bluuebunny/crossref_metadata_2025_split huggingface dataset:
1145 The Role of Emotional Intelligence in Surgical Leadership: A Qualitative Study
Authors: Chaudry A , Wong Z , Leighton P , Makhdoom N , Karantana A 
Published: July 2024

Abstract

Aim
Effective leadership is crucial in the NHS, enhancing patient safety and care quality. Surgical leaders play a vital role, addressing patient needs and managing teams (RCSEng, 2014). Emotional intelligence (EQ) is a key leadership skill, encompassing 12 competencies. However, EQ and leadership are often overlooked in medical training. This study investigates the significance of EQ in surgical leadership and aims to identify optimal methods for EQ development in surgery.

Method
The study employed semi-structured interviews (SSIs) with consultant and trainee surgeons, aiming to elucidate the influence of EQ on workplace behaviours in surgery. Ethical approval was obtained from the University of Nottingham Ethics Committee. Purposive sampling was used to select potential study participants with the aim of providing the most credible information to the study.

Results
Thematic analysis of transcribed interviews identified three overarching themes (Patients, Clinical Organisation, Surgeons) and related sub-themes. Results from 10 SSIs revealed that EQ positively affects job satisfaction, interpersonal relationships, teamwork, and mitigates burnout among surgeons. In the context of surgical leadership, EQ emerged as a catalyst for positive organisational culture change.

Conclusions
In conclusion, EQ is a crucial skill for surgical leaders, impacting various facets of their professional life. The study's findings contribute to the ongoing debate on the significance of EQ in surgery and advocate for evidence-based EQ training programmes in professional development. This research provides valuable insights for shaping effective leadership and training initiatives in the field of surgery.
156 A Survey of the Estimated Cost of Consumables Amongst UK Medical Students
Authors: Divekar O , Stephen S , d'Souza H , Pandya K , Kumar A 
Published: July 2024

Abstract

Aim
With increasing financial difficulties for the NHS, clinician’s awareness of the cost of consumable items utilised is vital. Unfortunately, clinician’s cost-awareness and exposure to health economics amongst students is limited. We hence undertook this survey to assess cost-awareness amongst medical students.

Method
An online questionnaire was distributed to London medical students. Participants were asked their demographic data and to estimate the cost of 10 consumable items. Each item’s actual cost was compared with the average, median and interquartile range of the estimated price. An estimate was deemed ‘correct’ if it was within 20% of the actual price.

Results
Across all items 9.63% of estimates were ‘correct’. There was no correlation between medical school or academic year and accuracy of cost-estimation. The most accurately estimated item cost was the ‘10ml syringe’ (19.55%), the least was the ‘1 litre bag of intravenous normal saline’ (0.50%). The most overestimated item cost was the ‘vial of 1.2g intravenous co-amoxiclav’ (median estimate/actual cost = 9.43), the ‘pair of standard sterile surgical gloves’ was the only underestimated item cost (median estimate/actual cost = 0.97).

Conclusions
We found a poor understanding of the cost of consumables amongst medical students. Whilst a lack of year 6 students and the London geographic limited this study, we believe this is the first large-scale survey assessing the cost of consumables amongst UK students. By providing a benchmark of current knowledge, this survey could serve as a catalyst for the inclusion of health economics in medical school, improving cost-awareness amongst students and doctors.
662 A Sustainable Laparoscopic Cholecystectomy Tray
Authors: Boag K , Maftei I , Henson A , Fletcher N , Griffiths R , Ho T , Toogood G , Peckham-Cooper A 
Published: July 2024

Abstract

Aim
The aim was to develop and trial a systematic methodology in order to streamline laparoscopic cholecystectomy trays across all sub-specialties in Leeds Teaching Hospitals Trust (LTHT), and to inform rationalisation principles nationally in partnership with NHS England’s sustainability team.

Method
70 laparoscopic cholecystectomies across all sub-specialties were independently observed and audited for instrument usage at LTHT from January to March 2023. The findings were summarised and a usage heatmap was developed. A subsequent ‘hackathon’ event was held in the form of a consensus session with key stakeholders from each sub-specialty to agree a proposed single instrument tray. Carbon and financial savings calculations were then undertaken to measure the impact of the changes.

Results
Audit results demonstrated an average of 112 instruments across four separate trays opened. The heat map demonstrated 42% of items were used from 0-5% of procedures. The hackathon event agreed a consolidated single tray of 65 items. With over 800 laparoscopic cholecystectomies taking place in LTHT per year predicted financial savings in sterilisation costs were over £22,000 and over 3 tonnes of CO2e annually.

Conclusions
Tray rationalisation and standardisation has significant financial and carbon savings and can be extrapolated to many types of procedures. Sustainable change is vital to meet NHS net zero targets and requires urgent attention. Stakeholder engagement was crucial to ensure changes were agreeable and would be sustained. Following the successfully trialled methodology and implementation NHS England have produced a guide for other trusts to implement similar changes.
657 Transplant Ureteric Stent Removal Using Isiris® in an Outpatient Setting
Authors: Stephens M , Strachan H , Varley R , Doherty D l , Solomon E , Moinuddin Z , van Dellen D 
Published: July 2024

Abstract

Aim
The risk of urological complications following kidney transplantation is reduced by the intraoperative insertion of ureteric stents. Transplant ureteric stent removal (TUSR) has traditionally been performed in theatre using flexible cystoscopy. Isiris® is a single-use flexible cystoscope. The aim is to analyse the acceptability, efficacy, and cost-effectiveness of Isiris®, for TUSR in a ward/outpatient setting.

Method
A retrospective analysis of a contemporaneously maintained database at a high-volume kidney transplant centre from January 2021 to June 2022. Data collected included clinico-demographic, operative and stent removal details including time to removal (gold-standard within 6 weeks) and refusal rates. A cost analysis was also performed based on equipment costs and NHS tariffs. TUSR was performed using Isiris® in outpatient ANP-led clinics or on wards by surgical middle grades or ANPs.

Results
345 patients were included in analysis with a median age of 54 (19-81). 99.13% were single ureteric anastamoses with 348 stents removed in total. The M:F ratio was 1.32:1. 98.85% of stents were removed using Isiris®, with a 1.15% refusal rate. 86.34% (n=297) were removed in clinic. Median dwell-time was 34 days, IQR 17.25 (25.75-43). 73.84% of stent removal was within 6 weeks. There were savings of £545.00 per stent removal, including expenses for failed Isiris TUSR, with overall savings of £154,021.20 and 86 theatre sessions freed for other activity.

Conclusions
Isiris® was acceptable and effective for TUSR. Savings were demonstrated compared to TUSR in theatre. Outpatient/ward TUSR reduces demand for theatre time, freeing theatres for other elective activities.
658 Treatment Outcomes Among Patients with Recurrent Urinary Tract Infections Using a Multidisciplinary Management approach in a Complex UTI Clinic: A 20-Months’ Experience
Authors: Chitteti P , Ekpeno I , Morris-Laverick J , Bezemer S , McCune V , Kubelka I , Nadeem M 
Published: July 2024

Abstract

Aim
Our aim was to assess the treatment outcomes among patients with recurrent UTIs managed in a novel multidisciplinary complex UTI clinic started by Department of Urology at a single tertiary care centre, over a 20-month period.

Method
In view of persistently increasing burden and prevalence of antibiotic resistance associated with UTIs, a multidisciplinary complex UTI clinic, is started by Urologists supported by specialist nurses and microbiologists was started in April 2021. A prospectively maintained database of 176 patients {(median age 57.4 years (14-89 years) and (Male:Female ratio of 1:10)} who were referred to our clinic, within a 20-month period was reviewed. Patient demographics, urine culture results (causative bacterial organism and antibiotic sensitivities), investigations performed, and treatment outcomes were recorded. Pre-treatment QoL (Quality of Life) and post-treatment PGI-I (Patient global impression of improvement Scale) Score were measured.

Results
Escherichia Coli (69%) was identified as the most common causative organism. 30% patients had multi-resistant bacterial organism on urine culture. Abnormal Flexible cystoscopy, Renal Tract USS, CT Urogram was reported in 14%, 13% and 11% respectively. All patients received information on general cystitis prevention measures. 46 (26%) required intra-vesical treatment (Gentamicin 12%, Amikacin 1% and Glycosaminoglycans 13%). 71% patients remained infection free on follow up. Pre-treatment 64% patients reported significant impact on their QoL. 88.6% (94) of the 106 patients, followed up after the completion of treatment had good improvement on PGI-I scale (Table 1).

Conclusions
A dedicated complex UTI clinic service with multidisciplinary treatment approach can be efficient in managing recurrent UTIs.
733 Rezum Water Vapour Thermal Therapy for Treatment of Lower Urinary Tract Symptoms: A Prospective Single-Centre Analysis
Authors: Barbour F , Breish M , Jenkins B , Sahadevan K 
Published: July 2024

Abstract

Aim
Benign prostatic enlargement (BPE) is a chronic disorder of the prostate with an increasing prevalence. In recent years, different minimally invasive treatment options for lower urinary tract symptoms (LUTS) secondary to BPE have been introduced. One of these technologies, Rezum, uses heat from radiofrequency generated water vapour to ablate prostatic tissue. Our study aims to investigate the safety and efficacy of Rezum through a consecutive series of patients who underwent the procedure in our department.

Method
A prospective study was conducted involving thirty-eight men with moderate-severe LUTS undergoing Rezum between January 2022 and February 2023. To measure efficacy, quantitative data was collected through pre-and post-operative international prostate symptom score (IPSS), quality of life score (QoL), simplified international index of erectile function (IIEF-5) checklists, and uroflowmetry to measure maximum flow rate (Qmax) and post-void residual (PVR). Patients were followed up to determine if there had been any side effects.

Results
The mean number of Rezum injections was 3.8 to each lateral lobe, and 0.81 to the median lobe. The results show a significant improvement in IPSS (24.1 to 9.8), QoL (4.8 to 2.0), and Qmax (10.4 to 16.8). There was no reduction in erectile function with the IIEF-5 actually slightly increasing (13.4 to 15.2).

Conclusions
Our single-centre prospective analysis shows that Rezum is a safe and effective minimally invasive treatment option for men with troublesome LUTS secondary to BPE. Rezum is a promising technology that could be offered to patients who wish to preserve their sexual function and discontinue their BPE medications.
958 Prostatic Artery Embolisation vs. Transurethral Resection for Benign Prostatic Hyperplasia: A Systematic Review and Meta-Analysis
Authors: Junaid Saleem R , Elkomos B 
Published: July 2024

Abstract

Background
This systematic review and meta-analysis aimed to comprehensively compare these two therapeutic approaches regarding peri-operative and post-operative outcomes.

Method
Studies reporting on peri-operative and post-operative outcomes of PAE and TURP in BPH patients were included. Meta-analyses were performed to assess differences in outcomes such as IPSS, post-void residual (PVR), maximum urinary flow rate (Qmax), Prostate volume, procedural time, and Quality of Life (QoL) scores using RevMan 5.4.Methodological assessment was done by using the Newcastle-Ottawa Scale (NOS) for observational studies.

Results
Our analysis included a total of 9 studies involving 1138 patients. The postoperative subgroup analysis revealed significant differences in IPSS (HR of 1.37 (95% CI: -2.27 to 5.01, p = 0.00001; I2 = 98%), PVR (HR 43.29 (95% CI: -10.38 to 96.96, p = 0.00001; I2 = 99%). In the comprehensive analysis, substantial heterogeneity (98%) was noted, yielding an HR of -9.58 (95% CI: -48.20 to 29.30; p = 0.00001), Prostate volume 13.94 (with a 95% CI: 9.34 to 18.54, resulting in a highly significant p-value of 0.0001 and an I2 statistic indicating 83% heterogeneity), procedural time and QoL, with an HR (54.70) CI: 23-86.39, p&lt;0.00001, I2=96%, and HR (0.27) CI: -0.39-0.93, p&lt;0.00001 and I2=97%, respectively, these all outcomes favoured TURP over PAE. However, post-operative Qmax, (HR -8.48 (95% CI: -13.89 to -3.07, p=0.00001 and an I2 =99%) favoring PAE over TURP. Conversely, PAE exhibited a slower but sustained improvement in QoL scores over time. Complication rates were almost same between the two groups.

Conclusions
TURP may offer a quicker improvement in BPH; however, PAE also provides a viable alternative with sustained QoL improvements and a potentially lower risk of post-operative complications. Individualized treatment decisions should consider patient preferences and clinical factors.
1256 Oncological and Urological Outcomes After Total Pelvic Exenteration – Our 10-Year Experience
Authors: Rajamoorthy S I , Uren A , Rajan K , Mubarak M , Dixon C , Jeavons F , Bose P , Lucas M , Featherstone J , Gill N , Kanda Swamy G V 
Published: July 2024

Abstract

Aim
Total pelvic exenteration (TPE) is a complex but potentially curative option for advanced pelvic malignancies. This study aims to evaluate long-term outcomes after TPE.

Method
Between February 2010 and February 2020, 88 patients who underwent TPE at our institution were included. Data extraction was done by retrospective examination of patient records. Incidence of perioperative complications, long-term outcomes and survival were noted.

Results
The mean age was 62.6 years (29-87 years). Colorectal malignancy (75%) was the most common indication. 63.7% of patients received chemo or radiotherapy or both pre-operatively. Median follow-up was 54 months (33.25 – 80.25 months). At 30 and 90 days, 20.5% and 8% of patients had a Grade 3 complication or above respectively. Complications related to urinary diversion were noted in 10 patients (14 events - 4 urinary leaks, 6 stoma related complications and 4 ileo-ileal anastomotic leaks). The 30- and 90-day mortality rate was 1.1% and 2.3% respectively. At 1, 3, and 5 years, overall survival was 89.8%, 64.8% and 63.6% respectively and cancer specific mortality was 5.7%, 18.2% and 31.8% respectively. Average glomerular filtration rate was 24.2 ml/min/m2 (p&lt;0.0001), 34.1% developing new onset chronic kidney disease 3B or worse and 3.4% requiring haemodialysis. 18.2% of patients required further urological intervention. There was no statistically significant difference in ureteric stricture rates between patients undergoing surgery for recurrent disease (p=0.86) or following prior radiotherapy (p=0.81).

Conclusions
TPE appears to provide long-term survival in over 60% of patients with advanced pelvic malignancies. Long-term complications are predominantly related to the urinary diversion requiring prolonged urological follow-up.
460 Exploring Optimal Antithrombotic Strategies for Acute Limb Ischaemia: A Comprehensive Review
Authors: Nair A , Maan B S , El-Sayed T 
Published: July 2024

Abstract

Aim
Antithrombotic therapy is an integral part of acute limb ischaemia (ALI) management. This study aimed to systematically review the up-to-date evidence available in antithrombotic management of ALI.

Method
A systematic search (PubMed, OVID, Embase, and Google Scholar) identifying Randomised Control Trials (RCT) and observational studies following PRISMA guidelines was conducted, to report on outcomes of ALI using different antithrombotic agents.

Results
6262 studies were originally screened, after removal of duplicates 10 studies were left that fully matched our criteria. No RCT was found comparing antithrombotic agents’ efficacy. Pre-intervention anticoagulation was associated with a risk reduction of amputation and improved secondary patency in ALI treated with prosthetic bypass grafts. Regarding intra-arterial thrombolysis, a continuous heparin infusion showed no advantage. Low weight molecular heparin should be considered as an alternative to unfractionated heparin in ALI patients after arterial embolectomy. Low dose Rivaroxaban and aspirin are associated with decreased major adverse cardiovascular events and amputation incidence following revascularisation, when compared to aspirin and placebo in ALI. Ticagrelor was not superior to clopidogrel with similar bleeding rates.

Conclusions
The evidence base is inconclusive to determine a standardised guidance. ALI presentation and aetiology might be the best current guide on the antithrombotic regime choice.
497 Fast-Tracking Varicose Vein Treatment: A Post COVID Pathway for Effective Care
Authors: Lee N , Tsirigotis S , Harris M , Somaiya P 
Published: July 2024

Abstract

Aim
Standard treatment pathways for varicose veins (VV) consist of a referral, first clinic appointment, vascular ultrasound (VUS) and a follow-up appointment to determine eligibility for intervention. Multiple appointments cause delays in treatment. Publication of the ‘NHS 10-year long-term plan’ and post-COVID waiting lists motivated this quality improvement project combining One-Stop Venous Clinics (OSVCs) and office-based truncal venous radiofrequency ablation/sclerotherapy (OBRFA/ST). The OSVCs aim to reduce waiting time from first appointment to treatment.

Method
All VV referrals (2021-2022) were prospectively assessed and seen in a combined VUS and vascular surgeon appointment: OSVC. Suitable patients underwent OBRFA/ST. Time from referral to surgery was compared to routine practice pre-pilot, and patient satisfaction questionnaires (PSQ), assessing the five Care-Quality commission standards, were conducted.

Results
Of 639 pilot patients, 175 (27.4%) underwent OBRFA/ST. 201 (31.5%) were discharged, 204 (31.9%) did not attend (DNA’d) appointment, 24 (3.8%) were unsuitable for OBRFA/ST, and 35 (5.5%) had other outcomes. Mean age was 52.1yrs; 53.8% female, 46.2% male. Mean time to intervention fell from 315 days to 61.6 days comparing routine practice to combined approach. PSQ’s demonstrated: 98% patients felt well-informed, 98% felt safe, 96% had adequate pain management, 97% felt it was a responsive service and the overall satisfaction was 91%.

Conclusions
This project demonstrated a substantial reduction in time to treatment with this combined approach and may positively influence a new pathway standard for VV patients.
Living in Legends: Frames, Legends and the Conflict over the Hamburg Hafenstraße, 1981–1995
Authors: van der Steen Bart 
Published: July 2024

Abstract
During the 1980s, a conflict over eight occupied houses in the Hafenstraße in Hamburg developed into one of the most contested squatter struggles in West Germany and strongly resonated with squatters abroad. As the conflict escalated, a long-drawn-out discussion unfolded between Hamburg’s squatters, authorities, media and inhabitants over who the squatters were and how the city should deal with them. This article sets out to explain why these eight buildings became such a potent symbol for so many different groups. In order to do so, it combines social movement studies methods with folklore studies approaches and analyses the Hafenstraße as a site of legend, as a canvas onto which various actors projected societal hopes, ideals and fears. Central to this analysis are the four main legendary tropes that circulated in the 1980s: the Hafenstraße as a refuge for young dropouts, as a lawless zone, as a haven for terrorists and as indicative of the city’s governance crisis. Finally, it asks how such legends informed people’s actions and explains the importance of these tropes in the escalation and resolution of the conflict.
O-055 Understanding endometrial functionality and embryo-maternal communication via in vitro “OMICs’’ platforms
Authors: Chuva de Sousa Lopes S M 
Published: July 2024

Abstract
The uterus (womb) is perhaps the most fascinating organ in the human body. It undergoes cyclical regeneration of its inner layer, the endometrium, and is notoriously unreceptive to implantation, except for a short period of time known as the window of implantation (WoI), the only time when it becomes receptive to the implantation of an embryo resulting in pregnancy.
A common reason for pregnancy failure is implantation failure. Similarly, many in vitro fertilisation (IVF) treatments that do not result in a live birth fail because the embryo does not successfully implant. This is a significant challenge as there is limited understanding of the exact timing and cellular/molecular characteristics of the human endometrium during WoI.
Here I will present results on the characterisation of the WoI in humans, contextualised with results from “omics’ platforms. Moreover, we will provide 3D data on the structural development of the human uterus, paving the way to develop innovative culture platforms to investigate embryo-maternal communication.