bluuebunny/crossref_metadata_2025_split huggingface dataset:
334 Localisation of Sentinel Node for Cutaneous Melanoma of Trunk
Authors: Rezacova M , McGaughey A 
Published: October 2021

Abstract

Aim
Our aim was to review localisation of sentinel node for cutaneous melanoma of trunk based on position. This was to investigate whether we can predict sentinel node position and therefore avoid scintigram.

Method
We have collected 50 patients with cutaneous melanoma of the trunk who underwent sentinel node biopsy. We have reviewed and recorded position of the melanoma and most likely position of sentinel biopsy. This has been on the day of surgery compared to scintigram.

Results
Majority of the melanomas have drained into the predicted location. Midline melanomas had tendency to drain bilaterally. The most difficult to predict were melanomas on the anterior aspect of trunk.

Conclusions
In majority of cases surgeons were able to predict position of sentinel node biopsy and therefore scintigram might not be necessary. If such approach is adapted, the need for radiologist involvement on the day of surgery may decrease.
811 Management of Patients with HPV-associated Oropharyngeal Cancer: A Units' Experience
Authors: Fernando S , Leow J , Wildan T 
Published: October 2021

Abstract

Aim
The low positive predictive value (PPV) of initial post-therapy PET-CT in patients with Human papillomavirus (HPV-) associated oropharyngeal squamous cell carcinoma (OPSCC) presents a challenge for teams managing residual disease after initial treatment. We aimed to investigate current management, post treatment surveillance protocols and outcomes of these patients within our unit.

Method
A retrospective review was performed of p16 positive OPSCC patients treated in 2018. Their primary treatment modality (radiotherapy (RT) or chemoradiotherapy (CRT), neck dissection), post-therapy PET-CT results, management decisions and final clinical outcomes were recorded.

Results
38 patients with p16 positive OPSCC were included in the study. 36 (94.7%) received primary CRT or RT, and 2 (5.3%) had primary neck dissections with adjuvant RT. 21 patients were found to have residual disease on the 3-month post-treatment PET-CT. Of these, 9 underwent further PET-CT surveillance, all showing no residual disease. 8 patients received ultrasound +/- fine needle aspiration, from which 1 showed incurable residual and distant metastasis. 2 underwent clinical surveillance, showing no residual disease. 1 had immediate salvage surgery, with further recurrence. 1 patient with persistent disease and lung metastasis received palliative immunotherapy.

Conclusions
31 patients were disease free at the end point of this study. This study explores the need for further investigation into features of residual disease in post treatment PET-CT that would indicate initial treatment failure and possible further early intervention. A surveillance strategy following initial post treatment PET-CT needs to be developed to aid in making this decision as early as possible in the post treatment phase.
874 Solitary Fibrous Tumours of the Pleura: Immunohistochemistry
Authors: Ishak L , Kostoulas N 
Published: October 2021

Abstract

Aim
To evaluate immunohistopathology markers of solitary fibrous tumours of the pleura (SFTP), including markers of benign and malignant variants.

Method
Retrospective review of immunohistopathology reports on 4 patients diagnosed with SFTP between January-October 2020 at the Golden Jubilee National Hospital. Data was collated on markers tested or detected. Benign and malignant cases were compared. A literature review was conducted to summarise the current evidence.

Results
Ki-67, Anti-bcl-2, CD99, STAT6, Desmin, AE1/3, Calretinin and S100 were tested in 100% (4/4) cases. CD34, EMA and CD117 were tested in 75% (3/4). Betacatenin and Vimentin were tested in 25% (1/4). Of those tested, Ki-67 was present in 100% (4/4), Anti-bcl-2 and CD99 in 75% (3/4), STAT6 in 50% (2/4), Desmin in 25% (1/4), AE1/3 in 25% (1/4), Calretinin in 25% (1/4), S100 in 0% (0/4), CD34 in 67% (2/3), EMA in 0% (0/3), CD117 in 0% (0/3), Betacatenin in 100% (1/1) and Vimentin in 100% (1/1). One out of 4 cases were malignant based on clinical presentation. Of the markers tested in all cases, Desmin was only detected in the malignant case, AE1/3 and Calretinin only in the benign cases, and the other markers in both benign and malignant cases. Anti-bcl-2 and Ki-67 intensity did not correlate with tumour diameter or malignant potential. Immunohistopathology could not confirm SFTP diagnosis in 50% (2/4) cases; it could not determine malignant potential or SFTP-subtype in 100% (4/4) cases.

Conclusions
A better understanding of SFTP immunohistopathology is needed for investigating SFTP, including benign and malignant tumour variants.
972 Investigating the Modified Glasgow Prognostic Score as A Tool in Patients Undergoing Surgery for Sarcoma - A Newcastle Cohort Study
Authors: Chan C , Rankin K 
Published: October 2021

Abstract

Aim
Sarcomas are an aggressive group of cancers with a poor prognosis. The modified Glasgow Prognostic Score (mGPS) uses CRP and albumin levels to generate a score from 0 to 2. A higher mGPS is associated with worse outcomes and is validated in various carcinomas. However, less evidence exists for its usefulness in sarcoma and this study aims to further investigate this area.

Method
All patients with a bone or soft tissue sarcoma diagnosis presenting to the North of England Bone and Soft Tissue Tumour Service between 2010 – 2014 were analysed. A retrospective review of clinical notes, pre-operative biochemistry results and oncological outcome was performed. Primary outcome measures were local recurrence or metastasis and overall survival (OS).

Results
80 patients met the inclusion criteria (28 females and 52 males). 64% of patients were aged &gt;50 at diagnosis. 78% of tumours were high grade (Trojani Grade 2/3) and 71% were &gt;5cm in size. 51 patients had a calculated mGPS=0, 19 patients had mGPS=1 and 10 patients had mGPS=2. In the mGPS=0 group, 22% developed recurrence or metastases and median OS was 42.2 months. For an mGPS of 1 and 2, the rate of recurrence or metastasis was 58% and 60% respectively, and median OS was 41.6 and 39.9 months.

Conclusions
Pre-surgical CRP and albumin levels (mGPS) may be important in predicting outcome and aiding the management of sarcoma patients. In this cohort, a higher mGPS (1/2) was associated with increased frequency of recurrence or metastasis, however further data is required to determine statistical significance.
1104 Plasma Circulating Cell-Free Messenger RNA as a Potential Biomarker of Melanoma
Authors: Ita M , Wang J H , Fanning N , Kaar G , Lim C , Redmond H 
Published: October 2021

Abstract

Introduction
Blood-borne cell-free nucleic acids are increasingly emerging as significant non-invasive adjuncts to current methods of disease status evaluation in cancer patients. In this study, we sought to examine whether significant differences exist in the plasma transcriptomic profile of advanced melanoma patients with a high disease burden compared to patients with therapeutic response.

Method
Plasma circulating cell-free messenger ribonucleic acid (ccfmRNA) was extracted from twenty patients with stage IV melanoma receiving immunotherapy. Pathway focused gene expression analysis was performed. Patients were assessed with paired blood sample collection and CT scan assessments at baseline and at 3 months follow up. Response Evaluation Criteria in Solid Tumours (RECIST 1.1) was used for tumour burden estimation.

Results
In stage IV melanoma patients, CCL5, GZMB and MYD88 genes were significantly over-expressed (p &lt; 0.05 versus healthy controls). In patients with high disease burden or progressive disease, CCL18, CCR1, CCR4, CD274, CSF2, and GBP1 genes were significantly over-expressed (p &lt; 0.05 versus patients with therapeutic response). Finally, in stage IV melanoma patients with brain metastases, CCL18, CCR1, CCR4, CD274, CSF2, EGF, GBP1, and PTGS2 genes were significantly over-expressed (p &lt; 0.05, versus patients without brain metastasis).

Conclusions
Significant differences were observed in the plasma transcriptomic profile between the various melanoma patient groups, and we postulate that these differences may be exploited to identify novel therapeutic targets or biomarkers relevant to melanoma. CCL4 and CCL5 are prognostic in melanoma, both genes had significantly higher expressions in low disease burden patients compared to patients with a high disease burden.
375 Points Mean Prizes, The Impact of Portfolio Points and Clinical Specialty on The Engagement of Trainees in Research
Authors: McVeigh J , Jeilani M , Super J 
Published: October 2021

Abstract

Aim
Research and scholarship are key outcomes for medical education in order to learn transferable skills outside of the core curriculum as highlighted in 2018 by the General Medical Council. We have provided a historical snapshot of the key factors influencing medical undergraduates and trainees engaging in research. We distributed an anonymous survey to all UK Foundation Trusts and medical schools, which covered simple demographic information, factors influencing involvement in research and intended clinical specialty. Descriptive statistics were calculated for the responses.

Results
There were 264 responses to the survey, 119 (45.1%) from women. The strongest motivating factor for respondents was points for future applications, which accounted for 138 (52.2%) of responses, and became increasingly important with seniority of respondent. Time accounted for the largest obstacle to engagement in research, with 151 (57.3%) votes. For the 83 responses from aspiring surgeons, the mean number of PubMed citable publications was 2.52 compared to 1.28 for the respondents who listed a non-surgical specialty as their intended career path.

Conclusions
The UK Foundation Programme recently decided to remove additional educational achievement points (including two points for publications) for the 2023 intake of Foundation doctors. Such a decision, combined with our finding of point-driven reasoning for engagement in research, could result in fewer juniors conducting research. However, given our results highlighting increased engagement in research of aspiring surgeons, it is hoped that this decision will not affect the field of surgical research, but further qualitative analysis is required to explore this.
1287 A Comparison of Surgical Decompression and Steroid Injections to Treat Carpal Tunnel Syndrome: A Meta-Analysis
Authors: La Costa F 
Published: October 2021

Abstract

Introduction
Carpal tunnel syndrome (CTS) is caused by compression of the median nerve at the wrist. It accounts for 90% of all entrapment neuropathies, with a 7-16% in the UK. It has a significant impact on patients’ daily lives. Clinically, CTS results in paraesthesia, while extreme cases may involve muscular atrophy and weakness. There is currently a disparity between optimal treatments for CTS. Therefore, this paper aims to identify the optimal treatment for CTS with post-treatment BCTQ (Boston Carpal Tunnel Questionnaire) scores (including both functional and symptomatic severity) at 1, 3 and 6 months.

Method
The BCTQ scores for were sited from PubMed, Google Scholar and the University of Dundee Library search engine by entering key words such as “carpal tunnel syndrome”, “surgical decompression”, “surgical release” and “steroid injection”. Means and standard deviations for pre- and post-treatment after 1, 3 and 6 months were obtained. From this, forest plots were constructed using a software where steroid injection and surgical decompression were inputted separately, and effect sizes were then compared for 1, 3 and 6 months.

Results
The meta-analysis included reviewing 133 articles. The effect size was determined using the random effects model. Steroid injection was more effective than surgical decompression after 1 and 3 months. However, after 6 months, surgical decompression was more effective.

Conclusions
Identification of long-term relief of CTS through surgical decompression allows the reduction of symptom recurrence and thus costly follow-up appointments. This study provides robust clinical findings for the optimal treatment of CTS.
64 Seizing an Opportunity: Setting Up A Virtual Wetlab During the COVID19 Pandemic
Authors: Holland L , Ahmed I 
Published: October 2021

Abstract

Aim
The COVID19 pandemic has negatively impacted surgical training across the globe. In the UK, educational events and training days were cancelled for trainees at all levels. However, these unusual times provide opportunity to develop novel teaching methods. Our aim was to design a “virtual cardiac surgery wetlab” that allows real-time skills training.

Method
With support from industry partners Edwards Lifesciences, Wetlab and Connexon365 (Webinar Hosting Platform) all the necessary materials were distributed. A package was sent to trainer and trainees that included microinstruments, sutures, synthetic vessels and valve models, high-definition camera, along with printed instructions and video to outline set-up of the rig. Trainees only need to provide is a computer. A consultant surgeon demonstrated how to perform a coronary anastomosis and aortic valve replacement and was then able to supervise trainees and provide real-time feedback using the online platform.

Results
Feedback from trainer and trainees has shown that the system is an easy-to-set-up, effective training tool for teaching cardiac surgery skills including coronary anastomosis and valve surgery. The online platform enabled good vision and engagement between trainer and trainee and also enabled recording of the session. Distributing all of the materials nationwide means the virtual wetlab can take place anywhere, including in the comfort of home, for both trainee and trainer.

Conclusions
Surgical skills training can still take place effectively in the absence of “real life” wetlabs. Given the current COVID19 pandemic continues to interrupt traditional surgical teaching, this method has potential to be adopted nationwide to minimise the disruption.
81 VIRTUAL: Virtual Interactive Surgical Skills Classroom – An Ongoing Randomized Controlled Trial
Authors: Fricker M , Nathan A , Hanna N , Asif A , Patel S , Georgi M , Hang K , Sinha A , Mullins W , Shea Jessie , Lamb Benjamin , Sridhar Ashwin , Kelly John , Collins Justin 
Published: October 2021

Abstract

Introduction
High costs and inaccessibility are significant barriers to face-to-face basic surgical skills (BSS) training. Virtual classrooms enable the combination of computer-based learning with interactive expert instruction. They may optimise resources and increase accessibility, facilitating larger-scale training with a similar educational benefit. We aim to evaluate the efficacy of virtual BSS classroom training compared to both non-interactive video and face-to-face teaching.

Method
72 medical students will be randomly assigned to three equal intervention groups based on year group and surgical skill confidence. Interventions will be implemented following an instructional video. Group A will practice independently, Group B will receive face-to-face training, and Group C will attend a virtual classroom. Participants will be recorded placing three interrupted sutures with hand tied knots pre- and post-intervention, and Objective Structured Assessment of Technical Skills (OSATS) will be blind marked by two experts. Change in confidence, time to completion and a granular performance score will also be measured. Each intervention’s feasibility and accessibility will be assessed.

Results
Data collection will be completed in January 2021. Significant improvement in OSATS within groups will be indicative of intervention quality. Difference in improvement between groups will determine the relative performance of the interventions.

Conclusions
To our knowledge, this will be the largest randomised control trial investigating virtual BSS classroom training. It will serve as a comprehensive appraisal of the virtual classroom’s suitability as an alternative to face-to-face training. The findings will assist the development and implementation of further resource-efficient training programs during the COVID-19 pandemic and in the future.
131 Perioperative Management of Warfarin on Surgical Wards at District General Hospital
Authors: Artyushina A , Norton E , Pathan A , Sen R 
Published: October 2021

Abstract

Introduction
Many patients admitted to surgical wards are on warfarin. Poor knowledge of guidelines regarding reversal and restarting of anticoagulant medications can delay surgery, lead to poor outcomes and delay the discharge of patients. The aim of this audit was to establish whether junior doctors are confident in managing warfarin according to local guidelines and to improve their knowledge and confidence.

Method
A questionnaire was used to assess confidence of junior doctors currently working in general surgical departments. An educational poster was placed in the junior doctors’ office and the questionnaire was repeated. We then conducted a teaching session on the perioperative management of warfarin and repeated the questionnaire again.

Results
Confidence in reversing and restarting warfarin was significantly higher following the teaching session (p = 0.017 and p &lt; 0.001 respectively). No significant difference was seen following the introduction of educational posters. Confidence in applying the guidelines on perioperative warfarin management was significantly higher following the teaching session (p &lt; 0.001). Following the introduction of educational posters and the formal teaching session doctors felt they knew better how to access the guidelines (not statistically significant for either guideline) and referred to them more (p = 0.0178 for warfarin reversing and p = 0.0940 for warfarin restarting guideline).

Conclusions
Having doctors who are confident in managing warfarin is crucial to avoid delays in treatment and discharge. This audit showed that a teaching session indeed improved doctors’ knowledge and confidence. Regular formal teaching is essential, and a repeat audit is planned to be performed during the next rotation.
370 Evaluating Knowledge of Common Surgical Instruments During Early Surgical Training in the United Kingdom: A Call for Formalised Training?
Authors: Chang C , Munro S 
Published: October 2021

Abstract

Aim
Knowledge of surgical instruments and their use is essential to effective surgical practice, enabling efficient task-specific utilisation and promoting clear intraoperative communication; thus, reducing the risk of error. However, variations in surgical instruments across different specialities and eponymous names can pose barriers to learning for early surgical trainees. There is a paucity of data on surgical instrument knowledge among early surgical trainees, and their knowledge acquisition route.

Method
questionnaire was distributed among early surgical trainees (ST3 and below) between 18 August 2020 and 18 November 2020 across various UK regions. Respondents were asked to answer ten multiple-choice questions to assess their surgical instrument knowledge levels. Respondents were also asked about their training level, experience, and opinion regarding formal surgical instrument teaching.

Results
Thirty-seven trainees responded to the questionnaire. The majority (81%) received no formal surgical instrument training. Most respondents (96%) feel they would benefit from formal training. The average test score was 50%. There was no evidence of improved performance with formal training, though the formal training received averaged less than one hour. Higher scores were associated with increased seniority and training years, indicating most trainees are learning ‘on-the-job‘.

Conclusions
There is generally an unsatisfactory level of knowledge in surgical instruments in early surgical trainees. Trainees have also overwhelmingly indicated a desire for formalised training on surgical instruments. The authors believe the lack of formal training may contribute to this knowledge gap and intend to design a new short course to address this.
511 Organising A Surgical Conference During The COVID-19 Pandemic – Is It ‘Virtually’ The Same?
Authors: Hashmi Y , Sahu M A , Hatt K , Osman S , Bhuiyan Z A , Ahmed U 
Published: October 2021

Abstract

Introduction
Surgical conferences are invaluable events for healthcare professionals; they provide opportunities to engage with upcoming scientific discoveries, network professionally with peers as well as expand learning through lectures and workshops. For medical students, conferences provide an opportunity to expand understanding beyond the undergraduate curriculum in an interactive manner. COVID-19 has caused disruption to the organisation and attendance of in-person conferences (IPCs). Virtual conferences (VCs) offer a viable solution, allowing delegates to attend from the comfort of their own homes.

Method
The aim of our study was to evaluate an organised VC and explore the perceived benefits and limitations of VCs compared to IPCs. A virtual one-day trauma & orthopaedics (T&O) conference was organised involving lectures, workshops, poster, and oral presentations. Anonymous questionnaire forms were distributed to delegates following the conference to assess the aims of our paper.

Results
From 106 responses, 96.2% rated the conference as ‘Excellent’ or ‘Good’ with 92.5% stating that it increased their passion for T&O surgery. Based on a five-point Likert scale (5= strongly agree, 1= strongly disagree), mean score of agreement for preferring VCs to IPCs was 3.30(± 1.24). Key advantages of the VC were a lower cost (70.8%) and not having to travel (77.4%), whereas the main limitation was the inability to participate in hands-on workshops (84.9%).

Conclusions
Despite the success of our VC, delegate feedback indicates a mixed response comparing VCs to IPCs. We share our findings to encourage similar events to be organised and for other specialties.
544 Allocation of Training Opportunities: Evaluation of a Rota Improvement Project
Authors: Orchard M , Griggs R 
Published: October 2021

Abstract

Aim
Surgical registrars are under increasing pressure to achieve their competencies for ARCP under the constraints of EWTD, service provision and on call requirements. Less than full time (LTFT) and academic trainees can struggle to get fair allocation of training opportunities. These pressures can lead to competition between registrars for training opportunities and resentment can develop. We created a novel rota allocation method by which theatre, clinic and endoscopy training sessions were allocated based on percentage of elective days worked across the month, ensuring all trainees had the same opportunities.

Method
The system was implemented for 3 months in the colorectal departments at 2 hospitals. Full time, LTFT and academic trainees were treated equally with theatre, endoscopy and clinics allocated by percentage of elective days per month. The spreadsheet of allocations was viewable by all trainees to ensure transparency. All surgical registrars involved were invited to complete a feedback questionnaire on the new system.

Results
The rota was implemented for 3 months with full allocation of shifts during the study period. Trainees were successfully allocated training sessions proportionally to elective days. 7/ 10 registrars gave feedback, 85% of whom felt the system was fair and 71% thought it improved working relationships between trainees. Comments included “scrupulously fair”, “highly efficient” and gives “more transparency”.

Conclusions
Allocation of trainees to clinical training opportunities can be difficult. We present an innovative method by which trainees get equal and fair access to the training opportunities available and has consequently helped to improve working relationships between peers.