bluuebunny/crossref_metadata_2025_split huggingface dataset:
821 Impact of a One-Day Conference on Perceptions and Understanding of T&O - Outcomes of the South West Orthopaedic Conference 2023
Authors: Drake W , El-Hassan M , Jones C 
Published: July 2024

Abstract

Aim
This study aimed to evaluate the effects of a student-organised conference on delegates’ motivation and understanding of orthopaedic surgery.

Method
This was a conference organised by students with the support of consultants from the Princess Elizabeth Orthopaedic Centre in The Royal Devon and Exeter Hospital. Identical questionnaires were completed immediately before and after the conference on google forms. The google forms were distributed to the delegates via their registered email address. The pre- and post-conference questionnaire had three sections comprising of understanding, motivations, and barriers to pursing orthopaedic surgery. Pre- and post-conference responses which were recorded on a Likert scale and were compared using Wilcoxon signed rank test. All data analysis performed was using IBM SPSS (v.28, USA).

Results
62 delegates completed the questionnaires, the majority of which were medical students with 4 junior doctors. Understanding of orthopaedics showed a significant increase in the majority of questions (p&lt;0.001), except the intention to pursue orthopaedics which showed no significant difference. Delegates were attracted to orthopaedics due to the work-life balance, prestige and salary (p&lt;0.001), however they showed a reduced interest in case variety and private practice. There was no difference in the barriers to pursuing orthopaedic surgery, except lack of patient contact which showed a significant increase (p&lt;0.001).

Conclusions
Orthopaedic conferences improve delegates understanding, perceptions and motivations to pursue a career in orthopaedic surgery. We therefore encourage orthopaedic surgeons and educationalists to increase exposure to orthopaedics for undergraduates by supporting more student-led initiatives to promote recruitment into orthopaedic surgery.
678 Investigating the Fidelity and Usability of Virtual Reality Surgical Training Platforms
Authors: Lestas F , Avrova A , Shoker J , Burke J , Harji D 
Published: July 2024

Abstract

Introduction
Virtual Reality (VR) technology has existed for decades; however, the fidelity of current applications has resulted in limited adoption in surgical training and no framework exists to assess usability of VR in surgery. This study aimed to define immersion quality and identify which metrics surgical trainees and trainers prioritise when utilising VR.

Method
Surgical trainees and trainers were eligible for inclusion. Participants were purposively sampled from delegates at the RCS England Future Surgery Show 2023. A 14-point questionnaire generated through steering-group expert consensus was utilised. Immersion was measured using the NASA Fidelity Rating Scale (1;excellent–6;very bad) and a usability importance metric (1;extremely important–5;not important). Parametric statistical tests were used following test of normality (µ=0.05).

Results
34(23M:10F) responses were analysed. 50%(n=17) were completing or had completed surgical training with experience across 8 different VR systems. 18%(n=6) had experienced side-effects. Mean immersion across the systems was 2.7±0.8(Good/Fair). ‘Ease of Use’(1.4±0.6) and ‘Translatable Training’(1.4±0.5) were the highest priority usability metrics with ‘Access’(1.9±0.8), ‘User Comfort’(1.6±0.6) and improvement in ‘Economy of Movement’(1.9±0.7) also regarded as Extremely important or Important. There was an observed difference in ‘User Comfort’ importance between Male(1.6±0.4) and Female(1.1±0.2) participants which approached significance(p=0.07).

Conclusions
Immersion of available VR surgical training platforms requires improvement. Side-effects remain common. Ease of use and translatable training are the highest priority metrics for end-users and should be central to any framework. Gender differences in VR usability requires further investigation.
1211 Patterns of Recurrences After Mastectomy for Invasive Breast Cancer and DCIS Followed by Immediate Breast Reconstruction: 13-Year Follow-Up from a Single institution
Authors: Reddy D , Amin H , Shergill M , Narayanan S , Sumian S , Jafferbhoy S , Marla S , Gopalan V , Hasan A , Nael E 
Published: July 2024

Abstract

Aim
A retrospective review was conducted at a single centre to analyse the patterns of recurrence in IBR.

Method
Between January 2009 and December 2021, 347 patients who had IBR for either invasive (244) or DCIS (125), were analysed retrospectively. The study included patients who received implants without ADM (10.8%), ADM with +implant (69%), Latissimus Dorsi flap +/- implant (18.1%), and deep inferior epigastric perforator-free flaps (2.5%).

Results
During the study period, 29 patients developed recurrence over a median period of 74 months (ranging from 24 to 125 months). Two patients had local cancer recurrence only (0.5%), 5 patients had local recurrence associated with distant or regional metastasis, (1.4%) and 19 cases with distal metastasis were identified (8.3%). The study found an overall survival rate of 96.4% and a disease-free survival rate of 91.7%. The most familiar sites of recurrence in breast cancer are distal recurrence, (Bone being the most common site), followed by local recurrence.

Discussion
This rate is in line with the expected range, assuming a standard of recurrence of 1% per year. Nevertheless, it is crucial to acknowledge the possibility of selection bias, as patients with advanced diseases and significant comorbidities may not have been offered IBR.

Conclusions
Based on the findings of the study, it can be inferred that mastectomy with (IBR) is a safe option for mastectomy.
470 Survival Stratification After Proximal Femoral Fracture Surgery Using the Modified Glasgow Prognostic Score
Authors: Kamande I , McGuire C , Meek D , Glen P 
Published: July 2024

Abstract

Aim
Proximal femoral fracture (PFF) after blunt trauma is common and significantly associated with mortality. A simple scoring system based on systemic inflammation, the modified Glasgow Prognostic Score (mGPS), has been shown to stratify survival in patients with malignant disease and we wished to assess its usefulness in the trauma cohort.

Method
Patient demographics, albumin, C-reactive protein (CRP), and survival data were retrospectively obtained from a previous local hip fracture audit of 278 adult (&gt;18 years) patients whose PFFs were repaired between October 2012 and April 2014 at the Queen Elizabeth University Hospital, Glasgow. Follow-up was for 18 months allowing the generation of survival curves and univariate analysis using Kaplan-Meier and Log Rank analyses. Multivariate survival analysis and hazard ratios were calculated using Cox Regression.

Results
The median survival was 26.5 months with a 41.4% 1-year mortality. On univariate analysis, one year mortality was associated with advanced age (&gt;80 years, p&lt;0.0001), American Society of Anaesthesiology (ASA) score(p&lt;0.0001), CRP (&gt;10mg/L, p=0.027), Albumin (&lt;35g/L, p=0.007), type of surgery (p=0.005) and mGPS (p=0.016). On multivariate analysis advanced age (p&lt;0.001), male gender (p=0.016), ASA score (p&lt;0.001) and mGPS (p=0.027) retained significance as predictive factors for 1-year mortality. A higher mGPS was associated with a shorter median survival (37.4, 27.6 and 24.0 months for mGPS 0, 1 and 2 respectively (p=0.048)).

Conclusions
This study demonstrated a statistically significant survival association with advanced age, ASA score, male gender and mGPS. This is the first study looking at mGPS as a predictive factor for one year mortality following PFF.
142 Understanding the Burden of Emergency Bariatric Surgery Admissions
Authors: Temple J , Manoharan G , Marsden M , Ramar S 
Published: July 2024

Abstract

Aim
To quantify the incidence and resource use of bariatric surgical emergencies (BSE) in a tertiary hospital setting.

Method
Patients were identified prospectively for 17 weeks from the 1st March 2023. Inclusion criteria were a bariatric emergency with an admission duration exceeding 24 hours.

Results
Of the 471 emergency general surgery admissions, 21 (4.5%) were identified as BSE. From 63 elective bariatric procedures, 4 (6.3%) necessitated prolonged stays owing to post-operative complications. Most patients were female (23/25), with an average age of 48 years (IQR 34-55) and a pre-operative BMI averaging 39 (IQR 37-44). The typical hospital stay was 5 days (IQR 1-15), with no reported fatalities. In total 23 patients had CT scans, 7 required surgical or procedural interventions, and 5 were admitted to the ICU. Interestingly, 12 emergency admissions had no prior NHS history, and 10 had undergone their procedures in Turkey. The post-surgery admission time was notably shorter for the Turkey group [2 (1-7) weeks] compared to those treated under the NHS [86 (5-750) weeks, p=0.003].

Conclusions
More than one patient per week is admitted for a BSE. These patients have substantial resource requirements and highlight the need for adequate training and preparedness to manage these emergencies.
960 Quality of Life Outcomes of Metabolic and Bariatric Surgery Tourism: A Single-Centre Survey-Based Study
Authors: Khan H J , Yunus T E , Nimeri A , Abbas H , Ghumman A K , Rana F A 
Published: July 2024

Abstract
Global obesity affects one in three adults, prompting increased demand for metabolic and bariatric surgery (MBS). Despite its effectiveness, limited access to MBS has led to more people seeking it through medical tourism for lower costs and shorter wait times. However, ethical concerns arise due to limited follow-up care and potential complications. This study compares the quality of life (QOL) of native MBS patients (n = 69) to those engaged in MBS tourism (n = 36) from 11 different countries, utilizing the Bariatric Quality of Life Index (BQLI). Conducted in Lahore, Pakistan, with 105 participants who had MBS in the last 3 years, the survey-based study aims to assess the impact of MBS tourism on QOL and the efficacy of bariatric surgery for weight loss. The study revealed no significant difference in the quality of life between MBS tourism participants and native patients (p &gt; 0.05). Both cohorts experienced considerable weight reduction post-MBS (p = 0.00001). A higher total weight loss percentage (TWL%) correlated positively with increased BQLI scores (p = 0.01). Younger patients experienced significantly improved quality of life after MBS compared to their older counterparts (r = -0.3, p = 0.005). The TWL% exhibited a progressive increase as the months advanced post-MBS (r =0.3, p = 0.004). The type of bariatric surgery (SG, RYGB, OAGB, SADI) didn't significantly affect post-MBS quality of life (p &gt; 0.05).
1080 Evaluating the Impact of Bariatric Surgery Tourism on an Emergency Upper GI Service: A Case Series
Authors: Patel E A , Gourgiotis S 
Published: July 2024

Abstract

Aim
The number of individuals seeking weight loss surgery has been increasing globally. It is not uncommon for patients to travel abroad for these procedures due to various reasons, such as cost savings or availability. This audit identifies patients who underwent bariatric surgery abroad and subsequently presented to our hospital, observes trends in presentation, types and frequencies of complications, and management strategies employed.

Method
A retrospective case study of medical records of patients who presented acutely following gastric bypass, sleeve, or gastric band operations abroad between January 2018 to July 2023 was performed.

Results
A total of 21 patients were identified. 17 (81%) were female, with mean age 42.2 years. 15 (71.4%) patients presented between 2022-2023, and 5 (33.3%) of these were diagnosed with leak. 11 (52.4%) had undergone sleeve gastrectomy, 6 (28.5%) Roux-en-Y gastric bypass and 4 (19%) gastric band. Operations were performed in 11 different countries, with 10 (47.6%) performed in Turkey. The commonest presenting complaint was abdominal pain (71%). Average Length of stay was 9.1 days (range 1-45). 9 patients (42.9%) had multiple attendances (range 2-6). 7 (33.3%) underwent surgery; 3 laparoscopic removal of gastric band, and 4 emergency procedures for leak, involving either laparotomy and/or endoscopic therapy.

Conclusions
The number of patients presenting with complications of bariatric surgery tourism has increased year-on-year. This is leading to a growing burden on NHS resources. Healthcare professionals, policymakers, and patients themselves must be aware about the importance of follow-up when deciding to undergo weight loss surgery abroad. A national audit is also warranted.
1225 Endoluminal Stenting for Sleeve Gastrectomy Leak: Case Report, Literature Review and Atlas of Endoscopic Management
Authors: Attia A , Vasas P 
Published: July 2024

Abstract

Introduction
One of the most serious complications of bariatric surgery is post-operative leak and it can result in significant risk on the patient. Early detection and management of postoperative leak is essential to reduce the morbidities and mortality of such complication. Endoluminal Stent placement is a less invasive alternative to surgical intervention for management of bariatric surgical leak. We are reporting a case of post sleeve gastrectomy leak that has been managed by inserting self-expandable metal stents (SEMS) via endoscopy.

Case presentation
A 55-year-old woman presented with gradual onset of epigastric pain and high temperature with reduced oral intake. She had had a Laparoscopic sleeve gastrectomy done in another country as a form of “medical tourism” 10 days ago. She had a CT scan revealed an irregular 4.5 cm paraoesophageal collection suggesting post-operative leakage.

Discussion
Endoscopic management of GI leaks provides a minimally invasive, safe, and efficient alternative for surgery in selected cases. Endoscopic management is then proven to be the least invasive method to control and repair post LSG leak.

Conclusions
The clinical presentation of post LSG leak can vary from mild abdominal pain to severe sepsis. Endoscopic management, with its different types, has been widely used because its less invasive yet very effective way of managing such feared complication.
990 A Rare Case of Adenomyoma in Gastric Pylorus of a Young Adult Female: A Case Report
Authors: Wickramasinghe V C , Saranga K G V , Piyarathne S A , Madhawa J K G , Prashantha A H A 
Published: July 2024

Abstract

Introduction
Gastric adenomyoma is a rare benign tumour which occurs 85% in antrum and 15% in pylorus. Although adenomyomas are benign, diagnosis is difficult as they are commonly found alongside with adenocarcinomas.

Case report
A 20-year-old previously healthy female presented with epigastric pain, gastric outflow obstruction features and weight loss for 3 months. Initial USS was followed by a CECT which, showed intramural mass lesion with necrotic centre arising from the inferior wall of the pre pyloric area of the stomach with acute inflammatory changes of the adjacent omental fat, giving differential diagnosis of GIST or gastrinoma at pyloric region. Subsequent upper GI endoscopy revealed a protruding pyloric mass without mucosal lesions. Unfortunately, the unavailability of EUS and biopsy posed a diagnostic hurdle. Intraoperatively, a mass intricately adhered to the transverse colon and omentum was discovered, leading to a surgical intervention involving distal gastrectomy, gastrojejunostomy, and jejunojejunostomy. Unexpectedly, histological analysis unveiled adenomyoma at the prepyloric area, characterized by Brunner’s glands, dilated glands, and heterotrophic small intestinal tissue.

Discussion
This rare manifestation of adenomyoma in the gastric pylorus, particularly in a young adult, highlights the challenges in accurate preoperative diagnosis. The favourable postoperative outcome prompts reflection on the potential role of advanced diagnostic tools, emphasizing the significance of EUS and biopsy in steering clear of extensive surgeries.

Conclusions
This case report underscores the crucial role of personalized diagnostic methods, especially in cases like ours where a rare adenomyoma mimicking other tumours.
456 Comparison of Postoperative Outcomes Between Robotic and Laparoscopic Surgery for Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis
Authors: Wuheb A 
Published: July 2024

Abstract

Aim
To evaluate comparative outcomes of robotic versus laparoscopic bowel resection in patients with inflammatory bowel disease (IBD).

Method
A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library, Clinical trials.gov and Science Direct. Comparative studies comparing robotic versus laparoscopic resection for IBD were included. Primary outcomes were post-operative complications rate. Operative time, conversion to open, length of hospital stays, and mortality were the evaluated outcome parameters.

Results
Eleven studies with total number of 5,566 patients divided between those undergoing robotic (n=365) and conventional laparoscopic (n=5,201) surgery. Moreover, subgroup analysis for sub-total colectomy group showed shorter LOS [MD: -1.62, P=0.03]. Overall complications rate was significantly higher in the laparoscopy group compared to robotic group [OR: 0.48, P=0.03], however the operative time was longer in the robotic group [MD: 40.61, P=0.00001]. Pooled analysis showed comparable results regarding conversion to open [OR: 0.46, P=0.15], anastomosis leak [OR: 0.92, P=0.84], abdominal abscess / collection [OR: 0.34, P=0.21], and mortality [RD: 0.00, P=1.00].

Conclusions
Compared to laparoscopic approach, Robotic surgery provides a significantly lower rate of post-operative complications and shorter LOS at the expense of operative time with similar 30-day Mortality.
566 Serum Thyroid Stimulating Hormone (S-TSH) Levels as a Predictor of Malignancy in Thyroid Nodules
Authors: Kottegoda G , Dadigamuwage S , Bhagya J , Kannangara D , Suganthini S , Gunawardena S 
Published: July 2024

Abstract

Introduction
The evaluation of thyroid nodules include: a clinical history and examination followed by ultrasonography and fine needle aspiration cytology of ultrasonically suspicious nodules. Even after a full evaluation, some thyroid nodules are found to be indeterminate in respect of malignancy. It has been suggested that high levels of sTSH can be used as a predictor of malignancy in thyroid nodules.

Method
A retrospective analysis of patients who underwent surgery for thyroid nodules between 01st January 2019 and 31st December 2022. Patients who had been on Thyroxine or Carbimazole/ Propylthiouracil were excluded. Data was collected using previous medical records and patient interviews. Statistical analysis was performed using SPSS version 24.

Results
Data collection was completed on 102 patients. 86 patients (84.3%, mean age 43.6 years) were female, and 16 patients (15.6%, mean age 45.2 years) were male. Histologically confirmed thyroid malignancy was present in 18 patients (17.6%), out of which 15 (83.3%) were female and 3 (16.6%) were male. There was no statistically significant (P&lt;0.05) difference in the sTSH noted in patients with thyroid carcinoma (mean sTSH 1.378 μIU/ml) compared to histologically benign nodules (mean sTSH 1.350 μIU/ml).

Conclusions
Multiple studies done in different settings have shown an association between a high sTSH and a higher possibility of thyroid carcinoma. However, in our cohort of patients no such association was observed.
1217 BiZact Tonsillectomies: An Update on Novel Technique for Efficiency Improvement
Authors: Hatfield T , Nwodo C , Sahota B 
Published: July 2024

Abstract

Aim
Tonsillectomies represent one of the most commonly performed ENT procedures worldwide. Waiting lists throughout the NHS remain large with associated delays in treatment and increased morbidity, so we must strive to maximise our operative efficiency. In the past 2 years in our trust, we have introduced the use of the BiZact tonsillectomy device in order to increase theatre efficiency and reduce operative and wait times. We have previously presented this work and here present updated figures.

Method
The BiZact device has been used by a range of consultants and registrars having been proven in multiple previous studies to offer a safe alternative to conventional technique tonsillectomies. Analysis of the theatre time, “time-on-tonsil” and post-operative bleed and admission rates has been continuous.

Results
Previously analysed conventional tonsillectomy data showed average recorded theatre time of 36m:00s (n=72). With 103 comparable BiZact tonsillectomies performed, the average theatre time for BiZact is 13m:11s, with an average time-on-tonsil of just 4m:22s (for bilateral tonsillectomy). A post-tonsillectomy haemorrhage rate of 17.5% was recorded including those attending separate trusts. There have been 0 primary post-tonsillectomy bleeds requiring return to theatre. 24% of BiZact tonsillectomies were performed by SHOs or Registrars.

Conclusions
The efficiency gains offered by BiZact tonsillectomy continue to be evident as numbers increase with more being performed by junior trainees. Bleed rates remain within the range of expected adult haemorrhage rates more recently observed nationally and internationally. This has facilitated further efficiency gains in our theatre usage for tonsillectomy lists with additional cases per session.
877 Demand-Side Barriers to Surgical Care in Low- and Middle-Income Countries - a Scoping Review
Authors: Rauf S , Faheem M , O’Flynn E 
Published: July 2024

Abstract

Aim
Thirty per cent of diseases worldwide can be treated by surgery or require the direct care of a surgeon. The Lancet Commission (2015) found that five billion people lack access to safe surgery, predominately those living in low- and middle-income countries, where nine out of ten people cannot access basic surgical care. Numerous studies have examined supply-side barriers, but few have examined the demand-side. We report a scoping review to identify and explore the barriers that prevent patients from seeking surgical care.

Method
A systematic search of multiple databases using the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines was conducted, looking for papers published between January 2015 and November 2023. Two independent reviewers charted qualitative variables and significant demographic data.

Results
Out of 2,899 studies examined, 228 met the inclusion criteria. The studies spanned six continents and fifty-seven countries. 14% were multi-country. Forty-seven barriers were identified and organised under ten headings. The five most frequently cited barriers were distance, fear/lack of trust, transport costs, reliance on religious/traditional healers and indirect costs (food/accommodation/companion).

Conclusions
Our review demonstrates the breadth of barriers contributing to the unmet need for surgery amongst all surgical specialities. While countries pursue their 2030 target to increase the provision of safe surgical care, there also needs to be a clear focus on understanding the factors that prevent patients from accessing established surgical care and how to mitigate them.