bluuebunny/crossref_metadata_2025_split huggingface dataset:
P62 Impact of the Covid-19 pandemic on the SeaSHeL study
Authors: Joshi Nikhil , Ahmed Muhammad , Mandavia Rishi ,   on behalf of the SeaSHeL Collaborative
Published: April 2021

Abstract

Introduction
The SeaSHeL Study is an ongoing national, multi-centre, cohort study investigating Sudden Sensorineural Hearing Loss (SSNHL). The study is supported by the INTEGRATE ENT Trainee Research Network and the Audiology NIHR Champions, as well as being adopted onto the NIHR Clinical Research Network. It aims to map the pathway of patients with SSNHL, develop a prognostic model to predict recovery of patients with idiopathic SSNHL and establish the impact on patients’ quality of life. Here we summarise the impact of the Covid-19 pandemic on the study and highlight methods employed to improve data collection.

Methods
Data collection commenced in October 2019 and as of August 2020, 227 patients have been recruited from 66 registered sites across England. This interim data was analysed. The primary outcome was the change in monthly patient recruitment and site registration. The secondary outcome was the completeness of the dataset.

Results
Initially, monthly site registration increased to a peak of 31 in December 2019 and monthly patient recruitment increased to a peak of 34 in February 2020. Both levels decreased during the first wave of Covid-19 with 11 patients recruited and 0 sites registered in April 2020. Both levels have been increasing since, with 21 patients recruited and 5 sites registered in August 2020. The dataset of 227 patients has 113 (49.7%) completed records.

Conclusions
This study represents the largest national cohort study into SSNHL. Despite the Covid-19 pandemic, data collection continued during the first wave and rates are now recovering to pre-Covid-19 levels. Key factors in this recovery are a collaborative research approach involving motivated trainees, an ethics amendment for follow-up data to be collected by telephone and continued engagement of collaborators through regular email correspondence and fortnightly newsletters.
P67 Integrated surgical teaching for juniors: surgical education during COVID-19
Authors: Kamble Rituja , Scantling-Birch Yarrow , Samarth Gargi , Larsson Emma , Maden Charlotte 
Published: April 2021

Abstract

Background
COVID-19 has impacted on the amount of formal theoretical and practical surgical teaching available for junior doctors and medical students. This added to an existing climate of variability in the undergraduate and foundation teaching curriculum. Junior doctors were subsequently reporting a lack in confidence when dealing with surgical patients. We aimed to assess the surgical learning needs of junior doctors and designed a quality improvement project that included implementing a surgical teaching programme to improve the quality of surgical education.

Methods
A baseline questionnaire was completed by foundation year one doctors to establish confidence levels in managing surgical patients and carrying out practical procedures. Two sequential improvement strategies were subsequently implemented and assessed using the Plan-Do-Study-Act methodology. Junior doctors participated in a local surgical workshop in limited numbers during cycle 1, and then attended four online webinar tutorials themed around general surgery for cycle 2.

Results
A total of 15 participants responded to the baseline questionnaire, 13 attended the workshop and a combined total of 572 viewed the four webinars. Mean confidence increase following the workshop was 113% (W = 91.0, p &lt; 0.001). Mean knowledge increase from the online webinars was 62.3% (t = 4.67, p = 0.009) and mean confidence increase was 66.67% (p &lt; 0.0001).

Conclusion
Junior doctors did not feel confident in assessing and managing surgically unwell patients. Implementing blended learning tools, such as online webinars, allowed the delivery of effective surgical teaching en masse and to continue the practice of social distancing during a viral pandemic.
P71 Investigating the rate of successful day case discharges for laparoscopic cholecystectomies between June-November 2019
Authors: Pancharatnam Rohan Andrew , Abraham Sheryl , Adeniran Anjolaoluwa , Candan Jonathan 
Published: April 2021

Abstract

Introduction
Laparoscopic Cholecystectomy (LC) is the gold standard treatment for symptomatic gallstones. The British Association of Day Surgery (BADS) recommend that at least 60% of LCs are performed as day cases. We investigated the rate of successful discharge for LCs and factors contributing to unexpected overnight stays.

Methods
Retrospective data analysis was performed on elective LCs between June-November 2019. Electronic records were reviewed for: admission and discharge date; time of procedure; length of procedure; training grade of the surgeon; use of total intravenous anaesthesia (TIVA) or volatile anaesthesia; use of IV morphine in theatre/recovery and reasons for failed discharge.

Results
A total of 119 patients underwent elective LC, of which 63 were planned day cases. 46 patients (73.0%) listed as day cases were successfully discharged the same day. LCs performed before 1pm had a success rate of 78.8% compared to 45.5% after 1pm (p &lt; 0.05). There was no statistically significant difference in success rates due to length of procedure; training grade of the surgeon; method of induction (TIVA or Volatile) or use of IV morphine in theatre/recovery. 17 planned day cases failed same day discharge. 7 of these patients (41.2%) reported pain and 4 (23.3%) reported nausea, vomiting or dizziness.

Conclusion
This centre successfully discharged 73.0% of planned day case LCs, although only 52.9% of elective LCs were listed as day cases. Success rates were positively associated with am procedures compared to pm. We recommend a review of operation scheduling and evening staffing in order to increase the probability of discharge on the same day.
P77 Management of vitamin B12 deficiency in primary care during the COVID-19 pandemic: Do all patients need to come in?
Authors: Desai Chaitya , Machado Beno , Kumar Sanjay 
Published: April 2021

Abstract

Introduction
Not all causes of vitamin B12 deficiency require intramuscular hydroxocobalamin (IMH). NICE guidance states that diet-related deficiency can be treated orally, but pernicious anaemia must be excluded via anti-intrinsic factor antibodies (anti-IFAB). Our aim was to audit the management of B12 deficiency during the COVID-19 pandemic when reducing footfall is vital. Then, implement staff education strategies to improve adherence to guidance.

Methods
Data for patients who received IMH from March-June 2020 was retrospectively analysed for: full blood count (FBC), B12, folate and anti-IFAB levels. These patients were sent letters to have blood tests for the missing investigations. Results were presented at meetings and flowchart-posters were distributed. Audit was closed with prospective data for patients who requested IMH from September-October 2020.

Results
From 46 patients identified, 82.6% had B12 and folate checked prior to therapy commencement, but 23.7% had an untreated folate deficiency. 79.3% of patients receiving IMH had never been tested for anti-IFAB; none of those tested were positive. A lack of awareness of the NICE guidance was identified as a key cause for non-adherence. Following the intervention, all 34 patients were appropriately investigated. Out of these, 8.8% had positive anti-IFAB levels and following a review of their clinical histories, all patients were commenced on appropriate therapy.

Discussion
IMH can have great benefit; but it is invasive, has financial and nursing-time implications, and increases the risk of contagion via footfall in the practice. Thus, this multi-cycle audit shows that appropriate investigations prior to commencing therapy is key.
P83 Online Multidisciplinary Review of Point of Care Ultrasound Images During the COVID-19 Pandemic
Authors: Shuker B A , Perry J 
Published: April 2021

Abstract

Point-of-care-ultrasound (POCUS) is a valuable diagnostic tool in intensive care. Evaluation of POCUS images acquired in our intensive care unit (ICU) prior to the COVID-19 pandemic had typically been performed solely at the point of care. Where further evaluation was required, cross-sectional thoracic imaging or departmental echocardiography would be requested. Clinicians also had access to ICU ultrasound machines for review of images, or to repeat studies for clarification of findings. However, the nature of the pandemic limited access to ICU to minimise contact with COVID-19.

Objectives
We aimed to develop an online solution for review of POCUS images by the multidisciplinary team (MDT).

Methods
Microsoft Teams was utilised to create a dedicated channel for the MDT to review POCUS images. Images were exported from ultrasound machines used inside our ICU to portable USB drives in standard formats (DICOM or WMV). The portable USB drives were decontaminated prior to transfer outside of the ICU. Anonymised images were uploaded with relevant clinical details to the Teams platform for MDT review.

Results
The online platform provided rapid access to images for review by the MDT. POCUS images from ICU patients with and without COVID-19 were reviewed. MDT review frequently led to a change in patient management. Significant examples included identification of a missed inferior vena cava thrombus leading to initiation of anticoagulation therapy, and rapid expert input for a case of cardiac tamponade.

Conclusion
The use of an online platform allowed our intensive care unit to establish a reliable method for images acquired from point-of-care-ultrasound to be remotely reviewed by an expert multidisciplinary team, consequently improving patient care.
P84 Optimising hand trauma care at a Major Trauma Centre (MTC) during the COVID-19 pandemic
Authors: Khajuria Apoorva , Jones Matthew 
Published: April 2021

Abstract

Introduction
This study evaluates the management of hand injuries during COVID-19 following the prompt implementation of the BOA guidelines; reconfiguration of hand services and implementation of the ‘one-stop’ model.

Methods
285 cases OVER A 1-MONTH PERIOD were RETROSPECTIVELY reviewed to evaluate the effectiveness of managing patients using the ‘one-stop’ model and the new Urgent Treatment Centre (UTC).

Results
277 patients were included in the study. During Covid-19, operative cases fell by 62%. 86.3% (239/277) of cases were managed in the UTC; 54.4% (130/239) required conservative management and 45.6% (109/239) required minor procedures (in UTC). REMOVABLE SPLINT USE was optimized through design of ‘softcasts’ for non-operative management of distal radius fractures. A patient education video: ‘softcast removal at home’ was created and in cases requiring sutures, 95.1% (39/41) were absorbable, thereby avoiding COVID-19 exposure for follow-up. Only 50.5% (140/277) of patients had formal follow-up arranged and patient information follow-up cards were developed.

Conclusion
The one-stop model prevents delay in definitive treatment, allows effective initial treatment, and minimizes the need for face-to-face follow up. In light of a possible second wave of COVID-19 cases, this new model should be considered for implementation by all hand’s units for the foreseeable future.
P88 Paroxysmal sympathetic storm and the role of beta-blockers in traumatic brain injury: a scoping review protocol
Authors: Nguembu Stéphane , Meloni Marco , Endalle Geneviève , Dokponou Hugues , Dada Olaoluwa Ezekiel , Kanmounye Ulrick Sidney 
Published: April 2021

Abstract

Introduction
Most cases of paroxysmal sympathetic hyperactivity (PSH) result from traumatic brain injury (TBI). Little is known about its pathophysiology and treatment, and several neuroprotective drugs are used including beta-blockers. The aim of our study is to collate existing evidence of the role of beta-blockers in the treatment of PSH.

Method
We will search MEDLINE, Web of Science, EMBASE, Cochrane, and Google Scholar. The search terms used will cover the following terms: “paroxysmal sympathetic hyperactivity”, “traumatic brain injury” and “beta-blockers.”: No language or geographical restrictions will be applied. Two independent co-authors will screen the titles and abstracts of each article following predefined inclusion and exclusion criteria. If there is a conflict the two reviewers will find a consensus and if they cannot a third co-author will decide.
Using a pre-designed and pre-piloted data extraction form, data from each included citation will be collected (authors identification, study type, TBI severity, type of beta-blockers used, dosage of the drug, clinical signs of PSH, Glasgow Coma Scale, Glasgow Outcome Scale, mortality, morbidity and length of stay). Simple descriptive data analyses will be performed and the results will be presented both in a narrative and tabular form.

Results
The effectiveness of beta-blockers in post-TBI PHS will be evaluated through clinical signs of PHS(increased heart rate, respiratory rate, temperature, blood pressure, and sweating), Glasgow Coma Scale, and Glasgow Outcome Scale. mortality, morbidity and length of stay.

Conclusion
At the end of this scoping review we will design a systematic review with metaanalysis if there are a reasonable number of studies otherwise we will design a randomized controlled trial.
P92 Power dynamics in healthcare teams – a barrier to team effectiveness and patient safety: A systematic review
Authors: Kearns Emma , Khurshid Zuneera , Anjara Sabrina , De Brún Aoife , Rowan Brendan , McAuliffe Eilish 
Published: April 2021

Abstract

Introduction
Hierarchies in healthcare teams are pervasive and widely acknowledged as impacting on working cultures. This review explores the impact of power dynamics in multidisciplinary healthcare teams on patient safety and team effectiveness.

Methods
A systematic review was conducted using five academic databases (PubMed, CINAHL, PsycInfo, Cochrane Library, Embase) between January 2010-2020. Potentially relevant articles were selected based on title and abstract review, followed by full text review, data extraction and data appraisal. Consistent with PRISMA guidelines, two researchers independently carried out all stages, from data screening to quality appraisal. A narrative synthesis was conducted.

Results
The databases searches yielded a total of 869 studies. 28 studies met the eligibility criteria and were included in the synthesis. Of these, 20 articles associated power dynamics with team effectiveness and 19 linked power dynamics to patient safety outcomes. Hierarchical power dynamics inhibit team communication and speaking up behaviours, which impacts team effectiveness and patient safety. Barriers to speaking up include workplace policies; respect for seniors’ experience; time pressures; feelings of intimidation and powerlessness; fears of reprisal and repercussions; perceived poor self-efficacy; lack of confidence and role clarity.

Conclusion
Hierarchies and power dynamics have a profoundly negative effect on patient safety and team effectiveness through their negative impact on communication and speaking up behaviours. Whilst hierarchies cannot be abolished, to improve team communication and collaboration, healthcare organisations and training programmes should consider initiatives that break down silos and promote an inclusive approach to patient care. Initiatives that target the practice of collective leadership and an open and supportive work environment have been shown to improve communication and team effectiveness.
Theme: Cross-disciplinary research
P100 Recruitment barriers in multicentre collaborative studies as demonstrated by a single unit experience of the Management of Acutely Symptomatic Hernias (MASH) study
Authors: Wilkins A , Findlay A , Yau J , Ettles C 
Published: April 2021

Abstract

Introduction
MASH is a multi-centre prospective cohort study assessing the management of patients presenting with symptomatic abdominal wall hernia. Consenting patients are recruited during acute admission, with telephone follow up at day 30 and 90. We performed a retrospective review of all patients referred to a single general surgical unit with a symptomatic hernia to quantify recruitment rate and identify barriers to recruitment.

Methods
Patients meeting the inclusion criteria 1st August to 18th September were identified from prospective handover lists and electronic records and compared to the prospectively compiled screening log. Reason for not enrolment was coded according to protocol with an additional code added for patients not identified at time of admission.

Results
8/23 (35%) eligible patients were enrolled. 15/23 (65%) were not enrolled due to; Patient not identified at time of admission n = 9 (60%), declined n = 2 (13.3%), too unwell to consent n = 2 (13.3%), translational barrier n = 1 (6.6%) and lacking capacity n = 1 (6.6%). Patients not identified at time of admission included those seen by clinicians not involved in study (new starters and locums) and those discharged directly from A&E with insufficient time and resources to gain consent.

Conclusion
In our unit 65% of eligible patients were not recruited, the majority of whom were missed at time of presentation. This study will generate important information on management and outcomes of acute hernias however strategies are required to recognise and mitigate recruitment bias. Staff turnover may be a significant factor in prospective studies, particularly those prolonged during the COVID-19 pandemic.
P102 Reporting of innovations in surgery: a systematic review of robotic liver resections
Authors: Biggs Sarah , Lee Keng Siang , Shah Max , Brankin-Frisby Tom , Leow Tjun Wei , Torkington Amber , Scroggie Darren , Jones Conor , Pathak Samir , Blencowe Natalie S ,   on behalf of the RoboSurg Collaboration
Published: April 2021

Abstract

Introduction
Liver resections are most commonly performed for either primary or secondary cancers. Consensus guidelines recommend that minor liver resections should be attempted laparoscopically, however this technique has limitations. These include difficulties with surgical access, ergonomics and visualization. Consequently, there has been increasing interest in innovative solutions such as robotic surgery. The IDEAL Collaboration has provided guidance for the reporting of surgical innovations, but it is not known how robotic liver resections have been reported. The aim of this study is to summarize technique descriptions and governance procedures, and understand which clinical outcomes have been reported.

Methods
A systematic review is being conducted in accordance with the PRISMA guideline. A search of Embase, Ovid Medline, the Cochrane Library and Web of Science was performed, using search concepts of “robotic” and “liver resection”. Articles will be screened to select primary research reporting outcomes of robotic liver resections. Data will be extracted on the reporting of study characteristics, governance and ethical arrangements, mitigations of harm, techniques and modifications, and outcomes. A descriptive summary of the data will be produced. The results will be critiqued in relation to guidance from the IDEAL Collaboration.

Results
The search returned 3063 articles, with 2385 remaining after de-duplication. An interim descriptive analysis of the data will be presented, summarizing how robotic liver resections have been reported. A critique of the available results in the context of IDEAL guidance will be provided.

Conclusion
This systematic review will describe how robotic liver resections have been reported as surgical innovations.
P105 Robosurgeons vs. robosceptics’: can we afford robotic technology or can we afford not to?
Authors: Sandhu Jasmesh 
Published: April 2021

Abstract

Aim
To investigate the cost-effectiveness of robotic technology in robotic-assisted radical prostatectomy in comparison with laparoscopic radical prostatectomy and open radical prostatectomy.

Methods
The British Association of Urology Surgeons database (2014–2016) and Cancer Research UK (2012–2014) were accessed in conjunction with media; keywords included: ‘Da Vinci’, ‘first robotic prostatectomy’, ‘hospital’ to estimate the cost-effectiveness of robotic-assisted radical prostatectomy in the National Health Service.

Results
Approximately 12/43 (27.9%) centres achieved 150 robotic-assisted radical prostatectomies per year while 26/43 (60.4%) centres have managed to meet 100 robotic-assisted radical prostatectomies per year in 2014–2016. A national mean of 120–130 robotic-assisted radical prostatectomies per year for 2014–2016 was estimated.

Conclusion
The cost of robotic-assisted radical prostatectomy is adequately justified if a high volume of surgeries (&gt;150) are performed in high volume centres by high volume experienced surgeons per year. This can be achieved by subsidising the cost of robotic technology, centralisation and establishing robotic training centres.
P110 SMILE: Sustaining Medical Education In a Lockdown Environment. Facilitator perceptions of a free online access medical education platform as an adjunct to the traditional undergraduate curriculum during lockdown
Authors: Pascoe John , Foster Paul , Quddus Muntasha , Kosti Angeliki , Guest Francesca , Stevens Sian , Bamford Richard , Coulston James 
Published: April 2021

Abstract

Introduction
SMILE is a free online access medical education (FOAMed) platform created by UK surgical trainees and a medical student. During lockdown SMILE delivered 200 lectures with student attendance as high as 1400, from both UK and overseas medical schools. We report facilitator perceptions of delivering FOAMEd via SMILE.

Method
A questionnaire was sent to 77 facilitators covering preconceptions and post-session perceptions of FOAMed.

Results
61/77 responses were received from faculty of a range of medical and surgical specialties. Only 38% (23/61) had previously taught online.
Engaging a large audience virtually was a common concern and 17% purposely made sessions less interactive than they would have done for face-to-face teaching: 95% (58/61) felt the technology was adequate to deliver sessions.
100% of facilitators appreciated the use of SMILE moderators to help bridge the gap between themselves and the audience
24% (15/61) of facilitators used applications such as mentimeter that they perceived as increasing their connectivity with large audiences.
100% felt that FOAMed would play a central role beyond Covid.

Conclusions
In the times of Covid, where online medical education is becoming the new normal, we show facilitators feel comfortable with delivering FOAMed. We also discuss how facilitators maximized effectiveness in very large audiences.