bluuebunny/crossref_metadata_2025_split huggingface dataset:
701 Do We Shy Away from Issuing Duty of Candour?
Authors: Farooq R , Tetley H , Daniel S , Riyad K 
Published: July 2024

Abstract

Aim
Transparency and openness are the key elements that clinicians must offer. Certain events mandate a duty of candour (DOC). An apology must be provided to the patient/family/carer, providing a factual account of events. Francis Enquiry, 2013 recommended that a statutory DOC should be introduced. Numerous Trusts have been fined by CQC for failing to comply with statutory DOC. The aim of this audit was to study the compliance of our department in issuing a DOC for unexpected return to theatre following an acute laparotomy.

Method
We carried out two retrospective audits between January 2022 – March 2023 in general surgery department at St. James University hospital, Leeds. Approval was gained locally, and audit was conducted by reviewing electronic notes of each patient for evidence of issuance of DOC. All initial operations were acute laparotomies.

Results
A total of 46 patients were identified during second cycle of audit as compared to 21 patients during first who had unexpected return to theatres. 4 out of 46 had written evidence of DOC following their return to theatre; 8.7% compliance rate with Statutory Duty of Candour Guidelines which is 2.3% lesser than the first cycle. (P=0.193).

Conclusions
There appears to be poor compliance in performing a DOC or if provided, evidence of its documentation. Providing verbal and written DOC should become normative behaviour. There needs to exist an automated alert system for those incidences that requires a DOC and appropriate time in the job plan to accomplish this.
320 Views and Awareness of Egyptian Surgical Trainees on Pursuing Membership of the Royal College of Surgeons (MRCS) in the UK: A Single-Institutional Study
Authors: Miller J 
Published: July 2024

Abstract

Aim
International surgical trainees view training overseas as an attractive pathway for achieving excellence in surgery. The internationally recognised MRCS examinations provide a benchmark that trainees can use to meet this aspiration while also benefitting from great international mobility. We aimed to look at the awareness and views of Egyptian surgical trainees to training in the UK and pursuing MRCS. The motivations for and the barriers to these aspirations were explored.

Method
An observational cross-sectional study of interns, residents, and assistant lecturers at Ain Shams University Hospitals was conducted from October to December 2023 using a 26-item paper-based survey. This was designed to assess understanding of UK surgical training and ascertain views on UK surgical training and pursuing the MRCS examinations.

Results
194 participants were involved in this study, with 58.76% being male and the mean age being 26.84 ± 2.58 years. 73.4% generally agree that pursuing surgical training in the UK is an attractive career option. 55.85% generally agree that it is a financially viable career option, and 31.38% remain neutral. 66.5% personally know someone who has trained in the UK and/or sat MRCS. 51.59% report it is easy to find information on UK training and the MRCS exams.

Conclusions
It is evident that surgical training in the UK and pursuing MRCS is an attractive option for Egyptian surgical trainees. However, many barriers and a lack of information make these aspirations hard to achieve. Further work is required to improve support structures and to assess if these sentiments are shared with trainees elsewhere.
488 Surgical Site Infection After Hand Trauma Surgery in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis
Authors: Shaw A , Chaplin G , Graham S , Beard D , Agarwal-Harding K , Wormald J 
Published: July 2024

Abstract

Aim
In low- and middle-income countries (LMICs) surgical site infections (SSIs) are the most common post-operative complication. Associated with increased morbidity and mortality, they impose a significant financial burden on patients. A recent meta-analysis found the overall SSI risk following hand trauma surgery is 5-10%. In this study a top-up-search and re-analysis was performed to establish SSI risk in the context of countries’ income classification.

Method
Our PRISMA-compliant systematic review searched MEDLINE, Embase, CINAHL, CENTRAL and clinicaltrials.gov to identify studies reporting SSI rates in adults undergoing hand or wrist surgeries for trauma. Studies were grouped by country-of-origin using World Bank income classifications. Meta-analysis of proportions was performed using R and risk of bias was evaluated.

Results
Of 11,056 screened s, 236 studies were included. None originated from low-income countries (LICs), 40 came from LMICs (16.9%), 48 from upper middle-income countries (UMICs) (20.3%) and 148 from high-income countries (HICs) (62.7%). Of LMIC studies, 70.0% were at high risk of bias, compared to 47.7% of UMIC and 31.1% of HIC studies. Meta-analysis demonstrated SSI risk in LMIC studies as 7.9% [95%CI 6.3-9.9], UMIC studies as 6.3% [95%CI 4.4-8.8] and HIC studies as 4.5% [95%CI 3.5-5.8].

Conclusions
No studies were identified from LICs, perhaps indicative of the limited hand surgery capacity. Reduced research was found from MICs compared to HICs. We concluded that SSI risk following hand trauma appears lower in HICs compared to UMICs and LMICs but may be under-reported in MIC studies. Further research into hand trauma burden and outcomes in LMICs is required.
681 Application of Low-Cost Automated Progress Tracking System (APS) on Laparoscopic Appendicectomy Simulation Models (LaApSi) for the Laparoscopic Simulation Training in the Lower-Middle-Income-Countries (LMICs)
Authors: Karki B B , Sharma S , Neupane P , Phuyal S l , Shrestha S , Katuwal S , Satyal S , Loubani M 
Published: July 2024

Abstract

Aim
To assess the effectiveness of the Low-Cost Automated Progress Tracking System on Laparoscopic Appendicectomy (LA) Simulation Models (LaApSi) for Laparoscopic Training in Lower-Middle-Income-Countries (LMICs). To assess and record the progression of trainees’ performance during simulation training.

Method
After the successful application and validation of the LaApSi model during laparoscopic courses at LMICs, the APS system has been prototyped to assess the trainee’s progression of LA. This system helps to assess surgical steps during simulated LA with the help of the LaApSi model integrated with wires at various anatomical positions giving real-time computer feedback and allowing users to assess the timing of operation, blood vessel excision and injury to the base of the appendix/caecum.

Results
The prototype version tested in LMIC showed excellent results in the detection of the above-mentioned parameters (shown in photos). This cost-effective model (LaApSi&lt; £5 and docking system &lt;£15) showed huge potential as a laparoscopic training model in LMICs. There will be additional validation of 16 APS models during the Laparoscopic Surgery Course in Nepal in Jan 2024 in collaboration with Nepalese Doctors Association-UK which we believe will further solidify its application in the LMICs

Conclusions
There is a need for the transition to high-fidelity low-cost laparoscopic simulation models from the traditional training methods in the LMICs which in the long-term address global surgery values. These systems have the potential for remote proctorship in the rural parts adapting the Hub & Spoke model and integrating AI and Machine Learning which eliminates the use of wires and sensors in the models.
1153 Pediatric Renal Stone Management in Africa: A Scoping Review and Analysis of Current Practices
Authors: Davis S , Anyakora C , Zubair A , Igbokwe M , Haladu Z , Ajibade A , Noah O , Agyeman C , Oisamokhai K , Enemoh O , Ikuborije P , Nwokeocha E , Ajari O , Adejala I , Mastaki V , Akinro O 
Published: July 2024

Abstract

Aim
Renal stones are solid deposits formed from minerals and salts that develop within the kidneys and urinary tract. While the condition is more common among adults, children and even infants can also be affected. There is an increasing incidence of paediatric renal stones in Africa alongside multiple challenges faced in managing the condition. This scoping review aimed to provide an overview of the management modalities of paediatric renal stones in Africa.

Method
This study utilised Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. A systematic search was conducted in three electronic databases: PUBMED, African Journal Online (AJOL), and Google Scholar, with 1,180 articles curated. After extensive examination, ten articles satisfied the inclusion criteria.

Results
The review found that calcium oxalate stones were the most prevalent type, accounting for 34.03% of cases, followed by whewellite stones and ammonium urate stones. The kidney was the most frequent location for stones, and the most common symptom was pain. Abdominopelvic ultrasound was the most frequently utilised investigation. Of the 886 patients managed for renal stones, 75.4% were managed surgically, 2.9% medically, and 21.7% spontaneously resolved without intervention.

Conclusions
This review identifies opportunities for improving the management of paediatric renal stones in Africa, including the need for standardised diagnostic and treatment protocols and the development of evidence-based guidelines tailored to the African context. Overall, this review provides valuable insights into the patterns and management of paediatric renal stones in Africa and highlights the need for further research to improve its management in the region.
1082 Maximising Surgical Outcomes in Midline Incisional Hernia Repairs: Are We Employing Every Possible Optimisation?
Authors: Belbase S , Naseer A , Jayawardena P , Lo T , Hamady A , Owera A 
Published: July 2024

Abstract

Introduction
Large midline Incisional hernia repair can involve complex surgery which poses many challenges, with a high recurrence and complication rate. The recently published European Hernia Society Guidelines has identified several risk factors contributing to the increased complications after surgical repair. We aim to assess the effect of these modifiable risk factors for adverse outcomes within our patient population.

Method
All adult patients who underwent a repair of midline incisional hernias larger than 3cm in a DGH hospital between July 2021 and July 2022 were included. Data on patient demographics, modifiable risks factors and complications were collected. Analysis was performed using Microsoft Excel.

Results
26 patients (age: 64 [33-84] years; M:F, 9:17) underwent a midline incisional hernia repair were included. The average hernia size was 8cm. The average body mass index (BMI) was 33.1, seven were smokers and three had diabetes mellitus. Of the three patients who developed a recurrence, average BMI was 36 and two were smokers. None of the patients were counselled for weight loss or smoking cessation.

Conclusions
In our cross-sectional study, patients with a large hernia, high BMI, diabetes, a smoking history are associated with adverse outcomes. We aim to highlight and raise the awareness to surgeons who perform these repairs to counsel their patients on their modifiable risk factors and its associated risk of hernia recurrence. Preoperative optimisation improves surgical outcome and subsequently reduces healthcare costs.
340 Investigating the Effectiveness of Folic Acid-Fortified Iodized Salt on Serum Folate Concentration- a Primary Prevention Strategy for Spina Bifida in India
Authors: Pattisapu J , Manda V , Rao M N , Kajana P M , Kancherla V , Veerappan V R , Kumar A , Oakley G P 
Published: July 2024

Abstract

Aim
Investigate the effectiveness of folic acid-fortified iodized salt in increasing serum folate concentrations among non-pregnant and non-lactating women of reproductive age

Method
All households in four rural Indian villages agreed to consume FA-fortified iodized salt (study salt) in a pre- and post-intervention study. Pre- and post-intervention serum folate levels were analysed from 83 eligible participants. A cohort study was done after consumption of approximately 300 mcg of FA daily using double fortified salt (FA + Iodine). We assessed the differences in median serum folate concentrations at baseline and 4 months.

Results
The median serum folate concentration increased from 14.6 nmol/L at baseline to 54.4 nmol/L at end of study. Two-tailed Wilcoxon Signed Rank Test showed the difference to be highly significant (p-value = 1.8 × 10-14). The villagers found the salt acceptable in color, taste and cooking properties. No untoward effects related to the study salt were noted.

Conclusions
Folic Acid for the prevention of Spina Bifida has over 3 decades of evidence to support it. In 2023, the World Health Assembly unanimously recommended FA to prevent incidence of Spina Bifida. India, currently estimated to bear a third of the global Spina Bifida burden, poses a unique challenge to mandatory fortification due to the heterogeneity in population, culture, and dietary patterns. FA-fortified salt presents an equitable opportunity to reach the entire population of India and avert a significant burden of Spina Bifida and its associated morbidity and mortality. Moreover, salt fortification infrastructure currently exists so FA-fortified salt poses a cost-effective primary prevention method.
547 Creation of a Machine Learning Model to Predict Cognitive Outcomes Post Deep Brain Stimulation Surgery for Parkinson’s Disease
Authors: Deshpande R , Haliasos N 
Published: July 2024

Abstract

Background
Parkinson’s disease (PD) is the second most common neurodegenerative disorder and continues to affect an increasingly large portion of the world’s population. Limitations of the medical treatment of PD with levodopa have led to deep brain stimulation (DBS) therapy being used to alleviate symptoms in advanced PD patients. Despite its efficacy with motor symptoms of PD, DBS has been noted to lead to worsening of cognitive outcomes in a percentage of cases. There is currently no predictive model for individual patient cognitive outcomes post DBS.

Aim
The aim of this study is the creation of a machine learning (ML) model which can help facilitate decision making for clinicians regarding offering DBS to patients. ML has the potential to analyse multiple variables and produce a predictive model for neurocognitive outcomes. The volume of variables analysed by ML is beyond the remit of calculations that can be performed by individual medical professionals for each patient.

Method
This study used mild cognitive impairment (MCI) as the outcome, at six months post DBS surgery to measure neurocognitive impact. Clinical and radiomics variables were used to train the models.

Results
Two predictive models were successfully generated – random forest and logistic regression, which showed an accuracy of 0.87 and 0.74 respectively.

Conclusions
The study concluded that it is possible to use ML to generate a prediction model for outcomes post DBS. The model can help optimise the decision-making process behind offering DBS surgery to patients and lend insight into the possible causes of poor outcomes.
1177 A Critical Review: What Do We Currently Know About the Genomics of Spinal Chordomas?
Authors: Woo Y T , Czyz M 
Published: July 2024

Abstract

Aim
To provide an insight into our current understanding in the genomics of spinal chordomas with regards to pathogenesis and treatments.

Method
Three terms – ‘spine’, ‘chordoma’ and ‘genomics’ were searched on PubMed and Embase. Papers published until 2022 were included. Exclusion criteria were conference s, letters, and duplicates. The final result was nineteen papers on PubMed, which were analysed in this review. Data collected were discussed under the respective subtopics.

Results
From the nineteen papers, the published evidence surrounding the genomics of spinal chordomas with respect to molecular pathogenesis and treatment modalities were collected and analysed. Brachyury and microRNAs (miRNAs) are two of the more significant molecular markers related to chordomas. Other molecular aberrations include chromosomal instability, long non-coding RNAs (lncRNAs), Sonic Hedgehog (Shh), as well as modifications in genome, exome, transcriptome, and proteome. Apart from surgical management, which is usually the gold standard approach to chordomas, genomic findings in chordomas have led to advancements in targeted therapy and immunotherapy. The integration of hyperthermia into radiotherapy could also be a potential novel therapy.

Conclusions
To date, great advancements have been made around the genomics of chordomas, but these are not specific to spinal chordomas. As such, apart from improving on the respective knowledge gaps identified in this review, studies focusing specifically on spinal chordomas would also be recommended.
496 Necrotising Fasciitis Within a Single Centre: A 5 Year Retrospective Review
Authors: Ejaz M , Sarwar U 
Published: July 2024

Abstract

Aim
Necrotising Fasciitis (NF) is a rapidly progressing soft tissue infection that necessitates prompt diagnosis and management. This study examined NF cases over a 5-year period at Bradford Royal Infirmary and those referred from local hospitals to enhance patient care and outcomes.

Method
Cases coded as “Necrotising Fasciitis” between April 2018 and January 2023 were retrospectively reviewed using electronic records. These encompassed patients transferred for plastic surgery input and those admitted under various specialties. Data on risk factors, admission details, surgical interventions, microbiology results, and outcomes were collected. Microbiology results included histology, tissue, swabs and blood cultures if sent.

Results
A total of 50 cases were identified - 33 male and 17 female patients with a mean age of 53 (range of 25-93). The mean Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score was 8.6 prior to debridement. Of the 13 cases with histological confirmation, 2 were calculated as low risk and 2 as intermediate. Tissue cultures showed 21 cases with E. Coli and/or Mixed Anaerobes (Type 1) and 8 with Group A Strep and/or Staph Aureus (Type 2). 4 cases did not require debridement, while others needed an average of 2.3 debridements. 23 of the 45 patients required reconstruction by the local plastics team. 37 patients of the total 50 were discharged, 3 self-discharged and 10 died acutely (22.2% mortality rate).

Conclusions
While the LRINEC score is a valuable indicator for NF, histology demonstrates its limitations. It is an adjunct, not a substitute, to clinical diagnosis, ensuring accurate management and preventing misdiagnosis.
611 Hydrogel Vue Spacer in Prostate Cancer Radiotherapy for Patients with Inflammatory Bowel Disease (IBD): Pilot Study
Authors: Hayyawi I , Alani A , Ahmed I , AlHasso A 
Published: July 2024

Abstract

Introduction
Patients with Inflammatory Bowel Disease and those with previous rectal surgery may have challenges when undergoing prostate radiotherapy due to increased rectal toxicity after radiotherapy which may preclude them from having radiotherapy for their prostate cancer. We need solutions that can minimize rectal toxicity while maintaining the efficacy of radiotherapy for patients. We report on our experience using SpaceOAR Hydrogel Spacer as a solution to minimize the radiation dose to the rectum and reduce toxicities.

Aim
To assess the benefits of SpaceOAR Hydrogel spacers following radiotherapy in patients who are at risk than average of rectal toxicity.

Method
We collected data from patients with IBD or previous rectal/bowel surgery who received radical radiotherapy with SpaceOAR Vue™ Hydrogel from period between Sep/2021 and Sep/2022. Data was collected including age, stage, baseline PSA, Gleason score, number of endoscopic assessment required and need for any surgical/medical intervention within one-year after completion of their radiotherapy.

Results
16 patients were included in the study with one year follow up. The range of age is (62-82 years), the dose of radiotherapy varies between 6000-7400Gy and the initial PSA range was (6.1-89). 8 patients required endoscopic assessment within 1 year of treatment (As a part of their normal follow-up). was normal in all patients except in 3 patients who has mild colitis. Biochemical control at one year was excellent.

Conclusions
Results demonstrated that the use of Hydrogel spacer in patients with IBD or previous bowel surgery undergoing radical prostate cancer radiotherapy is safe and is a reasonable strategy.
45 Skin Preparation in Arthroscopic Surgery – Are There Environmental Savings to Be Made?
Authors: Kutuzov V , Cornish E , Andrews H , Kapoor A , Jain N 
Published: July 2024

Abstract

Background
The environmental impact of surgery is concern that has been raised in recent years. Operating theatres have been found to create up to 230kg of waste per day. There is a need to reduce surgical waste whilst maintaining patient safety. This study assessed the waste and CO2 production associated with two accepted skin preparation techniques.

Method
Groups consisted of two consultant surgeons, both performing 5 arthroscopic procedures. Surgical skin preparation was performed with disposable ChloraPrep™ sticks or bottled Hydrex 0.5% solution with red dye. Annual waste and CO2 production was assessed via modelling.

Results
The disposable group generated a total of 876g of net waste compared to 1727g in the solution group. Waste per surgical case was 134.6g (SD 14.97) in the disposable group compared to 328.8g (SD 86.09) in the solution group. The disposable group produced significantly less waste than the solution group (P &lt;0.0069). In 2022, a total of 514 arthroscopies were performed at our institution (134 shoulder, 380 knee). Modelling using the research group data provided estimated annual waste in both groups; 225.132kg in the ChloraPrep™ stick group compared to 443.839kg in the Hydrex 0.5% solution group, with Kg CO2 production of 241.79-701.57 Kg and 476.68-1383.13 Kg in each group respectively.

Conclusions
This study demonstrates that choice of skin preparation in arthroscopy can significantly reduce waste and CO2 production, without a significant increase in cost.
796 Integrating Sustainability in Surgical Practice – the Student MedAID London Way
Authors: Sarela S , Asim N , Sheriff V , Samsudeen N , Mazzoleni A 
Published: July 2024

Abstract

Aim
Recognizing the imperative need for sustainable healthcare education given only 2-5% of students have had exposure within their degree, Student MedAID London (SMAL) was established to promote global health awareness by redistributing excess medical supplies and fostering a platform for increasing insight into this field.

Method
Volunteers actively engage with local healthcare providers to secure excess medical equipment, employing a screening process to ensure responsible donations. Teaching series, such as "Learn with Med-Aid" and online seminars, delve into global health topics often overlooked in medical school curriculum. This methodology offers a unique opportunity to integrate sustainability principles into the education of future surgeons.

Results
Social media and seminar engagement increased by 62% respectively since establishment in 2021, attracting over 1000+ followers across social media channels. The demographic has expanded beyond London medical students to include young healthcare professionals from across the UK and the USA. Furthermore, SMAL has acquired substantial storage space for medical donations and made successful donations to Tripoli Hospital in Lebanon. Notably, 90% of seminar attendees expressed a strong desire for more events, alongside 50% reporting it increased their confidence in global health and sustainability.

Conclusions
As the future generation of healthcare professionals increasingly expresses a heightened interest in sustainable practice, SMAL's endeavours uniquely underscore the profound impact that sustainability can have on surgical education. By raising awareness and actively engaging in the redistribution of medical supplies, the organization sets the stage for a paradigm shift towards more environmentally conscious healthcare initiatives in surgery.