bluuebunny/crossref_metadata_2025_split huggingface dataset:
1067 Prevalence of SIJ Pathology: A Retrospective Observational Study
Authors: Chooi J Y , Elmarawany M N , McCarthy M 
Published: August 2024

Abstract

Aim
Sacroiliac joint (SIJ) pathology is often said to be an underdiagnosed cause for lower back pain (LBP), with the literature suggesting a point prevalence of 25%. However, there is limited published evidence to support the true prevalence of SIJ pathology. This single-centred retrospective observational study aims to produce evidence on the prevalence of SIJ pathology detected through imaging.

Method
Patients presenting with LBP at a single spinal surgeon clinic from 2014 to 2022 were identified. Among them, patients who underwent SIJ imaging were selected. Their baseline characteristics, medical history, risk factors, examination findings, and imaging results were collected and analysed.

Results
A total of 969 patients were found to have presented with lower back problems. Within this group, 265 patients went on to have SIJ imaging, and 31 patients were found to have pathological SIJ. This suggests a pathological SIJ prevalence of 3.2% amongst patients presenting with LBP (31 out of 969 patients). A medical history of previous spinal surgery showed a strong correlation with degenerative SIJ (p=0.0049). Other known risk factors were not found to have a statistically significant correlation with the incidence of SIJ pathology. Examination findings of pain provocation tests, when used in combination, suggest a high specificity score.

Conclusions
The low prevalence rate from this study might suggest a lower index of suspicion for SIJ pathology. The real prevalence of SIJ pathology remains inconclusive. Further meta-analysis is required to understand the true prevalence rate of SIJ pathology.
1108 Teaching the Principles of Surgery Online – A Programme for UK Medical Students
Authors: Keogh K , Yadav Nongrum R , Komperla S , Titcombe R , Wahdan Q , Worden J , Lim C J , Byfield A , Khalil M 
Published: August 2024

Abstract

Aim
The RCSE publishes a National Undergraduate Surgical Curriculum on essential surgical knowledge for medical students. However, anecdotally, teaching on such topics varies across medical schools. This study looks to evaluate the impact of an online surgical teaching programme for medical students.

Method
Surgical societies from five UK medical schools collaborated on creating an eight-part teaching series on the principles of surgery, endorsed by ASiT. Topics include Anaesthetics and Pain Management, Surgical Wounds, Pre-Operative Preparation, Post-Operative Care, Nutrition and Fluids, Common Surgical Emergencies, Human Factors and Patient Safety, and Preparing an Operating List. Teaching is delivered by clinicians via Zoom. Self-perceived knowledge of topics is assessed before and after the programme, and feedback is collected for individual sessions. To date, three sessions have been delivered.

Results
163 participants completed the pre-course questionnaire, 87% of which were UK medical students (years 1 – 5). Questions were answered on 5-point scales, with 1 indicating low and 5 indicating high ratings for the relevant outcome. Self-rated knowledge of topics was poor, with more than 69% choosing 1 or 2 for all topics. Feedback for delivered sessions shows high ratings for relevance (more than 73% rated them 4 or 5) and confidence in topics (more than 82% rated them 4 or 5). Statistical analysis will be used to assess outcomes further once teaching is completed.

Conclusions
Initial results suggest strong interest for teaching on basic surgical principles, and that regular structured online teaching can be effective in increasing student confidence and knowledge attainment.
1206 Emergency Repair of a Traumatic Carotid Artery Rupture in a Bovine-Type Aortic Arch: A Case Study
Authors: Hurrell O , Strickland J 
Published: August 2024

Abstract
This joint vascular and cardiac case relates to a 14-year-old female who was involved in a pedestrian versus car collision and suffered polytraumatic injuries, the most life threatening of which was a tear to the base of the left common carotid artery (LCCA). This case became unique upon discovering the presence of a bovine-type aortic arch which limited endovascular options and led to the requirement of a surgical approach with cardiopulmonary bypass support.
The bovine-type arch with a proximal LCCA take-off had implications in surgical planning including the need for cardiopulmonary bypass support due to challenging clamp placement to ensure both cerebral and cardiac protection. This case presented challenges from both a cardiac and vascular perspective, due to atypical anatomy, patient size and uncertainty in an emergency scenario which led to multidisciplinary discussion and preparation for various surgical approaches.
1299 MANELS: A Retrospective, Multi-National, Longitudinal Study for Quantitative Analysis of Gender Distribution of Speakers at Paediatrics Surgery Conferences
Authors: Khaliq Raja A K , Abdi Z , Gargan A , Gargan K , Georgi M , Asif A , Thamilmaran A , Burton O , Leung K H C , Tse F , Lee K , Haque S 
Published: August 2024

Abstract

Aim
Academic representation of women at conferences is vital for improving underrepresentation in surgery, despite the rising number of females into the medical profession. This study aimed to quantify the gender distribution of speakers and prevalence of all-male panels (“manels”) at major paediatric surgical conferences.

Method
Retrospective analysis of annual meetings organised across three major paediatrics surgery conferences, between January 2016 and December 2021. Male and female faculty were academically stratified according to mean publications, citations, and H-index. A ‘Manel’ was defined as a session with 2 or more speakers, all of whom identified as male. Sex was defined by gender titles on conference program or Gender Balance Assessment Tool (GBAT).

Results
Of 13 conferences included, there were 896 invited speakers, of which 22.9% (n=205) were female. Across the 146 open panel sessions, 39.0% (n=57) were manels. There was a no correlation in the proportion of manels between 2016 and 2021 (p=0.31). No statistically significant difference in the percentage of manels was observed between online (50.0%, n=8) versus in-person conferences (37.6%, n=57) (p=0.341). There was no significant difference in the mean H-indices of invited speakers (male=26.4, female=21.6; p=0.149) and mean total citations (male=4463.1, female=2323.3;p=0.084). Male invited lecturers had significantly higher publications (male=185.7, female=111.9, p=0.036). Male panellist had a significantly higher H-index (male=19.8, female=15.7, p=0.001), publications (male=110.2, female=70.8, p&lt;0.001) and citations (male=2218.1, female=1310.3, p=0.01).

Conclusions
Despite the increasing representation of women within paediatric surgery, this study shows recurring disproportionate representation of female speakers across major conferences, illustrating the necessity for greater gender distribution and diversity.
174 The Histopathological Assessment of Gastro-Oesophageal Carcinoma Resection Specimens: A Quality Improvement project
Authors: Murphy S , Jeffery H , Vulliamy P , Dawas K 
Published: August 2024

Abstract

Aim
HERO consensus and Royal College of Pathologists provide guidance for the minimum dataset pathological evaluation of gastro-oesophageal cancer resection specimens. The project aimed to assess and improve adherence.

Method
A retrospective study of the pathological evaluation of gastro-oesophageal cancer specimens resected surgically at a tertiary cancer unit (October 2021-March 2022), and re-audit (July-December 2022) following presentation of first cycle results.

Results
26 and 23 specimens in rounds 1 and 2 respectively met inclusion criteria. Adherence was good in both rounds for reporting lymphovascular invasion status (92.3% vs 100%), correct reporting as R1 if tumour cells are found within 1mm of the margin (100% vs 100%), lesser curvature fat-blocking (100% vs 100%), and reporting of lymph node response following neoadjuvant chemotherapy (100% vs 100%). Improvement was seen in testing a minimum of 15 lymph nodes (88.5% vs 91.3%) and recording of resection margins in millimetres (CRM 77.8% vs 100%; LRM 80.8% vs 82.6%). One of the three specimens with &lt;15 node yield was retested in round 1, compared with both specimens in round 2. Reporting of peri-oesophageal fat blocking showed no improvement (88.9% vs 77.8%).

Conclusions
Adherence was good during cycle 1, and there was improvement in most domains following presentation of results. Of note, both specimens in the second cycle with lymph node yield &lt;15 were re-examined. Lymph node yield is determined by both surgical technique and avid pathology node search. The project proved to be an incentive for the MDT group as a whole to seek and adhere to good reporting practice.
51 Can We Predict the Outcome of Traumatic Paediatric Peripheral Nerve Injuries Using Ultrasound and Nerve Conduction Studies? a Case series
Authors: Virdee P K , Abed H , Lawley A , Jester A 
Published: August 2024

Abstract
Management of paediatric peripheral nerve injury varies across clinical practice. Clinical examination is favoured by some, whilst others use a combination of methods such as nerve conduction studies (NCS) and ultrasound studies (US). This case series reviewed outcomes of paediatric peripheral nerve injuries, which underwent both investigations, to establish optimal diagnosis and management of paediatric peripheral nerve injury.
A retrospective case series of eighteen paediatric traumatic peripheral nerve injuries presenting at a tertiary referral centre between January 2019 – August 2023 was completed. Data was collected regarding the type and date of injury, immediate intervention, investigation dates and findings, and management.
Eighteen traumatic upper limb injuries which had both US and NCS were included. The ulnar nerve was most injured, and half of nerve injuries were caused by supracondylar fractures. All cases had NCS completed before US. Fourteen NCS cases showed axonotmesis and four showed neurotmesis. Nerve continuity was visualised on US in eleven cases. Ten patients were managed conservatively. Two cases underwent surgical intervention, where US showed either scarring or non-visualisation.
NCS in paediatric peripheral nerve injury often shows high grade injury; with axonotmesis commonly reported. Most US conducted at similar timepoints to NCS show nerve continuity. Results suggest that US, in addition to NCS, can aid management of peripheral nerve injury and may reduce the need for surgical intervention. Delays in completing US may impact decisions to wait for spontaneous recovery. Future studies should utilise multi-institutional datasets to compare and establish suitable timeframes for injury-specific interventions to aid surgical decision making.
268 Silver Dressings, Metal Clips, VAC’s and Implants - Are Plastic Surgery Patients Safe in the MRI Scanner
Authors: Seddon I , Marar M , Kwasnicki R 
Published: August 2024

Abstract

Aim
Advancements in the devices and dressings used in plastic surgery continue to grow and with complexity comes confusion. This is a response to uncertainty amongst specialists which led to an adverse incident in a specialty where soft tissue imaging is most helpful. Our goal was to create a clear document to be used by the plastics team and radiology department with the aim of dispelling myths surrounding the MRI safety of devices and equipment used in plastic surgery.

Method
Focussing on the orthoplastic theatre environment, a list was collated of all surgical devices/equipment that are left in or on patients and may pose uncertainty with regards to safety when MRI scanning. Devices were divided into internal and external and included further subdivisions such as implants, metalwork, dressings and splints. A literature review was undertaken to identify the safety status (safe = green, unsafe = red, artifact/distortion = amber) of all devices/equipment. Surveys assessing usability were given to members of the plastics team and radiology department.

Results
The majority of devices/equipment were found to be MRI safe. A colour coded aide-memoire was designed and displayed electronically and physically. Positive feedback was received by radiographers and members of the plastics team in response to the memoire.

Conclusions
To clarify uncertainties and promote patient safety, a concise, comprehensive and user-friendly aide-memoire was created which confirmed the safety status of commonly used devices in orthoplastics theatres.
334 Immuno-Modulatory Impact of Adipose-Derived Stem Cells on Radiation-Induced Fibrosis
Authors: Cui X M , Wai J , Frommer M , Langridge B , Butler P 
Published: August 2024

Abstract

Aim
Radiation-induced fibrosis (RIF) is a complication of radiotherapy that occurs 4-12 months post-radiotherapy, which is used to treat head and neck squamous cell carcinoma that has a high morbidity in patients undergoing treatment for malignancy. Autologous fat grafting is a viable method to treat RIF, and adipose-derived stem cells (ADSC) were found to be one of the main components to contribute to that effect. ADSC has demonstrated the immunomodulatory effect by inhibiting inflammation and altering activity of immune cells in previous studies. The aim of this study is to evaluate the potential immunomodulatory effects of human ADSC on irradiated HDF.

Method
Human-derived fibroblasts (HDF) were cultured and irradiated (iHDF) in vitro in the experimental group, with the control group unexposed to radiation. Both experimental group and control group were then inoculated with ADSC-controlled media and co-culture with ADSC, whilst levels of key immunomodulators expressed by iHDF cells were obtained and measured via enzyme-linked immunosorbent assay (ELISA) and real-time reverse transcription-polymerase chain reaction (RT-PCR).

Results
ADSC has significant links with iHDF-secreted CCL3, CCL19, and IL-8, with the other immunomodulators having a subtle effect.

Discussion
The experiment revealed the complex nature of some immunomodulators that could exert both pro- and anti-inflammatory capabilities.

Conclusions
ADSC has some interactions with iHDF, although it is not completely elucidated within this experiment, ADSC was demonstrated to have anti-fibrotic capabilities, by promoting pro-angiogenic factors. Future works required to further investigate in vivo effects of ADSC.
713 Conversational Artificial Intelligence in Plastic Surgery: A Systematic Review
Authors: Zargaran A , Sousi S , Ahmed Z , Zargaran D , Mosahebi A 
Published: August 2024

Abstract

Aim
Rapid advancements in technology have paved the way for the use of artificially intelligent (AI) conversational agents. Conversational AI has the potential to transform patient pathways, with increasing use in triage, virtual consultations and post-operative care. The aim of this systematic review is to evaluate the scale and scope of conversational AI within Plastic Surgery.

Method
Following PRISMA guidelines, a systematic review of PubMed, Embase, PsychInfo, Scopus and Google Scholar using COVIDENCE software, was performed on applications of conversational AI within Plastic Surgery. Assessment of quality and risk of bias was performed for all studies.

Results
Overall, 479 studies were captured by the search and four were included in the final analysis. Three independent reviewers screened s and full texts with a kappa score for interrater reliability of 1.0. Uses of conversational AI included ChatBots (n=2), virtual assistants (n=1) and machine learning models (n=1). Conversational AI was used in various settings including flap monitoring, outpatient management of paediatric burns and general plastics in addition to frequently asked questions (FAQS), and analysis of conversations to promote quality improvement. Only two studies included an evaluation of end-user satisfaction and accuracy. Risk of bias was high, and level of evidence was low.

Conclusions
At present conversational AI has a variety of uses within Plastic Surgery ranging from ChatBots supporting doctors and responding to patient queries, to researching quality improvement strategies. However, conversational AI could be further utilised within Plastic Surgery and further study and innovation are required to fully leverage its potential.
742 Aesthetic Facial Botulinum Toxin Education – a Cross-Sectional Analysis of the United Kingdom (UK) Courses
Authors: Zargaran A , Mansour H Khademi , Smith K , Daneshi K , Sousi S , Zargaran D , Davies J , Woollard A , Mosahebi A 
Published: August 2024

Abstract

Aim
Unregulated proliferation of the aesthetic Botulinum Toxin injection industry represents a potential public health risk to patients. Robust educational standards are key to ensuring practitioner competence. This study assesses the current standard of educational courses in the UK, auditing compliance with Cosmetic Standards Practice Standards Authority (CPSA) and Joint Council for Cosmetic Practitioners (JCCP) guidance.

Method
A systematic online search was performed on search engines including Google, as well as social media platforms. Keywords included “Botulinum Toxin”, “Aesthetics”, “Course”, “Level 7”, “Training” and “certification” using Boolean operators. As a secondary outcome, compliance with national guidance from the CPSA and JCCP was audited.

Results
A total of 297 courses were included from across the UK (83.5% England, 4.7% Wales, 4% Northern Ireland, 7.8% Scotland). Only 25.3% of courses had assessments to pass for certification, whilst 49.9% of courses had no specified entry requirements. Methodologically, 73% had demonstrations on live models, 0.3% on plastic models and 0.3% were purely observational. Mean price for attending the courses was £1,442.14, whilst mean course duration was 1.8 days. Only 14% of courses offered level 7 accreditation. Only 3.4% were fully compliant with CPSA guidance, whilst 3.7% of courses were fully compliant with JCCP guidance.

Conclusions
Educational courses for aesthetic Botulinum Toxin treatments are falling significantly short of national guidance, with heterogeneity in duration, teaching style and accreditation. The majority do not have assessments to pass for certification or specific entry requirements, whilst there is significant variation in cost of courses.
83 Quality Improvement Project on the Adherence to Hot Gallbladder Pathway Clinical Guidelines: An Improvement of the Hot Gallbladder Referral Pathway
Authors: Malkawi H , Bonor E , Khalil A , Lynn W 
Published: August 2024

Abstract

Aim
The quality improvement project’s main aim is to improve utilization of the Hot-Gallbladder(HGB) list. Although the guidelines are clear, a large number of referrals did not meet the criteria and were deemed inappropriate. We designed a self-explanatory proforma and added educational posters/aids that helped increase orientation and clarified the process and criteria.

Method
A set period of referrals was examined and audited and compared to the data collected post introduction of the proforma. The first audit cycle looked at patients referred for emergency laparoscopic cholecystectomy during April-May 2023 which determined the need for interventions to improve utilization of the HGB list and adherence to guidelines. A well designed self-explanatory pro-forma was introduced along with informative posters. A second audit cycle was done during the months of June-July 2023 showing significant improvement.

Results
April-May 2023: 38 referrals, 4/34 accepted (10.5% successful). June-July 2023: 24 referrals, 7/24 accepted (29.2% successful). Average stay in hospital: April-May 2023: 6.45 days, June-July 2023: 3.88 days.

Conclusions
The introduction of the well-designed self-explanatory proforma has improved the quality of referrals and raised the awareness of the presence of the pathway. This has in turn improved utilization of HGB lists, decreased the load on elective lists and improved outcomes.
269 Quality Improvement: Implementing a General Surgery Ward Round Proforma at Stoke Mandeville Hospital
Authors: Khan F , Quek K , Cho S , Puttergill B 
Published: August 2024

Abstract

Aim
In keeping with Good Medical Practice endorsed by the Royal College of Surgeons, a specialised surgical ward round proforma was launched to ensure accurate, clear and comprehensive daily clinical records.1 This is to ensure professional practice and delivery of best medical care.

Method
The specialised surgical ward round proforma was designed and implemented for general surgery inpatients in May 2023. Data was collected at regular intervals to include compliance and aspects of proforma filled. In parallel, feedback forms were collected to improve subsequent versions of the proforma. Two cycles have been completed by October 2023.

Results
Compliance of use of the newly launched surgical proforma over the study period was &gt;85% (n=159). Essential items such as date, patient identity, ward name, NEWS score and presenting issue had high recording rates &gt;95%. Spaces dedicated to details such as analgesia and VTE were removed when transiting from version one to version two having noted reduced rates of completion &lt;30%. Supported by individual feedback, sections with similarly low documentation rates such as antibiotic regime and imaging results were retained due to their value on a patient-by-patient basis.

Conclusions
The introduction of a general surgery ward round proforma has proved useful in ensuring multiple aspects of a patient’s management are considered and documented. Our team looks to implement this proforma at a trust-wide level and aim to analyse improvements in multiple aspects of patient care including informed decision making in patient management, antibiotic stewardship, collaboration amongst the multidisciplinary team and continuity of care.
445 Improving Confidence of General Surgical SHO in Carrying Out Primary Surveys During Trauma Calls, at a Busy District General Hospital
Authors: Fardanesh A , Sharif M , Keshishian K , Jones L , Stavropoulou-Tatla S , Spiteri A , Rohatgi A 
Published: August 2024

Abstract

Aim
General surgery Senior House officers (SHOs) are expected to carry out primary surveys at district general hospitals, although many have not received adequate training to follow the gold-standard Advanced Trauma Life Support guidelines. This project aimed to assess and improve general surgery SHOs ability to undertake primary surveys at trauma calls.

Method
At baseline a questionnaire was distributed to all departmental general surgical SHOs, evaluating how many had attended ATLS, if they were running primary surveys and determining their perceived confidence in doing so (Likert scale out of 10). For the first intervention, we conducted lecture based primary survey teaching sessions. For the second intervention we conducted high fidelity simulation sessions for common scenarios

Results
At baseline we found that just 33% of SHOs carrying out primary surveys had completed ATLS. The perceived confidence average was only 56%. Indeed, roughly a third of SHOs felt they were confident in carrying out primary surveys – all of whom had already completed ATLS. The main limitation of confidence was reported to be being safe and efficient.
After the first intervention, average perceived confidence rose to 70%. After the second interventions simulations sessions, perceived confidence rose to 80%, and all SHOs taking part felt they were more confident in carrying out trauma calls.

Conclusions
This local teaching programme made up of lecture based and high-fidelity simulation teaching was effective at improving confidence of SHOs doing primary surveys. We propose trusts incorporate such programmes in induction especially for more junior SHOs, and those awaiting ATLS accreditation.