bluuebunny/crossref_metadata_2025_split huggingface dataset:
572 Introduction and Assessment of an Updated Multi-Modality Induction Program for Rotating Junior Staff in a Regional Plastic Surgery Centre
Authors: De La Cruz Monroy M , Bedri H , Leonard D 
Published: August 2024

Abstract

Introduction
An effective induction is essential for doctors in training, particularly in specialties to which they may have limited prior exposure.

Aim
To assess the confidence of junior Plastic Surgery doctors’ (FY/CT level) in core competencies and optimise our departmental induction program.

Method
Quality Improvement project at the Plastic Surgery Department of Leeds General Infirmary (May-September 2023). Doctors at FY/CT grade in post for a period of 8 weeks were invited to complete an online survey of their confidence with common Plastic Surgery competencies (Cohort A). Analysis of these data guided revision of the departmental induction program including updated didactic and practical sessions, and production of an electronic handbook. Follow up surveys were completed by a subsequent cohort (B) at 3 points: prior and immediately after induction, and 8 weeks post start.

Results
Cohort A and B were comparable in size (5 vs 4) and composition (FY/CT/Trust Grade). Cohort A were 25% “Not confident”, 26% “Somewhat confident”, 38% “Confident” and 11% “Very confident” in core competencies at 8 weeks. Cohort B, 8 weeks following revised induction, were 11%, 13%, 29% and 47% respectively (p&lt;0.00001). Cohort B also demonstrated progressive increase in confidence from immediately post-induction to 8 weeks, citing access to the electronic handbook as a significant factor.

Conclusions
This highlights the importance of appropriate educational guidance tools for the most junior members of the team in order to facilitate their learning experience, role confidence and therefore improve patient care.
600 QIP: Assessing the Financial Impact of Single-Use Ambulatory Flexible Cystoscopy
Authors: Ong A , Sharma V , Tanasescu G , Phan Y C 
Published: August 2024

Abstract

Aim
Single-use ambulatory flexible cystoscopes were introduced at a university hospital with the aim of improving patient care, overcoming issues with the availability of emergency theatres, and reducing the associated financial burden.

Method
The number of procedures listed as “cystoscopy and catheter insertion” or “flexible cystoscopy” on the electronic emergency theatre system “theatreman” were reviewed between 1/3/2019 to 1/3/2021. The second data cycle was between 02/03/2021 to 1/03/2023 after the introduction of the cystoscopes.

Results
Fifteen procedures occurred in the emergency theatre between 1/3/2019 and 1/3/2021. In the second cycle only one procedure was recorded between 2/3/2021 and 1/3/2023. The average cost per operation in the emergency theatre was £2,321.80. Whereas a single-use ambulatory flexible cystoscope cost £222.00. The cumulative emergency theatre cost was £34,827.00 prior to the introduction of the cystoscopes. 46.7% (7/15) of the procedures occurred after 8pm.

Conclusions
The introduction of single-use ambulatory flexible cystoscopes successfully reduced the number of cystoscopies and catheter insertions undertaken in the emergency theatre. This was reflected in a decline in emergency theatre costs. The use of a single-use ambulatory flexible cystoscope was £2,099.80 less than the cost to run an operation in an emergency theatre. The portable nature of the cystoscopes circumvented issues with accessing emergency theatre, reducing the wait-time from diagnosis to treatment. These results suggest that single-use ambulatory flexible cystoscopes are a cost-effective means of improving patient care.
650 Standardised Management of Ureteric Colic: A Quality Improvement Project
Authors: Stevens S , Yadav S , Chakraborty M , Wells H 
Published: August 2024

Abstract

Aim
Ureteric colic is a condition that contributes a significant amount to the workload of both emergency and urological services. The standards of its management are outlined by the British Association of Urological Surgeons (BAUS). We therefore endeavoured to evaluate the effectiveness of our treatment centre in achieving these standards with the aim to develops a new diagnostic pathway to improve the efficiency of managing ureteric colic.

Method
A pre-post intervention study design was used. The first cycle evaluated all ureteric colic cases referred to our department between September-October 2022. Data was extracted using local clinical and radiological software in line with local clinical governance guidelines. We subsequently developed a treatment pathway in conjunction with our emergency department to guide both diagnosis and initial management of acute presentations. The second cycle was performed during September 2023 to assess the efficacy of our pathway.

Results
Of the 37 new acute ureteric colic referrals reviewed during our second cycle, (Mean age: 48 years, Male: Female 2.4:1), 100% received their CT scan within the target window of 14 hours (Mean time: 02:12). 80% had correct Xray imaging performed which demonstrated a relative increase of 30% from the previous cycle (80% vs 50%). Furthermore 75% of patients had non-steroidal anti-inflammatory drugs (NSAIDs) prescribed and 70% had the correct blood tests done (Calcium and Urate).

Conclusions
Our pathway has demonstrated a significant improvement in the efficiency and accuracy of our department’s management of acute ureteric colic.
849 Routine Use of Validated Risk Prediction Model in the Management of Acute Appendicitis in a District General Hospital
Authors: Muthiah A , Bowry M , Francis L , Rahman A , Al-Khusheh M 
Published: August 2024

Abstract

Aim
Acute appendicitis is the most common general surgery emergency in the UK. Currently, there is no optimal diagnostic pathway for managing the right iliac fossa (RIF) pain. The right iliac fossa pain treatment (RIFT) study group has previously performed an analysis of different risk prediction models to search for the most specific one and made a website (appy-risk.org) to calculate risk scores on presentation. We aimed to look into our practice in a DGH and see how compliant we are in documenting risk scores on presentation with acute RIF pain.

Method
A list of patients presenting with acute RIF pain to the surgical assessment unit in September was prepared. Admission clerking notes were reviewed from the electronic patient record to look for the documentation of the appendicitis risk score. Standard statistical packages were used for data analysis.

Results
A total of 95 patients were presented with RIF pain. Of them, 17 were excluded from the analysis for being over 45 years old. Of the remaining 78 patients' records, only 7 (8.97%) had appendicitis risk scores documented in the clerking notes.

Conclusions
The RIFT study highlighted a high normal appendicectomy rate (NAR) in the UK in comparison to other European countries. In our hospital, NAR was 9.74% in the first six months of 2023. We are in the process of implementing a pathway to manage acute RIF pain using a risk prediction model as advised by the RIFT group to reduce our NAR to less than 5%.
885 Reducing Inequalities in Bowel Cancer Screening Access from Primary Care
Authors: Qasim A 
Published: August 2024

Abstract

Aim
Reducing inequalities in bowel cancer screening access by providing translated patient information to 90% of non-responders in a GP practice, in one month. The provision of information regarding the screening process to non-responding patients is a standard expected by cancer research UK, which is why it is vital to ensure that this information is equitable, and patient centred.

Method
Barriers to uptake include a lack of information for groups whose first language is not English. The GP practice is in a deprived area in Harrow, where the four most used languages (Gujarati, Tamil, Romanian and Arabic) are spoken among ethnic minority groups. This first PDSA cycle included the plan to complete a literature review and retrospective data collection from EMIS web, of the percentage of patients aged 60-74 who did not respond to a screening invite in the last 12 months. It was found that in a patient population of 3050, the percentage increased from 10% in 11/22 to 18% in 11/23. The Do part was the addition of translated posters explaining the programme in four languages and distributed via text message.

Results
Act the target was achieved since the proportion of patients receiving translated information increased from 0% to 100%. The software limitation did not allow identification of patients’ preferred language, and it was assumed that contact information had not changed.

Conclusions
Cancer screening education of ethnic minority groups can lead to improved access. A future PDSA cycle is required to assess the intervention’s impact on percentage uptake.
1162 Extended Hospital Stays: Awaiting Social Care Packages - an Interim Challenge or a New Norm?
Authors: Nabavi M , Quraishi M 
Published: August 2024

Abstract

Aim
This study in an Eastbourne DGH urology ward investigates the impact of delayed social care package preparations on patient bed occupancy, emphasizing the prevalence of medically fit patients awaiting social care.

Method
The investigation reviewed Mitchelham Ward patient records from July 1 to August 31. Bed occupancy, categorized into medical and social reasons, required the doctor's 'Medically Fit for Discharge' (MFFD) notation as inclusion criteria.

Results
In July and August, MFFD patients occupied 10.75% and 0.77% of bed days, averaging 5.9%. The observed monthly discrepancy prompts a need for more extensive studies. Medically fit patients in hospitals incur economic burdens and health risks, costing approximately £450 per bed day. The study estimates a monthly expenditure of over £7,000 on patients overstaying in Mitchelham Ward.

Conclusions
The issue of patients awaiting social care packages is rapidly growing nationwide. Locally, addressing this problem requires enhanced collaboration with social care services. Healthcare workers should acknowledge the economic and health risks. Adequate safety measures and specialized care for these patients are imperative to reduce associated health risks. The economic impact emphasizes the urgency of proactive measures at both local and broader healthcare levels.
32 Photogrammetry 3D Models : A Novel Approach to Surgical Medical Education but What About Their Accuracy?
Authors: Aliotta S 
Published: August 2024

Abstract
Surgical teaching and learning of anatomy are mostly based on the donation of human bodies. It is acknowledged that students learn anatomical structures best by dissecting cadaveric specimens or the exploring prosected specimens. However, the availability and accessibility of these specimens is limited due to their confinement to licensed facilities and their short-shelf life. The integration of 3D digitization and modelling in medical education has delivered promising results. Despite the progress in 3D imaging techniques, the accuracy and reproducibility of these models have not been thoroughly investigated. This paper seeks to show the various factors which may alter model inaccuracy and irreproducibility.
Six archaeological bone human specimens were digitized in this study. The photogrammetry models were compared to micro-CT-based reference models and a low-cost 3D laser scan.
Results show that photogrammetry provides overall the most accurate reconstruction of the specimens across all the comparisons. The inter-and intra-observer error was also assessed. Results showed no significant trend in intra-observer variability. In regard to inter-observer variability, a minimal variation was recorded. This is significant as it demonstrates that the data obtained is reproducible and robust, in particular applicable for the repeatability of the same data from different users with minimal overall variability. This paper has highlighted the accuracy of photogrammetry as a useful low-cost tool for the 3D reconstruction of cadaveric models for surgical medical education.
790 Basic Robotic Technical Skills Course (BRITS): A Critical Evaluation of an Evolving Surgical Curriculum
Authors: Ike D I , Asemota N , Jacob A , Okorocha C , Stamenkovic S 
Published: August 2024

Abstract
Robotic-assisted surgery has rapidly advanced, significantly impacting various surgical specialties. Traditionally, robotic training primarily targeted experienced surgeons, but recent data from robotic training programs challenge this paradigm. Robotic surgery offers a conducive environment for both novice and expert training, potentially featuring a shorter learning curve compared to laparoscopic methods.
The Barts Thorax Centre at Barts NHS Trust has conducted six courses, involving over 80 surgical trainees specializing in cardiothoracic surgery, with the participation of more than 12 consultants and senior faculty members.
Each course aimed to enhance participants' knowledge and skills in robotic thoracic and minimally invasive surgery, focusing on three educational goals: 1) assessing participants' pre-course knowledge and skill levels in core aspects of robotic surgical training, 2) evaluating overall course satisfaction and satisfaction with individual sessions, and 3) gauging self-rated improvements in knowledge and skills upon course completion.
The BRiTS' course curriculum has proven effective in introducing essential concepts of robotic thoracic surgery, as indicated by pre-course and post course assessments highlighting the demand for such educational offerings. A well-structured curriculum, combined with dedicated faculty and industry support, forms the basis for successful implementation of robotic surgical training. Participants expressed strong appreciation for the high-fidelity models provided in the wet lab stations, as evidenced in the post-course feedback.
This experience underscores the importance of expanding robotic training opportunities to a broader spectrum of surgical professionals, ultimately contributing to improved patient care and outcomes in the field of robotic-assisted surgery.
795 Elevating Medical Education Through Standardised Bedside Teaching
Authors: Copperwheat A , Kandikattu S 
Published: August 2024

Abstract

Aim
This project aimed to maximise the learning opportunities derived from bedside teaching (BT) through standardised junior doctor (JD) tutor education and increased sessions.

Method
Surveys collected feedback on current BT from medical students and general surgery JDs. Next, a presentation and reference sheet were provided to JDs. Students then received the standard number of BT sessions with Teaching Fellows for the first six weeks, followed by additional sessions from the JDs in the final six weeks. Repeat surveys evaluated the effectiveness.

Results
Before the scheme, students felt sessions with JDs were disorganised. They desired more sessions and increased variety. JDs rated confidence and knowledge an average of 5.8/10, and wished for education on BT. Following the scheme, nearly 100% of students found the extra sessions useful, appreciating the expertise of other doctors. The sessions were rated high for usefulness (8.8/10). 83% of students found the sessions well prepared but many wished for a greater variety of specialties to be covered. All students achieved a grade of Excellent in their OSCE exams. JDs confidence increased to 7.8/10, with 80% feeling an improvement.

Conclusions
In conclusion, the scheme had a positive impact. This was evident from increased student satisfaction, enhanced JD confidence and exam results. However, some areas, such as speciality teaching, require improvement to fully optimise BT as a tool in medical education. It would be advisable for other departments to adopt this scheme as it emphasises the value and importance of BT, which is currently not fully utilised.
31 A Comparison of Deep Learning Artificial Intelligence Methods with Radiologists in Breast Cancer Screening for Guiding Patient Management
Authors: Furness D 
Published: August 2024

Abstract

Background
Breast cancer is the most common type of cancer in women. Mammograms are the most used method of screening; however, this technique has limited sensitivity. According to the USPSTF, the screening age for breast cancer in the US has reduced by 10 years which will produce thousands more images, increasing the demand on radiologists.

Aim
AI algorithms aim to assist radiologists and detect cancers that would have otherwise been missed. The aim of the integration of AI into screening is to enable quicker breast cancer detection, leading to earlier treatment which may include surgery in some cases.

Results
Recent studies which compare the performance of Deep learning, Convolutional neural network (ResNET) models with radiologists in breast cancer screening, have shown an increased accuracy of malignancy detection when radiologists read images in combination with AI than radiologists reading the scans alone.

Discussion
Radiogenomics could be utilised to predict the likelihood of patients developing breast cancer, taking into consideration patient factors and image data, aiming towards precision medicine. However, there are some limitations with the use of AI in the screening programme, such as access to large quality data, data privacy, transparency and explainability.

Conclusions
AI has the potential to shift breast cancer detection to a more proactive than reactive approach, increasing the speed and accuracy of diagnosis and contributing to the establishment of a more patient-centred approach to treatment.
However, more research is needed into this field and ethical considerations must be evaluated prior to implementing AI fully within the screening programme.
352 Systematic Review and Meta Analysis: Transanal Hemorrhoidal Dearterialization (THD) versus Milligan-Morgan Hemorrhoidectomy (MMH) in Grade III/IV Hemorrhoids
Authors: Kazemi N , Mena J , Elzeftawy M 
Published: August 2024

Abstract
In cases of hemorrhoidal disease, when conservative measures fall short in providing relief or in advanced stages of the disease, surgical intervention becomes necessary. This article presents a systematic review and meta- analysis comparing THD and MMH for the treatment of grade III/IV haemorrhoids.
The study included relevant articles that reported outcomes of THD and MMH in patients with grade III/IV haemorrhoids. Data on demographic characteristics, follow-up duration, operation time, grade of haemorrhoids, and post-operative complications were extracted and analysed.
The included studies revealed varying sample sizes and patient ages, with THD and Milligan-Morgan Haemorrhoidectomy performed on individuals aged 48 to 58.8 years. Both surgical techniques demonstrated comparable efficacy in addressing post-operative complications like pain, bleeding, incontinence, and itching. Minor variations in bleeding rates were noted, possibly linked to differences in operation time. Follow-up durations ranged from 12 months to 7.0 years, revealing promising outcomes for THD and Milligan-Morgan Haemorrhoidectomy in pain relief and recurrence prevention. The available evidence showed low recurrence rates and high patient satisfaction with both approaches. THD offers advantages such as reduced post-operative pain and faster recovery, while Milligan-Morgan Haemorrhoidectomy remains a reliable surgical method. Consideration of patient characteristics, surgeon expertise, and individual preferences should guide the choice between the two techniques.
Further research with standardized methodologies, larger sample sizes, and extended follow-up periods is essential for more robust conclusions and comparative effectiveness data. The systematic review and meta-analysis presented here contribute valuable insights for clinicians in making informed treatment decisions.
1085 Power Tools and Hand Injuries
Authors: Gkorila A , Moura F S 
Published: August 2024

Abstract

Aim
Power tools are frequent culprits in traumatic upper limb injuries. The resulting wounds have significant heterogeneity since these depend on the tool characteristics. Wider kerf blades, outward-facing teeth, crushing and avulsion-causing mechanisms may limit the ability of end-to-end repair requiring more complex reconstruction.

Method
We outline the mechanism of action of these tools, allowing hand surgeons to appreciate the injury and facilitate surgical planning.

Results
Angle grinders' handheld nature result in unilateral injuries. As the number of the affected fingers increases, the site of injury moves more proximally. Chain saws injuries are multi-digital, proximal arm open fractures, or amputations with chewed soft tissues. The most common mechanism of injury for most saws is the kickback phenomenon. The cut of circular, mitre, table saws blade comes solely from its teeth, rather than the disk itself. The number and shape of the teeth will determine the resulting cut. The repetitive reciprocating motion of the jigsaw blade will result in multiple small but deep lacerations. Planers' spinning blades remove wood at the depth difference of the in- and out-feed bases, resulting in shallow but extensive cuts. Power drills have the capacity to cause high speed rotating trauma resulting in localised shear and friction burn injury. Sanders are culprits of friction burns, abrasions or lacerations from the tool or the workpiece if not securely fixed.

Conclusions
Hand trauma from DIY machinery can cause not only physical disability but also have devastating psychological impact. We encourage trauma surgeons to learn the different configurations of the tools highlighted herein.
1092 Perioperative Practices and Early Post-Transplant Outcomes in Deceased Donor Simultaneous Kidney Pancreas Transplants (SPK): Results of a National Transplant Access to Theatre (NTACT) Audit
Authors: Borbas B , Mujeeb M , Tanase A , Aroori S 
Published: August 2024

Abstract

Aim
Deceased donor simultaneous kidney-pancreas transplants (SPK) outcomes hinge on donor and recipient factors. Limited UK data on perioperative practices and outcomes prompted the National Transplant Access to Theatre (NTACT) study, aiming to unveil the current landscape.

Method
A prospective audit covered adult deceased donor kidney-only transplants in five UK centres from February to September 2022. RedCap recorded data and analysed descriptively.

Results
Among 29 SPK transplants, 24 were analysed. Preoperative antibiotics were universal, and consultant surgeons led all operations, though only 62.5% were directed by consultant anaesthetists. Central and arterial lines were standard, with 42% using advanced hemodynamic monitoring. Goal-directed fluid therapy, done using static parameters in 62.5% of cases, was common. Post-operatively, 75% were routed to the Intensive Care Unit. Encouragingly, 30-day mortality was 0%, and primary graft function rates were 83% for kidneys, 92% for pancreas. The median hospital stay was 12 days (IQR: 11-18), with a 29% readmission rate and 33% re-operation rate. Notably, readmission rates differed between Donation after Circulatory Death (DCD) and Donation after Brain Death (DBD) organs (17% vs. 41%).

Conclusions
Diverse perioperative practices and notable early complications were observed. While limited sample size precludes statistical associations, this underscores the need for future, more extensive studies.