bluuebunny/crossref_metadata_2025_split huggingface dataset:
822 Burn Bright, Learn Brighter: Igniting Expertise in Burns Care with Virtual Reality
Authors: Hirniak J , Nikookam Y 
Published: July 2024

Abstract

Aim
To assess the effectiveness of a burns assessment and management course for junior doctors, comparing virtual reality (VR) training with traditional didactic instruction and moulage.

Method
Foundation doctors (n=36) were divided into two groups: one receiving VR training and the other traditional instruction with in-person moulage practicals covering burns assessment and emergency management. An objective structured clinical examination (OSCEs) and pre, post and 6-weeks post-course questionnaires assessed knowledge retention and performance. Analysis involved paired sample t-tests. Qualitative analysis evaluated post course feedback.

Results
The VR group exhibited a significant increase in burns assessment accuracy and knowledge (p&lt;0.05) but a decrease in burns management (p&lt;0.05) compared to the control group in the OSCE. Both groups demonstrated significant improvement of 24% (VR, p&lt;0.05) and 21% (control, p&lt;0.05) in knowledge post-course. There was also significant retention at 6-weeks, with mean improvement of 19% (VR, p&lt;0.05) and 17% (control, p&lt;0.05). Qualitative feedback highlighted the VR's superior visualisation in assessment scenarios, while moulage-based practicals were perceived as more realistic for burns management. 33% considered an occupation in burns as a subspecialty, 100% reported increased confidence in burns assessment and management.

Conclusions
VR training proved effective in enhancing burns assessment skills, but its realism in burns management scenarios was questioned. Integrating VR alongside traditional methods demonstrated a comprehensive improvement in participants' overall burns care competency and a notable boost in confidence levels. Findings underscore the importance of balancing technological advancements with practical realism in plastic surgery education.
531 Research Priorities for Oesophageal Cancer : Results from a Priority Setting Partnership
Authors: Crotty F , Ao Lik L , Tan E , Gergaghty V , Murray P J , Murray T , O’Connor P , Delaney F , Tansey C , Moore J , Lysaght J , Ravi N , Reynolds J , Donohoe C 
Published: July 2024

Abstract

Aim
Oesophageal cancer is the seventh most common cancer worldwide and the sixth leading cause of cancer-related deaths, and it remains one of the hardest cancers to treat. Despite advances in the last decade, oesophageal cancer still has high morbidity and mortality burdens, and further research is needed to improve those outcomes. The aim of the Priority Setting Partnership was to bring together patients, family, caregivers, and the multidisciplinary healthcare team to identify and prioritise the most important unanswered questions for future research.

Method
Following the James Lind Alliance methodology, different stakeholders were asked to list their uncertainties about oesophageal cancer, which were then checked against existing evidence, categorised, and formed into questions. These then went through a survey for interim ranking, and those shortlisted were discussed at a final workshop to identify the Top 10 unanswered research questions.

Results
230 responders to the initial survey, two-thirds of which were patients, revealed 365 uncertainties. After removing duplicates and previously answered questions, sixty-three remained for interim ranking, and twenty-five were shortlisted for the workshop. Participants agreed on their Top 10 priorities, which covered topics such as prevention, current and novel treatment options, nutrition, survivorship concerns, and risk factors for developing oesophageal cancer, particularly at a young age.

Conclusions
Patients, family members, carers, and healthcare professionals collaborated to identify the most important questions for oesophageal cancer research. The results can help direct funding and attention to the shared priorities of those with personal experiences living with and providing care for oesophageal cancer.
231 A Comparative Study Between Open Pre-Peritoneal Approach Versus Laparoscopic Trans-Abdominal Pre-Peritoneal Approach in Recurrent Inguinal Hernia Repair: A Prospective Cohort Study
Authors: Hassan B , Awad P , Elkomos B 
Published: July 2024

Abstract

Aim
To compare the open pre-peritoneal approach and Laparoscopic trans-abdominal pre-peritoneal approach in the management of recurrent inguinal hernia which was previously managed through an open anterior approach regarding their intra-operative time, the post-operative outcomes.

Method
The current study is a prospective cohort study, a single-center trial conducted from June 2021 to June 2022 at Ain Shams University Hospitals.

Results
There were 74 patients in our study 37 patients in each group. Group (I) underwent an open pre-peritoneal approach and group (II) underwent a Laparoscopic trans-abdominal pre-peritoneal approach. Regarding intra-operative time, the mean time in minutes in the group (I) is 63.33 with a standard deviation of ±11.95. While in group (II) the mean time in minutes is 81.21 with a standard deviation of ±18.03 (p=0.015). Regarding the hematoma occurred in 4(10.8%) patients in group (I). While in 2(5.4%) patients in group (II) (p=0.674). The wound infection was found in 5 (13.5%) patients in group(I) and zero patients in group (II)(p=0.021). Finally, recurrence after one year was found in 3(8.1%) patients in group(I) and 1(2.7%) patient in group (II) (p=0.615).

Conclusions
The results of this study demonstrate that both approaches are effective for recurrent inguinal hernia following anterior approach mesh hernioplasty, with comparable results. Laparoscopy has been associated with a lower rate of recurrence and overall complications compared to open technique, however, it is difficult to draw definitive conclusions about the preferred option due to its lengthy learning curve and difficulty to perform.
1172 Innovative Low-Cost Vascular Anastomosis Simulation Training Model for Vascular Anastomosis Training
Authors: Abdullah M , Deshpande R , Khambalia H , Giuffrida G , Moinuddin Z , van Dellen D 
Published: July 2024

Abstract

Aim
Vascular anastomosis is an important but complex skill requiring mastery by trainees across multiple specialities, with significant risk of suboptimal outcomes. Simulation allows multiple repetitions of a procedure within controlled environment, allowing training without accompanying patient risk. Current simulation courses on vascular anastomosis are expensive and inaccessible to several junior trainees. A low-cost scaffold was developed for vascular anastomosis training and aimed to assess trainee feedback on utility and acceptability.

Method
The kit was built using following: Six 27 x 0.9 cm latex balloons, Ferrero Rocher chocolate box, Polypropylene 6.0 surgical sutures, Castroviejo needle holder and Forceps. Sharp scissors were used to make openings in the chocolate box, the balloons were then passed through. The kit’s utility was assessed via trainee feedback (N=16, ranked 1-5 where 1 was Unsatisfactory and 5 was Excellent).

Results
Trainees were able to perform various types of anastomoses: end-to-end, end-to-side, and patching, using our model. The resistance to needle passage through latex balloons was found to closely resemble that of real arteries and veins. Median rating of different categories in trainee feedback were as followed: Improved understanding 4, Helped practice 5, Realistic 4, Appropriateness for learning 4 and Affordability 5, ranging between 3 and 5.

Conclusions
Improved skills lead to better outcomes in surgical practice. Steps should be taken to make simulation more accessible. Low-cost models help reduce financial impact on trainees and are suitable for a wide range of institutions, including those with limited resources. Subsequent research should assess the effectiveness of this model across various contexts.
503 An Audit of the Management of Ankle Fractures Undergoing Open Reduction Internal Fixation (ORIF) Against the British Orthopaedic Association (BOA) Standards for Trauma
Authors: Yung E , Senthilkumaran S 
Published: July 2024

Abstract

Aim
To assess compliance of the management of ankle fractures with ORIF at Aberdeen Royal Infirmary and Woodend Hospital against the management of ankle fractures guidelines in the BOA standards for trauma.

Method
A retrospective analysis of patients who underwent ORIF of ankle fractures from 12/06/2022 to 06/06/2023 was conducted. Pilon fractures and open fractures were excluded. Operations notes, admissions, discharge and clinic letters, and imaging were used.

Results
201 patients met the inclusion criteria. 155 patients had complex fractures (posterior malleolus involvement, Maisonneuve, or syndesmotic injury); 46 had non-complex fractures. Only 47.74% of the complex fractures underwent CT imaging. Post-operation, only 14.43% and 12.45% of patients were full weight-bearing and partially weight-bearing, respectively. 97.01% of all patients had a follow-up clinic within 6 weeks post-operation. However, following the first clinic follow-up, only 24.88% and 25.87% were full weight-bearing and partially weight-bearing, respectively. The remaining patients were classified as non-weight-bearing.

Conclusions
Most of the patients were managed according to the guidelines. However, greater use of CT imaging for complex fractures can be done for defining fracture configurations. Additionally, more patients need to be allowed weight-bearing immediately post-operation and after their first follow-up clinic, as promoted by the BOA. Results were presented at the 21/11/23 mortality and morbidity meeting, and this issue was acknowledged by the orthopaedic surgeons. The post-operation note template will be revised, and a poster including the BOA guidelines on weight-bearing and imaging will be introduced in the department. A re-audit will be done in 2024 to assess any changes.
541 Development and External Validation of the “Global Surgical-Site Infection” (GloSSI) Predictive Model in Adult Patients Undergoing Abdominal Surgery
Authors:   GlobalSurg Collaborative NIHR Global Research Health Unit on Global Surgery, McLean K 
Published: July 2024

Abstract

Aim
To develop a novel prognostic score to predict 30-day surgical-site infection (SSI) following gastrointestinal surgery, and externally validate in comparison to existing prognostic models.

Method
This was a secondary analysis of 3 independent prospective international cohort studies conducted on a global basis. This included adults undergoing gastrointestinal surgery. Model development was performed in the GlobalSurg-2 dataset (January-July 2016). The primary outcome was 30-day SSI, with two predictive techniques explored: penalised regression (LASSO) and machine learning (XGBOOST). Final model selection based on prognostic accuracy (Area Under the Curve [AUC], 95% confidence interval) and clinical utility. Novel and previous scores were externally validated in GlobalSurg-1 (July-November 2014), and GlobalSurg-3 (April-October 2018).

Results
30,029 patients were eligible: 14,019 (SSI=12.3%) in the derivation cohort, and 8,464 (SSI=11.4%) and 7,546 (SSI=15.7%) in the validation cohorts (GlobalSurg-1 and GlobalSurg-3 respectively). The LASSO model was selected due to similar discrimination to XGBoost in the GlobalSurg-2 dataset (AUC: 0.738, 0.725-0.750 versus 0.737, 0.709-0.765), but greater explainability. The final GloSSI score included six variables: country income, ASA, diabetes, and operative contamination, approach, and duration. Discrimination remained good on external validation in GlobalSurg-1 (AUC: 0.730, 0.715-0.744), but moderate discrimination in GlobalSurg-3 (AUC: 0.606, 95% CI 0.588-0.623). Nonetheless, this demonstrated superior performance to external validation of all previous models evaluated within GlobalSurg or prior datasets.

Conclusions
The GloSSI score allowed accurate prediction of SSI with 6 simple variables routinely available at surgery across income settings. This can inform use of intraoperative and postoperative interventions to modify the risk of SSI and minimise associated harm.
229 A Comparative Study Between Laparoscopic Sleeve Gastrectomy with Omentopexy Versus Conventional Laparoscopic Sleeve Gastrectomy: A Prospective Cohort Study
Authors: Awad P , Hassan B , Elkomos B 
Published: July 2024

Abstract

Aim
Sleeve Gastrectomy, is a widely used procedure globally. However, omentopexy is a newly added variation, which involves reattachment of the omental to the stomach. Currently, there is not enough data regarding this technique, so this study evaluates the impact of omentopexy in Laparoscopic Sleeve Gastrectomy on intra-operative time and complications within one year of follow-up.

Method
A prospective cohort study was conducted from June 2021 to June 2023 in Ain Shams University Hospitals and other non-government hospitals, which included 174 for a one-year follow-up.

Results
In our study 87 patients in each group. Both groups underwent Laparoscopic Sleeve Gastrectomy, Group (I) with omentopexy while Group (II) without omentopexy. Regarding intra-operative time, the mean time in minutes in the group (I) is 115.45 minutes with a standard deviation ±11.19. While in group (II) is 79.8 minutes with a standard deviation of ±13.3 (p=O.001). Regarding complications rate within one year. leakage occurred in 1(1.14%) patient in group (I). While, in 3(3.4%) patients in group (II) (p=0.62). Bleeding was found in 1 (1.1%) patient in group(I) and 2(2.3%) patients in group (II) (p=1). GERD was found in 10(11.49%) patients in group(I) and 12(13.7%) patients in group (II) (p=0.82).

Conclusions
Omentopexy with LSG has shown to be a successful merging technique in terms of decreasing the rate of leakage and bleeding, although it appears to require more operative time, further refinement of the learning curve is possible to further reduce operative time.
230 A Comparative Study Between Central Quadrantectomy and Nipple Resection with Areola Preservation Versus Grisotti Flap Mammoplasty in Central Breast Lesions Extending to Nipple: A Randomized Clinical Trial
Authors: Awad P , Hassan B , Elkomos B 
Published: July 2024

Abstract

Aim
To evaluate central quadrantectomy and nipple resection with areola preservation (CQ-NR-AP) as a new reconstructive oncoplastic technique Versus Grisotti flap mammoplasty (GFM) in central malignant tumours of the breast extending to the nipple, in terms of time procedures, breast symmetry, patient satisfaction, post-operative complications and local recurrence.

Method
The current study is a single-blind, prospective, randomized, controlled, single-center trial conducted from May 2018 to May 2023 in the breast surgical unit of Ain Shams University Hospitals, which included 40 patients presented with central breast lesions extending to the nipple including one-year follow-up postoperative.

Results
As regards the mean intra-operative time in minutes, in the group (I) was 80.1 with a standard deviation of ±13.9, and ingroup (II) was 138.9 with a standard deviation of ±14.02(p=0.001). The seroma was detected in zero cases in group (I) and 2(10%) cases in group II (p=0.487) and those two cases were managed by aspiration only. Regarding, the wound infection was found in one case (5%) in group (I) and 3(15%) cases in group II (p=0.605). Regarding patient satisfaction and breast symmetry was much better in the group (I)

Conclusions
Central quadrantectomy and nipple resection with areola preservation were determined to be safer, easier, and associated with a lower incidence of complications in one-year follow-up as compared to the Grisotti flap mammoplasty technique. In addition, better patient satisfaction is one of the most difficult accomplishments in the management of centrally located breast tumors.
127 Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention in Heart Failure with Reduced Ejection Fraction Patients: A Systematic Review and Meta-Analysis Stratified by Left Ventricular Ejection Fraction
Authors: Hammad A , Jubouri M , Al-Tawil M , Awad W , Bashir M 
Published: July 2024

Abstract

Aim
The primary objectives were to assess differences in mortality, repeat revascularization, new postoperative myocardial infarction (MI), and cerebrovascular accidents (CVA/stroke) between PCI and CABG in HFrEF patients, stratified by the degree of LVEF reduction.

Method
A comprehensive search of electronic databases was conducted, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria comprised clinical trials or observational cohort studies with ≥20 patients per group, comparing long-term outcomes in HFrEF patients (LVEF &lt;50%) who underwent PCI or CABG. Data was extracted, and quality was assessed using the New Castle Ottawa (NOS) Risk of Bias tool. Hazard ratios (HRs) were pooled for time-to-event outcomes, with subgroup analysis based on LVEF. Heterogeneity was assessed, sensitivity analysis conducted, and publication bias evaluated.

Results
Twenty studies involving 25,031 patients met the inclusion criteria. In the severe LVEF reduction group (&lt;35%), CABG was associated with significantly higher long-term survival, reduced repeat revascularization, and fewer postoperative MIs compared to PCI. In patients with moderate LVEF reduction (&lt;40%), there was no difference in long-term survival, but repeat revascularization was lower in the CABG group . In the mild LVEF reduction group (&lt;50%), CABG was associated with superior long-term survival and reduced repeat revascularization. Stroke rates were similar between PCI and CABG in all groups.

Conclusions
Individualized patient care should consider the degree of LVEF reduction when selecting between PCI and CABG, with CABG generally favored for improved outcomes in HFrEF patients. However, clinical presentation, patient characteristics, and cost-effectiveness should also be considered in the decision-making process.
232 A Comparative Study Between Stapled Hemorrhoidopexy and Harmonic Scalpel Hemorrhoidectomy in Management of Third and Fourth-Degree Piles: A Randomized Clinical Trial
Authors: Hassan B , Awad P , Elkomos B 
Published: July 2024

Abstract

Aim
This study compares the results of stapled hemorrhoidopexy (SH) and harmonic scalpel hemorrhoidectomy (HSH) in the management of Grade III and Grade IV piles.

Method
The current study is a single-blind, prospective, randomized, controlled, single-center trial at Ain Shams University Hospitals.

Results
There were 70 patients in our study 35 patients in each group. Group(I) underwent stapled hemorrhoidopexy (SH) and Group (II) underwent harmonic scalpel hemorrhoidectomy (HSH). The mean time of the procedure in SH was 24.42 mins ± 2.367. While in HSH was 31.48 mins ± 2.21. Post-operative pain in SH showed to be less painful during the first two weeks. However, there is persistent mild pain in most of the patients of SH postoperative during and after two weeks. However, in HSH there was significant improvement in pain after two weeks. Wound infection was detected in 3(5%) patients in group (I) and no patients in group (II) (p=0.077). Postoperative bleeding occurred in 4(11.4%) patients in group (I), While no patients were detected in group (II) (p=0.039). there were 3(15%) cases of incontinence to gases only scored by Wexner score 3/20 in group (II). Recurrence in one-year follow-up occurred in 7 (20%) patients in group (I). While in group II 1(2.9%) patient was reported with recurrence (p=0.024).

Conclusions
HSH was determined to be safer, easier, and associated with a lower incidence of recurrence in one-year follow-up as compared to the SH technique. In addition, better patient satisfaction is one of the most difficult accomplishments in the management of hemorrhoids.
1053 Parathyroid Phenomenon Causing Primary Hyperparathyroidism: A Case for Surgeons, Radiologists and Pathologists
Authors: Griffin K , McKnight K , Al-Kendi B , Kerin M , Abd Elwahab S M 
Published: July 2024

Abstract

Background
Parathyroid lipoadenomas are a rare parathyroid phenomenon and an unusual cause of primary hyperparathyroidism. The histological composition of these neoplasms makes them a diagnostic challenge, as their high adipose content leads to difficulty localising them on imaging and can lead pathologists towards a wrong diagnosis. There are less than 100 cases in the literature since they were first described in 1958, and to our knowledge this is the largest parathyroid lipoadenoma to be reported.

Method
A minimally invasive parathyroidectomy with intraoperative parathyroid hormone monitoring was performed in the case of a male with a large neck mass and symptomatic primary hyperparathyroidism.

Results
A giant parathyroid lipoadenoma was excised, with an appropriate decrease in intraoperative parathyroid hormone level observed. The patient has been cured of his primary hyperparathyroidism, with no issues following his discharge from our institution.

Conclusions
We highlight the importance of having the parathyroid lipoadenoma as a differential diagnosis for patients who develop primary hyperparathyroidism.
258 Ultrasonography-Guided Drainage Versus Surgical Drainage for Deep Neck Space Abscesses: A Systematic Review and Meta-Analysis
Authors: Alzaid M , Ramadhan M , Abul A , Karam M , Alsaif A , Stapleton E 
Published: July 2024

Abstract

Aim
Deep neck space abscesses (DNAs) are relatively common otolaryngology-head and neck surgery emergencies. We conducted the first and robust systematic review and meta-analysis to evaluate outcomes for ultrasonography-guided drainage (USD) versus conventional surgical incision and drainage (I&D).

Method
The protocol was published a priori (PROSPERO: CRD42023466809) and the study adhered to PRISMA guidelines. MEDLINE, EMBASE, Cochrane CENTRAL and key ENT journals were searched. Primary outcomes were length of hospital stay and recurrence. The secondary outcomes included scar formation/cosmetic, reported complications and cost savings. The quality of included studies was assessed using the Cochrane ROBINS-I and RoB2.0 tools. Fixed effects model was applied.

Results
Of 646 screened articles, seven studies enrolling 384 participants were included. USD was associated with a significantly shorter length of hospital stay (Mean Difference [MD] = -2.31, P &lt; 0.00001), but no statistically significant difference was noted in the recurrence rate compared to I&D (odds ratio [OR] = 2.02, P = 0.21). USD appears to be associated with more cost-savings, better cosmetic outcomes, and fewer post-operative bleeding events.

Conclusions
USD appears to be associated with a shorter length of hospital stay, making it a viable and more cost-effective alternative. More randomized trials with adequate outcomes reporting are required to optimise the current evidence.