bluuebunny/crossref_metadata_2025_split huggingface dataset:
930 Single-Centre Experience in Establishing a Robotic General and Colorectal Surgery Programme in the UK
Authors: Broadhurst W , Rajaratnam K , Bevan K , Georgiades F 
Published: August 2024

Abstract

Aim
To describe our centre’s experience in establishing a robotic programme for general and colorectal surgery procedures.

Method
Data from a prospectively maintained database were collected for all robotic-assisted procedures carried out in our centre since the procurement of the robotic platform.

Results
38 cases were completed with the DaVinci Xi (Intuitive Surgical Inc, USA) robotic platform under the care of 2 consultant surgeons between April - November 2023. 37% (n=14) of the cases were proctored and 92% (n=35) were bowel resections for malignancy. 60.5% (n=23) of the patients were male with a median age of 69.5 years (IQR 56.7-76.7 years) and a median BMI 26.5 Kg/m2 (IQR 23.9-28.6 Kg/m2). 17 patients (44.7%) were classified as ASA 3 due to their comorbidities. No cases were converted to open or laparoscopy with a median total console time of 284 minutes (IQR 160-335 min). There was no difference in total console time if the case was proctored (p=0.204, Student t-test). A stoma was formed in 12/35 (34.3%) of bowel resections, which all were planned preoperatively. All anastomoses were stapled with 16/30 (53.3%) being intracorporeal. The median length of stay was 5 days (IQR 4-8 days); the presence of a proctor did not significantly impact this (p=0.679, Mann-Whitney-U test). 5.3% (n=2) had a significant postoperative complication (Clavien-Dindo ≥3). No mortalities or hospital readmissions were recorded within 30 days of the procedure.

Conclusions
The presence of a proctor had no impact on total console time or patient outcomes in our centre’s small cohort.
199 Teaching Basic Surgical Skills Using a More Frugal, Near-Peer, and Environmentally Sustainable Way: Mixed Methods Study
Authors: Smith B , Paton C , Ramaraj P 
Published: August 2024

Abstract

Aim
To evaluate the impact of a novel program of weekly, lunchtime BSS sessions on quantitative and qualitative factors.

Method
A weekly, lunchtime BSS course was designed to achieve the outcomes of the Royal College of Surgeons BSS course over one foundation doctor rotation. Sessions included knot tying, suturing, abscess drainage, application of plaster of Paris, joint aspirations and reductions, abdominal wall closure, and basic laparoscopic skills. The hospital canteen sourced unwanted pig skin and belly from the local butcher. Out-of-date surgical equipment was used. Pre- and post-session feedback was assessed for perceived increase in confidence. Thematic analysis of voluntary semi structured interview transcripts were performed to understand the impact of the course on perceived well-being, quality of training, and interest in a surgical career.

Results
There were 64 responses. Confidence was significantly improved from 47% to 73% (95% CI 15%-27%; P&lt;.001; t13=5.3117) across all surgical skills over 4 iterations. In 7 semi-structured interviews, 100% of the participants reported improved perceived well-being, value added to training, and positivity toward near-peer teaching and 71% preferred local weekly teaching. Interest in a surgical career was unchanged.

Conclusions
This course was feasible around clinical workloads, resourced locally at next to no cost, environmentally sustainable, and free to attend. The course offered junior doctors not only a weekly opportunity to learn but also to teach. Peer-led, decentralized surgical education increases confidence and has a positive effect on perceptions about well-being and training. We hope to disseminate this course, leading to reproduction in other centres, refinement, and wide implementation.
369 Addressing Inconsistencies in Surgery Teaching at UK Medical Schools Through Near Peer-Led Interventions
Authors: Irfan M , Asim N , Fouda S S , Alberto I 
Published: August 2024

Abstract

Aim
The UK's medical education struggles with inconsistent surgical teaching, causing gaps in students' grasp of principles. Existing studies note varied competence levels in graduates, citing knowledge, motivation, and confidence gaps in surgery. To tackle this, St. George’s Medical Education Society offers structured near peer-led sessions on surgical specialties. Delivered by junior doctors with insights into students' challenges, this program aims to standardise and enhance learning for future surgeons.

Method
Six sessions were organised, covering surgical specialties like breast surgery, trauma, and orthopaedics, targeting crucial clinical scenarios and exam content. The curriculum delved into prevalent conditions, management strategies, and exam-focused topics, offering a comprehensive grasp of surgical principles. Interactive sessions included case discussions, group activities, and specific examples, enriching learning through speakers' personal experiences. Surveys using 5-point Likert Scales evaluated improvements in student confidence, understanding, and motivation, gauging the intervention's impact on surgical knowledge and confidence levels.

Results
Before the sessions, average scores for understanding, confidence, and motivation (n=67) were 2.0, 2.3, and 4.5 respectively, on a 5-point Likert Scale where (1) was poor and (5) was most confident. After the sessions, these increased to 4.0, 4.0, and 4.3. This resulted in increases: 88.64% in understanding, 109.95% in confidence, and 15.85% in motivation.

Conclusions
These sessions connected theory with practice, preparing students for surgical complexities while instilling a deeper appreciation for the challenges and rewards of a medical career. This experiential learning is crucial, ensuring students' readiness and competence in the dynamic field of surgery.
813 Improving Surgical Education Through Gamification – the Creation of SurgiPlay, a Surgical Education Game
Authors: Davies B L J , Ransome M , Eardley N 
Published: August 2024

Abstract

Aim
Gamification is the process of making a task more engaging by adding game-like elements. Gamification has become a considerable component of education and has forged its way into medical education. Literature praises gamification, and with technological advancement, its use has widened, providing new ways of learning. This project aimed to improve surgical induction and education at a District General Hospital (DGH), using gamification, through the creation of SurgiPlay.

Method
SurgiPlay is an interactive board game created to aid surgical education and provide a thorough surgical induction that is engaging and consistent. This game looks at four key elements of a “junior surgical doctors” job – ward jobs, clerking, clinical skills, and post-operative complications. It also includes the key induction processes, including referral pathways, staffing, and prioritising. Surgical Foundation doctors completed pre-SurgiPlay and post-SurgiPlay questionnaires to analyse the effectiveness of the game.

Results
The induction process was inconsistent, left questions unanswered, and was not engaging enough for the trainees to remember key elements. A fundamental problem was the need for more staff to cover induction/teaching. Surgiplay retracts this need, allowing new doctors to induct themselves without impacting patient care and clinical commitments. In the post-SurgiPlay questionnaires, 78% of respondents felt confident upon commencing their placement, with 66.6% feeling confident in their basic surgical skills. Further, respondents felt the gamewas “interactive”, “different” and “motivated through a new type of learning.”

Conclusions
Continual adaptations will be made to SurgiPlay, with hopes it will pioneer a new route for gamification in medical education.
941 Building the Ideal Home Practice Models for Surgical Skill Development
Authors: Balaji A , O’Regan D 
Published: August 2024

Abstract

Aim
In surgical education, the development of proficient skills is paramount. We discuss the concept of crafting the ideal home practice models for surgical skill enhancement with a focus on low-cost, sustainable, and efficient methods to practice outside the operating room, supported by the literature, evaluation of courses, and anecdotal experience.

Method
Building on the literature, we examine specific organic models that can be easily sourced, such as bananas, baked potatoes, and poached eggs, and their unique advantages in surgical training. We explore the inherent characteristics of these models that align with the needs of surgical skill development.

Results
Organic models offer a cost-effective and sustainable solution for surgical practice at home, corroborated by previous research. They provide active feedback through tactile sensations, mimicking real tissue characteristics. The banana, with its immediate feedback and haptic qualities, excels in needle entry, rotation, and exit practice. Due to the change in colour from oxidation, trainees can clearly see the needle path and evaluate their performance. The baked potato allows for practice of various needle angles and discourages skimming of tissue. The friable poached egg provides fine skill refinement with real-time feedback by practicing lightness of touch and appropriate needle rotation to prevent tearing into the yolk subsequently causing a leak.

Conclusions
The ideal model necessitates affordability, minimal setup effort, sustainability, and effective real-time immediate feedback, supported by realism. As we explore innovative approaches to surgical education, these models emerge as valuable allies, enabling learners to refine their skills in a convenient and impactful manner.
1132 The Best Way to Develop a Surgeon: An International Comparison of Medical Education and Surgical Training
Authors: Bucknor A , Pedreira R , Bhat D , Zamani M , Furnas H 
Published: August 2024

Abstract

Aim
Currently, interest in surgical careers is declining globally. Surgeons share ideas internationally without sharing much about training. This study compares international pathways toward surgeon development with the aim of seeking improvements.

Method
A 70-question anonymous survey was distributed internationally to surgeons of all specialties. Data were analysed in SPSS Statistics for Macintosh (IBM). A value of p&lt;0.05 indicates statistical significance.

Results
The 463 respondents from the U.S. (59%); U.K. (16%); Europe (10%); Canada (5%), and the Rest of the World (RotW)(10%) averaged age 46; 64% were female. Non-U.S./Canadians (93%) attended 5- and 6-year medical schools; U.S. respondents were far more likely (91%) to attend non-medical 4+-year university before medical school. Weekly training-hour weekly mandates spanned &lt;48 (9%) to 80+ (45%); 76% surpassed mandate hours; 9% reported accurate hours. Average educational debt ranged from $14,000 (Europe) to $179,000 (U.S.). Few (19%) felt training allowed family building. Nearly all U.S./Canadians felt competent after training, versus U.K. (81%), RotW (74%) and Europe (70%).

Conclusions
The outlook of surgery as an attractive career depends on the way we develop future surgeons. Based on best practices from different countries, the authors recommend a 6-year maximum university/medical education requirement; elimination of mandatory non-surgical training years; single-program surgical training; 60-hour work-weeks; competency-based training; AI tools for training and tasks; advanced-care providers for non-educational tasks; certifying at completing of training; and support of childbearing and childcare.
1163 Do UK Core Surgical Trainees Lead Healthy Lifestyles?
Authors: Ramjeeawon A , Parfitt C , Khudr J , Eckersley M , Ziolkowska K , Kungwengwe G , Iqbal M , Lim J Y 
Published: August 2024

Abstract

Aim
To understand whether UK Core Surgical Trainees (CSTs) lead healthy lifestyles as per NHS and government issued guidance on health behaviours, and whether their poor health behaviours are related to the demands of being a CST.

Method
An anonymised questionnaire addressing five areas of health (exercise, diet, smoking, alcohol, and sleep) was distributed in UK Deaneries to CSTs with a minimum of 6 months of CST training.

Results
151 CSTs in eight deaneries responded (average Deanery response rate: 27%). 19% exercised ≥4 times per week. 41% exercised &gt;2 hours per week. 33% reported sleeping ≥7 hours per night; 87% reported sleeping less since becoming a CST. 25% ate 5 portions of fruit or vegetables a day, 46% reported eating a balanced diet. 20% drank ≥7 cups of fluid per day. 72-93% of individuals reporting poor health behaviours in these areas stated these were due to the demands and stressors of being a CST. 11% stated they smoked and 3% reported drinking ≥14 units of alcohol per week, 88% and 19% respectively reported deteriorations in these behaviours due CST demands and stressors.

Conclusions
Most CSTs do not lead healthy lifestyles regarding exercise, sleep, and diet. While it is recognised that surgical training is demanding, trainees must be encouraged to value these health behaviours to promote long-term quality of life, career longevity, and mental well-being for the individual. From an institution perspective, the health of surgical trainees should be promoted and supported to ensure an appropriate surgical workforce to meet the demands of our population.
1249 Supporting Emergency theatre Teams with the Use of ENT Equipment
Authors: Sattar Z , Kelly M , an Hutson K 
Published: August 2024

Abstract

Aim
Emergency theatre teams may not always be familiar with the use of ENT equipment out of hours, especially given the relative infrequency of ENT emergencies compared with other surgical specialties. This was one of the factors identified at our district general hospital in a delay to theatre for an emergency ENT case. We aimed to deliver a reference guide and educational session to theatre staff at our hospital as part of a quality improvement project to minimise the risk of delays to theatre in ENT emergencies.

Method
We created an infographic presentation detailing correct use and set up of both the mastoid and endoscopic sinus surgery kits. We delivered an interactive education session and measured the pre- and post-session confidence of the staff using a quantitative rating scale and qualitative feedback.

Results
Sessions were delivered to 14 theatre staff members at our hospital. 100% of respondents reported the minimum level of confidence with the use of ENT equipment prior to the session. 100% of staff reported either 4/5 or 5/5 confidence after the session.

Conclusions
Our project demonstrated positive change and increased staff confidence in using ENT equipment. It may serve as a template for other provider teams with a demonstrated educational need for staff unfamiliar with the use of surgical equipment and kits that are used infrequently. Our project also demonstrates a low-cost and effective method of education for surgical staff and may also be useful as a ‘refresher’ resource for ENT theatre teams.
477 Patient Reported Outcomes and Surgical Site Infection in Surgically Treated Soft Tissue Facial Injury: A Meta-Analysis
Authors: Wong Z Y , Richards M , Wormald J C R 
Published: August 2024

Abstract

Importance
Soft tissue facial injuries (STFI) constitute a significant portion of craniofacial trauma cases and are burdensome to emergency departments. Therefore, this study aims to investigate the risk of surgical site infection (SSI) and the patient-reported outcomes (PROs) for operative management of STFI.
Data Sources A PRISMA-compliant search was conducted and included studies measuring any PRO or the risk of SSI by any classification or diagnostic method. Meta-analysis was performed using R. Pooled effects of primary outcomes were estimated using the DerSimonian and Laird random-effects model/generalised linear mixed model, when feasible.

Results
Out of 8,897 screened studies, 40 were included. 12 studies reported PROs, while 31 reported SSI risk following operative treatment for STFI. The pooled Patient Scar Assessment Scale (PSAS) score at 6-12 months post-intervention (5 studies, n=217) was 16.16 (95%CI 15.34-16.97, p &lt; 0.001). Cosmetic outcomes did not differ across various techniques or suture. Limited evidence was found regarding the effect of surgical treatment in terms of quality of life and psychological impact compared to conservative management. The pooled SSI risk (n=13,524) was 2.68% (n=657; 95%CI 1.59%-4.50%).

Conclusions and Relevance
Our findings emphasise the limited and unreliable evidence available on SSI and PROs following operative treatment for STFI. Future studies employing robust methodologies are needed to investigate optimal approaches for managing STFI effectively.
1020 Drug-Eluting Bead, Irinotecan (DEBIRI) Therapy for Refractory Colorectal Liver Metastasis: A Systematic Review
Authors: Soomro F H , Ansar M , Nazir I , Razzaq A , Khalid M A 
Published: August 2024

Abstract

Introduction
Colorectal cancer and related mortality present a profound challenge in its management, even in this modern age. DEBIRI is a new technique that involves embolisation of the feeding vessels to the tumour and delivering irinotecan for its chemotherapeutic effects. A significant amount of literature compares DEBIRI as an adjunct to various lines of chemotherapy. However, so far, not much data is available on DEBIRI as a singular treatment for those patients who have had multiple chemotherapies and still progressed and are not fit for liver resection. In this systematic review, we aim to highlight and bring together the results of those studies which focused on this specific patient group.

Method
A systematic review of the literature, was conducted to identify articles documenting patients who had disease progression despite chemotherapy and were not fit for surgical resection. The level of evidence and quality was assessed by two independent reviewers.

Results
Out of seven studies that met the final criteria, we found a pooled cohort of 302 patients.The majority of the studies reported only G1/G2 toxicities among the patients, with maximal toxicity of G4 in a few selected patients. The median overall survivll in our pooled cohort was 19.52 months. The median progression-free survival in our data was 5.76 months.

Conclusions
Our systematic review concludes that DEBIRI is undoubtedly a useful treatment modality with an acceptable toxicity profile. This treatment offers a good overall survival benefit for refractory colorectal liver metastasis.
512 Evaluation of Computed Tomography Artefacts of Carbon-Fiber and Titanium Implants in Patients with Spinal Oligometastatic Disease Undergoing Stereotactic Ablative Radiotherapy
Authors: Rijs Z , Saha P , Kawsar K A , van de Sande M , Lui D 
Published: August 2024

Abstract

Aim
This study evaluated artefacts on computed tomography (CT) images using Hounsfield units (HU) in patients with spinal oligometastatic disease (OMD) that received carbon fibre (CF) or titanium spine implants and underwent stereotactic ablative radiotherapy (SABR). Pre- and postoperative HU were measured at the vertebral body, pedicle, and spinal cord at three different levels: the lower instrumented vertebra, the level of metastatic spinal cord compression, and an uninvolved level.

Method
This retrospective single centre study included patients ≥18 years with spinal OMD who received CF or titanium spinal implants (including pedicles, screws, and rods) between 2018 and 2020.A closely matched gender and age group of patients that received CF (n=11) and titanium implants (n=11) was selected because gender- and age-related osteoporotic changes in bone density could potentially influence CT artefact measurements.

Results
Significant differences in HU were observed at the vertebral body, the pedicle, and the spinal cord at the lowest instrumented vertebra level for both CF and titanium (average increase 1.54-fold and 5.11-fold respectively). At the metastatic spinal cord compression level, a trend towards a higher HU-increase was observed in titanium compared with CF (average increase 2.51-fold and 1.43-fold respectively).

Conclusions
The relatively high postoperative HU-increase after insertion of titanium implants indicated CT artefacts, while the relatively low HU-increase of CF implants was not associated with artefacts. Therefore, we propose a CT artefact grading system based on postoperative HU-increase. This could be used in future studies to assess if less CT artefacts lead to better tumoricidal effects and decreased adverse effects after SABR.
1008 Can the Nottingham Hip Fracture Score (NHFS) Predict Mortality After a Fragility Distal Femur Fracture?
Authors: Vaghela M , Benson D , Rogers B , Chan G 
Published: August 2024

Abstract

Aim
Fragility distal femur fractures (DFFs) are associated with comparable 30-day and 1-year mortality rates to fragility hip fractures. Since 2020/21 fragility DFFs have been included in the NICE Best Practice Tariff mechanism, with increasing focus on their outcomes. The Nottingham Hip Fracture Score (NHFS) is a validated risk stratification tool for predicting 30-day mortality after a fragility hip fracture. A NHFS &gt;5 is associated with significantly increased risks of mortality. This study aims to assess the validity of the NHFS in predicting 30-day and 1-year mortality after a fragility DFF.

Method
A retrospective review of all fragility (patients &gt;60-years-of-age) DFFs at a high-volume major trauma unit between October 2014 and December 2021 was performed. Native and periprosthetic DFFs were included. The NHFS was calculated as per the original description by Wiles et. al. Receiver operator characteristic curves (ROC) were constructed and the area under the curve (AUC) was used to assess the reliability to predict mortality.

Results
A total of 183 patients (with 73 periprosthetic DFFs) were included with an overall 2.7% 30-day and 24.6% 1-year mortality. The AUC for 30-day and 1-year mortality ROC showed outstanding and acceptable discrimination respectively (AUC 0.929 and 0.724). These results were maintained when native DFFs and periprosthetic DFFs were analysed individually. A NHFS &gt;5 was associated with a significant increase in mortality risk at 30-day and 1-year (p&lt;0.01).

Conclusions
The NHFS is accurate in predicting 30-day mortality after DFFs in both native and periprosthetic injuries, whilst providing a good indication to 1-year mortality.
1016 Qualitative Account of an Arthroplasty Elective Experience at the Hospital for Special Surgery in New York
Authors: El-Hassan M 
Published: August 2024

Abstract

Aim
Junior doctors applying for Core Surgical Training are awarded points for completing a surgical elective. As a final year medical student in 2023, I travelled to The Hospital for Special Surgery (HSS) in New York, at the Complex Joint Reconstruction Centre for four-weeks. I aim to showcase the benefits of travelling abroad for UK medical students interested in orthopaedic surgery.

Method
This is a qualitative account of my experiences working with attendings and research fellows in the Complex Joint Reconstruction Centre at HSS.

Results
I attended clinics and scrubbed into theatres using a variety of innovative robotic technology in knee arthroplasty, including robotic-assisted knee arthroplasty (Mako Smart Robotics™ and ROSA® Knee System) and computer-assisted technology (Intellijoint KNEE® Surgical Inc, Kitchener, Ontario). I was actively involved in departmental research meetings, drafting two case reports in cementing techniques to improve Varus-Valgus alignment in Total Knee Arthroplasty (TKA). I attended 3D printing workshops which produced custom-implants for complex revision cases.

Conclusions
An elective at HSS gave me an insightful experience with furthering my understanding of complex orthopaedic conditions, taught by pioneering orthopaedic surgeons in the USA. I broadened my experience in Trauma & Orthopaedics, which has allowed me to make a more informed decision in pursuing this specialty. I encourage medical students and junior doctors to pursue similar experiences to further their passion for orthopaedic surgery.