors: Marzano F , Pace V , Milazzo F , Caraffa A , Antinolfi P 
Published: May 2021

Abstract
Increasing age expectations and number of joint replacement procedures have made interprosthetic femoral fractures (IFF) a progressively more common diagnosis and a challenge for surgeons. A gold standard and universally accepted classifications and guidelines do not exist yet.
Customized structured electronic searches performed in PubMed database. Relevant key terms: IFF, classification interprosthetic fracture, peri-implant femoral fracture, biomechanics interprosthetic femur fracture, radiographic femur fracture, risk factor IFF. 42 articles finally included (up to 2019).
High morbidity and mortality linked to IFF. Standardised classifications, management guidelines and surgical approaches are not available yet. Periprosthetic classification systems are still utilized even if not entirely appropriate. High rate of failure is related to thinner cortical bone, larger medullary canals and variable stresses depending on the distance among implants. High complication rates in all studies. Stress risers and implant stability based on fracture patterns and stress forces. Several surgical options with no uniformity. Less invasive surgical procedures are associated to reduction of metalwork failure rate, better preservation of vascularization and better functional-clinical outcomes.
Lack of specific classification systems and management guidelines. Several surgical options are available with no uniformity of results. Attention to stress risers and preservation of bone stock and vascularization are key aspects for better results.
170 Primary Breast Lymphoma-Mimicking Inflammatory Breast Disease: A Case Report
Authors: Alam R , Basak B , Ahsan A , Gupta A S , Islam S , Akther S M Q 
Published: May 2021

Abstract
Primary breast lymphoma (PBL) is an unusual clinical entity accounting for 0.4–0.5% of all breast neoplasms. The usual presentation includes a painless palpable mass similar to that of breast carcinoma. Diffuse large B-cell lymphoma (DLBCL) is the most common identifiable type of PBL based on the histopathological examination.
We report an unusual case of 22 years old Bangladeshi woman presented with a 6-month history of a lump on left breast. Although the lump was initially small, it began a rapid growth after 4 months. The swelling was localized and did not show any skin involvement or discharge and as she didn’t have any positive familial history of breast carcinoma her primary attending physician diagnosed it as a case of breast abscess. When local incision and drainage proved ineffective, she was referred to us. After doing an immunohistochemistry from incisional biopsy the diagnosis was confirmed as Diffuse Large B-cell Lymphoma. The patient was treated initially by chemotherapy with CHOP therapy followed by wide local excision.
Early and accurate diagnosis of PBL is crucial for selecting the appropriate MDT treatment strategies to avert potentially harmful surgical interventions.