bluuebunny/crossref_metadata_2025_split huggingface dataset:
833 Hyper Acute Dialysis Access Pathway (HADAP) – Undertaking Creation of Arteriovenous Fistulae in The Renal Ward
Authors: Shetty S , Chowdary P , Dabare D , Seet C , Ahmed R , Barlas A , Lindsey B 
Published: May 2021

Abstract

Introduction
The impetus to apply the “lean method” to creation of arteriovenous fistulae came with the pandemic restricting access to theatres. Here we present HADAP implemented in a dedicated procedure room in the Renal ward.

Method

Between April and September 2020, 44 patients underwent ward-based arteriovenous fistula operations with no more than 3 people in the room – surgeon, runner and patient. The parameters assessed were duration of operation, complications, patency, patient and surgeon feedback and financial implications.

Results

The service was predominantly registrar-led who created 91% of the fistulae. 95% operations were completed successfully with a 2-week primary patency of 73% and no surgical site infections. 40% of the procedures were radiocephalic fistulae. 14% procedures required surgical assistance by the runner. The average operating time reduced from 90 minutes for the first 10 cases to 50 minutes for the last 9. A structured questionnaire showed positive feedback from both patients and surgeons (4-5 out of 5). This service has cleared potentially 9 main theatre lists for more complex procedures.

Conclusions

Our study demonstrates the successful implementation of a novel operating environment allowing expedited care for renal failure patients. It has enhanced our ability to deliver a dialysis access program despite the challenges of COVID.
191 Performance at Medical School and Foundation Programme Selection Can Predict Success in The MRCS Examination
Authors: Ellis R , Scrimgeour D , Brennan P , Lee A , Cleland J 
Published: May 2021

Abstract

Background
Identifying factors that predict success in the Membership of the Royal College of Surgeons (MRCS) examination can aid trainees’ exam preparation and help deaneries identify candidates likely to require additional support. We assessed whether performance at Medical School and UK Foundation Programme selection (Educational Performance Measurement (EPM) and Situational Judgement Test (SJT)) predicted MRCS success.

Method
We analysed data from the UKMED Database for UK graduates who had attempted MRCS Part A (n = 1,975) and Part B (n = 630) between 2013-2017. Univariate analysis examined the relationship between performance and the likelihood of passing MRCS at first attempt. Logistic regression identified independent predictors of MRCS success.

Results
Each additional EPM decile increased the chances of passing MRCS by 52% for Part A (odds ratio 1.52 [95% confidence interval 1.46-1.60]) and 27% for Part B (1.27 [1.18-1.38]). Each EPM point awarded for degrees increased the likelihood of passing Part A by 29% (1.29 [1.12-1.48]). SJT score was not a statistically significant independent predictor of MRCS success (P&gt;0.05).

Conclusions
This is the first study to investigate the relationship between UK medical school performance and postgraduate surgical exam success. Higher ranked students are more likely to succeed in the MRCS compared to their lower ranked peers.
525 Automated Continuous Instrument Tracking in Laparoscopic Box Trainers Predicts Performance at Assessment: A Prospective Cohort Study in Core Surgical Trainees
Authors: Shivank K , Ilin R , Walker K , Brennan P 
Published: May 2021

Abstract

Introduction
Box-trainers enable deliberate practice of laparoscopic skills and can be equipped with instrument tracking metrics to provide feedback. However, the relationship between metrics, assessment outcomes and practice are unclear.

Method
Core surgical trainees were provided take-home box trainers with SurgTrac™ instrument tracking metrics for practice (eoSurgical Ltd., Scotland, UK). Practice was incentivised by certification and video assessment of a basic task, peg capping. Assessment was by consultant general surgeons, using objective structured assessment of technical skills (OSATS). The following metrics were analysed: task duration, distance moved by instruments, average instrument speed, average instrument acceleration, left- or right-handedness and instrument smoothness. Metrics were correlated to OSATS scores using regression analysis. Threshold for significance was p = 0.05.

Results
During the study period, there were 1639 peg capping performances by 85 trainees; 103 video recordings were submitted for assessment. All metrics were significantly associated with OSATS score, except instrument acceleration. The multiple linear regression model was highly correlated with actual scores (Pearson correlation 0.658; p &lt; 0.001). Practice was positively correlated with regression model predicted OSATS score (regression analysis; ANOVA p &lt; 0.001).

Conclusions
Instrument tracking metrics reliably predict OSATS performance and practice improves predicted score. Trainees can use metrics in unsupervised practice and gauge whether they are improving as expected.
548 “The New Normal”? How We Adapted Simulation Training in The Midst of the Coronavirus Pandemic
Authors: Metcalfe K , Pollard J , Jeffreys D , Thomas I 
Published: May 2021

Abstract

Introduction
Delivering high quality teaching during an international pandemic is challenging but becomes increasingly important when trainees are taking on new roles and responsibilities. Instead of ceasing our simulation programme, we adapted it to comply with local infection control guidelines. We devised in-situ high-fidelity ward round simulations for all levels of trainee, from newly qualified doctors to senior registrars.

Method
The ward round consisted of three simulated patients with a range of conditions appropriate for the level of trainee, role-played by faculty members. The simulations were offered to all Foundation Year Doctors, Junior Middle Grade Doctors and Surgical Speciality Trainees with all participants wearing Personal Protective Equipment (PPE) according to COVID-19 infection control policy.

Results
A total of 81 trainees took part in the simulations. Almost all reported it as ‘very useful’ and that it improved confidence in progressing to the next stage of their career. Trainees also found it enjoyable and that personalised feedback allowed them to identify areas for development.

Conclusions
We have shown that ward round simulations can be run safely and effectively despite current COVID-19 restrictions. Even senior trainees found that a ward round simulation was useful and were keen to see it become a regular part of deanery teaching.
967 COVID READY Study: Cross-Sectional Survey of Medical Students Volunteering During the Coronavirus Pandemic (COVID-19) In the United Kingdom
Authors: Byrne M , Ashcroft J , Wan J , Alexander L , Harvey A , Schindler N , Brassett C 
Published: May 2021

Abstract

Introduction
We aimed to identify the willingness, attitudes, and practice of medical students towards volunteering in a clinical capacity during the COVID-19 pandemic.

Method
We distributed a cross-sectional survey from 2/5/2020 to 14/6/2020 to all medical students at UK medical schools.

Results
A total of 1145 medical students from 36 medical schools completed the questionnaire. 82.7% of students were willing to volunteer, but only 34.3% had volunteered. The strongest predictors of willingness to volunteer on multiple linear regression were the beliefs that volunteering to work would benefit their medical education (estimate=0.35±0.03, adjusted P &lt; 0.001) and that they would have a positive impact (estimate=0.33±0.03, adjusted P &lt; 0.001). The majority of students were willing to take up a clinical role and were confident in having the necessary skills, but there was a discrepancy between the role’s students were comfortable performing and those they were assigned. Thematic analysis of the issue’s students would face when volunteering identified five themes: safety, professional practice, pressure to volunteer, finances and logistics, and education.

Conclusions
This study identifies areas for consideration from those responsible for workforce planning, healthcare provision, and student safety. We provide recommendations to facilitate a volunteering process that is safer for students, staff, and patients.
145 Outcomes of Unstable Distal Radius Fractures – A Meta-Analysis of Bridging External Fixation Versus Volar Plating
Authors: Mulrain J , Joshi K , Doyle F , Abdulkarim A 
Published: May 2021

Abstract

Introduction
Distal radius fractures are common and trends for fixation have changed with increased use of volar locking plates in recent time. A meta-analysis will summarise the best evidence for treatment.

Method
A systematic review was conducted using PRISMA methodology to identify studies that reported clinical and/or radiological outcomes in patients with AO type C distal radius fractures when treated with external fixation versus ORIF.

Results
10 randomised trials were included in this review, reporting on 967 patients. Clinical outcomes are in favour of volar plating at 3 months post-operation, but no difference between the two groups is seen at 6 or 12 months. Analysis of complication rates shows a minute increase in risk-ratio for volar plating versus external fixation. Subgroup analysis showed significantly higher re-operations after plate fixation and significantly higher infection after external fixation.

Conclusions
Internal fixation of complex distal radius fractures confers an improved clinical outcome at early follow up only and a minimally increased risk of complications. The improved grip strength with volar plating is only superior at early follow up and no long-term superiority is seen with either intervention. The type of surgery in this injury type therefore remains at the surgeon’s consideration on a case-by-case basis.
455 Proton Beam Therapy in Rectal Cancer: A Systematic Review and Meta-Analysis
Authors: Fok M , Toh S , Maducolil J E , Fowler H , Clifford R , Parsons J , Vimalachandran D 
Published: May 2021

Abstract

Introduction
Radiotherapy for locally advanced rectal cancer is conventionally performed using photon-based radiotherapy (PBR), carrying significant risk of toxicity to organs at risk (OAR). Proton beam therapy (PBT) potentially delivers equivalent dosimetric radiation to the targeted tissue with improved sparing of OAR. We aimed to compare dosimetric irradiation of OAR for PBT versus PBR in patients with rectal cancer and assess any oncological outcomes.

Method
An extensive electronic literature search was performed from inception till April 2020 and subsequent meta-analysis performed.

Results
Six articles met the inclusion criteria. Dosimetric data of irradiation delivered to OAR for PBT and PBR were calculated for the same patients. PBT had significantly less irradiated small bowel compared to 3DCRT and IMRT, (MD -16.95, 95% CI [-24.03, -9.88], p &lt; 0.00001) and (MD -6.96, 95% CI [-12.99, -0.94], p = 0.02) respectively. Similar results were observed for bladder and pelvic bone marrow. Two studies reported clinical and oncological results for PBT in recurrent rectal cancer with overall survival reported as 43% and 68%.

Conclusions
Dosimetric treatment plans have less irradiation of OAR for rectal cancer with PBT compared to PBR. There is a need for further research in PBT and rectal cancer, as promising results have been shown in recurrent rectal cancer.
490 The Relationship Between Aortic Calcification Along with Cardiopulmonary Function and Postoperative Complications in Patients Undergoing Colorectal Cancer Resection
Authors: Ong W H 
Published: May 2021

Abstract

Introduction
The degree of aortic calcification (AC) visible on the preoperative CT and cardiopulmonary exercise test (CPET)-derived measures of fitness have been proposed as predictors of postoperative complications (POC). This study aims to examine the relationship between AC, CPET and POC in patients undergoing CRC resection.

Method
Patients who had undergone CPET prior to CRC resection in a single centre were identified from a prospectively maintained database. Oxygen uptake (VO2) at the anaerobic threshold (AT) and peak exercise were recorded. Visual scoring of AC was performed. POC were recorded as infective and non-infective using the Clavien-Dindo (CD) scale.

Results
A total of 48 patients were included. AC was more common in older patients. A trend was reported between greater burden of proximal AC and major complications (CD 3-5) while AT &lt; 11 was found to be associated with non-infective complications. No statistically signification association was noted between either AC or CPET variables and POC.

Conclusions
This study shown possible association between AC or preoperative CPE-derived measures of exercise tolerance and POC after colorectal resection. Relationship between AC and CPET variables was not clearly defined due to small sample size. Further work is warranted to investigate these relationships in a larger cohort.
463 “The ABCD Team – Reducing Patient Harm: Non-Technical Skills-Based Education”
Authors: Mohamed M 
Published: May 2021

Abstract

Background
Although health-care workers are trained to provide basic, intermediate, or advanced life support from a technical perspective, working as a team is a more complex process in acute situations. Responding to the emergency buzzer from the ward staff, and before the medical emergency arrival, could be sometimes chaotic. This may result in deficient initial management or missing basic measures.

Context
The “ABC Team” is a project, aimed to enhance the health care providers' skills in dealing with emergency situations, within the surgical ward, in an organized manner.

Innovation
Guidance for the staff was created to identify an exact job for every health care provider in the shift by assigning one job/person. Over a period of 5 months, individual training was given to the ward staff. Roles are assigned in the shift handover and A, B, C, D cards (to be attached to the ID) were printed with the information needed for a quick response. Simulation training sessions were organized before launching the project.

Implications
Streamline patient care significantly improved and ABCD assessment time is broken down to half. Pre and post project surveys showed approximately 80% of staff are now satisfied, confident and clear with their role in the emergency event.
635 Can Virtual Clinics Streamline Urology Referrals from Primary to Secondary Care?
Authors: Madathilethu S C , Sarmah P B , Khan M F 
Published: May 2021

Abstract

Introduction
The COVID-19 pandemic caused the UK to enter lockdown from 23rd March to 8th May 2020, necessitating Urology clinics to be conducted virtually. Our study aimed to assess whether new Urology referrals could be triaged and have an outcome arranged virtually before being seen by a specialist in clinic, thereby reducing referral to investigation wait-times.

Method
Retrospective data was collected from 23rd March to 8th May 2020 of new patient referrals consulted virtually in Urology outpatient clinics. Referrals were grouped into categories of presentation and outcome.

Results
642 new patients were consulted virtually during the study period. 181 (28.1%) had further imaging requested; of these, the presentations with the greatest proportion of patients with this outcome were those referred with imaging findings (50%), UTI/cystitis (43.1%) and scrotal symptoms (34.3%). 116 patients (18.1%) were added to the waiting list for procedures; 85 were for flexible cystoscopy, for which the commonest indications were UTI/cystitis (36; 55.4%) and haematuria (15; 55.5%).

Conclusions
Certain urological presentations can be triaged straight to investigation by when directly referred from Primary Care, thus reducing referral to investigation wait-time and increasing outpatient protocol efficiency.
606 Mortality and Pulmonary Complications in Patients Undergoing Upper Extremity Surgery at The Peak of the SARS-Cov-2 Pandemic in the UK: A National Cohort Study Presented on Behalf of The Corona Hands Collaborative
Authors: Dean B , Duncan J 
Published: May 2021

Abstract

Introduction
This study reports the 30-day mortality, SARS-CoV-2 complication rate and SARS-CoV-2 related hospital processes at the peak of the first wave of the pandemic in the UK.

Method
This national, multicentre, cohort study at 74 centres in the UK included all patients undergoing any surgery below the elbow at the peak of the UK pandemic. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients.

Results
This analysis includes 1093 patients who underwent upper limb surgery from the 1st to the 14th of April 2020. The overall 30-day mortality was 0.09% and the mortality of day case surgery was zero. The SARS-CoV-2 complication rate was 0.18% (2 pneumonias) and the overall complication rate 6.6% (72 patients). Both SARS-CoV-2 related complications occurred in patients who had been hospitalised for a prolonged period before their surgery and a total of 19 patients (1.7%) were SARS-CoV-2 positive.

Conclusions
The SARS-CoV-2 related complication rate for upper limb surgery even at the peak of the UK pandemic was low at 0.18% and the mortality was zero for patients admitted on the day of surgery. Urgent surgery should not be delayed pending the results of SARS-CoV-2 testing.
702 Evaluation of Risk Prediction Models for Postoperative Pulmonary Complications in Adults Undergoing Major Abdominal Surgery: A Systematic Review and External Validation Study in The Respiratory Complications After Abdominal Surgery (RECON) Cohort
Authors:   STARSurg Collaborative
Published: May 2021

Abstract

Introduction
Postoperative pulmonary complications (PPCs) following major abdominal surgery result in substantial morbidity and mortality, yet stratifying patients for risk-modifying interventions remains challenging. This study aimed to identify and externally validate PPC risk prediction models in an international, prospective cohort.

Method
A systematic review was conducted to identify risk prediction models for PPC following abdominal surgery. External validation was performed using data from a prospective dataset of adult patients undergoing major abdominal surgery from January to April 2019 in the UK, Ireland, and Australia. The primary outcome was identification of PPC within 30-days (StEP-COMPAC criteria definition). Model discrimination and diagnostic accuracy were compared.

Results
Six unique risk prediction models were eligible from 2819 records (112 full texts). These were validated across 11,591 patients, with an overall PPC rate of 7.8% (n = 903). The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score provided the best discrimination (AUROC: 0.709 (95% CI: 0.692-0.727), yet no risk prediction model demonstrated good discrimination (AUROC &gt;0.7).

Conclusions
The risk of PPC for patients following major abdominal surgery in the pre-covid era is not well described by existing prediction tools. New prediction tools are required to account for additional variation introduced for patients affected by SARS-CoV-2 infection.
926 CSF Rhinorrhoea After Endonasal Intervention to The Skull Base (CRANIAL): Multicentre Pilot Study
Authors: Khan D Z , Marcus H J ,   CRANIAL Collaborative
Published: May 2021

Abstract

Introduction
CRANIAL (CSF Rhinorrhoea After Endonasal Intervention to the Skull Base) is a prospective, multicentre observational study seeking to determine: the scope of skull base repair methods used, and the corresponding rates of postoperative CSF rhinorrhoea in endonasal transsphenoidal (TSA) expanded endonasal approaches (EEA) for skull base tumours.

Method
A prospective, observational cohort pilot study was carried out at eleven neurosurgical units, via NANSIG and BNTRC collaboratives.

Results
192 cases were included – 167 TSA (87%), 25 EEA (13%). The most common (MC) pathologies included: pituitary adenomas (n = 150/192), craniopharyngiomas (n = 7/192) and meningiomas (n = 4/192). The MC skull base repair techniques used were tissue glues (n = 135/192, MC Tisseel®), grafts (n = 94/192, MC fat or Spongostan™) and vascularised flap (52/192, MC nasoseptal). These repairs were most frequently supported by nasal packs (n = 127/192) and lumbar drains (n = 23/197). Biochemically confirmed CSF rhinorrhoea occurred in 10/167 (6%) TSA and 4/25 (16%) EEA. 5 cases required operative management for CSF rhinorrhoea (CSF diversion or direct repair). Qualitative feedback was largely positive (e.g., user-friendly data collection), demonstrating acceptability.

Conclusions
Our pilot experience highlights the acceptability and feasibility of CRANIAL. There is clear precedent for multicentre dissemination of this project, in order to establish a benchmark of contemporary skull base neurosurgery practice.
13 Medical Students’ Mood Adversely Affected By COVID-19 Pandemic: An Interim Analysis from the SPICE-19 Prospective Cohort Study Of 2075 Medical Students and Interim Foundation Doctors
Authors: Bandyopadhyay S , Georgiou I , Baykeens B , Gillespie C , de Andres Crespo M , Bashir M , Handa A , Saunders K 
Published: May 2021

Abstract

Introduction
In order to appropriately support medical students and foundation year doctors, it is imperative that we understand the impact the COVID-19 pandemic has had upon them. This study assessed the effects of the COVID-19 pandemic on medical students and interim foundation year doctors across the United Kingdom (UK), and the support that they received and sought.

Method
A prospective, observational, multicentre study was conducted. All medical students and interim foundation year doctors were eligible to participate.

Results
A total of 2075 individuals participated. There was a decrease in participants’ mood when comparing their mood before the pandemic to during the pandemic (p &lt; 0.0001). Social distancing negatively impacted the mood of the greatest number of participants. All areas of life included in the study were found to have been significantly more negatively impacted than positively impacted (p &lt; 0.0001). 931 participants wanted more support from their university.

Conclusions
When medical students return to their universities, there is likely to be a need for enhanced wellbeing support, adaptations in the short-term and long-term strategies for medical education, and provision of financial guidance. If no action is taken, there may be a knock-on effect on workforce planning and the health of our future workforce.
693 Are Virtual Clinics the New ‘Normal’? – A Single-Institution Comparative Analysis of Outcomes and Cost-Effectiveness of Virtual and Face-To-Face Clinics
Authors: Hassanzadeh-Baboli D , Pavithran A , Khawaja I , Maan Z , Deshpande A 
Published: May 2021

Abstract

Introduction
The coronavirus (COVID-19) pandemic has had a profound impact on clinicians, hospital resources and patients. Urology Virtual clinics (VCs) were initiated at our institution to ensure continued provision of service during the pandemic. The study aim was to analyse outcomes and cost-effectiveness of VCs compared to pre-COVID-19 face-to face (F2F) clinics.

Method
We retrospectively analysed the VCs from 18th March 2020 to 1st July 2020 and compared them to F2F clinics in the same period in 2019. Clinical outcomes were compared, and potential financial savings were estimated to see if VCs can be incorporated into future practice.

Results
1317 patients were reviewed in 2020 as compared to 1941 in 2019. We noted similar rates of discharges [25.4% (2020) v/s 24.1% (2019)], follow-ups (48.7% (2020) v/s 48.4% (2019)] and patients who did not attend/answer (6.8% (2020) v/s 6.6% (2019)]. Potentially, over £100,000 can be saved by changing 50% appointments to VCs.

Conclusions
Our data shows that VCs are non-inferior to F2F clinics and have allowed continued effective service provision during the COVID-19 pandemic. There is potential to incorporate VCs into future practice without compromising on efficacy. Further data collection and analysis is ongoing at our institution on a larger scale.