bluuebunny/crossref_metadata_2025_split huggingface dataset:
107 Should All Medical Students Receive Clerking Simulation Teaching?
Authors: Bretherton K , Hinton A , Charles-Rudwick M , Tidd C 
Published: July 2024

Abstract

Aim
Simulation-based teaching for clerking hospital admissions is not routinely offered in medical school curricula. The Advanced Clinical Reasoning (ACR) course was developed to improve confidence and clinical proficiency in managing surgical and medical patients by allowing students to work through simulated cases in a safe environment.

Method
The ACR course was optional and face-to-face, consisting of six surgical and six medical simulated cases. The session was divided into practice forming management plans, simulated referrals, and discussion of answers. Students completed pre-course, immediate post-course and six-week post-course questionnaires and knowledge tests.

Results
Qualitative confidence forming management plans significantly increased post-session and at 6 weeks (p &lt;0.00001), as did preparedness for an acute surgical shift (p &lt;0.00001). The mean knowledge test score pre-session was 64%, which increased significantly to 77% immediately after the course (p = 0.0003) with a significant increase from baseline sustained at 6 weeks (p = 0.0012). 100% of students would recommend the course to another student, with 88% keen to repeat the course with a different case.

Conclusions
There was statistically significant qualitative and quantitative improvement in both confidence and knowledge after the course, which remained six weeks later. This supports previous research that simulation teaching has excellent outcomes and should be utilised more widely in medical school curricula. The future of this project is to conduct a remote course with a similar sample size to compare outcomes for face-to-face and remote teaching.
610 The Effectiveness of Adipose Tissue Derived Mesenchymal Stem Cells Mixed with Platelet Rich Plasma in the Healing of Inflammatory Bowel Anastomoses: A Pre-Clinical Study in Rats
Authors: Geropoulos G , Psarras K , Papaioannou M , Geropoulos V , Niti A , Nikolaidou C , Koimtzis G , Symeonidis N , Pavlidis E T , Koliakos G , Pavlidis T E , Galanis I 
Published: July 2024

Abstract

Aim
Anastomotic leak is a detrimental complication following bowel surgery leading to prolonged hospital stay, increased healthcare costs and significant increase in morbidity and mortality. The aim of this study is to investigate the effect of adipose derived mesenchymal stem cells (MSCs) mixed with platelet rich plasma (PRP) in the healing of bowel anastomoses, in an inflammatory environment .

Method
Thirty-five male Wistar rats were divided into five groups of seven animals: normal controls, colitis controls, PRP, MSCs, and PRP + MSCs. All groups underwent laparotomy, segmental colectomy and anastomosis in situ. Colitis was previously established by transrectal administration of 2,4,6-trinitrobenzene sulfonic acid (TNBS) except for the normal controls. Post-mortem histopathological, tissue hydroxyproline and anastomotic bursting pressure (ABP) assessments were performed.

Results
Tissue hydroxyproline and ABP were significantly increased in the group of PRP+MSCs compared to colitis controls (p=0.0151 and p=0.0104, respectively). Inflammatory cell infiltration was lower and fibroblast activity higher in PRP + MSCs group, but not statistically significant. Neoangiogenesis (p=0.0073) and anastomotic area epithelialization (p=0.0182) were significantly higher in PRP + MSCs group compared to colitis controls.

Conclusions
The synergic effect of the PRP and MSCs is shown to significantly improve healing in bowel anastomoses even on a background of inflammation. These results give hope for primary anastomosis and potentially avoiding stoma and its complications, especially in immunocompromised or malnourished patients undergoing bowel resection. Clinical studies should follow in order to support the clinical application of PRP and MSCs combination in gastrointestinal anastomoses.
1040 Morphometric Study of Human Aortic Valve Along with a Case of Bicuspid Aortic Valve in Cadaver
Authors: Borthakur D , Dhawan V , Kumar R , Nomani K , Singh S 
Published: July 2024

Abstract

Aim
The morphometric data pertaining to the aortic valve is very relevant for aortic valvular diseases and prosthetic valve transplant thereof, but such data is variably described in autopsy studies which prompted us to study the same in cadaveric hearts of Indian population. We also present a case of symmetrical bicuspid aortic valve (BAV).

Method
Thirty formalin fixed cadaveric hearts of both genders, aged between 58 -83 years were taken. Guidelines for using cadaver for teaching and research were followed. Various attributes of the aortic valve viz. number, width and height of cusps, number and depth of aortic sinuses, number of coronary ostia were recorded. All measurements were made with Vernier callipers and statistical analysis was performed with Microsoft Excel version 2019.

Results
The mean cusp heights were 18.28±0.54 mm, 19.52±0.34 mm and 20.91±0.46 mm respectively for the right, left and the non-coronary cusps. The mean depths of the aortic sinuses were 17.3±0.68 mm, 16.8±0.74 mm and 15.9±0.32 mm respectively for the right, left and the non-coronary sinus. We also observed symmetrical BAV in 1 (2.5%) out of the 30 specimens but the death of the individual was unrelated to the presence of the anomaly.

Conclusions
The morphometric parameters obtained in the study would help in transplanting prosthetic aortic valve with greater compatibility. The chance of encountering congenital BAV even in individuals with no cardiac ailment should be borne in mind.
1096 The African Surgical Outcomes Study in Paediatric Patients (ASOS-Paeds) and Global Paediatric Perioperative Mortality - a Meta-analysis
Authors: Taylor E , Tesfaye E , Ramakrishnan R , Abdulwahed E A , Bittaye M , Elhadi M , Torborg A , Biccard B 
Published: July 2024

Abstract

Aim
There is little data for surgical outcomes of children in Africa. This is of particular importance as children constitute 40% of the African population, compared to a global average of 25%. As part of ASOS-Paeds - a prospective cohort study of children undergoing surgery in African countries, we undertook a meta-analysis to synthesise the evidence on global paediatric perioperative mortality.

Method
We searched MEDLINE, Embase and WHO Global Index Medicus for studies published within the last decade, reporting paediatric perioperative mortality. We included studies with ≥200 children that reported perioperative mortality for multiple surgical specialties and procedures. Perioperative mortality was defined as death within 30 days of surgery. For meta-analysis, proportions were combined using a random effects model.

Results
After screening 13,258 s and reviewing 158 full-text reports, data from 9 studies were eligible for synthesis along with data from ASOS-Paeds. The meta-analysis included 579,733 children from Africa, Europe, and North America. The pooled perioperative mortality rate per 1,000 children (95% CI) was 17.91 (9.78, 26.04) in Africa compared to 2.18 (0.95, 3.42) in Europe and North America. This equates to excess paediatric perioperative mortality in Africa between 6 (in the best-case scenario) to 25 (in the worst-case scenario) per 1,000 children.

Conclusions
Perioperative mortality for children undergoing surgery in Africa is 8-fold higher than in Europe and North America. Access to safe and affordable anaesthesia and surgery should be a public health priority and urgent action is needed to improve surgical outcomes for children in Africa.
756 Impact of Hands-on Laparoscopic Simulation on Confidence and Skills in Medical Trainees: A Prospective Study
Authors: Khan H , Zilani N 
Published: July 2024

Abstract

Aim
The growing significance of minimally invasive procedures necessitates a shift in the traditional surgical training model towards a more apprenticeship-based approach. This requires the introduction of simulation training in surgical education to be more prominent. This study aimed to explore the effectiveness of a hands-on laparoscopic simulation on confidence in laparoscopic and surgical skills, giving insight into its use of teaching for doctors & medical students, as well as the correlation between confidence and practical skills.

Method
83 medical students and foundation year doctors attended a laparoscopic simulation hands-on session and completed pre- and post-event questionnaires using a 5-point Likert scale assessing their confidence in practical skills and ability to perform laparoscopic surgical procedures. Attendees also rated how important they believe laparoscopic simulators are for improving surgical skills. Statistical significance & normality were determined using the one-tailed Shapiro–Wilk test and a follow-up T-test was conducted.

Results
Attendees had demonstrated a significant increase in confidence in the practical skills required in laparoscopic surgery after having done the simulation (average pre-event & post-event 2.11, 3.69 respectively, p = p = 2.99 10-19); as well as confidence in the ability to perform the procedures (average pre-event & post-event 1.71, 4.16 respectively, p = p = 2.99 10-23).

Conclusions
The study has shown that laparoscopic simulations are effective in increasing the confidence of attendees in the practical ability of laparoscopic simulations and skills required for laparoscopic surgery, showing a positive impact of introducing laparoscopic simulation into surgical training. Further studies are required with long-term follow-up in order to measure sustainability.
809 A Systematic Review of Quality Assurance Processes in Simulated Surgical Training Programmes
Authors: Campioni-Norman D , Mavroveli S , Boshier P , Robb H , Walsh C , Hanna G 
Published: July 2024

Abstract

Aim
To provide a comprehensive overview of quality assurance processes implemented within published simulated surgical training programmes, identifying areas of deficit.

Method
A systematic review was conducted according to PRISMA guidelines. Databases were searched from 1947 until April 2023 to identify studies reporting structured simulation programmes undertaking qualitative assessment of laparoscopic technical skills. The assessment had to be procedural (e.g., appendicectomy) versus tasks (e.g., bean drop). Simulation had to be physical modalities (synthetic/cadaveric). Virtual and augmented reality modalities were excluded.
Data was extracted against an existing quality assurance standards framework for simulation-based education, developed by the Association for Simulated Practice in Healthcare (ASPiH) in partnership with Health Education England. Study quality was appraised using the Medical Education Research Study Quality Instrument (MERSQI).

Results
39 studies were included, with 17 from USA and 3 from UK simulation programmes. Range of participants was 6-256, with 7 studies reporting &gt;50 participants. Faculty: 40% (n=15) of studies reported no description of faculty expertise or selection. 60% (n=24) of studies implemented no assessor training. 90% (n=35) described no faculty evaluation or feedback. Activity: Variability was seen in assessment methods including number of stations, assessors, and assessment tools. 60% (n=24) of studies sought no feedback on their programme. 90% (n=35) of the programmes were not aligned to curricula or learning needs analyses.

Conclusions
This review highlights deficits in the implementation of quality assurance processes including faculty selection, training, and programme feedback. It also highlights the variability of assessment methods, reiterating the need for individualised robust validation processes.
271 Effects of Bariatric Surgery on Metabolic and Hormonal Balance: A 10-Year Retrospective Study
Authors: AlSaket L , Figura K , Bentley Ribot H , Thomas A , Sufi A , Lo S 
Published: July 2024

Abstract

Background
The increasing demand on Gastric bypass and other weight-loss surgeries known collectively as bariatric surgery is well documented but the long-term effects on some parameters have not been satisfactorily analysed over the years. Surgeons are dealing with a level of uncertainty regarding the most likely reason behind this metabolic derangement following such procedures in the follow up clinics.

Aim
To study the long-term effects of bariatric surgery and weight reduction procedures on Parathyroid function, calcium levels, Vitamin D and determinants of bone health.

Method
10-year retrospective study looking at patients underwent bariatric surgery between the years 2006 – 2008 within the Yorkshire area and their follow up data.

Results
We found that the median calcium levels have decreased significantly compared to its level prior to the operation, even though the absolute value of calcium remained within the normal reference range, it was lower than that of the baseline for each individual, resulting in an increased PTH and ALP levels to a low statistical significance and important clinical significance.

Conclusions
Calcium levels being lower than the baseline but still within the normal reference range is affecting both PTH and ALP leaving the patient at increased risk of bone weakness complications and other hormonal disturbances.

Recommendation
During the post-operative follow up plan, calcium levels should be adjusted to mimic the levels of the individuals’ pre-operative values, and the baseline should be the reference range rather than the actual lab reference assuming Calcium levels preoperatively were within the normal range.
366 A Case Study: Application of Personalised External Aortic Root Support to Overcome a Failing Ross Procedure
Authors: Chan-A-Sue T , Karsan R , Lockhart C , Ball P , Austin C , Austin C 
Published: July 2024

Abstract
Aortic root aneurysms are traditionally treated by aortic root replacement surgery alone or in combination with aortic valve replacement in a Modified Bentall procedure. We present a novel surgical approach using a Personalised External Aortic Root Support (PEARS) in the management of an aortic root aneurysm in a 24-year-old male, initially presenting in infancy with mixed aortic valve disease who underwent a free root Ross procedure in 2010 aged 11. Follow-up cardiac magnetic resonance imaging and transthoracic echocardiography showed mild aortic and pulmonary valve regurgitation with aortic root dilatation (51mm). In 2022, Computerised tomography (CT) exhibited dilation of the Sinus of Valsalva (43mm) and ascending aorta (56 mm). MDT review deemed redo valve-sparing root replacement appropriate as the ascending aorta was &gt;55mm with an approximate 8mm increase over three years. As the young patient wished to avoid warfarinisation and the autograft valve maintained good function, a reduction PEARS was considered. In September 2023, a reduced aortic PEARS graft (80% reduction) was implemented along with a redo of the right ventricle to pulmonary artery conduit. Whilst applying the PEARS it was noted that there was a retroaortic circumflex artery, care was taken to mobilise this aberrant vessel to avoid compression by the graft. Cardiopulmonary bypass and cross-clamp times were 180 and 116 minutes respectively. Intraoperative transoesophageal echocardiography confirmed good bi-ventricular function with no pulmonary regurgitation additionally on postoperative CT the aortic diameter was 38mm. In conclusion, application of a reduction PEARS is a potential alternative to a valve-sparing aortic root replacement method in young patients.
1287 Timing of Surgery for Operable Non-Small Cell Lung Cancer and Concordance Between Clinical and Pathological Staging: The Aftermath of the Covid-19 Pandemic
Authors: Qamar A , Qamar Y , Shazly A , Abouelea Y , Yonis H , Islam H 
Published: July 2024

Abstract

Aim
The present study assessed the concordance between clinical and pathological staging of non-small cell lung cancer (NSCLC) in patients who were referred with operable tumors.

Method
We retrospectively reviewed case records of 123 consecutive patients with operable NSCLC, who underwent curative surgery and whose pathology was evaluated at our institution between January 1, 2021, and December 31, 2021. Histopathology reports, imaging information, and multidisciplinary (MDT) team notes were retrieved from hospital digital records.

Results
The cohort included 73 (59%) women and 50 (41%) men in the age range of 46-88 years (median age 73 years [IQR 67-77]). Median time interval between staging CT and surgery (91 days [IQR 76.5-117.5]), and PET and surgery (70 days [IQR 57.5-92.0]) indicated that UK guidelines of &lt;62 days between initial referral and commencement of definitive treatment were not being met in the majority of cases. EBUS-TBNA was performed for 15 (12%) patients and the median interval between EBUS-TBNA and surgery was 44 days (IQR 41.0-66.5). Discordant clinical and pathological TNM staging was evident in 65% of cases, including 45% of clinically understaged cases; and four patients with undetected pT4 disease. Six tumors staged postoperatively as N1 had been staged clinically as N0. For five cases with unforeseen N2, clinical staging was N0; surgery might not have been necessary for these patients.

Conclusions
Discordance between clinical and pathological staging of NSCLC is associated with treatment delays. Reduced time interval between staging CT/PET and surgery may have avoided inappropriate resections.
1004 Urgent Explant of Infected Aortic Stent Graft in a Patient with Kidney Transplant Using Biological Aortoiliac Reconstruction and a Temporary Axillo-Femoral Perfusion Shunt: 6-Year Follow-Up and Literature Review
Authors: Yiu J , Biasi L , Khan T , Taylor D , Price N , Bell R , Sallam M 
Published: July 2024

Abstract

Background
Written consent obtained for case report. A 59-year-old male who was 3-months post-EVAR repair under immunosuppression for kidney transplantation and anti-retroviral HIV treatment presented to ED in 2017 with abdominal pain and fever. CTAP revealed pyelonephritis in renal allograft. Blood cultures were positive for staphylococcus epidermidis. PETCT showed high-intensity uptake around endograft. Urgent explant of endograft and insitu biological aorto-biiliac graft reconstruction with bench prepared bilateral long saphenous veins were performed.

Results
The predicted challenges were locating source of infection, immunosuppressed state, and allograft preservation. Dacron graft was used as temporary perfusion shunt (left axillary artery to right superficial femoral artery) for renal allograft on right external iliac vessels. Endograft was removed via rooftop incision with visceral rotation. Supra-celiac and supra-superior mesenteric artery clamping times were 15 and 35 minutes. The source of infection was from infected appendix proximal to graft with erosion of right external iliac artery resulting in appendectomy in the same operation. Following 12-weeks of OPAT antibiotic-therapy, repeat PETCT revealed low-grade uptake around aortic graft and inflammatory markers were back to baseline. At 6 years in 2023, patient remains clinically well with ∼20% allograft function. Maintaining kidney allograft perfusion in the setting of elective non-infected aortic graft explant was previously reported, but with ENROUTE system (Rasheed et al., 2018).

Conclusions
The satisfactory long-term outcomes discussed here demonstrated with MDT planning involving vascular surgery, infectious diseases, renal medicine and patient, explant of infected graft with insitu biological graft reconstruction in renal transplant patients presenting with complex aortic-graft infection is feasible.
1166 Thymoma and Good's Syndrome: Analysing the Role of Surgery in a Case Series
Authors: Singh C , Anderson R , Hawari M , Jadoon M 
Published: July 2024

Abstract

Background
Good’s syndrome is a rare paraneoplastic phenomenon with unknown pathogenesis in patients with thymoma. The incidence is 0.15 cases per 100,000 population per year. Patients typically have hypogammaglobulinemia, reduced B cell and CD4+ T cell count, and present with recurrent infections and autoimmune manifestations.

Case Summary
This case series highlights two patients with Good’s syndrome who underwent thymectomy in a United Kingdom Thoracic Surgery Unit. Patient 1, a 57-year-old female, presented with a history of recurrent infections (including Pneumocystis jiroveci), dysphagia, and dyspnoea. The subsequent discovery of a thymoma led to a diagnosis of Good Syndrome. Patient 2, a 61-year-old male, exhibited recurrent infections and immunological abnormalities, eventually leading to the identification of a thymoma.
Both patients were diagnosed in their 5th decade, and shared similar clinical profiles with absent B cells, reduced NK cells, hypogammaglobulinemia, and an anterior thymoma. Preoperatively, they received IVIG transfusions. The surgical intervention involved robotic-assisted thymectomy for both patients. Histopathological assessments classified Patient 1 as T1bNxMxR1 and Patient 2 as T1aNXMXR1 providing insights into the extent of the thymomas. Post-operatively they continue to have prophylactic antibiotics and IVIG and have been reportedly well.

Conclusions
Patients with Good Syndrome are at significant risk of opportunistic infections and may present repeatedly to medical specialties. Thymoma and its associated symptoms can precede immunodeficiency. Consequently, thorough consideration of this diagnosis, interdisciplinary collaboration, and preoperative planning is vital for the effective management of this extremely rare syndrome. Successful outcomes are achievable through timely IVIG and full surgical resection.
1215 Cardiovascular Compromise and Hypertensive Crisis Secondary to Phaeochromocytoma
Authors: Fetuga L , Shkoukani Z , Houghton N 
Published: July 2024

Abstract
Phaeochromocytoma is a rare tumour of the chromaffin cells in the adrenal medulla, which secretes catecholamines. While associated with genetic disorders e.g., MEN-2, they tend to occur sporadically, and are often initially asymptomatic, found incidentally on imaging. Classical symptoms of Phaeochromocytoma include headaches, sweating, and palpitations, with sustained or paroxysmal hypertension which is refractory to a cocktail of antihypertensives.
A variety of presentations have been reported in the literature including, but not limited to colitis, intracerebral haemorrhage, and PRES syndrome.
We present a case of a 64-year-old man with an incidental left adrenal nodule. This radiologically indeterminate lesion was initially asymptomatic. Secretion studies revealed elevated metadrenaline levels, and an MIBG scan with positive avidity unveiled the lesion's pheochromocytoma nature.
Whilst awaiting surgical intervention, the patient required emergency admission with a hypertensive crisis, presenting with left-sided flank pain and a blood pressure peaking at 220mmHg systolic. ECG findings were consistent with a myocardial infarction-like picture, and echocardiogram demonstrated regional wall motion abnormalities. CT coronary angiography revealed no significant coronary arterial disease – confirming that the patient’s presentation was in fact secondary to the pheochromocytoma.
Pre-operative optimization is crucial for safe surgery. After the crisis, surgery was delayed by 6 weeks for cardiac rehabilitation. The patient was admitted a week before the procedure for optimal haemodynamics. Adrenalectomy proceeded as planned after alpha-blockade.
A structured endocrine surgery clinic follow-up was established to assess the patient's ongoing recovery, and cardiovascular status. This case highlights cardiovascular implications of phaeochromocytoma, stressing a multidisciplinary approach for hypertensive crises and optimising outcomes.