bluuebunny/crossref_metadata_2025_split huggingface dataset:
172 Does Decision Fatigue Impact on Surgical Outcomes? – a Scoping Review
Authors: Ijaz M , Whiteway S 
Published: August 2024

Abstract

Aim
Decision fatigue refers to the concept that the effort required to make repetitive decisions depletes our psychological resources and consequently leads to a fall in the quality and output of further decisions. In carrying out their jobs and often responding to emergency situations, the way surgeons perceive and make decisions plays a crucial role. It is therefore important to consider the effect decision fatigue may have on surgeons and their patients. The aim of this scoping review is to examine evidence from published studies on the impact decision fatigue has on clinical practice and patient outcomes.

Method
A computerised literature search was performed using two online databases: PubMed and Web of Science, Cochrane and Google Scholar. This yielded 9 studies that met the pre-determined criteria.

Results
Analysis of six studies indicate a consistent correlation between decision fatigue and its impact on healthcare professionals, while two studies present contrasting findings, asserting no significant influence. Notably, one study contributes evidence supporting both perspectives, adding complexity to the discourse.

Conclusions
Given the disparity in the evidence, we concluded that decision fatigue is not a generic phenomenon and that it manifests itself in different ways in individuals; with an individualised threshold to the number of high-quality and cognitively demanding decisions one can make before the consequent decisions are impacted. Therefore, more research that takes a qualitative approach is needed to understand the clinical impact of decision fatigue within surgical specialities in more detail.
264 The Impact of COVID-19 on Elective Tonsillectomies in Greater Glasgow and Clyde
Authors: Mathioudaki E , Culley C , Lyuman E , Lim W , Tailor H , Douglas C 
Published: August 2024

Abstract

Aim
Recurrent tonsillitis causes increased morbidity, and negatively impacts a patient’s quality of life. COVID-19 led to a dramatic decline in elective tonsillectomies. Our aim is to quantify the impact of COVID-19 on the number of elective tonsillectomies performed in the adult and paediatric populations; evaluate the impact of the pandemic on healthcare outcomes and utilisation, including indication for surgery, SIGN compliance, waiting times, post-operative complications.

Method
This study employed a multicentre retrospective population analysis within the NHS Greater Glasgow and Clyde (GGC) health board, looking at adult and paediatric populations (n=2,535 and n=4,166 respectively) from 2016 to June 2023. A further retrospective cohort analysis compared the adult cohorts of 2016 (n=359) and 2021 (n=89).

Results
Adult and paediatric tonsillectomies declined from 2016 to 2021 by 81.0% (p&lt;0.0001) and 33.1% (p&lt;0.01) respectively. Detailed analysis revealed an increased proportion of adult tonsillectomies with diagnostic purposes (11% to 31%), as opposed to recurrent tonsillitis which fell (74% to 52%). In 2016, 66.98% of routine adult tonsillectomies complied with the Scottish Government (12 weeks), whereas in 2021 only 4.92% met this target. Conversely, post-operative bleeding decreased from 1 in 4 (24.5%) to 1 in 5 (20.2%) over this timeline.

Conclusions
Considering COVID-19, surgical prioritisation led to a fall in elective tonsillectomies. The numbers have recovered to pre-pandemic levels in children, reflecting the greater urgency to reduce the risk of long-term cardiovascular health problems associated with obstructive sleep apnoea. Furthermore, this study demonstrates the marked changes to routine tonsillectomy practice in the GGC health board because of COVID-19.
526 Clinical Efficacy and Safety of Oral Sirolimus Therapy in Patients with Klippel-Trenaunay Syndrome in a Single Specialist Centre
Authors: Nisbet R , Pang C , Evans N , Papadopoulou A , Khalifa M , Brookes J , Lim C S 
Published: August 2024

Abstract

Aim
The evidence on the efficacy and safety of sirolimus therapy in patients with Klippel-Trenaunay Syndrome (KTS) remained scarce. This study aimed to assess this for patients for whom standard treatment alone was inadequate.

Method
This was a retrospective study of all adult patients with diagnosed KTS who were treated with oral sirolimus where standard therapy was inadequate in a single specialist centre since May 2016. Demographic and clinical data including patient-reported responses, visual analogue scores for pain and adverse effects, and quality-of-life scores (SF-36) were reviewed.

Results
Fourteen KTS patients (6 males: 8 females) with a median age of 44 (range: 27-57) years were included. Six patients stopped sirolimus within two months due to extensive rashes and itching, mouth ulceration, severe chest infection, worsening KTS symptoms, and multiple intolerable side effects. The median duration was 803 (IQR: 1106) days if sirolimus was tolerated. Four patients reported significant reduction in pain, 3 patients had reduced limb swelling, 1 had reduced episodes of cellulitis, 1 had improved coagulopathy and only 2 patients demonstrated limited improvements from sirolimus. The most common adverse effects were headaches (n=5), fatigue (n=5) and abdominal discomfort (n=5). There was an improvement in the mean scores for physical functioning (5.0), role limitations due to emotional problems (11.1), pain (2.5), depression (2.25) and anxiety (0.7).

Conclusions
Oral sirolimus therapy was clinically effective and safe in some complicated patients with KTS when standard therapy alone was inadequate. Longer follow-up would be needed to evaluate oral sirolimus therapy in KTS patients.
529 The Benefit of a University-Supported Foundation Trainee Teaching Buddy Scheme on Medical Student Preparedness for Practical Examinations
Authors: Sokhal B S , Menon S P K , Nanthakumar N , Polymerou E , Carny A , Xiang J , Balbadaoui A , Ashworth C , Rao V 
Published: August 2024

Abstract

Background
A key aspect of Health Education England’s foundation training learning outcomes is to develop the clinical teacher.

Aim
The aim of this initiative was to pair up year 3 medical students (trainee) with foundation trainees (trainer) for bedside teaching ahead of year 3 Objective Structured Clinical Examinations (OSCEs).

Method
Sign-up forms were distributed to year 3 medical students and foundation year trainees of a medical school and affiliated university teaching hospital. Trainees were instructed to deliver their teaching in accordance with the university’s year 3 curriculum and sign-off sheets for work-based assessments. Feedback forms for trainees and trainers were distributed which gathered information on content covered and perceptions of the scheme. Questions were formatted with multiple choice answers and Likert scale of agreement.

Results
27 students provided feedback. 20 (74.0%) students agreed their history taking improved and 24 (88.9%) students agreed their clinical examination skills improved. 24 (88.9%) agreed the scheme enhanced their clinical experiences and 23 (85.2%) agreed the scheme helped prepare them for knowledge examinations and OSCEs. 25 (92.6%) answered they would recommend the scheme to future year 3 students.

Conclusions
For year 3 students, this scheme enhanced clinical experience, confidence in history taking and clinical examination, and preparedness for summative examinations.
553 Early Diagnosis and Clinical Management for Acute Mesenteric Ischemia & Gastrointestinal Complications Following Cardiac Surgery: A Comprehensive Review of the Literature
Authors: Rojanathagoon T , Nainwal T , Lee K B C 
Published: August 2024

Abstract

Aim
Acute mesenteric ischemia (AMI) and gastrointestinal (GI) complications following cardiac surgery are rare but have significant effects on post-operative mortality and morbidity. This review sought to analyse the current diagnosis and management of these conditions.

Method
An updated comprehensive review of the literature to assess the early diagnosis and clinical management to address AMI and GI complications following cardiac surgery in adult patients was performed. A literature search was conducted on PubMed, Ovid Medline, and Embase. Relevant articles were screened by two authors, data extracted, and presented in the relevant sections.

Results
In an analysis of 8 retrospective and case control studies with a total of 264,369 patients who underwent cardiac surgical procedures, 834 had AMI and 7,684 had other GI complications. The average diagnosis time for AMI was 7.5 days and other GI complications was 7.15 days. The overall average mortality in those with AMI and GI complications being 15.2%, with AMI alone indicating significantly higher mortality than other GI complications, in this case 44%. Studies included cited nonspecific symptoms or nonsuggestive characteristics in patients with AMI. Computed Tomography, endoscopy, and colonoscopy were the most common diagnostic tools.

Conclusions
Although the incidence of AMI and GI complications post cardiac surgery is low, the prognosis is poor. In GI complications like AMI where early postoperative symptoms can be unclear, maintaining a high index of suspicion in patients at high risk alongside a low threshold for diagnostic studies can allow for a reduced diagnosis time and earlier intervention, critical in improving morality rates.
1288 The Role of a Student-Led Neuro-Society Organized Neurosurgical Conference
Authors: Al Salloum L 
Published: August 2024

Abstract

Aim
Gain insight into student perceptions of neurosurgery as a surgical specialty. Utilize workshops and a conference to ensure neurosurgery's accessibility. Compare results to previous annual conferences and evaluate the role of these events in bridging the gap between 'competitive' specialties.

Method
Organization of a one-day national neurosurgical conference supported by the local neurosurgical department. Offering neurosurgeon-led workshops and lectures to provide practical skills, portfolio advice and networking opportunities. Hosting eleven, consultant-marked poster presentations throughout the day. Utilizing pre-and post-conference surveys distributed to attendees to establish baseline opinions and post-conference impact through use of a five-point Likert Scale and free-text questions.

Results
Our study involved 47 medical students. After the conference, participants demonstrated a heightened comprehension of the nuances of a neurosurgical career and the strategies for obtaining training. They also expressed an augmented awareness of neurosurgery research, elective options, audits, and project opportunities. The workshops were well-received, and respondents recommended incorporating more female speakers in future sessions.

Conclusions
Student neuro-societies' efforts in hosting neurosurgical conferences effectively bridge the divide between limited exposure to neurosurgery and the challenges of competitive training selection. These conferences provide medical students with an introductory insight into a neurosurgical career through a combination of lectures and hands-on workshops. Attendees not only learn about achieving relevant milestones but also have a platform to present their research. The prospect of adopting student neuro-society-organized conferences on an international scale could serve as a valuable global educational tool, offering significant support to aspiring neurosurgeons among medical students worldwide.
177 Investigating the Secretome of Adipose Derived Stem Cells on Extracellular Matrix Remodelling in Radiation-Induced Fibrosis
Authors: Wai J M Y , Cui X , Frommer M , Langridge B J , Butler P 
Published: August 2024

Abstract

Aim
Radiation-induced fibrosis (RIF) is a debilitating complication following radiotherapy, characterised by fibroblast proliferation and excessive extracellular matrix (ECM) deposition, leading to functional and aesthetic impairments. Although autologous fat grafting (AFG) has shown promise in reversing RIF, the mechanisms, largely attributed to adipose-derived stem cells (ADSCs), remain elusive. This study aimed to investigate ADSCs’ and their secretome on ECM remodelling in RIF management.

Method
The anti-fibrotic potential of the ADSC secretome on human dermal fibroblasts (HDFs) subjected to ionising radiation was assessed via a series of in vitro experiments. Control HDFs were compared with irradiated HDFs to assess any phenotypical changes. Irradiated HDFs were treated with ADSC pre-conditioned media (CM) or ADSC co-culture (CC). Gene expression (COL1A1, TGF-β1, CCN-2, MMP-1, MMP-3, TIMP-1, ACTA2, TNC) was assessed via real-time quantitative PCR (RT-qPCR). ProCollagen1a1 and CCN2 protein concentrations were assessed by ELISA.

Results
Irradiated HDFs demonstrated changes in fibrotic gene expression. ADSC-CM treatment significantly reduced COL1A1 expression, although protein levels remained unchanged. TGF-β1, CCN2, MMP-3, TIMP-1 and ACTA-2 exhibited reduced expression post-ADSC-CM treatment whereas TNC expression was found to be significantly increased. Co-culture with ADSCs led to a general, but not statistically significant, decrease in pro-fibrotic gene expression. Notably, CCN-2 protein expression significantly increased.

Conclusions
This study demonstrates that ionising radiation results in a pathological pro-fibrotic phenotype in HDFs. The ADSC secretome potentially mitigates this, reducing pro-fibrotic gene expression. Unexpectedly, co-culture experiments highlighted a complex interaction with upregulation of fibrosis-associated genes. Further research is needed to clarify these interactions to improve therapeutic interventions for RIF.
251 Patient-Reported Outcome Measures Following Surgical Management of Hidradenitis Suppurativa
Authors: Berjaoui N , Galo A 
Published: August 2024

Abstract
Hidradentitis suppurativa (HS), also known as Acne inversus is a chronic and impairing inflammatory skin disease affecting hair follicle, which has both physical and psychological effects on patients. This study aims to evaluate patient-reported outcomes after Hidradenitis suppurativa (HS) excision and healing using secondary intention versus graft versus flaps, using HS-Quality of Life-24 and POSAS assessment modalities to capture the quality of life related to HS and its impact on the hair follicle. A retrospective analysis of patients with hidradenitis suppurativa to the axilla underwent excision and reconstruction at St. Thomas Hospital's plastic surgery department. Data was collected using GALAXY, HSQoL24, and POSAS, with higher scores indicating greater disease impact. Other factors included wound healing time, dressing changes, information received, and overall satisfaction. A study of 52 patients, 73% female, with an average age of 36, found that wound closure was achieved through secondary intention HS excision. The average total score for HSQoL24 was 62, 54, and 40, respectively. The healing duration ranged from 14 days to 2 months in 40% of cases, and 52% to 12 months in 52% of cases. 60% of cases involved alterations in medical therapy, and 28% experienced weight loss post-surgery. Patients reported overall satisfaction with the surgery, with satisfaction ratings for local flap, SSG, and healing with secondary intention. SSG and local flaps effectively provide coverage for hidradenitis suppurativa, improving quality of life and reducing scar-related complications, however still further research is needed - the optimal surgical approach regarding HS remains uncertain due to paucity of data.
373 The Use of Botulinum Toxin to Improve Cosmesis in Patients with Facial Asymmetry Following Facial palsy/synkinesis
Authors: Makhdoom N , Chaudry A S , Yu Wong Zhen 
Published: August 2024

Abstract

Aim
Facial Palsy (FP) is a common, debilitating condition with a broad range of aetiologies. It causes unilateral paralysis, functional impairments, and asymmetry resulting in overall reduced facial aesthetics. Secondary complications like hyperkinesis or synkinesis can result in a reduced quality of life, including social isolation and deteriorating mental health. Treatments, including botulinum toxin (BTX) injections, aim to correct this asymmetry. This review assesses BTX's efficacy, safety, and cost-effectiveness for enhancing facial symmetry in FP.

Method
PubMed was used to find studies that analysed BTX’s effects and outcomes on patients with FP and its resulting complications. Only studies from 2010 to 2022 in English were included. A total of 16 studies were identified.

Results
Intramuscular injections of BTX are a beneficial long-term treatment for individuals with FP. BTX reduces hyperkinesis, synkinesis and enhances facial symmetry, leading to better cosmesis and improved overall quality of life. The amount of toxin required ranges from 0.5-17 units depending on the muscle targeted with platysma requiring the most amount of toxin. When treating both sides of the face, the normal side requires more toxin compared to the affected side. Limited evidence was found to suggest BTX's potential in acute FP.
Therapeutic effects ranged between 1-21 days, lasting about 4 months, requiring safe, periodic repetition. Adverse effects were found to be mild, transient, and rare with no severe complications or toxin resistance reported.

Conclusions
BTX can be considered a safe and effective treatment to improve facial symmetry and overall cosmesis in the long-term management of patients with facial palsy.
391 Management of Patients Presenting to the Emergency Department with Hand Lacerations
Authors: Bugeja K , Bugeja C , Pace R , Osman Abdelmajid W Abdelmajid , Chircop K L 
Published: August 2024

Abstract

Aim
The audit aimed to assess the adherence to The British Society of Surgery of the Hand (BSSH) guidelines for triaging patients with hand lacerations in the Emergency Department (ED) and to evaluate the impact of adherence on patient outcomes.

Method
A retrospective audit was conducted on 120 consecutive patients who presented to the ED with hand lacerations during the last year. Data was collected from Clinical Patient Administration System (CPAS) and iSoft Clinical Manager (iCM). The BSSH guidelines were used as reference.

Results
The audit included data from 120 consecutive patients who presented with hand lacerations over the past year. With 23 patients being female and 97 being male, various mechanisms of injury, including sharp objects, machinery, animal bites, and others were documented. The triage assessments according to BSSH guidelines were conducted, and adherence to the guidelines was noted in 79%, while in 21% it was not. The average time to assessment was 208 minutes98.3% of patients received adequate wound cleaning. 56.6% received tetanus administration whilst 68.3% received appropriate antibiotic prescription. 30.8% were referred to hand surgery.25.8% experienced complications, with tendon injury being the most common. 97.5% received appropriate wound closure whilst 99.1% received appropriate dressing. 75.8% received appropriate pain management. 92.5% had a follow up scheduled at an appropriate clinic.

Conclusions
The audit highlights both successes and areas for improvement in adherence to BSSH guidelines for hand lacerations in the Emergency Department. While there is commendable adherence, efforts will focus on implementing and refining guidelines to ensure consistent and optimal patient care.
692 A Comparative Analysis of Standard Versus Jelonet/Gamgee Dressings for Lower Limb Free Flap Reconstruction
Authors: Jageer P , Kiely J , Day S , Rollett R , West C , Bhat W 
Published: August 2024

Abstract

Aim
Lower limb free flaps require regular monitoring in the immediate days postoperatively and often mean prolonged outpatient wound care. Post-operative dressings are particularly difficult when a circular external fixator is used. Circumferential post-operative dressings are the standard option, such as Jelonet/gauze/wool/crepe. An alternative option is the use of Jelonet and gauze, with Gamgee (JGG) wrapped loosely over the frame instead. This allows easier monitoring with complete flap visualisation, avoids constriction and much quicker dressing application. This dressing option has been previously described, but no comparative study between standard dressings and JGG dressings has been made.

Method
A retrospective study was completed for consecutive patients treated with a circular frame and free flap for reconstruction of either acute open tibial fractures or fracture related infection between January 2022-October 2023. Demographics, co-morbidities, peri-operative details, flap and wound healing outcomes were recorded and analysed with descriptive statistics and linear regression using Jamovi 2.3.21.

Results
27 patients (average age 40.3 years) were identified, 81% open fracture, 41% gracilis, 37% ALT. 56% had standard dressings, and 44% JGG. No statistically significant difference was found between the dressing groups for flap failure, inpatient stay, or time to completed healing.

Conclusions
This study demonstrates clinical equivalence in outcomes between standard and JGG dressings for this patient group. The JGG dressing also has the advantages of quick and easy application, with improved flap visualisation. We recommend its use in this patient group.
840 Audit Cycle of Surgical Management of Traumatic Open Hand Wounds at BRI – Compliance with BSSH Guidelines
Authors: Bansal R , Teklay S , Shariff Z 
Published: August 2024

Abstract

Aim
To assess whether the Plastic Surgery Department at Bradford Royal Infirmary are compliant with BSSH guidelines regarding timing of surgery for open soft tissue hand traumas (target rate 100%).

Method
Two retrospective data collection sets between 11th October 7th November 2021 and 7th March to 3rd April 2022 using Bradford’s Electronic Patient Records (EPR) and Xero PACS to review Plastic Trauma Clinic (PTC) clerking notes; Operation notes and Clinic letters. Patients included were all adult patients attending PTC with open soft tissue injuries needing definitive surgical treatment in an operating theatre/PTC.

Results
The initial study found a compliance rate of 74%, with a 62.5% compliance when it was the patient’s dominant hand. The number of individual soft tissues for repair was 14 for Flexor Tendon (FT), 17 for Extensor Tendon (ET) and Digital Nerve (DN) with compliance rates of 83.3% for FT and 76.4% for both ET and DN. The repeat cycle found an overall compliance of 72% with 62.5% for FT and DN and 81.5% for ET.

Conclusions
The main reason for non-compliance was due to hospital bed capacity and a lack of list space. Recommendations to improve theatre efficiency was made but despite this the same issues presented in the 2nd cycle. There was a total of 69 days of delay from the initial operation date, resulting in 17 overnight stays. Further recommendations to accurately plan allocated theatre time and not rely on the acute list to reduce cancellations have been made with a view to re-assess.