bluuebunny/crossref_metadata_2025_split huggingface dataset:
1225 How Are Acutely Symptomatic Hernias Repaired in The UK? Surgical Techniques from The MASH Study
Authors: Spence O ,   MASH Steering group,   MASH Collaborators
Published: October 2021

Abstract

Aim
Minimal evidence exists guiding the emergency management of acutely symptomatic abdominal wall and groin hernias (ASH) and there is a lack of consensus on optimal surgical technique. The aim of this study was to explore surgical techniques used in the repair of ASH.

Method
A prospective 12-week cohort study (NCT04197271) recruited adult patients with ASH across 23 UK sites. Baseline characteristics, quality of life, management strategy and 30/90-day outcomes were collected. For those undergoing surgery, detailed information was recorded on: time to surgery, anaesthetic technique, grade of surgeon, intraoperative findings, antibiotic use, operative approach, repair technique (mesh vs suture), mesh/suture type and position, and whether bowel resection/stoma formation was required.

Results
Of the 264 patients recruited, 214 (82%) underwent acute repair within 48 hours of admission. 95% of patients underwent open repair, 93% under general anaesthetic. Mesh was used in 89% of inguinal hernia repair vs 29% umbilical hernia repair. The majority (86%) used a synthetic non-absorbable mesh (94% inguinal, 84% umbilical). Mesh placement varied widely for epigastric and umbilical hernia, with onlay used most commonly (24%). Similar variation was seen in suture choice. 8% of patients developed an SSI by 30 days, the majority which were in umbilical repairs. One patient developed early hernia recurrence (umbilical) requiring surgery.

Conclusions
This data demonstrates variation in the surgical management of ASH, especially with the use of mesh. Laparoscopic surgery was uncommon. Further studies are required to clarify optimal technique strategies in the emergency setting.
155 A Machine Learning-Based Approach for Predicting Surgeons’ Subjective Experience and Skill Levels: Neuroimaging Study
Authors: Keles H O , Cengiz C , Demiral I , Ozmen M M , Omurtag A 
Published: October 2021

Abstract

Aim
Measuring cognitive load is important for surgical education and patient safety. Traditional approaches of measuring cognitive load of surgeons utilise behavioural metrics to measure performance and surveys and questionnaires to collect reports of subjective experience. There is a need for more automated, more accurate and objective evaluation methods.

Method
Functional neuroimaging data was collected using wireless NIRS device from sixteen surgeons (11 attending surgeons and 5 surgery resident) and 17 students while they performed two laparoscopic tasks (Peg transfer and String pass). Participant’s subjective mental load was assessed using NASA-TLX survey. Machine learning approaches were used for predicting the subjective experience and skill levels.

Results
The Prefrontal cortex (PFC) activations were greater in students who reported higher-than-median task load, as measured by the NASA-TLX survey. However, in the case of attending surgeons the opposite tendency was observed, namely higher activations in lower v higher task loaded subjects. We found response was greater in the left PFC of students particularly near dorso- and ventrolateral areas. We quantified the ability of PFC activation to predict differences in skill and task load using machine learning while focusing on the effects of NIRS channel separation distance on the results. Our results showed that the classification of skill level and subjective task load could be predicted based on PFC activation with an accuracy of nearly 90%.

Conclusions
The high accuracy of results is encouraging and suggest the integration of the strategy developed in this study as a promising approach to design automated, more accurate and objective evaluation methods.
1006 Impact of The Human Factor on Student Interest in Orthopaedic Surgery: A Randomised Control Trial
Authors: Feeley A , Feeley I , Lee M , Merghani K , Sheehan E 
Published: October 2021

Abstract

Aim
The positive learning experiences of students on surgical rotations which subsequently influence career choice may be delineated into practical and interpersonal themed factors. It remains unclear the relative impact each component has on the student experience and subsequent specialisation. We evaluated the influence of having senior resident mentor during practical simulation in orthopaedic surgery has on medical student interest in surgery; their comfort in theatre; and its role in enhancing knowledge acquisition within the rotation

Method
Medical students undergoing clinical rotations in a Regional University Hospital were randomised to undertaking a a virtual reality simulated operation independently or performing under the guidance of an experienced resident. Baseline levels of interest in surgery, comfort in theatre, perceived barriers to surgical learning and entry to surgery were established and compared to answers following completion of the tutorial. Qualitative feedback was collected regarding the benefits and limitations to the experience. Presented according to CONSORT guidelines.

Results
Participants in the resident guided group achieved significantly higher simulated performance scores compared to the control (p &lt; 0001), with an increase in orthopaedic surgery from baseline expressed to a statistically significant degree (p = 0.04). 100% participants strongly agreed it was a beneficial learning experience which would be useful in surgical curricula.

Conclusions
Surgical trainee guided simulation led to improved performance and interest in orthopaedic surgery, while virtual practical experience was felt to be a useful learning tool independent of supervision. Further research is needed to establish the role of interpersonal interactions in student surgical experience.
1515 A Survey on The Perceived Effect of Background Music on Intra-Operative Stress, Anxiety and Surgical Task Load On the Operating Surgeon
Authors: Pearson L , Narayanan A , Fisher J , Khashram M 
Published: October 2021

Abstract

Introduction
Music is commonly played in operating theatres throughout the world though its use remains controversial. There is growing literature supporting the notion that playing background music can improve a surgeon’s task performance and reduce performance stress. We present findings from our survey of surgeons about their perceptions of the effect of intra-operative music on their stress levels.

Method
Surgeons and registrars from three different specialties – general, vascular, and paediatric surgery – in a single tertiary centre were surveyed on their views on the effect of music in theatre. Two instruments were used to assess parameters of stress: the modified 6-point state trait anxiety inventory (STAI-6) and the surgical task load index (SURG-TLX).

Results
There were 35 respondents across the three surgical specialties (78% response rate). Pop and “easy listening” were the most popular genres. A majority felt music improved their temperament (75%) and perceived stress (63%). 59% of respondents reported no to low perceived anxiety with music, compared with 31% reporting moderate and 9% high anxiety based on STAI-6 parameters. Regarding SURG-TLX parameters and music, respondents overall perceived feeling less anxious, rushed and mentally fatigued though more distracted.

Conclusions
Music is generally thought to have positive subjective effects on the theatre environment with regards to anxiety levels, temperament, perceived stress, and parameters within the surgical task load index. This is counterbalanced by a smaller group of respondents who felt that music can impair communication and increase distraction within theatre. Music used appropriately may reduce perceptions of stress in theatre.
1636 Improving Plastics SHO Induction: A Three-Cycle QI Project and National Survey
Authors: Leong S , Vijayasurej K , Faderani R , Sin-Hidge C , Gibson J , Jessop Z 
Published: October 2021

Abstract

Aim
Burns and Plastic Surgery is a wide-ranging exciting field that is rarely taught well in undergraduate medical curriculums. As such, it is imperative that we design and deliver a safe and effective induction programme for Foundation doctors and core trainees who are new to this specialty.

Method
Plastics SHOs rotating to our unit from December 2019 to December 2021 completed quantitative and qualitative questionnaires on the departmental induction they received. Statistical analysis and thematic analysis of their quantitative and qualitative responses were performed respectively. We aimed to describe the process of modifying our induction programme to the modern learner's learning needs. In addition, we surveyed Plastics SHOs in all Plastics units in the UK to compare and assimilate best practice.

Results
A combination of didactic and practical workshops resulted in significantly improved learner satisfaction, SHO preparedness for oncalls and knowledge of departmental policies in our unit. SHO shadowing was the most preferred and effective method of SHO induction nationally but rarely used. SHO handbooks were useful but employed by less than 40% of Plastics units nationally.

Conclusions
Through a multi-cycle QI project and national survey, we look forward to presenting the ideal design of an SHO induction programme for a specialty that requires structured clinical assessment and procedural skills. In summary, the ideal SHO induction programme consists of a combination of didactic tutorials, practical workshops, and peer shadowing. This is crucial in maintaining patient safety and junior doctor well-being when tackling the often-busy plastic surgery oncalls.
98 Intracorporeal Versus Extracorporeal Anastomosis in Laparoscopic Right Hemicolectomy: Meta-Analysis of Randomised Controlled Trials
Authors: Qayum M , Nawaz G , Hajibandeh S , Hajibandeh S 
Published: October 2021

Abstract

Aim
To evaluate comparative outcomes of intracorporeal (ICA) and extracorporeal (ECA) anastomosis in laparoscopic right hemicolectomy.

Method
We conducted a systematic search of electronic databases and bibliographic reference lists. We applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases. Overall perioperative morbidity, anastomotic leak, surgical site infection (SSI), paralytic ileus, bleeding, postoperative pain within 5 days, conversion to an open procedure, length of incision and procedure time were the evaluated outcome parameters. Combined overall effect sizes were calculated using random-effects models.

Results
We identified 4 randomised controlled trials reporting a total of 399 patients evaluating outcomes of ICA (n = 199) and ECA (n = 200) in laparoscopic right hemicolectomy. The ICA was associated with significantly shorter length of incision (MD:-1.82, P &lt; 0.00001), lower postoperative pain score on day 2 (MD:-0.69, P = 0.0007), day 3 (MD:-0.80, P = 0.02), day 4 (MD:-0.83, P = 0.01) and day 5 (MD:-0.49, P &lt; 0.00001) when compared to ECA. Moreover, it was associated with significantly shorter length of hospital stay (MD:-0.27, p = 0.03). However, there was no significant difference in overall perioperative morbidity (RR:0.79, P = 0.47), anastomotic leak (RR:1.29, P = 0.65), SSI (RR:0.61, P = 0.42), bleeding (RR:0.70, P = 0.71), ileus (RR:0.60, P = 0.45), conversion to open (RD:-0.02, P = 0.45), number of harvested lymph nodes (MD:0.82, p = 0.06), and procedure time (MD:16.04, p = 0.06) between two groups.

Conclusions
The meta-analysis of level 1 evidence demonstrated that ICA and ECA have comparable perioperative outcomes in laparoscopic right colectomy although the former may be associated with less postoperative pain probably due to shorter incision length.
353 AIR Score Based Management of Appendicitis
Authors: Carlile A 
Published: October 2021

Abstract

Introduction
Appendicitis is the most common cause of an acute abdomen. Approximately 7% of the population will be affected at some point. The development of AIR has been developed to aid diagnosis and decreasing the number of negative appendectomies while also safely identifying those who have developed appendicitis.

Aim
This retrospective audit, which aims to assess the effects of the introduction of AIR score risk on the negative appendicectomy rate of patients admitted to Taranaki Base Hospital.

Method
All patients under General Surgery receiving open appendicectomy, laparoscopic appendicectomy or diagnostic laparoscopy for evaluation or treatment of appendicitis from January 1st 2017 – December 31st 2018.

Results
The negative appendicectomy rate dropped 11.1% after introduction of the AIR score, we also noted a decrease in CT scan use.

Discussion
Our results suggest that the Air score could be used as an adjunct to the clinical diagnosis of acute appendicitis.
856 Mortality and Morbidity Meetings in Oral and Maxillofacial Surgery: Hindsight is 20/20
Authors: Ahmed A , McMillan K 
Published: October 2021

Abstract

Aim
Mortality and Morbidity (M&M) meetings form a critical part of clinical governance however they often suffer from hindsight bias and lack objectivity. To combat this, Kahoot surveys were disseminated to senior clinicians prior to M&M meetings. Each case to be discussed is presented as a survey item with the clinical and radiographic information that was available to the performing surgeon pre-operatively and participants are asked to detail their ideal treatment. The aims of this study were to determine if the introduction of Kahoot surveys prior to M&M meetings improves the objectivity of the discussions and reduces the effects of hindsight bias.

Method
A 12-item questionnaire relating to the introduction and utility of Kahoot surveys prior to M&M discussions was distributed to all registrars and consultants within our department.

Result
An 80% response rate was obtained (16/20 responses). Prior to the introduction of Kahoot surveys, 62.6% of surgeons felt case discussions were clouded by the benefit of hindsight. Comparatively, 68.8% indicated the use of pre-M&M surveys reduced the effects of hindsight bias. 56.3% of participants expressed the objectivity of case discussions improved and 50% felt the quality of feedback improved.

Conclusions
The use of Kahoot surveys prior to M&M meetings demonstrates that withholding the case outcome until each clinician has given their own opinion reduces the effect of hindsight bias. The surveys utilise the Bolam Test, thereby enabling us to determine the correct error classifications with greater objectivity. Furthermore, they facilitate a higher quality of discussion and feedback.
1153 “To FNA Or to Not FNA, That Is the Question.” A 5-Year Retrospective Epidemiological Study Of 238 Surgical Parotid Cases Treated at An East Yorkshire OMFS Unit
Authors: Townend G , Moussa A , Akoush Y , Dhanjal G , O'Higgins C , Gladwin L , Taha A , Mizen K , Crank S , Philip J 
Published: October 2021

Abstract

Introduction
Fine needle aspiration (FNA) is a surgical procedure used to aid with diagnosis and subsequent treatment planning. This study compares FNA histology with final histology (gold standard) for diagnostic accuracy in parotid surgery patients.

Method
A retrospective investigation of patient records from January 2014-January 2019 was performed to find eligible patients that underwent parotid surgery. Histology reports of the ultrasound (US) FNA and final parotid sample were compared for diagnostic accuracy and ability to differentiate between malignant & benign tumours.

Results
240 parotid surgeries on 238 patients were undertaken between 2014-2019 under OMFS and ENT specialities. 137 US FNA’s were performed, of these, there was an 85% diagnostic rate. Of the diagnostic FNA’s 79% reach gold standard, with the histology matching that of the final histology. Of the 24 without diagnostic accuracy, 2/3 were still able to differentiate between malignant and benign lesions. Overall, the US FNA’s were able to differentiate malignant and benign parotid lesions in 93% of cases.

Conclusions
The audit has proven US FNA to be an accurate diagnostic test, it gives extra data to aid in the decision making and planning for parotid surgeries. Although US FNA has shown to be more accurate in diagnosing benign parotid tumours; it is useful in detecting cellular change which could be indicative of malignancy.
1203 Sialendoscopy In Non-Stone Sialadenitis Is an Effective Therapeutic Approach
Authors: Karia R , Pepper T , Ryba F 
Published: October 2021

Abstract

Introduction
The aim of this retrospective case series was to investigate the therapeutic effectiveness of salivary endoscopy for non-stone related sialadenitis and obstructive symptoms.

Method
The records of 46 patients who underwent salivary endoscopy between September 2018 and December 2019 were reviewed. Included cases presented with at least one symptomatic major salivary gland, with no history or evidence of stone disease on clinical or radiologic examinations.

Results
A total of 22 patients (48%) and 26 glands were identified. These patients had a mean age of 50.8 years (range 27–74) and 73% were female. Most cases (19/26) involved the parotid gland. The primary imaging modality used was ultrasound, with sialography reserved for suspected strictures. The most common sonographic finding was ductal dilation (50%). Dexamethasone was instilled at completion of sialendoscopy in 23/26 cases. Outcomes included symptomatic improvement in 15/18 patients (4 patients have follow-up pending) with 5/15 experiencing complete symptom resolution. 2/18 patients did not have any symptomatic improvement, and 1/18 experienced acute infection that was treated with antibiotics. No patients required gland excision.

Conclusions
Salivary endoscopy is a minimally invasive and effective treatment for patients with non-stone sialadenitis that is refractory to conservative measures. Our review demonstrated 83% therapeutic benefit with gland preservation in all patients.
1208 Silent Sinus Syndrome: Systematic Literature Review and Report of Case Treated with A Customised PEEK Orbital Floor Implant
Authors: Denholm K A , Pilkington R J J , Keith D J W 
Published: October 2021

Abstract

Aim
Silent sinus syndrome is a rare condition characterised by progressive, painless enophthalmos with subsequent development of hypoglobus due to orbital floor resorption. It is caused by hypoplasia of the ipsilateral maxillary sinus due to atelectasis. It may be associated with previous orbital floor surgery or trauma or may be idiopathic. We describe the case of a 33-year-old female treated with a customised orbital floor implant, and a review of the condition from available literature.

Method
A total of 53 patients with a diagnosis of silent sinus syndrome reported in 7 different papers from 2003-2020 were compared in age, presenting signs and symptoms, radiographic findings and the types of treatment provided.

Results
The patients ranged from ages 19 to 91, with an average age of 45.1 years, and a male to female split of 29:24. The most common presenting sign was progressive unilateral enophthalmos, usually in the absence of any ocular symptoms. Treatments included endoscopic maxillary antroscopy, orbital floor repair (prefabricated or customised) and septoplasty.

Conclusions
Silent sinus syndrome typically presents with unilateral enophthalmos which is often painless and not associated with any visual disturbance. It possesses characteristic clinical and radiographic signs. The management of choice is surgical and does not tend to recur in the years immediately following resolving treatment. Since the advent of 3D printing, accurate customised orbital plates can now be designed to correct the hypoglobus which is a major aesthetic component when it presents in this condition.
1211 An Ameloblastoma Or Intra-Oral Basal Cell Carcinoma? A Clinical Case Report
Authors: Crummey S , Amini A 
Published: October 2021

Abstract
A basal cell ameloblastoma is an uncommon benign neoplasm and has a similar histological appearance to basal cell carcinoma of the skin. This clinical case report will discuss an ameloblastoma originating in the maxilla and of the baseloid variant. The objective of report is to highlight the possibility of misdiagnosis from this challenging case.
A 34-year-old male was referred to the maxillofacial department with recurrent nasal regurgitation following dental extraction from the left maxilla 1 year previous. Clinically there was an oro-antral fistula visible and initial CT showed cystic lesion in the left maxilla likely to represent an odontogenic cyst. The patient underwent extraction and enucleation, where the diagnosis of the amelobalstoma was established with need of resection. Partial maxillectomy and primary closure with buccal fadpad was performed in the second stage and histological results showed a 6mm completely excised basal cell carcinoma within the oral mucosa and no bony invasion. Due to this extremely unusual results, secondary histological review was requested, and conclusion was a fully excised basal cell ameloblastoma. Following the procedure and subsequent reviews, the patient has no evidence of oro-antral fistula or recurrence of this rare type of neoplasm.
A basal cell ameloblastoma variant is a rare lesion and due to its’ similar histological appearance to a basal cell carcinoma, can lead to a misdiagnosis. The aim of the report is to show the unusual presentation and findings along the way to correct diagnosis in this case.
1327 Youtube As in Information Source for Microsurgical Training: A Systematic Review of Video Content
Authors: Ochuba P , Uppal J , Langan D , Chai A 
Published: October 2021

Abstract

Aim
The COVID-19 pandemic has resulted in fewer physical microsurgical training opportunities, forcing trainees to seek virtual alternatives. As one of the largest video-sharing platforms globally, YouTube is increasingly being used to provide educational content. With additional emphasis placed on these videos, there will likely have an impact on training progression further down the line. This research aims to evaluate YouTube video content as a microsurgical training information source.

Method
We searched Youtube.com for videos demonstrating and teaching microsurgical techniques. Search terms included “microsurgical”, “teaching”, “anastomosis” and “flap”. All videos of neurosurgical nature were excluded. Thirty-one videos were evaluated using nine criteria and using a modified GQS score. To reduce duplication, included videos were limited to two from one source.

Results
Initial results show 79% of the videos were GQS Score 4/5 and therefore of good quality, despite only 38.7% featuring human procedures. 82.8% of the videos found were from medical websites, with most generated from three independent sources. The highly-scoring YouTube videos tended to have an audio voice-over or subtitles and clearly described the instruments and materials used.

Conclusions
The results demonstrated that high-quality videos are easily accessible on YouTube and deemed useful as educational tools. However, trainees should be aware that varied sources provide videos that range in quality; and the learning acquired may not directly correspond to learning objectives set out by governing bodies and is unlikely to be comparable to real-life observation in theatre. Overall, evidence for the current educational value of YouTube for microsurgical techniques is somewhat limited.