bluuebunny/crossref_metadata_2025_split huggingface dataset:
429 Does Time to Definitive Treatment Have Influence on the Clinical Outcomes of Open Hand Injuries? a Systematic Review
Authors: Chee S Y , Quinlan C 
Published: August 2024

Abstract

Aim
Hand injuries pose a significant financial burden due to medical expenses and occupational disability. They constitute about 20% of emergency department attendances. Minimal evidence exists to confirm that the rate of complications of open hand injuries is not increased by waiting to perform definitive operative repair. The study’s aim is to collate existing evidence to investigate the influence of surgical timing on the outcomes of open hand injuries.

Method
A systematic literature search of Medline and Embase computerised literature databases and manual bibliography searches were conducted using the PRISMA 2020 guidelines and the SWIM criteria. Descriptive/ quantitative data were extracted, and we grouped the results obtained to enable a clear and transparent interpretation of our findings. Eligible articles included adult subjects (&gt;16 years old), open hand injuries distal to the radius and ulna, reported clinical outcomes and were published in English.

Results
13 studies were included in the qualitative synthesis. Our studies involved patients aged 26 to 87, predominantly male. 13 studies examining the time to definitive treatment assessed various clinical endpoints: infection rates (n=12), total active motion/ extension (n=1), length of hospital stays, (n=1) revision surgery rates (n=1), non-union rates (n=1) and functional outcomes (n=1). Overall, the findings showed that time to definitive treatment did not result in adverse outcomes for open hand injuries.

Conclusions
These findings support the idea of managing open hand injuries in an ambulatory, semi-urgent setting, which could potentially contribute to improved healthcare service planning and enhance the quality of patient care.
644 Advancements in Biofabrication of Human Skin and Its Microvascularity
Authors: Seraj S S 
Published: August 2024

Abstract

Aim
Bioengineered in-vitro human skin substitutes with reliable “take” has been the aspiration of clinicians and bioengineering researchers when tackling compromised skin in chronic wounds, burns, malignancy and trauma. Microvasculature of these artificial models is key for maintaining hold into the recipient site. The purpose of this review is to outline the current body of literature regarding skin substitutes and innovations in bioengineered vascularity.

Method
A narrative literature review using a systematic approach was performed by using a search strategy and MESH terms: "((3D Bioprinting) OR (Biofabrication) OR (tissue engineering)) AND ((skin tissue) OR (skin substitutes) OR (human skin))". MEDLINE (PubMed), Embase (OVID) and CENTRAL (cochrane library) databases were examined. Inclusion and exclusion criteria were applied.

Results
Previous developments in 3D bioprinting involved forming multilayered scaffolds, hydrogel/gelatine bioinks, preset moulds with tissue-engineered keratinocytes and fibroblasts. Artificial angiogenesis in-vitro models have included lining biofabricated microtubules or pores with human placental pericytes or endothelial cells. Extrusion-based bioprinting has been popular either in a "top-down" or "bottom-up" approach to construct scaffolds. Pore size diameters of these substitutes have adhered to &gt;100µm. Autologous fat grafting has provided a viable microvascular option.

Conclusions
Only a few studies and clinical trials have managed to tackle the vascularity issue of human skin substitutes. Exploration into integration 3D bioprinted scaffolds, fat grafting with a bottom-up approach using micropores lined with endothelial cells provides promise for future research. Further studies must be undertaken to assess feasibility, cost and "take" of such grafts initially in human subjects with industry support.
731 Profiling United Arab Emirates Aesthetic Botulinum Toxin Practitioners: A National Cohort Analysis
Authors: Zargaran A , Zargaran D , Sousi S , Al-Khafaji M , Mohamed F , Al-Khafaji M , Davies J , Mosahebi A 
Published: August 2024

Abstract

Aim
The global aesthetic Botulinum Toxin market has been growing yearly, with concomitant concerns over lack of regulation and oversight. Whilst robust laws are in place in UAE regarding who is licensed to practice, practitioners remain largely unknown. This study aims to quantitatively evaluate practitioners and their professional background in the UAE.

Method
A comprehensive search was performed on internet search engines and social media in Abu Dhabi, Dubai, Fujairah and Sharjah. Clinics were then contacted via WhatsApp to corroborate online information. The list of practitioners was cross-referenced with professional regulatory bodies, as well as year of qualification and country of qualification.

Results
A total of 694 practitioners were identified from 310 clinics. 50.7% were male, while 49.3% were female. The most common practicing specialty were dermatologists (48.3%), followed by plastic surgeons (39.4%). Only one non-medical practitioner was identified. Practitioners qualified from a total of 51 different countries with the most common one being Syria (n=76), followed by Egypt (n=71). The modal year of qualification was 2016.

Conclusions
This paper is the first to describe the range of aesthetic Botulinum Toxin practitioners in UAE, their professional backgrounds and experience. Knowledge of professional background is an important consideration when introducing regulation and monitoring public health impact, and this provides a foundation for further regional and international public health studies.
1285 Evaluation of Post-Operative Outcomes for Peripheral Nerve Injuries to the Hand: A Single-Centre Study
Authors: Panikkar M , Elfaki A , Izadi D 
Published: August 2024

Abstract

Aim
This study aims to investigate all adults who suffered peripheral nerve injuries to the hand over a one-year period to assess adherence to The British Society for Surgery of the Hand (BSSH) guidelines for nerve trauma. It also aims to assess clinical outcomes and provide strategies to optimise patient care.

Method
This is a single-centre retrospective analysis of 76 adult peripheral nerve injuries between November 2022 and November 2023. Data was collected and analysed regarding patients’ time from predentation to repair, mechanism and nature of injury, intra-operative practices and post-operative recovery and management.

Results
60% of nerve injuries were repaired by consultant plastic or orthopaedic surgeons. On average, nerve injuries were repaired within 3.3 days of referral. 83% of nerve injuries were to digital nerves of the hand. The infection rate reported at the time of patients’ first clinic appointment was 8%. 10% of patients underwent secondary procedures including full-thickness skin grafts and further washouts. 84% of patients were referred to hand therapy following surgery.

Conclusions
This data highlights high rates of adherence to the BSSH guidelines with regards to the time from presentation to repair, in addition to the availability of competent hand therapy services and experienced microsurgeons to facilitate satisfactory post-operative outcomes. It also identifies areas for improvement including documentation of intra-operative equipment and the use of pharmacological aids.
113 R-E-S-P-E-C-T: A Closed-Loop Audit Increasing the Quality of ReSPECT Documentation in a Tertiary Surgical Centre in the United Kingdom
Authors: Wagner B , Flint M , Jenkins B , McNish A , Rutland T , van Laarhoven S 
Published: August 2024

Abstract

Aim
Resuscitation Council UK guidelines suggest Recommended Summary Plans for Emergency Care and Treatment (ReSPECT) must be considered for all patients at risk of deterioration or cardiac arrest or who want to have their wishes documented. This quality improvement project aims to evaluate the use of ReSPECT forms in acute general surgical admissions and improve compliance with the ReSPECT process.

Method
The audit was registered with the local audit department (REF: GENSUR/CA/2023-24/03). Data was collected in the form of random spot-checks, quantitatively and qualitatively evaluating the completion of ReSPECT forms for all patients admitted via the general surgical ‘take’ at a large inner-city hospital. The first intervention was the addition of ReSPECT forms to the surgical admissions proforma. Second-cycle intervention involved educating clinical teams about the importance of ReSPECT completion by delivering a teaching session and producing a novel poster to be displayed in the unit.

Results
The initial completion rate of accurate ReSPECT forms was 8%, with 30% counter-signed by the responsible consultant. Re-audit following the first intervention showed ReSPECT form completion rate of 27%, with 50% of forms counter-signed by a consultant.

Conclusions
The addition of ReSPECT forms to the surgical admission proformas is a simple and effective way of increasing compliance. Overall quality of ReSPECT documentation improved with our interventions, however, there remains scope for further improvement and ongoing education of clinical teams is paramount to improving compliance with the ReSPECT process long-term.
464 ENT Handover Audit Using ‘RAAAIDSSS’ Method: Initial Step in Excellent Patient Care
Authors: Jamalludin A N Binti , Sahu B 
Published: August 2024

Abstract

Background
Patient handover is vital in ensuring patient safety and quality of patient care, in line with Royal College of Surgeons Guidance of Safe Handover (2007). ‘RAAAIDDSSS’ method stands for resection (surgery), airway, anticoagulant, antibiotics, intake, drain, serology, scans, structure (plans). It shows comprehensive clinical updates for planning best management, ensuring smooth flow of activity and reducing morbidity. This method is ideal as otolaryngology patients often have altered airway anatomy and airway plans and consequently variable feeding routes.

Aim
To audit the compliance of RAAAIDSSS method.

Method
This is a prospective audit in ENT Department Imperial College Hospital NHS Trust, done in August and October 2023, with sample (n=100) for each cycle. The format was implemented in handover sheet and case presentation was run according to this method.

Results
First cycle showed good compliance to RAAAIDSSS handover method. The least compliant component is ‘structure’ which showed only 62%. Results were presented in local teaching. Second cycle showed significant improvement. Almost all components showed 100% compliance, except for the ‘intake’, which was 90%. Overall shows positive compliance to this handover method.

Conclusions
The department has showed improved compliance with the RAAIDSSS method. This audit brings significant positive impacts and changes to clinical practice in terms of patient safety, service efficiency and quality of patient care. This audit also holds valuable clinical value and opens doors for further audits as well as project expansion regionally and nationally.
757 Rapid Deployment of a Virtual Fracture Clinic (VFC) at a London District General Hospital: Safely Building on a Pragmatic Measure to Bring About Lasting Service Impact
Authors: Erotocriou M , Chammaa R , Mellet S , Berber O , Overton A 
Published: August 2024

Abstract

Aim
We report our experience of rapidly deploying a Virtual Fracture Clinic (VFC) at our institution as a safe alternative to a traditional fracture clinic and demonstrate how innovation can be built upon to enact lasting change.

Method
The VFC was assessed using 3 PDSA cycles. Initially, a paper referral system was established along with detailed injury management pathways. In the 2nd PDSA cycle an electronic referral system was introduced. The 3rd PDSA cycle involved ED staff training sessions, alongside a patient webpage. At each stage the number of VFC referrals, clinic follow-ups and patient satisfaction were measured.

Results
There was a statistically significant (p-value&lt;0.01) reduction in the number of new face-to-face follow-up appointments between pre-VFC (4083) and post-VFC (713); an increase in patient satisfaction (p-value&lt;0.05) and a reduction in non-attendance (p-value&lt;0.01). Recent executive review demonstrated ongoing success and sustainability with the creation of 1600 face-to-face clinic slots which could be used for elective or post-op patients, reducing the pressure on orthopaedic services.

Conclusions
We have demonstrated that a VFC model can be deployed rapidly and safely as an emergency measure and subsequently refined into a permanent and effective service thereby dramatically improving efficiency and cost effectiveness over a short period. Rapid, bold innovation is possible in the NHS but requires short-term pragmatic changes which can then be nurtured to amplify their lasting effect. Our work highlights that key to success are strong clinical leadership, the meaningful engagement of all stakeholders and senior managerial/operational support.
824 Assessing the Quality of Surgical Operation Notes in the General Surgery Department at a District General Hospital (QI Project)
Authors: Sherafat A , Alhammali T , Ali A , Kamath S , Marcu V 
Published: August 2024

Abstract

Aim
assessing the current adherence to Royal College of Surgeons (RCS) guidance on the standards of documenting operation notes. There are 18 elements that must be present on operation notes including date and time of operation, name of surgeon and anaesthetist, type of anaesthesia, findings of operation, potential complications, closure technique, information on implants and signature of the surgeon.

Method
The present audit was a retrospective study of patients' notes to review their operation notes. 93 operation notes that were recorded August-September 2022 were reviewed in the first cycle. The second cycle reviewed 46 operation notes in May 2023.

Results
The outcome of the audit showed satisfactory adherence to majority of the RCS recommendations. Time of the operation was only recorded in 9% of operation notes in the first cycle which improved to 76% in the second cycle. Only 46% of operation notes in the first cycle were signed by a surgeon which improved to 67% in the second cycle.

Conclusions
Areas that mainly required improvement were identified to be recording time of the operation and signature of the surgeon in the first cycle. The result of the first cycle of audit was communicated to surgeons. The electronic operation note templates were also updated. The second cycle showed a significant improvement in the quality of operation note documentation in May 2023. A continuous cycle of audit should be implemented to ensure the documentation standards are maintained.
1046 IV Maintenance Fluids Prescribing in General Surgery Patients
Authors: Tan J X , Tan H M , Sasapu K 
Published: August 2024

Abstract

Aim
Identify if DPOW general surgery team is meeting NICE guidelines for IV fluids prescribing and offer solution for quality improvement.

Method
NICE guidelines 2013 states that patients should receive 25-30ml/kg/day of water and 1mmol/kg/day of sodium, potassium, and chloride with regards to maintenance fluid therapy. We conducted a retrospective audit on surgical patients. Post-operative emergency laparotomy patients were chosen randomly from surgical inpatient wards in DPOW hospital over the course of one month. Maintenance IV fluids prescribed over 24 hours were collected, adjusted according to the patients’ weight, with the exclusion of individuals with AKI and heart failure. Microsoft excel was used to calculate the average weight, fluid volume and electrolyte administration.

Results
Over the specified time frame, 21 patients were identified. The mean weight among these patients was 72kg. The typical daily intake of total fluid volume amounted to 2.5L. During the 24-hour post-operative period, the mean electrolyte concentration administered were as follows: 249mmol Sodium, 12mmol potassium, 228mmol chloride. Taking into account the average patient weight, there is a net administration of +177mmol sodium, -60mmol potassium, +156mmol chloride.

Conclusions
The electrolytes administered were inappropriate with too much sodium, chloride and too little potassium. Patients on average received 246% excess sodium, 83% less potassium and 217% chloride than the recommended daily requirement. Interventions including teaching sessions and posters to foundation doctors to improve the appropriateness of intravenous maintenance fluids prescription in the hospital has been done. The next data collection after intervention will be done by the end of December 2024.
1250 Literature Review: Revolutionizing Emergency General Surgery; Harnessing the Power of Robotics and Pioneering the Future Landscape of Artificial Intelligence
Authors: Al Maawali S S 
Published: August 2024

Abstract

Aim
This review embarks on two critical fronts: firstly, an exploration of the integration of robotic surgery in emergency general surgery, and secondly, a forward-looking anticipation of the role of artificial intelligence (AI). The objective is to provide profound insights into the potential applications of robotics in urgent surgical scenarios, endorsed by a meticulous systematic review supported by the World Society of Emergency Surgery (WSES)1. Concurrently, the review evaluates the future trajectories of AI, accentuating its potential within healthcare.

Method
The study meticulously conducts a PRISMA-compliant literature search encompassing PubMed and the Cochrane Library, spanning from 1980 to 2022. Fifty-two studies, enveloping urgent conditions undergo meticulous scrutiny2. The parallel review on AI delves into major advancements, dissecting advantages, obstacles, and potential implications according to the WSES methodology1.

Results
Robotic assistance in urgent general surgery, predominantly utilising the Da Vinci® system, demonstrates feasibility across surgical emergencies2. Simultaneously, the review on AI illuminates a promising trajectory for robotic technologies, emphasising their potential to revolutionise healthcare through improved patient outcomes, and precise solutions for challenges1.

Conclusions
This study envisions a landscape where robotic surgery emerges as a formidable ally in emergency settings, showcasing not only feasibility but also safety. Simultaneously, it underscores the role of AI in reshaping healthcare. It creates a balanced approach that integrates technology while preserving the human touch. This synthesis heralds a future where robotics and AI seamlessly converge, delivering enhanced patient care.
480 RCS Good Surgical Practice Consent Guidelines: An Audit of Compliance After the Introduction of Digital Consent
Authors: San N T , Martin J , Rahman K , Brahmbhatt K , Mahmood A , Lister G , Bowrey D 
Published: August 2024

Abstract

Background
Informed consent is an ethical and legal obligation of modern-day clinicians. It protects patients from harm and doctors from litigation. Digital consent may enhance patients’ satisfaction and understanding, whilst also facilitating shared decision making. At our institution, digital consent (Concentric®) was introduced to the General Surgery department in May 2022.

Aim
To evaluate whether electronic consent forms on Concentric® followed RCS Good Surgical Practice Guidelines.

Method
A retrospective review was conducted on all patients consented using Concentric® by the General Surgery team for the calendar month of August 2023. Endoscopic procedures, blood transfusions and duplicate consent forms were excluded. Data was collected based on current RCS Good Surgical Practice Guidelines. Additional information was extracted from the theatre management software (ORMIS), correlating the time of consent with the date of the procedure.

Results
Over the month, 398 consent episodes were evaluated. Compliance with RCS standards was as follows: benefits and risks of procedures (100%), clinicians involved (100%), indication for procedure (87%), alternative treatment (62%), and patient information leaflet with follow-up information (37%).
Among elective procedures (186 episodes), only 32% of patients were consented prior to the day of surgery. Where there was a significant interval (&gt;24 hours) between the original consent signing and the operation, only 52% had consent reconfirmed.

Conclusions
This audit identified areas of good practice and areas for improvement in relation to digital consent in general surgery. Making fields on the form mandatory would likely improve compliance with current RCS standards.
826 Does Prehabilitation Improve Quality of Life After Gastrointestinal Cancer Resection?
Authors: Razzaq A , Niaz O S , Seabrook M , Rao A 
Published: August 2024

Abstract

Aim
This study aims to evaluate the effects of prehabilitation on the quality of life (QoL) of patients undergoing gastrointestinal cancer resection, addressing the existing gap in knowledge regarding this specific population.

Method
A systematic search of relevant terms was independently conducted by two authors across multiple databases. Selection criteria were applied rigorously, with conflicts resolved through consultation with senior researchers. From the initial pool of 33 articles, 6 studies were chosen for inclusion. Data extraction and analysis were performed to assess the significance of prehabilitation interventions on post-resection QoL.

Result
The selected 6 studies, despite displaying noticeable heterogeneity in methodologies and outcomes, consistently indicated a positive impact of prehabilitation on the role functioning aspect of QoL, as measured by the C30 QoL survey. The studies collectively involved a substantial number of patients.

Conclusions
The evidence from the reviewed studies suggests a favourable influence of prehabilitation on the post-resection QoL of gastrointestinal cancer patients, particularly in the domain of role functioning. However, limitations such as heterogeneity in Randomised Controlled Trials (RCTs) and a lack of long-term follow-up data, should be acknowledged. To provide more definitive conclusions, future RCTs should employ standardised QoL questionnaires like the C30 QoL and extend follow-up periods. This would enhance our understanding of the role of prehabilitation in improving patient outcomes following gastrointestinal cancer resection.
101 "Why Is This Person a Surgeon if They Can't Keep Their Hands Still?"- the Experience of Enhanced Physiological Tremor in Surgical Trainees
Authors: Greenlees G , O’Hanlon M 
Published: August 2024

Abstract

Aim
All humans experience a degree of physiological tremor which may be exacerbated by anxiety, fatigue, or caffeine. Physiological tremor visible to the naked eye is termed enhanced physiological tremor (EPT). The effect of tremor on surgical trainees has been explored in laboratory conditions but there has been limited exploration of the effect of anxiety on EPT. There is increasing recognition that surgical performance anxiety is a common phenomenon and we therefore set out to explore trainees experience of EPT, particularly its relationship with performance anxiety.

Method
Twelve surgeons in training were recruited to participate in semi-structured interviews on surgical performance anxiety and EPT. Interviews were conducted using Microsoft Teams and an inductive content analysis of transcripts was performed.

Results
All participants had experienced or witnessed EPT. EPT was felt to be common in surgical trainees and driven by surgical performance anxiety. Perceived evaluation by supervisors and other staff was a common trigger for surgical performance anxiety. Trainees outlined a variety of coping mechanisms such as using humour and physiological explanations for their tremor. EPT was generally described as improving with experience but could provoke negative emotions such as shame in trainees who experienced tremor.

Conclusions
Our findings add to a growing body of evidence on surgical performance anxiety and provide one of the first descriptions of trainee’s experiences of EPT. Further research, particularly to determine the prevalence of EPT in surgical trainees and explore the experience of supervising surgeons is warranted to gain a deeper understanding of the phenomenon.