bluuebunny/crossref_metadata_2025_split huggingface dataset:
141 Simulation Training: The Impact on the Confidence and Preparedness of Novice Otolaryngology ST3 Registrars
Authors: Rai A , Patel P , Khan H , Shukla S , Mehtani N , Acharya V , Tolley N 
Published: July 2024

Abstract

Aim
This research employs the HoloLens2™ and a variety of models to evaluate the impact on the confidence and preparedness of ST3 trainees following their engagement in simulated otolaryngology cases.

Method
A total of 29 ST3 trainees engaged in ten 1-hour long simulation stations across a span of two days. The participants engaged in both technical and non-technical skills within elective, emergency, and ward-based scenarios. Questionnaires were used to document self-reported confidence and preparedness before and after each simulation. Primary outcomes included change in trainee confidence and preparedness pre- and post-station.

Results
The participants reported a significant increase in confidence (p&lt;0.001) and preparedness (p&lt;0.001) after all stations. The greatest improvements in comparison to all other stations were self-preparedness in the rigid bronchoscopy station and self-confidence in the sphenopalatine artery (SPA) ligation station. A significant improvement in self-confidence (p&lt;0.001) and self-preparedness (p&lt;0.0001) was observed after the non-technical HoloLensTM session.

Conclusions
The use of Otolaryngology simulation stations improved confidence and preparedness of managing common ENT presentations in the ward, elective, and emergency settings for ENT ST3 trainees. This approach serves as a valuable supplement to the conventional surgical apprenticeship, facilitating the acquisition of both technical and non-technical skills. The implementation of mixed reality technology creates an immersive environment to develop trainees’ non-technical skills. However, future work is required to assess the impact on the long-term benefits of trainee skill retention and clinical proficiency.
559 Can Poller Screws Decrease Pain Relief in Femoral Fractures?
Authors: Bradshaw F , Eisner A , Zhang J , Brown A , Wakefield E , Krkovic M 
Published: July 2024

Abstract

Aim
Poller screws, used alongside intramedullary (IM) nails for femoral shaft fractures, aim to expedite healing and minimize complications by enhancing fracture stability and controlling IM nail insertion. Despite their benefits, the impact of poller screws on post-operative pain is understudied. This retrospective cohort study aimed to compare opioid medication needs in femoral shaft fractures managed with IM nails with and without poller screws.

Method
Between January 2015 and December 2022, a retrospective analysis was conducted on femoral shaft fractures treated at a major trauma centre. Patients primarily treated with IM nails were included. Patient and operation notes, along with radiographs, identified poller screw utilization and categorized screw generation. Opioid medication data, converted to "coverage" (days) and "strength" (morphine milligrams equivalent or MME), was collected. Two-tailed independent samples T-tests compared patients treated with (n=43) and without poller screws (n=364).

Results
Second-generation poller screws significantly reduced opioid strength requirements in the first post-operative year (603.6 vs. 1711.6 MME, p=0.03), except the first month. However, no significant difference was observed in the number of days with opioid prescriptions throughout the first post-operative year for each poller screw generation.

Conclusions
This study highlights the potential of poller screws in reducing post-operative pain in femoral fractures. Future endeavors aim to use a larger patient sample, but these results signify the promise of poller screws in mitigating post-operative pain in IM-treated femoral fractures.
699 Gender Inequality in Orthopaedic Radiation Protection: An Audit
Authors: Kovacs L , Wang J , Lee R 
Published: July 2024

Abstract

Aim
The literature demonstrates an increased prevalence of breast cancer in female orthopaedic surgeons compared to the population baseline. One contributor to this alarming statistic may be exposure to frequent low-dose radiation inherent to orthopaedics. The British Orthopaedic Association (BOA) has emphasised the importance of wearing lead aprons that provide adequate coverage, especially of the axillary region in women. To assess the availability of vests that fulfil such criteria, an audit of the lead aprons available at our local adult tertiary centre was undertaken.

Method
Lead protective equipment used by the orthopaedic theatres were documented by type, size, and brand. Data collection occurred prior to theatre activity requiring lead use, to ensure all equipment was present.

Results
115 pieces of equipment were identified - 43 standard vests, 9 tabard gowns with side coverage, 4 tabard gowns without side coverage, 48 skirts and 11 thyroid covers. Vests, skirts, and tabard gowns ranged from XS (n=4), S (n=21), M (n=15), L (n=46), to XL (n=12), unidentifiable size (n=6). Vests, skirts and tabard gowns ranged from several different brands including Xenolite Male (n=45), Xenolite Female (n=29) and Kenex (n=23).
No boleros, high axilla vests, or vests with wings/sleeves/axillary shields, were identified.

Conclusions
This audit demonstrated inadequate adherence to BOA recommendations and a lack of size diversity. With increasing numbers of women in orthopaedics, there is a need to raise more awareness and address this safety concern to mitigate a larger concerning trend.
1190 Clinical Features and Outcomes from the Acute PresentatiOn of coLorectaL Cancer – an internatiOnal Snapshot (APOLLO) – an International Prospective Audit
Authors: Essa N ,   Eurosurg Collaborative
Published: July 2024

Abstract

Aim
The APOLLO study aimed to describe the international variation in the presentation, management and outcomes of patients presenting acutely with colorectal cancer.

Method
APOLLO was an international prospective, multicentre cohort study delivered through the EuroSurg student and trainee-led collaborative network. Adult patients presenting acutely with colorectal cancers were included. The primary outcome was 90-day mortality. Country-level variation was analysed using funnel plots.

Results
1414 patients (216 centres, 39 countries) were enrolled (median age 70 years; 645 females [45.6%]; ASA Grade I-II: 689 [48.7%]). Common presentations were bowel obstruction (n=774, 54.7%), gastrointestinal haemorrhage (n=297, 21.0%),bowel perforation (n=161, 11.4%). Overall, 56.9% of patients presented with a new diagnosis of cancer (n=804), 13.9% presented while awaiting elective surgery (n=196), and 9.3% while undergoing neoadjuvant therapy (n=132). Most cases were managed with curative intent (n=805, 56.9%). Of the 1022 patients undergoing surgery, 813 underwent surgical resection (79.5%), 582 underwent stoma formation (56.9%), and 498 (48.7%) underwent primary anastomosis. Only 57 patients underwent colonic metallic stenting (4.0%). Overall, 90-day mortality was 19.4%; 90-day surgical mortality was 13.9% and 90-day non-operative mortality was 33.7%. There was significant variation in overall mortality, but not surgical mortality, between countries after case-mix adjustment.

Conclusions
Emergency colorectal cancer presentations carry significant mortality with and without surgery. Many acute presentations are in patients with known colorectal cancer awaiting treatment. Operative mortality is similar globally, but overall mortality varies between countries. Further work is needed to guide individualised decision making on who benefits from acute surgery with curative-intent.
820 “Antibiotics Because We’re Inserting a Mesh”: A Study to Evaluate Antibiotic Prophylaxis in Elective Hernia Repairs
Authors: Harry H , Lingam G , Kirmani N 
Published: July 2024

Abstract

Aim
Inguinal hernias are one of the most common pathologies worldwide. Over 20 million inguinal hernia repairs are performed each year. The HerniaSurge Collaboration recently updated their international guidelines for groin hernia management. They concluded that antibiotic prophylaxis is not recommended in elective open inguinal mesh hernia repairs in average-risk patients in a low infection risk environment. In laparoscopic hernia repairs, antibiotics are never recommended. This study aimed to identify current practice for antibiotic prophylaxis use in elective inguinal hernia repairs within our district general hospital environment.

Method
A retrospective study was performed, evaluating all elective inguinal hernia repairs with mesh between 1st June 2022-31st December 2022. Both laparoscopic and open techniques were included in this study. Operative notes were reviewed to ascertain if patients had been given antibiotics intra-operatively.

Results
The study identified 84 patients who underwent an inguinal hernia repair with mesh across a 7 month- period. Of these, all were operated on in a low-risk environment. 94% (N=79) were given antibiotic prophylaxis intraoperatively.

Conclusions
Antibiotic prophylaxis is still being used for low-risk patients undergoing elective inguinal hernia surgery. This is not in keeping with current hernia guidelines which suggests that there is no significant benefit to antibiotic use. Excessive antibiotic use is associated with an increase in adverse events, an increased rate of antibiotic resistant organisms and increased healthcare costs.
807 Reliability of Simulation-Based Assessment of Surgical Technical Skills
Authors: Campioni-Norman D , Mavroveli S , Boshier P , Hanna G 
Published: July 2024

Abstract

Aim
To examine the reliability of surgical trainees’ assessment data from a structured simulation training and assessment programme.

Method
The General Surgical Skills Programme is a simulation-based surgical training programme integrated within the clinical training pathway for surgical trainees across London. It is tailored to each trainee’s level of training and subspecialty. The ‘Junior’ pathway involves nine training sessions and one assessment session performing three procedures (Inguinal hernia [IH], laparoscopic cholecystectomy [LC] and small bowel anastomoses [SBA]).
Within the scope of the Programme, skills assessment data collection was initiated in 2012. Data collected includes demographics and training data (grade/subspecialty/case numbers). Each procedure is assessed by two consultant surgeons using two procedure specific assessment tools, a visual analogue scale (VAS) and competency assessment tool (CAT). Reliability analyses were performed using SPSS for ‘Junior’ data over a four-year period.

Results
In total, 355 surgical trainees (Male = 199, Female = 154, Missing = 2) were assessed from 2014 to 2017 (2014 n=105; 2015 n=92; 2016 n=89; 2017 n=69). Both assessment tools showed satisfactory inter-item reliability (IH-CAT α=.794-.903, LC-CAT α=.837–910, IH-VAS α=.851-.991, LC-VAS α=.831-.986, SBA-VAS α=.778-.984). Inter-rater reliability, ICC (1,2), was good to poor across all tools. (IH-CAT .345-.510, IH-VAS .243-.600, LC-CAT .271-.766, LC-VAS .157-.678, SBA-VAS .225-.278).

Conclusions
The assessment tools used within the Programme both demonstrate satisfactory inter-item reliability. Inter-rater reliability is variable, highlighting a potential utility for assessor training within the Programme.
645 Time to Cholecystectomy for Gallstone Pancreatitis
Authors: Powell S , Froggatt P 
Published: July 2024

Abstract

Aim
AUGIS 2016 guidelines state that patients with mild gallstone pancreatitis should undergo a cholecystectomy within the same admission or if discharged within two weeks of presentation. This reduces readmission and leads to shorter hospital stays. In 2020, compliance at Poole hospital was 57%. This audit aimed to identity current compliance and opportunities for improvement.

Method
Retrospective study of patients admitted at Poole Hospital from 01/12/22 to 31/05/23. This was followed by presentation of findings and discussion at staff meeting and staff education and re-audited from 10/07/23 to 10/11/23.

Results
29 patients with gallstone pancreatitis were admitted during the initial study period. 22 fit for surgery, 2 patients passed away and 5 were unfit for surgery. 9 had cholecystectomy within 2 weeks giving a guideline compliance of 41%. Median hospital stay overall was three days. Median wait time to cholecystectomy was 5.5 days. Three patients who did not have a cholecystectomy within 2 weeks were later readmitted with pancreatitis. Five patients had previously been admitted with gallstone related diseases. The main barrier to compliance identified was a lack of regular theatre slots for cholecystectomy leading to regular cancellation on CEPOD.
The later re-audit showed a compliance of 32%.

Conclusions
Compliance with AUGIS guidelines has fallen since 2020. Unfortunately, staff education and presentation of findings failed to improve compliance and a high rate of readmission wastes resources. To improve, service configuration is needed with dedicated theatre slots, this should be considered for the planned Poole and Bournemouth general surgery department mergers.
666 Audit of Tip-Apex Distance in Dynamic Hip Screw Fixation of Proximal Femoral Fractures
Authors: Potter M , Hickey B 
Published: July 2024

Abstract

Aim
Lag screw cutout is the commonest mechanical failure in dynamic hip screw (DHS) fixation of proximal femoral fractures. Tip-apex distance (TAD), the combined distance from the tip of the lag screw to the apex of the femoral head on AP and lateral views, is the most important predictive factor for cutout. TAD &gt;25mm is associated with a high risk of cutout. The aim was to determine the proportion of DHS fixations performed in our department with ‘acceptable’ TAD (&lt;25mm) and assess the impact of weekly departmental metalwork meetings.

Method
Retrospective data was collected of all DHS fixations performed in our department in a 6-month period. Intraoperative imaging was reviewed to determine TAD. Posters illustrating TAD recommendations were displayed in theatre, and a weekly departmental metalwork meeting was introduced, reviewing imaging from all surgeries performed. Post-intervention, a further audit cycle over a 6-month period was performed.

Results
50 patients underwent DHS fixation during the initial audit cycle. Mean TAD was 22.85mm (range 15mm – 36mm); TAD exceeded 25mm in 13 cases (26%). In the second cycle (n=53), mean TAD reduced to 14.95mm (range 8.5mm – 29.4mm), with 1 case exceeding 25mm (2%).

Conclusions
The introduction of a weekly departmental metalwork meeting has significantly reduced the mean tip-apex distance of DHS fixations in our department, as well as the proportion of fixations with an unacceptable TAD. This should reduce the risk of lag screw cutout in these patients.
182 Keyboard Warriors Sparking a Digital Renaissance: The New Frontier in Traumatology Documentation
Authors: Ridha M , Ventour G , McParlin J , Cartner E , Khalid Z , Zaffar A , Ross-Thriepland S 
Published: July 2024

Abstract

Aim
To align clinical records with the high-caliber examinations performed, specifically targeting the vague "Neurovascularly Intact" or 'NVI' term. By enhancing record accuracy, the initiative sought to improve patient recovery tracking and provide robust medicolegal documentation, all while easing the workload of on-call doctors.

Method
Our audit evaluated the initial clerkings by on-call doctors for trauma patients, analyzing 59 records (n=59) against NICE and BOAST standards pre-intervention. To rectify the prevalent use of 'NVI', we introduced an autotext template, activated by 'NVIL' or 'NVIU', which auto-populates with a detailed assessment while allowing clinician customization. Post-intervention, we examined a further 57 records (n=57) to assess the impact on documentation quality.

Results
Before intervention compliance was poor: Nerve listed (11.86%), motor tested using MRC grading scale (8.47%), sensory tested (22.03%), blood vessel listed (18.64%), CRT tested (18.64%), and limb color recorded (6.78%). After intervention, compliance increased: nerve listed (91.23%), motor function (96.49%), sensory (96.49%), blood vessels (92.98%), CRT (94.74%), and limb color (82.46%). Documentation of 'NVI' reduced from 55.93% to 3.51%. Fisher's Exact Test with post hoc Bonferroni correction shows results were statistically significant (P&lt;0.05).

Conclusions
This audit heralds an innovative breakthrough by adeptly leveraging system one thinking through technology to enhance documentation in the NHS. By introducing the autotext template, we've elevated documentation precision, strengthened medicolegal safeguards, and shifted the focus from service-dominated tasks to allow time for physician professional growth.This advancement is a significant stride towards balancing the scales, emphasizing the importance of both patient outcomes and physician development in a system under pressure.
355 Predictors of Textbook Outcome Following Oesophagogastric Cancer Surgery: A Single-Centre Analysis
Authors: Velayudham G , Dermanis A , Kamarajah S , Griffiths E 
Published: July 2024

Abstract

Aim
Textbook outcome (TO) is a multidimensional composite measure representing an ideal perioperative course, which has been utilised to assess the quality of care in oesophagogastric cancer surgery. We aim to determine TO rates among oesophagogastric cancer patients in a UK tertiary centre, investigate predictors of TO attainment, and evaluate the relationship between TO and survival.

Method
A retrospective analysis of a prospectively collected departmental database between 2006-2021 was conducted. Patients that underwent radical oesophagogastric cancer surgery with curative intent were included. TO attainment required margin-negative resection, adequate lymphadenectomy, uncomplicated postoperative course, and no hospital readmission. Predictors of TO were investigated using multivariable logistic regression. The association between TO and survival was evaluated using Kaplan-Meier analysis and Cox regression modelling.

Results
667 oesophageal cancer and 312 gastric cancer patients were included. TO was achieved in 35.1% of oesophagectomy patients and 51.3% of gastrectomy patients. Several factors were independently associated with a low likelihood of TO attainment: T3 stage (OR:0.41, 95% CI [0.22-0.79], p=0.008) and T4 stage (OR:0.26, 95% CI [0.08-0.72], p=0.013) in the oesophagectomy cohort and high BMI (OR:0.93, 95% CI [0.88-0.98], p=0.011) in the gastrectomy cohort. TO attainment was associated with greater overall survival in oesophagectomy and gastrectomy cohorts, however, it was not associated with recurrence-free survival in the gastrectomy cohort.

Conclusions
TO is a relevant multidimensional metric that can be utilised to compare surgical quality between centres and investigate patients at risk of TO failure. Enhancement of preoperative care measures can improve TO rates and subsequently, long-term survival.
682 Impact of Regionalisation of Major Trauma Services on Hip Fracture Care in England: A Comparative Study
Authors: Potter M , Uzoigwe C , Azhar S , Symes T 
Published: July 2024

Abstract

Aim
Following the establishment of Major Trauma Networks in England in 2012, there were concerns that pressures regarding resource allocation in Major Trauma Centres (MTCs) may negatively impact their care of hip fracture patients. This study aimed to compare outcomes in hip fracture care between MTCs and trauma units (TUs).

Method
National Hip Fracture Database data was extracted from 01/01/2015 to 31/12/2022 for all hospitals in England. Outcome measures included perioperative medical and physiotherapy assessments, time to surgery, Best Practice Tariff (BPT) compliance, discharge to original residence, and mortality. Data was pooled and weighted for MTCs and remaining hospitals (TUs).

Results
487,089 patients were included from 167 hospitals (23 MTCs, 144 TUs). MTCs achieved marginally higher rates of orthogeriatrician assessment within 72 hours of admission (91.1% vs 90.4%, p&lt;0.001) and mobilisation by first postoperative day (81.9% vs 79.7%, p&lt;0.001). Fewer patients underwent surgery by the day after admission in MTCs (65.2% vs 69.7%, p&lt;0.001). There was poorer compliance with BPT criteria in MTCs (57.3% vs 60.4%, p&lt;0.001), and fewer MTC patients were discharged to their original residence (60.4% vs 63.5%, p&lt;0.001). There was no difference between MTCs and TUs in 30-day mortality (6.8% vs 6.8%, p=0.825).

Conclusions
This study demonstrates that MTCs have greater difficulty in providing prompt surgery to hip fracture patients. However, their marginally superior perioperative care outcomes appear to compensate for this, with similar mortality rates compared to TUs. These findings suggest that the regionalisation of major trauma in England has not significantly compromised the overall care of hip fracture patients.
973 Managing Primary Endocrine Treatment (PET) in Breast Cancer Patients: An Audit of Resource Utilisation and Risks
Authors: Abolanle P , James S , Obilanade F , Zabkiewicz C 
Published: July 2024

Abstract

Aim
Primary endocrine treatment (PET) is considered in patients with oestrogen receptor (ER) positive breast cancer who decline or are deemed unfit for surgery. This treatment can affect bone density resulting in osteoporosis and risk of fractures. With increasing demand on resources, our aim was to examine clinical practices in this vulnerable patient group, balancing risks whilst ensuring good patient selection for treatments.

Method
We reviewed patients who had PET for ER positive breast cancer from a single consultant database in a district general hospital in South Wales between May 2018 and March 2023. We examined use of bone density (DEXA) scans, bone protection medications, outcomes, and complications.

Results
48 patients were included, aged 50-95 years (median 80) and male: female (1:47). All were ER positive, excepting 2 with limited prognosis empirically started on treatment. Reasons for PET included patient choice (15%), palliative treatment (8%), co-morbidities (65%), late stage (4%) and other (8%). There were 27 deaths (54%), with mean time from diagnosis to death 14 months (range 1-50 months). 5 patients (10%) had DEXA scan and 16 (33%) were on bone protection. 3 patients had fractures whilst on PET, likely due to pre-existing conditions.

Conclusions
The frail breast cancer patient population has limited life expectancy and should not be over-investigated unnecessarily. It could be debated as to how much benefit bone protection provides, given the low fracture rate. Further studies are required to determine benefits of empirical bone protection in PET patients.