bluuebunny/crossref_metadata_2025_split huggingface dataset:
P113 Starting a research collaborative in the midst of a pandemic – the Humberside experience
Authors: Totty J , Hitchman L , Wilkins A , Loubani M ,   on behalf of the CASSH Research Collaborative
Published: April 2021

Abstract

Introduction
The COVID-19 pandemic severely impacted research activities. Large international research collaboratives have successfully produced high quality COVID-related research. We aimed to investigate factors that influence trainee engagement in collaborative research and quantify engagement in our local area to propose methods to ensure all trainees have the opportunity to take part in impactful research.

Methods
This is a mixed methods study consisting of a survey to trainees regarding their experiences in research and an assessment of engagement in COVID-related research. The survey was circulated to undergraduates and trainees of all grades in February 2020.

Results
Engagement with the survey was poor, with a &lt; 10% return rate. 43% of respondents stated that they had no experience of research. Engagement with collaborative research was popular, with responders declaring involvement with at least 7 other collaboratives. Reasons for participating in research were improving patient care (23%), producing high quality research (19%) and CV building (19%). Barriers included perceived lack of time (23%) and lack of knowledge about research (23%).
The CASSH collaborative co-ordinated the local response to COVIDSurg, COVIDSurg|Cancer and the COVER study, involving 20 trainees contributing data on 368 patients.

Conclusions
All research collaboratives rely on the enthusiasm of participants in order to succeed. We have presented some of the motivators and barriers to participation in our region and outlined how we have built on national projects to improve engagement on a local level. Further projects are planned to capitalise on this improved engagement.
P126 The FLIP study – Fluid resuscitation In Pancreatitis
Authors: Moir John , Tingle Sam , Hawthornthwaite Emma , Robinson Stuart , French Jeremy ,   NOSTRA
Published: April 2021

Abstract

Introduction
Acute pancreatitis is a common condition encountered in emergency general surgical presentations. The severity of this condition can range from mild, whereby symptoms settle with simple conservative measures, to severe and potentially life threatening in up to 20% of cases. Intravenous fluids are the cornerstone of management in these patients, however there is very little guidance and poor quality evidence within the research literature regarding optimal intravenous fluid administration. The aim of this study is to establish current clinical practice within the North East of England regarding the rate of intravenous fluid administration in acute pancreatitis and the effect this has on patient morbidity and mortality.

Methods
This project is a prospective multi-centre snapshot audit of patients presenting with acute pancreatitis over a one month period, with 30 days follow up. Inclusion criteria are patients aged 18 or above with acute pancreatitis. Data will be collected on intravenous fluid administration in the first 72 hrs following admission in addition to demographics and severity scoring. The primary outcome measure will be admission to HDU/ITU with key secondary end-points including 30-day mortality, length of stay, radiological evidence of pancreatic necrosis and evidence of organ failure.

Results
The results of this study will be prepared in accordance with guidelines set by the STROBE: (Strengthening the Reporting of Observational Studies in Epidemiology) statement for observational studies. Data will be collected and analysed with appropriate statistical tests using SPSS. Statistical significance will be defined as a p value of ≤ 0.05

Conclusion
Data collection will be completed in early 2021 with analysis and write up planned for early in the new year. Pending the results of phase one, an RCT will be designed to determine the optimal rate of intravenous fluids for improved patient outcome.
P128 The implications of SARS-CoV-2 on a Cardiothoracic unit
Authors: Luckwell Rhys 
Published: April 2021

Abstract

Introduction
The effort to prevent healthcare systems becoming overrun during the 2020 COVID-19 pandemic has come at the cost of delaying operations and with that bringing difficult risk analysis to help decide which operations should go ahead. With COVID-19 being a novel disease there is limited evidence for guidance on this issue. We have previously presented work highlighting the high risk of mortality associated with a perioperative cardiothoracic patient becoming COVID-19 positive and thus decided to implement a series of changes to departmental perioperative practice. This work presents these interventions and compares the infection and the mortality rate with those before the intervention was put in place.

Method
Two retrospective loops were performed. Pre intervention, 5/3/20 – 20/4/20, and post intervention, 21/4/20- 23/6/20. Inclusion criteria: patients who had received cardiothoracic surgery at University Hospital of Wales within 4 weeks of the positive COVID-19 PCR (1st loop n = 53, 2nd loop n = 40). Exclusion criteria included re-admissions from greater than 4 weeks (n = 2). Interventions included 14 day pre op isolation, a strict multifaceted screening regime, reverse barrier nursing and delaying operations if diagnostic uncertainty.

Results
9/51 patients from the pre intervention loop and 2/40 from post intervention loop tested +ve for COVID-19. The pre intervention mortality was 5/9 and post intervention mortality was 0/2.

Conclusion
Our data suggest that simple changes to perioperative practice can decrease the transmission of COVID-19 during this period. Thus, allowing surgical services to run at a reduced risk
O2 Facilitating engagement in surgical research through a virtual systematic review network: The RoboSurg Collaborative
Authors: Jones Conor S , Dada Mo , Dewhurst Max , Dewi Ffion , Pathak Samir , Main Barry G , Blencowe Natalie S ,   on behalf of the RoboSurg Collaborative
Published: April 2021

Abstract

Introduction
For students and trainees, COVID-19 has restricted opportunities for training and development. We sought to develop a virtual network to facilitate remote engagement and training in surgical research during COVID-19.
RoboSurg aims to conduct a series of systematic reviews, to summarise and critique the reporting of studies of robot-assisted surgery across seven upper gastrointestinal procedures.

Methods
A protocol was developed based on previously published work. Searches were undertaken to identify studies evaluating robotic pancreas, liver, oesophagus, stomach, gallbladder, bariatric and anti-reflux surgery. Participants were identified through social media and collaborative research networks. Abstracts were screened for inclusion by two participants. Data extraction is completed by teams of collaborators, entered into a bespoke REDCap database and verified by senior team member. Changes are logged, with rationale and feedback provided to collaborators and reviewed by a third reviewer to assess consistency. Results of each review will be summarised in narrative syntheses.

Results
A total of 134 collaborators have registered, with 73 active participants. Collaborators range from second year medical students to surgical registrars across the UK. To date, 9444 abstracts and 1653 full texts have been screened with 422 eligible articles identified. Data extraction for two systematic reviews, including 193 articles, has been completed using this approach.

Conclusion
RoboSurg has developed a network and methodological framework for the remote conduction of complex systematic reviews, which can be utilised to engage and train students and trainees in surgical research.
O3 Forming a novel trainee-led research collaborative during times of crisis: Lessons learned from the COVID:HAREM collaborative
Authors: Javanmard-Emamghissi Hannah ,   The COVID:HAREM Collaborative Group
Published: April 2021

Abstract

Introduction
At the beginning of the COVID-19 pandemic, the effect it would have on our healthcare system was unknown. As a result, surgical guidelines shifted to recommend non-operative management despite uncertainty of its efficacy compared to standard operative management. Within general surgery, nowhere was this more relevant than with the management of appendicitis, the most common abdominal emergency worldwide. This novel research collaborative was set up during the COVID-19 pandemic to assess the outcomes of appendicitis patients managed with antibiotics compared to appendicectomy.

Methods
Without the time to obtain funding for the project, trainee-driven recruitment of sites was vital and used established trainee-led regional research networks and twitter (@Covidharem). Further backing was provided by surgical societies who published and promoted the study protocol on their platforms. The steering group used surgical networks and contacts to recruit sites who were not already involved and RedCap was used for data entry to allow for real time monitoring of data completion.

Results
In just twelve weeks, 471 individual collaborators were recruited from 101 sites across the United Kingdom and Ireland. The collaborative went from inception to 500 patients uploaded in 30 days. The collaborative to date has recruited nearly 3500 patients, published both the protocol and an interim analysis within 4 months, and hosted a highly successful webinar.

Conclusion
Quality research can be achieved in times of crisis, the key to successful projects is trainee driven and led, focussed “snapshots” that can be implemented rapidly during the dynamic environment of a crisis.
O7 SMILE: Sustaining Medical education In a Lockdown Environment Can free online access medical education be effective for the retention of long term knowledge acquisition?
Authors: Pascoe John , Foster Paul , Quddus Muntasha , Kosti Angeliki , Guest Francesca , Stevens Sian , Bamford Richard , Coulston James 
Published: April 2021

Abstract

Introduction
The 2020 coronavirus lockdown lead to medical educators finding new ways to teach. SMILE is a free online access medical education platform created by UK surgical trainees and a medical student that delivered 200 live lectures to students during lockdown, with up to 1500 students from every UK medical school as well as abroad. This study aims to demonstrate line education is an effective tool for knowledge retention.

Method
Students were invited to participate in three live sessions covering haematuria, bone infections/tumours and endocrine emergencies, in which students complete knowledge assessment over time .
Quiz-based polls using zoom were taken before and after each session. After two weeks and again at one month the same quiz questions were sent out to attendees of the lecture.

Results
312 students completed all 4 tests. In all three sessions average scores improved post lecture (haematuria 58%-85%; endocrine emergencies 48%-70%; osteomyelitis/bone tumours 40%-77%). At 2 weeks (H 86%; EE 78%; O/BT 75%) and 4 weeks (H 88%; EE 76%; O/BT 69%) scores remained high.

Conclusion
This study demonstrates that FOAMed is able to engage audiences in a unique way on a large scale with evidence of long-term knowledge retention.
O9 The Effects of Coronavirus (COVID-19) on operative and work-based assessment (WBA) activity on surgical training
Authors:   COVID-STAR collaborative research group, Clements Joshua 
Published: April 2021

Abstract

Background
COVID-19 has had a global impact on all aspects of healthcare including surgical teaching and training. The COVID-STAR qualitative study demonstrated a perceived negative impact of COVID-19 on numerous aspects of surgical training across all specialties and training grades. The aim of this study is to investigate how COVID-19 has affected operative case exposure and work-based assessments for surgeons in training.

Methods
Anonymized data has been sought from the Intercollegiate Surgical Curriculum Programme (ISCP) database for operations and work-based assessments in each specialty, involving surgical trainees on an approved training programme at defined Pre-COVID (16/03/19 – 11/05/19) and COVID (16/03/2020 – 11/05/20) timepoints. Primary outcome measures are the percentage (%) difference in WBA and operative activity between time points respectively. Differences in training activity between time periods will be tested using Pearson χ2 and Kruskal–Wallis tests for categorical and continuous variables respectively.

Results
This study has been approved by the ISCP Data Analysis, Audit and Research Group, and data will be managed in accordance with ISCP data governance. The hypothesis of this study is that COVID-19 has caused a reduction in the operative and WBA activity of trainees across all specialties.

Conclusion
This study seeks to quantify the impact of COVID-19 on operative training activity and completion of WBAs in clinical practice. This information will inform major stakeholders involved in optimising surgical training in the COVID-19 recovery phase.
V2 Evaluation of risk prediction models for postoperative pulmonary complications in adults undergoing major abdominal surgery: A systematic review and external validation study of the REspiratory COmplications after abdomiNal surgery (RECON) cohort
Authors:   STARSurg Collaborative, Kouli Omar 
Published: April 2021

Abstract

Background
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.

Methods
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. 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 (AUC: 0.709 (95% CI: 0.692-0.727), yet no risk prediction model demonstrated good discrimination (AUC &gt;0.7).

Conclusion
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.
V5 Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic
Authors:   COVIDSurg Collaborative
Published: April 2021

Abstract

Background
Surgical services are preparing to scale up in areas affected by COVID-19. This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery.

Methods
This international cohort study included adult patients undergoing elective surgery for cancer in areas affected by SARS-CoV-2 up to 19 April 2020. Patients suspected of SARS-CoV-2 infection before operation were excluded. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery. Preoperative testing strategies were adjusted for confounding using mixed-effects models.

Results
Of 8784 patients (432 hospitals, 53 countries), 2303 patients (26.2 per cent) underwent preoperative testing: 1458 (16.6 per cent) had a swab test, 521 (5.9 per cent) CT only, and 324 (3.7 per cent) swab and CT. Pulmonary complications occurred in 3.9 per cent, whereas SARS-CoV-2 infection was confirmed in 2.6 per cent. After risk adjustment, having at least one negative preoperative nasopharyngeal swab test (adjusted odds ratio 0.68, 95 per cent confidence interval 0.68 to 0.98; P = 0.040) was associated with a lower rate of pulmonary complications. Swab testing was beneficial before major surgery and in areas with a high 14-day SARS-CoV-2 case notification rate, but not before minor surgery or in low-risk areas. To prevent one pulmonary complication, the number needed to swab test before major or minor surgery was 18 and 48 respectively in high-risk areas, and 73 and 387 in low-risk areas.

Conclusion
Preoperative nasopharyngeal swab testing was beneficial before major surgery and in high SARS-CoV-2 risk areas. There was no proven benefit of swab testing before minor surgery in low-risk areas.
V8 Reporting of governance and ethical considerations in innovative surgical procedures – a systematic review
Authors: Zucker Benjamin , Lawrence Ruby M , Baker Will , Scroggie Darren , Jones Conor , Blencowe Natalie S ,   RoboSurg Collaborative
Published: April 2021

Abstract

Introduction
The process of innovation in the field of surgery has largely resulted in improved patient outcomes. However, the uncertainty around the potential benefits and harms of innovative procedures mean that both research governance and ethics are important considerations for those who innovate. Though the need for ethical approval is standardised, other patient safeguards are surgeon and procedure dependent, such as the information provided during the consent procedure. It is currently unknown how ethical considerations in innovative surgery have been reported. This systematic review aims to evaluate the reporting of governance arrangements and ethical safeguards applied to innovative surgical procedures, using a case study of robotic upper gastrointestinal surgery.

Methods
The RoboSurg collaboration is conducting a set of systematic reviews to evaluate reports of innovative robotic surgical procedures including: pancreatectomies, gastrectomies, Roux-en-Y gastric bypasses, oesophagectomies, liver resections, cholecystectomies and anti-reflux operations. Databases were searched in April 2020 using relevant search terms including ‘oesophagectomy’ and ‘robotics’. Data extracted include details of approvals from Institutional Review Boards, ethics committees and clinical effectiveness groups, a priori study registration, and patient consent.

Results
Interim results for the reporting of governance arrangements and ethical safeguards from studies detailing robotic oesophagectomies will be presented. The search yielded 1908 abstracts for screening, of which 101 were included. The proportion of studies reporting on each ethical safeguard for patients undergoing this innovative procedure will be described and summarised.

Conclusion
This review will evaluate how governance and ethical safeguards in studies of innovative surgical procedures have been reported.
V10 The role of surgical trainees in recruiting to multicentre RCTs: an example from the Sunflower Study
Authors: Huppler Lucy , Staight Sarah , Urbonas Tomas , Johnston Judith , Tryliskyy Yegor , Jacob Manoj , Collingwood Jane , Jepson Marcus , Pathak Samir ,   Natalie Blencowe on behalf of the Sunflower Study
Published: April 2021

Abstract

Background
The Sunflower Study aims to compare the effectiveness of expectant management and MRCP prior to laparoscopic cholecystectomy (LC) in patients at low or moderate risk of common bile duct stones. This is the largest surgical randomised controlled trial (RCT) in the UK and a secondary aim is to describe trainees’ contributions.

Methods
Participants are randomised to receive expectant management or MRCP in a 2:1 ratio. Over 13,500 patients from more than 50 UK hospitals are required over five years. Trainees’ contributions are documented as follows: total number signed up to the study; number enrolled in the NIHR associate PI scheme; and the number of patients approached and recruited. The proportion of ‘emergency’ and ‘elective’ patients recruited was also recorded.

Results
Sunflower has been open since February 2019 and 48 centres are currently participating. A total of 104 trainees have been actively involved and 34 are/have been enrolled in the associate PI scheme. To date, 3992 patients have been screened, by trainees (n = 719,18%), consultants (n = 439,11%) and research nurses (n = 2214,71%). 1996 patients have been recruited, 359(18%) of which by trainees, 319(16%) consultants and 1318(66%) research nurses. Of the recruited patients, 423 (21%) presented as emergencies, recruited by trainees (n = 169,40%), consultants (n = 59,14%) and research nurses (n = 195,46%).

Conclusions
Trainees have an important role to play in recruiting patients to multicentre surgical RCTs, in particular in emergency settings, which can help improve studies’ generalisability. The associate PI scheme seems to provide an extra incentive for trainees to be involved in an RCT.
Malaria Infection Is Common and Associated With Perinatal Mortality and Preterm Delivery Despite Widespread Use of Chemoprevention in Mali: An Observational Study 2010 to 2014
Authors: Mahamar Almahamoudou , Andemel Naissem , Swihart Bruce , Sidibe Youssoufa , Gaoussou Santara , Barry Amadou , Traore Moussa , Attaher Oumar , Dembele Adama B , Diarra Bacary S , Keita Sekouba , Dicko Alassane , Duffy Patrick E , Fried Michal 
Published: April 2021

Abstract

Background
In malaria-endemic areas, pregnant women and especially first-time mothers are more susceptible to Plasmodium falciparum. Malaria diagnosis is often missed during pregnancy, because many women with placental malaria remain asymptomatic or have submicroscopic parasitemia, masking the association between malaria and pregnancy outcomes. Severe maternal anemia and low birthweight deliveries are well-established sequelae, but few studies have confirmed the relationship between malaria infection and severe outcomes like perinatal mortality in high transmission zones.

Methods
Pregnant women of any gestational age enrolled at antenatal clinic into a longitudinal cohort study in Ouelessebougou, Mali, an area of high seasonal malaria transmission. Follow-up visits included scheduled and unscheduled visits throughout pregnancy. Blood smear microscopy and polymerase chain reaction (PCR) analysis were employed to detect both microscopic and submicroscopic infections, respectively. Intermittent preventative treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) was documented and prompt treatment regardless of symptoms given upon malaria diagnosis.

Results
Of the 1850 women followed through delivery, 72.6% of women received 2 or more IPTp-SP doses, 67.2% of women experienced at least 1 infection between enrollment up to and including delivery. Malaria infection increased the risks of stillbirth (adjusted hazard ratio [aHR] 3.87, 95% confidence interval [CI]: 1.18–12.71) and preterm delivery (aHR 2.41, 95% CI: 1.35–4.29) in primigravidae, and early neonatal death (death within 7 days) in secundigravidae and multigravidae (aHR 6.30, 95% CI: 1.41–28.15).

Conclusions
Malaria treatment after diagnosis, alongside IPTp-SP, is insufficient to prevent malaria-related stillbirth, early neonatal death and preterm delivery (PTD). Although IPTp-SP was beneficial in Mali during the study period, new tools are needed to improve pregnancy outcomes.

Clinical Trials Registration
NCT01168271.