bluuebunny/crossref_metadata_2025_split huggingface dataset:
WP8.1 - Perceptions of Higher General Surgical Trainees and Trainers towards Multidisciplinary Team assessment: A deanery’s experience of the new General Surgical curriculum
Authors: Johnston Judith , Quinton Naomi 
Published: September 2024

Abstract

Aims
Explore how multidisciplinary team (MDT) working is assessed as a capability in practice (CiP).
Understand perceptions of problems with assessment of MDT as a CiP.

Methods
Semi-structured interviews were conducted virtually with 8 Higher Surgical Trainees (HST) and 4 Trainers following recruitment within a single deanery. Interviews were transcribed and analysed using reflexive thematic analysis. Ethical approval was granted.

Results
Most participants did not feel that they engaged meaningful with assessment of MDT as a CiP. Despite forming part of the Multi-Consultant Report (MCR), 75% of trainers were unaware of any formal assessment and expressed confusion over the introduction of the new curriculum. All participants reported that they felt MDT as a CiP was most appropriate for senior HST, particularly those peri-FRCS. HST felt excluded from the MDT process while trainers felt trainees did not engage. Trainees placed more value on MDT assessment in their declared subspeciality. All interviewed expressed that other activities were prioritised above MDT, particularly operating. When assessed, participants felt it was based on a balance of knowledge, presentation and preparation. Both HST and trainers felt participation rather than attendance was vital but currently not practiced. When considering grading of assessment, there was confusion from all participants in how to differentiate Level3 (Indirect Supervision) from Level4 (Day1 consultant), particularly in the context of multiple trainers in attendance.

Conclusion
Implementation of MDT as CiP has caused confusion among HST and trainers. It is poorly used and valued. The CiP is perceived as more beneficial to senior HST.
WP8.2 - Human Factors Analysis of CORESS cases using the NOTSS Framework
Authors: McLennan Elizabeth , Wohlgemut Jared , Okocha Michael , Corbett Harriet 
Published: September 2024

Abstract

Aims
Determine human factors implicated in cases submitted to the Confidential Reporting System in Surgery (CORESS), using the non-technical skills for surgeons (NOTSS) framework.

Methods
Consecutive cases submitted to CORESS, between 2005 and 2011 were evaluated as an interim analysis. The type of case, whether patient harm occurred, Clavien-Dindo (CD) classification, and the location of the incident were collected. Demographic data was not collected because they are often changed to protect patient identification. Each case was reviewed according to the non-technical skills for surgeons (NOTSS) taxonomy.

Results
There were 100 cases included in this interim analysis. The most common types of cases were delayed diagnosis (n=19), known complications (n=10), near misses (n=10), poor surgical technique (n=9), misuse of equipment/device (n=8), and wrong site surgery (n=5). Two-thirds of patients were harmed, with complications ranging from minor to life-threatening (9 CD I, 10 CD II, 32 CD III, 12 CD IV), and 4 resulting in death (CD V). Incidents occurred most frequently in the operating theatre (n=54), the ward (n=16), or the emergency department (n=9). There were 71 incidents that endangered patient safety related to deficiencies in situational awareness, 59 to poor communication and teamwork, 48 to poor decision-making, and 48 related to leadership failures.

Conclusions
The main human factors implicated in surgical patient safety incidents related to errors in situational awareness, communication and teamwork, and to a lesser extent, decision-making, and leadership. Efforts to prevent medical errors should be focused on clinician human factors training.
WP8.4 - A closed-loop audit on the use of abbreviations in consent forms in the digestive disease department at a tertiary care centre
Authors: Singh Anurag , Gulab Adil , Bhaskaran Premjithlal , Toh Wei , Elzahed Nada , Sajid Muhammad 
Published: September 2024

Abstract

Background
Consent forms can be misinterpreted due to the use of abbreviations and also in a court of law as a medico-legal document We performed this closed-loop audit to identify and improve the quality of medical consenting in this department.

Method
A prospective collection of data was done from July – Aug 2023 for the first cycle and Oct- November 2023 for the second cycle. 180 (100 surgical and 80 endoscopy) consent forms were analysed in the first cycle and 100 (50 surgical and 50 endoscopy) consent forms in the second cycle. Interventions in the form of posters, teaching sessions and discussions in the clinical governance meeting were used to improve the practice.

Results
In the first cycle, 99% of the surgery and 76 % of the endoscopy had abbreviations. The majority of abbreviations used were in the “risk” subsection (85% in surgical and 86 % in endoscopy) and in the title section (75% in surgical and 86 % in endoscopy).
In the second cycle, 56% of the surgery and 4 % of the endoscopy had abbreviations. The majority of abbreviations used were in the “risk” subsection (42% in surgical and 78 % in endoscopy) and in the title section (38% in surgical and 66 % in endoscopy).

Conclusion
There was a significant drop in the use of abbreviations after the intervention. There were a few biases during the audit including unequal distribution of the consenting doctor. We are planning to improve this figure further by emphasising the importance of consent forms in the induction program of new juniors in the department.
ThP1.14 - A Review of The Implication of Botulinum Toxin Type-A in Breast Surgery
Authors: Lim Jun Sing , Cui Xiangmei , Wai Jasmine , Mosahebi Afshin 
Published: September 2024

Abstract

Background
Breast cancer is a common form of cancer in women, with 28% newly diagnosed in the UK in 2020. Botulinum toxin A (BONT-A), first used for strabismus treatment, could be used in breast surgery to address postoperative complications. This study aims to investigate the efficacy of the implementation of BONT-A on various breast surgeries.

Method
A systematic literature review was conducted with 57 studies identified, including 6 RCTs, 1 retrospective chart review, and 1 case report. Data extraction and analysis were done using PRISMA, ROBVIS, and GRADE, including improvements in post-operative pain and upper limb impairments, capsular contracture, and scar minimization.

Results
The studies involved 347 patients and examined the role of BONT-A in breast reconstruction. Studies reported no clinically significant change in pain intensity up to 6 months from a single administration of BoNT-A (mean 13/100; 95% CI, -4 to 31). Studies showed that after 9 months of 100U intradermal injection, there is improved scar development (15.17±7.6 vs. 13.04±5.44, p=0.034 on the POSAS scale), were smoother (37.46±7.51 vs. 56.77±32.03, p=0.003 at 9 months), with reduced width (p&lt;0.001), reduced early post-operative formation (9 vs. 6 P=0.001 on VSS), and improved capsular contractures. There have been no major adverse events reported across all studies.

Conclusion
BoNT-A may reduce scar formation but lacks evidence for managing postoperative complications, requiring further RCT and observational studies.
ThP2.3 - Fluorescein Sodium - An Alternative to Methylene Blue In Detecting Sentinel Axillary Lymph Node In Carcinoma Breast
Authors: Manjunath Vedanth , Nadipanna Sreeramulu Patarapalli , Sreeramulu Pradhay 
Published: September 2024

Abstract

Aim
To ascertain the validity of fluorescein sodium in the identification of SLN in patients with Breast carcinoma.

Material and Methods
A Prospective Observational study was conducted among 30 patients with carcinoma breast aged &gt;18 years with no clinically identifiable axillary lymph nodes at the Department of General Surgery at a single centre, in rural India over period of 2 year. Institutional Ethical clearance was obtained prior to the start of the study and Informed consent was obtained from all the patients recruited

Results
Mean age was 53.13 ± 14.180 years. The majority of subjects were in the age group 51 to 60 years (26.7%). 20% were in stage T2N0M0, 30% were in T3N0M0 and 50% were in T4BN0M0. on HPE 86.7% had Infiltrating Ductal Ca, 10% had Lobular Ca and 3.3% had Squamous Cell Ca. Fluorescein Dye staining had a sensitivity of 84.21%, specificity was 30.99%, Positive Predictive Value was 39.51%, Negative Predictive Value was 78.57% and Diagnostic Accuracy was 49.54% in comparison with HPE. Methylene Blue staining had a sensitivity of 44.74%, specificity was 35.21%, Positive Predictive Value was 26.98%, Negative Predictive Value was 54.35% and Diagnostic Accuracy was 38.53% in comparison with HPE.

Conclusion
From the study findings it can be concluded that the detection of SLNs using fluorescein was high compared to methylene blue, both methods were feasible and safe in patients with breast carcinoma. Fluorescein dye had better validity in the diagnosis of Sentinel lymph node compared to Methylene blue in the Carcinoma of the breast.
ThP2.4 - Unveiling the Odds: Identifying the Axillary Recurrence rates in Invasive Breast Cancer Surgery in a district general hospital - Seventeen years of Surgical Performance decoded
Authors: Ravindran Sharanya , Kryjak Zigniew , Glassman Daniel 
Published: September 2024

Abstract

Introduction
Axillary recurrence should be minimised by effective staging and treatment where appropriate Minimum standard &lt;5% axillary recurrence at 5 years Target &lt;3% axillary recurrence at 5 years according to UK ABS guidelines.

Methods
All patients with primary cancer diagnosed at our institution between January 2004 and December 2020 were identified from a prospectively maintained database of operations obtained from the medical coding department. Demographics of the patients, pre-operative investigations, MDT discussion outcomes, operative details (and complications), post-operative pathology, neo-adjuvant and adjuvant therapy regimens and follow-up data were recorded. All patients were followed up to the censoring date of December 2021 which gave a median follow-up of 18 months (range, 12- 204).
Axillary recurrence and treatment regimens were recorded. Primary outcome measures were overall axillary recurrence and disease-free. IBM SPSS Statistics (Version 26.0 (IBM Corporation, Armonk, NY, USA) was used for statistical analysis to determine patient and pre-operative pathological characteristics that were predictive of isolated axillary recurrence after completion of the primary treatment course. Significance was defined as P&lt;0.05.

Results
There were 4024 women diagnosed with breast cancer in Midyorks trust between this period who were referred and had surgical intervention.
Of these, 107 patients were identified with recurrences.
12 were found to have an isolated axillary recurrence (8 ANC 4 SLNB)

Conclusion
The 17-year isolated axillary recurrence rate of women treated was 0.3%.
Multimodality management at the time of recurrence, including axillary surgery, radiation, and systemic therapy, significantly improved the morbidity
ThP2.10 - Echocardiographic changes of left ventricular function in coronary artery bypass graft patients - A prospective study with meta-analysis
Authors: Bhaskaran India Premjithlal , Bhaskaran Premjithlal , Aslam Mohammed 
Published: September 2024

Abstract

Coronary artery bypass graft (CABG) improves left ventricular function and reverses adverse remodelling. This has resulted in improved survival rates and decreased the incidence of cardiac events.
Systematic review identified the Echocardiographic (ECHO) indices followed by CABG from the published data. The second part of this study compares the ECHO index of the patients, who had CABG.

Results
Overall, 191 citations were identified from the initial search, of which 43 studies were retrieved. Later, 8 studies included in the review and 6 were subjected to meta-analysis. There was a change in E/A Ratio (MD = -0.33; 95% CI = -0.42 to -0.25), Peak A-Wave (MD = 0.57; 95% C.I = 0.20 to 0.94), and E/E’ Ratio (MD = -3.80; 95% CI = -4.87 to -2.73), Peak E-Wave (MD = 0.26; 95% CI = -0.08 to 0.60), Left ventricular ejection fraction (LVEF) (MD = -0.43; 95% CI = -1.79 to 0.93), diastolic dimension (MD = 0.12; 95% CI = -0.00 to 0.23). However, There was no change in systolic dimension (MD = 0.10; 95% CI = -0.04 to 0.24) among CABG cases. The prospective study includes 30 CABG cases. Of these, 23 (76.7%) males and 7 (23.3%) females with mean age was 62.12 + 8.16. There was a change (p &lt;0.05) LVEF, peak systolic gradient (PSG) from pre operative to six months after CABG.

Conclusion
In spite the changes in E/A Ratio, Peak A-Wave, E/E’ Ratio, LVEF and PSG are the most important echocardiographic indices associated with CABG.
ThP3.13 - Impact of gastrojejunostomy anastomosis diameter on weight loss following laparoscopic gastric bypass: a systematic review
Authors: Al-Fagih Othman , Zuberi Sharukh , Iqbal Fahad , Askari Alan , Munasinghe Aruna , Al-Taan Omer 
Published: September 2024

Abstract

Introduction
Laparoscopic Roux-en-Y Gastric Bypass (RYGB) is a preeminent procedure for achieving significant weight reduction and alleviating obesity-related comorbidities. However, the influence of gastrojejunostomy (GJ) anastomosis diameter on weight loss is not well-elucidated. This review examines the effect of GJ diameter on post-RYGB weight loss outcomes.

Methods
A meticulous systematic search of the literature, limited to English-language publications, was executed with the assistance of an expert librarian. The search encompassed all studies available up to 3 August 2023, the date of the last search. Study quality was evaluated utilizing the Newcastle-Ottawa Scale. Due to the heterogeneity of the outcomes, a narrative synthesis approach was adopted.

Results
From 1,026 records screened, 6 studies met the inclusion criteria, demonstrating a range of GJ diameters and follow-up durations (1-5 years). Generally, smaller GJ diameters were associated with more significant weight loss in the short to medium term. There appears to be a threshold for the reduction in diameter; beyond this, the risk of complications such as stenosis may escalate. The studies indicated a moderate to low risk of bias and underscored the importance of accurate GJ area quantification post-operation.

Conclusion
This review identifies a negative correlation between smaller GJ diameters and weight loss after RYGB. Future investigations should prioritize the standardization of measurement techniques and investigate the potential of intra-operative and artificial intelligence-based methodologies for optimal GJ diameter determination, with the aim of augmenting patient outcomes in bariatric surgery.
ThP4.6 - Diagnostic Implications of Extra-biliary Revelations in Magnetic Resonance Cholangiopancreatography (MRCP) Imaging: Expanding Clinical Insights
Authors: Tan Chin K , Wong Mei K , Ng Shou K , Stevenson Carla , Khan Khurram S 
Published: September 2024

Abstract

Aim
Magnetic Resonance Cholangiopancreatography (MRCP) is increasingly utilised to assess the biliary tree. The primary aim of this study was to assess the prevalence of extra-biliary findings on MRCPs. Secondary aim was to assess the need for subsequent investigations and subsequent outcomes.

Methods
This was a retrospective cohort study of consecutive MRCPs performed on adult patients in a single centre from November 2020 to September 2022. Patient demographics, indication(s) for MRCP, MRCP results including extra-biliary findings and subsequent investigations and outcomes were analysed from electronic case notes.

Results
1,016 MRCPs were included in this study; 616 (60.6%) were for female patients and median age was 64 years (IQR 50-75). 652 (64.2%) were inpatient and 418 (41.1%) were urgent. 592 (58.3%) had at least one extra-biliary finding and 96 (9.5%) required urgent follow-up investigations with 26 (2.6%) new diagnoses of malignancy.
213 (21%) had renal cysts, 18 (11.6%) had hepatic cysts, 69 (6.8%) had pancreatic cysts, 28 (2.8%) had liver cirrhosis, 23 (2.3%) had peripancreatic collection(s), 42 (4.1%) had a hiatus hernia, 79 (7.8%) had pleural effusion(s), 46 (4.5%) had splenomegaly and 2.6% (n=26) had identified diverticular disease.

Conclusions
More than half of the MRCPs conducted revealed at least one extra-biliary finding. Within the findings that required urgent investigations, more than 25% had newly diagnosed malignancy. This emphasises the high sensitivity of MRCPs extends beyond biliary pathologies and can be used in diagnosing extra-biliary pathology. We suggest a structured proforma should be used by clinical radiologists for reporting MRCPs.
ThP5.4 - Which Resection for Distal Cholangiocarcinoma?: Retrospective Study
Authors: Lamara Abdelhak , Nini Badreddine 
Published: September 2024

Abstract

Introduction
The treatment of distal cholangiocarcinoma (DCC) is contingent upon the patient's condition and the local and lymphatic extent of the disease. Surgery remains the sole radical treatment, albeit infrequently feasible and often followed by biliary drainage. The surgical procedure involves resecting the bile duct with healthy distal and proximal margins, accompanied by lymphadenectomy. Cephalic pancreatectomy (DPC) is deemed the optimal oncological treatment for DCC.

Method
This retrospective study encompasses cancers of the main bile duct. Various factors influencing treatment were analyzed, focusing on the type of resection (biliary and pancreatic).

Results
From January 2014 to December 2021, 119 patients were treated for distal cholangiocarcinoma (88 men, 31 women, average age: 61 years). Twenty-one patients underwent endoscopic drainage, 17 transhepatic drainage, and 55 surgical interventions. Among them, 9 underwent preoperative drainage, 28 radical resection, 10 DPC, 18 biliary resections, and one total pancreatectomy. In 27 patients, radical surgery was impossible; 20 underwent drainage, and 7 did not. Three early surgical revisions in the biliary resection group, with incidents of digestive hemorrhage and hemoperitoneum. Two moderate pancreatic fistulas and immediate postoperative hypoglycemia were recorded. Two deaths in the biliary resection group and 7 in-hospital deaths in the biliary drainage group. All patients with external drainage died before 12 months, while 8 patients from the endoscopic drainage group survived after 12 months. Patients with radical surgery and adjuvant treatment exhibited longer survivals (36 months vs. 45 months).

Conclusion
Improving the prognosis of DCC requires early diagnosis and radical surgery combined with adjuvant treatment.
ThP5.10 - Post ERCP Pancreatitis at a Tertiary Center - A Retrospective Incidence and Causal Analysis
Authors: Jain Shubham , Orabi Amira , Davis George Neelankavil , Anderson Sarah , Mekhail Peter 
Published: September 2024

Abstract

Background
Incidence of Post Endoscopic Retrograde Cholangio-Pancreatography (ERCP) Pancreatitis (PEP) varies between 3.5% and 9.7% as per the 2014 meta-analyses. Our aim was to evaluate the incidence, perform a causal analysis and gauge the financial implications of PEP in our hospital for general surgical patients to help optimise the utilisation of resources.

Methods
All General Surgical patients who had ERCP between 01/10/2022 and 31/03/2023 were included in the analysis. A successful ERCP was defined as cannulation of the biliary tree. The digital patient records were analysed and collected onto a master datasheet. They were divided into PEP and non-PEP groups.

Results
A total of 131/155 attempted ERCPs were successful. Of these 131, 13 (9.92%) developed PEP. Females were predominantly affected. Three out of six patients (50%) undergoing ERCP for malignant biliary obstructions developed PEP. Elective ERCPs (15% vs 6.5%) and higher mean bilirubin levels &gt;= 134.92 µmol/L posed a greater risk of developing PEP (p-value=0.021). The mean hospital stay was 3.5 days longer (2-49 days) in the PEP group. The total extra cost to the NHS ranged from £20,475 - £35,763 over 6 months.

Conclusion
Patients with gallstone disease should receive prompt cholecystectomy in adherence to NICE guidelines to reduce the risk of gallstone-related problems and ERCP need. This in turn would lead to a reduction in PEP and positively affect the financial implications on the NHS. We also recommend a randomised control trial for patients with grossly deranged liver function tests to compare ERCP with laparoscopic cholecystectomy and common bile duct explorations combined.
ThP7.1 - The effect of socioeconomic status on outcomes in major trauma: a systematic review and meta-analysis
Authors: Koh Amanda , Adiamah Alfred , Melia Georgia , Blackburn Lauren , Brooks Adam 
Published: September 2024

Abstract

Background
Major trauma poses a significant public health concern, with survivors often suffering long-term disability. There is growing interest in understanding the complex relationships between socioeconomic deprivation and major trauma in recent years. Anecdotal evidence suggests that social deprivation leads to more violent and debilitating injuries. There remains, however, a paucity in literature evaluating major trauma outcomes in relation to socioeconomic deprivation.

Methods
A comprehensive search of MEDLINE, EMBASE, and Cochrane databases was performed to identify eligible studies from 1947 to March 2024. The primary outcome is to establish the proportion of patients with the highest socioeconomic deprivation, with secondary outcomes evaluating surgical intervention rates, length of stay, and mortality. Quantitative pooling of data was based on the random effects model.

Results
Fourteen studies reporting on 878,872 major trauma patients were included. A substantial proportion of major trauma incidents occurred in the most deprived group at 28%. There were more male patients in the most deprived compared to the least deprived group (OR 1.36, 95% CI 1.14-1.63, I2=99%). There were no differences in surgical intervention (OR 1.74, 95% CI 0.97-3.13, I2=0%) and length of stay (WMD 1.15 days, 95% CI -0.32-2.62, I2=82%) regardless of background. Interestingly, mortality was higher in the most deprived group (OR 2.02, 95% CI 1.14-3.57, I2=80%).

Conclusion
Major trauma is more prevalent in deprived areas. Although rates of surgery and length of stay did not differ, mortality is higher in the most deprived group. The planning of public health interventions should target areas of higher deprivation.