bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP1.14 - Advancing Surgical Education: A Pilot Study Evaluating the Impact of Augmented Reality in Post-Graduate Surgical Skill Training
Authors: Aloul Zaina , Colman Samuel , El-Bahnasawi Mohammed , Abdulkader Nayaab , Rawaf David , Khalil Miriam 
Published: September 2024

Abstract

Aim
The landscape of post-graduate surgical education, influenced by the clinical pressures of the COVID-19 pandemic, has prompted a shift towards prioritizing patient safety and embracing simulated technology for skill development and assessment. This study aims to evaluate the influence of (LapAR™) simulation on the acquisition of surgical skills and the overall training experience for junior surgical trainees.

Methods
15 trainees and 2 consultants were recruited across five training sites. Participants used (LapAR™) at home to perform ten appendicectomies, interspersed with LapPass tasks. Objective metrics, including completion time and distance, were quantified, followed by comprehensive interviews.

Results
Junior surgical trainees demonstrated improvements in completion time, distance travelled, smoothness, acceleration, and ambidexterity during repeated laparoscopic appendicectomies. It is of interest that trainees were meeting consultant benchmarks across all modalities. Qualitative analysis emphasized the relevance of Augmented Reality in early surgical training, advocating for its mandatory integration. Participants sought prolonged access to (LapAR™), acknowledging its value for list preparation, skill acquisition, and knowledge enhancement. Home-based training offered flexibility, contrast to the pressures of traditional surgical environments. Despite technical challenges, (LapAR™) delivered realistic educational benefits.

Conclusion
(LapAR™) presents a scalable and transformative approach to enhancing surgical skills while addressing common challenges faced by trainees. This study validates its efficacy through improved skills aligned with objective metrics, positive evaluations of educational content, and unanimous agreement on the realism of the simulation. Augmented Reality bridges the gap between surgical training and practice, offering a scalable solution to elevate the standards of surgical education.
SP2.7 - A Consultant General Surgeon's approach to evaluating malnutrition in emergencies: a qualitative study
Authors: Ashmore Daniel , Baker Daniel , Wilson Tim , Halliday Vanessa , Lee Matthew 
Published: September 2024

Abstract

Background
Patients undergoing an emergency laparotomy are often malnourished. Identifying malnourished patients is a prerequisite to offering targeted nutritional support. This study explores how consultants identify malnourished patients, why they use that approach and the barriers experienced.

Methods
General surgical consultants involved in emergency surgery were invited. We used purposive sampling to ensure a broad representation of consultant experience across different practice settings. Following ethical approval (UREC 050436), semi-structured interviews were conducted online, audio-visually recorded and transcribed verbatim. Interviews were coded and analysed in NVivo. A framework was developed and reviewed by an independent researcher and supervising team. Interviews continued until saturation.

Results
Eighteen interviews were conducted (14 male, consultant experience 6 months-23 years) across three hospital settings (4 district general, 10 teaching, 4 intestinal failure unit). Identifying malnutrition consisted of three themes: ‘surgeon’ (knowledge, experience, planning ahead); ‘patient’ (selection, composition, clinical progress, operative considerations); and ‘institution’ (collaboration, extended surgical team). Three themes also encompass the barriers experienced: ‘surgeon’ (understanding, culture, ownership, time constraints); ‘institution’ (provision, staffing, conflict, hospital setting); and ‘wider context’ (research, external factors). These influenced clinical decision making, which had two themes; ‘to join or not to join’ (risk taking, site of anastomosis) and ‘nutritional support’ (timing, delivery).

Discussion
This study highlights a range of barriers that consultants experience when assessing patients for malnutrition, which affects operative and clinical decision making. It provides a framework upon which issues can be addressed by surgeons and policy makers in order to improve outcomes for malnourished patients.
SP3.1 - Could shorter length of stay and oncological non inferiority justify a radical paradigm shift towards RAS to be the gold standard for all rectal cancer resections
Authors: Qazalbash Zeeshan Ali , Khopekar Faid , Tan Chin , Khan Junaid , Mukherjee Arijit 
Published: September 2024

Abstract

Aim
Robotic-assisted surgery (RAS) has proven to be an effective alternative to open (OP) and laparoscopic-assisted (LAP) rectal cancer resections. We aim to evaluate pathological and peri-operative outcomes of patients in a single centre undergoing rectal cancer resections using all three surgical techniques to evaluate whether RAS should be the gold-standard.

Methods
We retrospectively identified all elective rectal cancer resection cases since 2019 at our centre offering OP, LAP, and RAS services. We audited length-of-stay (LoS), complications, readmission rates, margin clearance status, and lymph node yield.

Results
Since 2019, there were 28 OP, 77 LAP, and 35 RAS resections performed. The median LoS for OP resections was 11 days, for LAP was 8 days (p=0.02) and was lowest for RAS resections (3 days, p=0.005). Readmission rates were highest for OP resections (21.4%) and were identical for LAP and RAS resections (14.2% each). Complications (OP 25%, LAP 34%, RAS 37%; p&gt;0.05) were categorized using Clavien-Dindo (CD) classification with LAP having highest proportions of CD-IV (7.7%) and CD-V (7.7%), whereas RAS and OP resections had no severe complications (CD-IVa/IVb/V).

Conclusion
Our analysis shows significantly superior outcomes for shorter LoS and clear non-inferiority of RAS in all other aspects as compared to conventional approaches. Efforts must be bolstered to introduce RAS for rectal cancer resections in the long run considering the need for increasing training opportunities and improved resources to allow for a stable transition to RAS led services, rather than a radical conversion. Further studies are warranted to substantiate our observation.
SP5.4 - Is Fecal Calprotectin a useful test?
Authors: Tamanna Dr , Brodie Arjuna , Rao Milind 
Published: September 2024

Abstract

Aim
To identify whether there is a correlation between a positive Fecal Calprotectin level(FCP) and a diagnosis of Inflammatory Bowel Disease.

Method
Data was collected retrospectively from a database of all colonoscopies performed at a District General Hospital. Data was collected including patient demographics, FCP result, colonoscopy and histology report from the hospital electronic record system.

Results
A total of 450 patients underwent a colonoscopy for any reason with 250 male and 200 female. The average age was 63.5 years. Patients undergoing surveillance or interventional colonoscopies were excluded.
90 patients were referred for colonoscopy with a change in bowel habit and all these patients had a FCP. Out of these, 42 had a FCP greater than 99 ug/g. Only 4 had IBD confirmed on histology, 3 had non-specific bowel inflammation. Of the other 360 patients who underwent a colonoscopy for other indications, 33 had a FCP sent, with 6 being positive.
Out of a total of 48 patients who had a positive FCP, 25 had a FCP result greater than 250 ug/g. however, only three of these patients had IBD confirmed on histology.

Conclusion
The results show no correlation between a positive FCP and a diagnosis of IBD even using a higher cut off at 250 ug/g. For most cases with altered bowel habits or rectal bleeding, a FCP should not be recommended as it will not change the need for a colonoscopy.
SP5.6 - Sleep Quality and Barriers to Sleep on a Postoperative Surgical Ward
Authors: Gray Carol , Lumsden Emma , Watson Hannah , Payne Christopher 
Published: September 2024

Abstract

Aim
Sleep is an essential part of recovery post-operatively and poor sleep quality has been linked to increased patient pain, increased rates of post-operative complications such as delirium and to longer hospital stays. It is widely accepted that adults need at least seven hours of sleep at night. Surgery can induce a degree of insomnia and thus we sought to identify quality of sleep on a postoperative general surgical ward and to identify common barriers to sleep and reasons patients experience interruptions to sleep.

Methods
Using patient questionnaires, we investigated quality of sleep and explored factors, both intrinsic and extrinsic, which influenced patients both falling asleep and being woken throughout the night.

Results
Average age of participants was 73yrs. Average length of sleep was only 5.4 hours. 89% patients reported having sleep interrupted throughout the night and on average patients were awoken 2.4 times throughout the night. Only 11% reported feeling refreshed in the morning after sleep. Noise and pain were the most common barriers identified to falling asleep affecting 73% of patients. The predominant reasons for being awoken from sleep were noise (94%), interruptions for observations/bloods (67%) and thirst (33%).

Conclusions
This study has identified a high prevalence of poor sleep quality in postoperative surgical patients. Common factors influencing this are noise, pain and interruptions by medical staff. Many of these can be addressed through simple interventions to promote better recovery of patients by recognising and supporting the need for high quality sleep.
SP6.6 - Examining the Immunomodulatory Effects of Fibrosis Induced by Radiation Using Adipose-derived Stem Cells
Authors: Cui Xiangmei , Wai Jasmine , Frommer Marvin , Langridge Benjamine , Butler Peter 
Published: September 2024

Abstract

Background and Introduction
Radiation-induced fibrosis (RIF) is a complication of radiotherapy in the treatment of head and neck cancer. RIF is characterised by the formation of fibrous tissue and is associated with significant morbidity. Autologous fat grafting (AFG) is a promising approach for treating RIF, and adipose-derived stem cells (ADSC) have been identified as key contributors to this therapeutic effect.

Method
The experimental group included subjecting human-derived fibroblasts (iHDF) to radiation, whereas the control group remained radiation-free. Both groups were then treated with ADSC-controlled medium and co-cultured with ADSC. The amounts of important immunomodulators produced by iHDF cells were then collected and evaluated using enzyme-linked immunosorbent assays (ELISA) and real-time reverse transcription-polymerase chain reaction (RT-PCR).

Results
Co-cultured iHDF samples demonstrated a slight reduction in CCL2 concentrations compared to untreated iHDF samples (p = 0.0006). The iHDF co-culture samples exhibit a marginal elevation in CCL3 levels compared to the untreated iHDF samples (p = 0.0247). The co-culture samples of iHDF demonstrate a substantial and measurable elevation in IL-8 levels compared to the untreated iHDF samples (p = 0.027). The expression of Col1A1 is decreased in iHDF samples in comparison to control groups.

Discussion
CCL2 is implicated in the recruitment of ADSCs to specific locations. The elevated production of IL-8 in ADSC samples is associated with the pro-angiogenic characteristics of ADSC secretions, which promote healing in fibrotic tissue.

Conclusion
ADSCs were shown to possess anti-fibrotic properties via stimulating pro-angiogenic factors. However, experimental data indicates a concomitant elevation in pro-inflammatory factors. Further research is needed to explore the in-vivo effects of ADSC.
SP6.9 - Assessing European Pancreas Transplant Practices to Optimize Patient Outcomes
Authors: Sharma Hemant , Masood Omar , Vandellen David , Moinuddin Zia , Forgacs Bence , Tavakoli Afshin , Augustine Titus , Dhanda Raman 
Published: September 2024

Abstract

Purpose
Practise variability exists in pancreas transplantation, but the extent across the EU is unknown. We surveyed pancreas transplant surgeons to assess current practices.

Methods
A 40-question survey was sent to 84 surgeons at 17 centres in 8 EU countries. Validity and reliability were analysed. Variability was evaluated using descriptive statistics and random effects modelling.

Results
The response rate was 92% (78/84). The survey demonstrated good validity and reliability (Cronbach’s alpha 0.82). Substantial variability existed in donor selection criteria such as acceptable BMI (range &lt;10 to 35) and age (&lt;30 to &gt;60 years). Back-bench preparation also varied, including arterial reconstruction (52% continuous vs. 48% interrupted sutures) and duodenal closure (66% always buried staple line, 34% not). Systemic portal venous drainage was most common (70%), but 22% used portal drainage. Post-operative anticoagulation varied from 1 week to 3 months in duration. Random effects modelling found significant variability attributable to individual surgeons, centres, and case factors.

Conclusions
This rigorous survey identified modifiable targets to improve the quality and consistency of pancreas transplantation across the EU. Standardised best practise guidelines should focus on reducing variability in donor selection, back-bench preparation, surgical techniques, and post-operative management.
Volume of Pancreas Transplants Performed Annually per CenterNumber of Transplants PerformedRespondents, n (%)&lt;1036 (46%)11-2016 (21%)21-4013 (17%)41-608 (10%)605 (6%)
Surgical Experience of RespondentsNumber of PancreasTransplants Performed AnnuallyRespondents, n (%)&lt;24 (5%)2-528 (36%)6-817 (22%)8-129 (12%)1520 (26%)
SP6.10 - The Inevitable Way Ahead: “Small Bites” Closure For Extraction Sites In Colorectal Resections
Authors: Mony Damien , Ninkovic-Hall George , Wilson Jeremy , Magee Conor 
Published: September 2024

Abstract

Background
“Small bites" technique is widely recognised for its benefits in reducing incisional hernias after laparotomy. In 2018, our institution introduced a standardised closure technique using 2-0 PDS sutures in a small bites fashion for laparotomies in colorectal surgery, in contrast to the previously favoured 'loop' PDS mass closure. Training on this technique was provided to surgical staff, although its adoption was not mandatory.
This study aimed to review our local rate of incisional hernia at extraction sites following small bites vs mass closure.

Method
Our retrospective study included all adult patients who underwent laparoscopic or robotic colorectal resections involving an extraction site between 2018 and 2022. The closure technique used and incidence of hernia was evaluated; all patients had a minimum of 2 years clinical or radiological follow up.

Results
Of the 403 resections over 5 years, 249 met the inclusion criteria (47% female; median age 69 years, range 31-89). Robotic procedures accounted for 21.7% (n=54), and 54.6% (n=136) were for T3 cancers, with 69.1% (n=172) classified as N0. Most cases, 77.5% (n=193), featured midline extraction sites, while 22.5% were off-midline (i.e. transverse).
Mass closure was employed in 54.6% of cases (n=136), with 19.9% (n=27) developing confirmed extraction site hernias.
Small bites closure was utilised in 45.4% of cases (n=113), with 5.3% (n=6) experiencing confirmed extraction site hernias (p&lt;0.05).

Conclusion
Our data, the first of its kind, highlights a potential significant difference in extraction site hernia rates between mass closure (19.9%) and small bites closure (5.3% (p&lt;0.05)).
Moving forward, if done correctly, small bites closure should be considered the gold standard for extraction sites.
SP6.14 - The Burden of Penetrating Junctional Injuries in a UK Major Trauma Centre: a Retrospective Cohort Study
Authors: Ramaraj Prashanth , Watkins Ben , Super Jonathan , Aylwin Christopher , Hettiaratchy Shehan 
Published: September 2024

Abstract

Background
Junctional injuries occur at the join of ‘anatomically distinct zones’. The emergence of junctional injuries in trauma care has been a consequence of recent battlefield casualties; accounting for 21% of potentially survivable deaths from haemorrhage. Although well described in military literature, there are no civilian studies into junctional injuries. This study aims to examine the epidemiology and resource burden of junctional penetrating injuries.

Methods
Retrospective study of adult and paediatric patients with penetrating injuries to a junctional zone presenting to an urban MTC in one year. Electronic patient records were searched and data on anatomical distribution of injury, imaging and theatre utilisation, inpatient stay, and discharge codes extracted. Discharge codes were referenced with the National Schedule of NHS costs to produce a cost.

Results
In 132 patients 92.4% (n=122) were male with median age 27.5 and in hospital mortality 1.6% (n=2). Saturday and Sunday were most frequent 37.9% (n=50) and 81.8% (n=108) attended after 1700 and before 0800.
37.9% (n=50) of injuries were buttock; 22% (n=29) neck; 18.9% (n=25) multiply-injured; 8.3% (n=11) axilla; 6.8% (n=9) diaphragm; and 6.1% (n=8) groin. Median Injury Severity Score (ISS) 8.
46.2% (n=61) underwent surgery; 50.8% (n=67) were admitted, 7.6% (n=10) to ITU. Median length of ward stay was 3 days. 15.9% (n=21) received blood products. The overall cost was £914,076.

Conclusion
Junctional injuries are a significant resource burden. Buttock wounds were the most common but had the lowest median ISS and cost. Diaphragmatic injuries appear distinct from junctional wounds in terms of ISS and cost, and may be separate to other junctional zones.
SP7.4 - Analyzing Geriatric Trauma Patterns: Prevalence, Injury Types, and Transfer Delays in Riyadh, Saudi Arabia
Authors: Khan Lubna , Aldarsouni Fayez , Alsubaie Norah 
Published: September 2024

Abstract

Aim
To analyze geriatric trauma prevalence, injury pattern, transfer delays to trauma centers, and assess undertriage to non-trauma centers in Riyadh City.

Method
We conducted a retrospective review of 11,140 incident reports from 50 Red crescent Center in Riyadh City from the official data registry of the Red Crescent of Saudi Arabia from January 2021 to March 2023. Cases meeting "red criteria" (SBP &lt; 110 mmHg or HR &gt; SBP) were identified. Using QGIS, we mapped the regional distribution of dispatch and non-trauma centers. Network service zone analysis delineated level 1 and 2 trauma center service areas reachable within 15-, 30-, 45-, and 60-minute intervals. Dispatch centers were grouped to assess mistriaging of red criteria cases. Delays were defined as travel time &gt;60 minutes to a non-trauma center. Data were analyzed using SPSS 26 and R statistics.

Results
Majority of geriatric trauma patients (65.6%, n=7312/11140) were classified under red criteria. Penetrating injuries were the most common (51.2%, n=5704/11140), followed by fall-related injuries (38%, n=4234/11140), and finally motor vehicle accidents (6%, n=669/11140). Among red criteria cases, majority of the patients (65.6%, n=2360/3419) transferred to level 1 and 2 trauma centers were delayed, most commonly seen in the 15-minute area of south and middle Riyadh and the 45-minute service area of northern and southern Riyadh. Nearly of quarter of the red criteria patients (23.54%, n=1721/7312) were transferred to a non-trauma center.

Conclusions
Addressing delays in accessing trauma centers and transfers to non-trauma facilities is imperative, warranting focused intervention. Addressing preventable delays and enhancing the capabilities of Red Crescent centers are vital for improving geriatric trauma care in Riyadh.
SP7.6 - Incidence of hepatic pseudoaneurysm formation following blunt and penetrating abdominal trauma in the paediatric cohort: A 6-year retrospective analysis
Authors: Green James , Patel Neeral , Bunting Chris , Yung Diana , Rati Kuran , Cox Seth 
Published: September 2024

Abstract

Introduction
Hepatic pseudoaneurysm (HPA) is a rare but potentially life-threatening sequelae of liver trauma. Little data exists in the literature in regards HPAs in paediatric patients. We aimed to determine the incidence and risk factors of HPA formation in children with blunt and penetrating liver trauma.

Methods
A retrospective analysis was performed on patients admitted to our institution under the age of 18, found to have liver injury on initial trauma protocoled CT imaging between 2017 & 2022. Patients were identified from The Trauma Audit and Research Network (TARN) database. Data relevant to the study aims was collected.

Results
34 patients were identified. (mean age 12 ± 5.4 years 76.5% male 23.5% female) 67.6% of patients suffered blunt injury (mean ISS 34.3 +/- 20.4 95% CI [25.4-43.1] median AAST 3) and 32.4% patients suffered penetrating liver injury (mean ISS 19.5 +/- 9.61 95% CI [12.6-26.4] median AAST 3) Four patients were excluded from further analysis due to loss of life from the primary injury. 18 patients (60%) underwent repeat CT. Of the 12 patients that did not have a repeat scan, 6 patients (50%) had a repeat USS at 6 weeks. follow up CT identified 4 HPAs (11.7%), of which two were treated with embolization.

Conclusion
HPA formation in paediatric liver trauma presents a significant clinical challenge. While the lack of standardised protocols poses a hurdle, a personalised approach informed by individual patient factors and the use of contrast enhanced ultrasound (CEUS) may optimise HPA detection while minimising radiation exposure.
SP8.13 - Exploring General Surgeons' Experiences of Adverse Events Perceptions of Support: A Scoping Review and Qualitative Study of General Surgical Trainees
Authors: Beling Jacob , Banks Jessica , Moug Susan , Bisset Carly 
Published: September 2024

Abstract

Aims
This study aimed to deepen understanding of the psychosocial impacts of adverse events on general surgical trainees and evaluate the experiences of current support mechanisms.

Methods
The study was conducted in two parts: a scoping review and a qualitative focus group study. The scoping review was conducted in accordance with the PRISMA-ScR guidelines and JBI methodology. These themes were taken forward for extended discussion as part of a focus group study of general surgical trainees (n = 10; split in two discrete groups of five participants). Reflexive thematic analysis using anonymised transcripts and contemporary field notes were used to analyse the data.

Results
The scoping review identified six themes related to the impact of adverse events on surgeons' well-being and professional performance. These were clarified and elaborated on through qualitative analysis of focus group data, developing three key themes with associated subthemes: (1) Support structures and external factors influencing responses to adverse events, (2) impact on clinical practice and professional development and (3) methods of learning from adverse events. Surgical trainees experience significant emotional and professional repercussions in the aftermath of adverse events, often exacerbated by insufficient formal support and a prevalent blame culture within hospital environments.

Conclusions
Substantial deficiencies exist in the support structures available to surgical trainees dealing with adverse events. It is evident that the existing systems fail to adequately address the complex needs of trainees, leading to significant emotional distress and professional insecurity. System changes are necessary for surgical trainees, including the establishment of mentorship and peer support networks.