bluuebunny/crossref_metadata_2025_split huggingface dataset:
315 Diversity at the Heart of the Specialty: A National Initiative for Widening Participation in Cardiothoracic Surgery
Authors: Kirkley K , Layton G , Tariq J , Booth K , Bhatti F 
Published: August 2024

Abstract

Aim
Students from widening participation (WP) backgrounds are less likely to apply for and obtain places to study medicine (1). This compromises the long-term diversity of the applicant pool for cardiothoracic surgery (CTS). It is well established that patient care is adversely affected by a lack of diversity within healthcare professionals. As such, this national initiative set out to promote CTS amongst senior school students in the UK, with a focus upon those from WP backgrounds.

Method
Students were invited via the Medical Schools Council to six online lectures and were invited to submit a competitive application to undertake work experience within a CTS unit. Twelve students were selected to participate in a clinical placement and were provided with an online, interactive coaching resource to aid cross-centre standardisation of experience. All attendees were invited to complete electronic questionnaires before and after their experiences.

Results
482 students attended lectures, with 100% providing feedback afterward. Attendees were most frequently female (77%), from ethnic minority groups (80%) and WP backgrounds (42%). Perceived barriers to pursuing this career included inability to gain work experience (71%), financial restrictions (45%) and lack of application mentoring (41%). 100% of students recommend the work experience scheme as helpful. Students reported improved confidence with the hospital environment, the role of a doctor and the specialty. All were more likely to consider a career in surgery following this exposure.

Conclusions
Low-cost interventions utilising pre-existing cardiothoracic surgical networks can successfully engage a large, diverse population of students who feel restricted from accessing our specialty.
346 Transforming ENT Induction: Assessing the Impact of an AI Avatar Delivered Induction Course on Trainee Confidence at John Radcliffe Hospital, Oxford
Authors: Kazemi N , Siddique H , Maweni R 
Published: August 2024

Abstract
In the evolving landscape of surgical education, innovative methods are crucial for enhancing trainee proficiency. This study evaluates the impact of an AI Avatar delivered ENT induction course, which utilises interactive video and image technology, on changes in trainees' confidence in key ENT skills, and as well as the role of AI tutors in this process.
We analysed pre- and post-course feedback from participants enrolled in the entinduction.co.uk SHO induction program from the John Radcliffe Hospital, Oxford, ENT department. The primary focus was on changes in confidence across seven key ENT skills. Paired t-tests assessed the statistical significance of these changes.
There were 24 participants. 8 GP Trainees, 10 FY2s, 2 Core surgical trainees and 4 Clinical Fellows. All areas showed statistically significant improvements in confidence post-course (p &lt; 0.05). The highest increases were observed in identifying normal endoscopic upper aerodigestive tract anatomy (Δ=+3.87), identifying endoscopic pathology (Δ=+3.83), managing ENT emergencies (Δ=+3.67), triaging ENT referrals (Δ=+3.63) and managing upper airway obstruction (Δ=+3.27). Notable increases were also present in identifying ear pathology on otoscopy (Δ=+2.90) and identifying normal ear anatomy on Otoscopy (Δ=+2.88).
Overall course quality was highly rated (mean=8.45/10), with a strong recommendation level from participants. The AI tutors were positively received, with varying impact on learning and retention.
The ENT induction course significantly boosted participants' confidence, affirming the effectiveness of its curriculum and pedagogical approach. The integration of AI tutors was well-received, highlighting their potential in enhancing surgical education. These results advocate for the continued adoption of innovative instructional strategies in surgical training programs.
928 The Process of Learning Anatomical Variations among Surgeons: A Journey of Developing Expertise
Authors: Chand C P , Brand K , Wilmhurst L , Bazira P , Clunie L 
Published: August 2024

Abstract

Aim
This qualitative study aimed to develop a theoretical framework that explained the process of learning anatomical variations among surgeons using the constructivist grounded theory methodology.

Method
Initial purposeful and subsequent theoretical sampling of surgical trainees and consultants was utilised. Semi-structured interviews were conducted with 6 surgical consultants and trainees. Data analysis was informed by the grounded theory methodology.

Results
The resultant theoretical framework proposed a three-step iterative learning process that represents the journey of developing surgical expertise. The first step of the process is encountering a variant which encourages trainees to identify the variant and establish their understanding of normal anatomy. The next step is to deal with the variant as required by evaluating its clinical impact and using surgical skills to manage it accordingly. In the third step, trainees engage in self-directed learning about the variant. As they progress, trainees develop an increasing awareness of anatomical variations relevant to their surgical sub-specialty and begin to learn how to deal with the variant. Playing a crucial role in a trainee’s learning process at each step is the consultant who provides clinical supervision during the encounter, guidance when dealing with the variant, and encourages reflective practice after the encounter.

Conclusions
This study is one of the first to explain the process of learning anatomical variations, providing a unique insight into the current standards of surgical training in the United Kingdom. It calls for a greater emphasis on exploring how the learning and teaching of anatomical variations can be integrated within the surgical training curriculum.
1133 Assessment of Medical Students’ Competence in Wound Closure Techniques
Authors: de Carvalho L , Walker J , Grieve S 
Published: August 2024

Abstract

Aim
The aim of this audit was to assess the level of medical students’ competence in in basic wound closure, which is a skill listed in the GMC’s outcomes for graduates. Secondary aims included assessing self-reported confidence levels, before and after a period of teaching in wound closure techniques, and likelihood of students choosing a surgical career.

Method
A cohort of UK Medical Students attended face to face practical suturing sessions with tutors. Students were assessed against a standardised Objective Structured Assessment of Technical Skills (OSAT) before and after receiving practical suturing sessions and a period of self-directed learning. Students completed pre-session and post-session online questionnaires rating their self-confidence on performing a variety of wound closure techniques. Students were also asked to indicate whether they would be likely to choose a surgical career on the post session questionnaire.

Results
The percentage of students being able to competently perform simple interrupted sutures for wound closure increased significantly from 0 to 100%. Analysis of the student’s questionnaires demonstrated a significant improvement in self-rated confidence across all suturing techniques. 72% of students indicated that they would be more likely to choose a surgical career after the teaching.

Conclusions
Medical students often get minimal suturing teaching during their education despite wound closure being an important skill in many medical specialities and required by the GMC’s standards for medical graduates. Lack of adequate hands-on practice can detrimentally impact student’s competence and confidence, and this can potentially translate post-graduation, and influence their choice of speciality.
675 A Systematic Review of Sustainability Practises in Plastic Surgery
Authors: Iakovou D , Sousi S , Glynou S P , Ahmed Z , Zargaran A , Zargaran D , Mosahebi A 
Published: August 2024

Abstract

Aim
There is an urgent need to tackle climate change, with surgery being a carbon hotspot for emissions in healthcare. This study explores literature detailing current sustainability practices and initiatives in plastic surgery and evaluates methods used facilitating the pursuit of achieving net zero targets.

Method
Following the PRISMA guidelines, systematic search was performed in MEDLINE, EMBASE, and Cochrane Library databases. Studies concerning sustainability practices in plastic surgery were included. The registration number is PROSPERO (CRD42023446104).

Results
The search yielded 1,083 studies of which 13 met the inclusion criteria. The studies were analysed for their data on waste, usage, and carbon footprint. Hand surgery was the leading subspecialty in taking initiatives to tackle waste, such as the use of surgical packs to account for the use of wide-awake local anaesthesia no tourniquet technique (WALANT), while also taking into account surgeons’ preferences. Other initiatives encompassed craniofacial, skin cancer and breast surgery. Hand surgery initiatives also included a survey suggesting that hand surgeons agreed that reductions in carbon footprint while maintaining patient safety is crucial. Successful recycling initiatives were reported with a monthly average of 39.6 tonnes per month. Five studies, representing skin and hand surgery, presented reduction in cost by individualising sustainability practices for specific procedures.

Conclusions
The necessity of tailoring sustainability strategies on the requirements of each surgical procedure was demonstrated. The development of standardised outcome sets was emphasised to evaluate the best practices in sustainability and further research is needed in collaboration with healthcare professionals for a more sustainable clinical future.
74 Efficacy of WHO Surgical Checklist in Reducing Post Operative Complications: A Systematic Review
Authors: Qaiser S , Khan M S 
Published: August 2024

Abstract

Objective
To determine the effect of WHO surgical checklists in reducing post-operative adverse effects.

Method
A single-step search strategy was utilised. The data bases that were included in the search included MEDLINE, CINAHL, EMBASE, Conchrane Data Base, Proquest, Index Copernicus, Google Scholar and Scopus. Moreover, reference lists of identified reports and articles were searched for additional studies. Studies published in English before September 2021 were included. Keywords and titles were used to search through databases. Research included focused on the WHO surgical safety checklist and excluded all other checklists.

Findings
Following review of title and of 17,821 publications, 93 studies were identified as meeting the inclusion criteria and selected for full retrieval and assessment for methodological quality. Of these, 13 were of sufficient quality to be included for review. Among these 10 articles reported that complication rates were impacted and 9 out of these reported an overall decrease in the complication rates. Thirteen studies reported mortality, out of 12 reported a decrease in the mortality rates of the patients.

Conclusions
It is sufficed to say that application of the surgical checklists leads to improved surgical outcomes and a reduction in the post-operative adverse effects such as mortality and complication rates. Further research is required to assess the effect of the checklist on the quality of life of the patients. Research is required to assess applicability while eliminating psychological effects checklists have on the patients.
1230 Mesenchymal Stromal Cells for the Enhancement of Flexor Tendon Repair in Animal Models
Authors: Economou A , Eleftheriou A , Epanomeritakis I E , Khan W 
Published: August 2024

Abstract

Aim
Our goal was to determine the efficacy of MSCs in enhancing the biomechanical properties of surgically repaired flexor tendons in vivo.

Method
A PRISMA systematic review was conducted using five databases (PubMed, MEDLINE, EMBASE, Web of Science, and CINAHL) to identify studies using MSCs for the enhancement of surgical repair of flexor tendon injuries in animal models. Ten studies were included in our systematic review. We extracted the results of biomechanical testing of repaired flexor tendons, including the maximum load, elasticity, stiffness, and range of motion analysis. The histological and macroscopic appearances of repair tissue, as well as any complications observed, were also recorded.

Results
While some authors reported a promising improvement in biomechanical properties following treatment with MSC, this was inconsistent across the studies. This may, in part, be explained by the variety of cell delivery methods used. We suspect that injections of MSCs within a biocompatible solution may perform better than cells embedded in polymer scaffolds, which can provoke an inflammatory reaction that impairs healing. Further variation between studies was noticed with regard to the MSC source, cell concentration, and post-operative immobilisation protocols, all of which may alter the outcome of the repair.

Conclusions
In summary, while current in vivo evidence suggests that MSCs may enhance the surgical repair of flexor tendons, there is insufficient evidence at present to recommend this treatment for use in humans. Future studies are necessary to investigate the role of the individual variables mentioned in order to standardise a potential treatment approach.
750 Simultaneous Islet Cell and Kidney Transplantation: An Initial Single Centre Experience
Authors: Jeyasuresh Y , Doherty D T , Birtles L , Greenwood-Morgan M , Lowe M , Azmi S , Khambalia H , Van Dellen D 
Published: August 2024

Abstract

Aim
Simultaneous Islet and Kidney (SIK) transplantation aims to improve glycemic control and renal function by combining an islet transplant with a renal allograft for patients with Type 1 Diabetes Mellitus (T1DM) and renal failure. This provides diabetic improvement and removal from dialysis burden, with reduced peri-operative risk compared to solid organ simultaneous pancreas and kidney transplantation. We aimed to evaluate the outcomes of the United Kingdom’s initial cohort.

Method
A retrospective analysis of SIK recipients was performed between 03/2017 and 04/2023 at our hospital.

Results
22 SIK were performed (72.7% donors after brain death). The mean recipient age was 56 with 54.5% female. The median diabetes duration was 42 years (IQR 22) with median post-SIK follow-up of 361 days (IQR 783). There was a median 1 infusion per recipient (median IQR 1) with median islet equivalence (IEQ) of 323,500 IEQ (IQR 141,250). HbA1c and exogenous insulin requirements were significantly lower after transplant (HbA1c: 62.7 vs 51.6mmol/mol, p&lt;0.001; IU: 40 vs 23 units/day, p&lt;0.001) while C-peptide significantly increased (15.9 vs 535.8pmol/l, p&lt;0.001). Hypoglycaemic episodes/patient/year reduced (7 pre-transplant, vs 1.5 post-transplant). Median islet graft survival was 4.9 years. lgls functional classification at the end of follow-up was satisfactory (7 Optimal, 1 Good, 10 Marginal and 4 Failure). eGFR significantly increased post-SIK (15.4 vs 49mL/min/1.73m2, p&lt;0.001).

Conclusions
SIK ameliorates renal failure whilst improving glycaemic control with a satisfactory complication profile. Larger and longer cohort analysis is required to fully understand the benefits of SIK for patients with complicated T1DM.
38 Anterior Knee Pain Assessment in Tibial Nailing: A Comparative Retrospective Study of Suprapatellar and Infrapatellar Approaches
Authors: Ilyas M W , Amer A S , Vakil H , Alaraj M , Naqvi S Z , Al-Kharouf K 
Published: August 2024

Abstract

Aim
To assess whether there is a statistically significant difference between incidence of anterior knee pain in supra-patellar vs infra-patellar tibial nailing techniques.

Method
This retrospective study, conducted at a UK trauma centre, data was analysed using ICD-10 and OPCS codes to identify patients with tibial fractures who underwent IM nail fixation. Among 312 patients, 206 met inclusion criteria, excluding those with unavailable records, limited follow-up, and paediatric patients using flexible nails. Two groups, "Suprapatellar Nailing" and "Infrapatellar Nailing," were compared for anterior knee pain incidence via clinical follow-up data. Statistical analysis tested the null hypothesis i.e., "Infrapatellar nailing causes more documented anterior knee pain than suprapatellar nailing."

Results
Out of 206 patients, 140 were males and 66 were females with mean age of 43 years (Range 16-91). 60.2% (n=124) were treated with infrapatellar nailing as compared to suprapatellar nailing 39.8% (n=82). Anterior knee pain was reported in 14.2% (n=17) of infrapatellar cohort as compared to 14.6% (n=12) in the suprapatellar cohort. Chi square statistic with yates’ correction is 0.0124, with a p value of 0.91. The result is not significant (p &gt; 0.05).

Conclusions
The 14.4% mean incidence of anterior knee pain in both groups is relatively low compared to existing literature. Despite the need for a large sample size to establish statistical significance, our study indicates no significant difference in anterior knee pain incidence between infrapatellar and suprapatellar nailing techniques, suggesting equivocal outcomes in skilled hands. We recommend a multicentre study, particularly given the increasing use of suprapatellar nailing, to achieve statistical significance.
59 Adherence to NICE Guidelines for Mobilization After Distal Femoral Fracture Surgery in Elderly Patients: Impact on Surgical Outcomes
Authors: Elegbede A , Sadekar V , Shakya A , Symes T 
Published: August 2024

Abstract

Aim
This study aims to evaluate adherence to NICE guidelines for postoperative mobilization after different distal femoral fracture fixation methods in elderly patients. We also explore the implications of guideline compliance, focusing on the timing and extent of weight-bearing.

Method
Retrospective data collection spanned six months at Hull University Teaching Hospitals, involving patient records and descriptive statistical analysis.

Results
Of the 18 identified patients, 16 were analysed (2 managed non-operatively). The mean age was 82.5 years (4 males, 12 females), with an average surgery delay of 3.4 days. Fracture types included intra-articular (4), extra-articular (4), and periprosthetic (8). Implants included 8 plate osteosynthesis, 6 intramedullary (IM) nails, and 2 dynamic femoral rods (DFRs). Post-surgery weight-bearing status: non-weight bearing (NWB): 7 (5 plates + 2 nails), Partial weight-bearing (PWB): 3 (2 plates + 1 nail), Full weight-bearing (FWB): 6 (2 DFRs + 1 plate + 2 nails). Weight-bearing by implant type: Plate: NWB: 5/8, PWB: 2/8, FWB: 1/8. Nail: NWB: 2/6, PWB: 1/6, FWB: 3/6. DFR: FWB 2/2. Five fatalities occurred: 4 in NWB and 1 in PWB groups; 4 with plate fixation and 1 with IM nail.

Conclusions
Only 37.5% initiated FWB in under a week. Encouraging early weight-bearing may reduce mortality following distal femur fractures in the elderly.
150 Audit in Post-Operative Documentation in Trauma and Orthopaedic
Authors: Abouzied S 
Published: August 2024

Abstract

Introduction
Post operative surgical documentation is a critical component of patient care and ensures seamless communication among health care providers. In this audit we evaluated the quality of orthopaedic operative notes against the RCS-England guidelines aiming to improve adherence to these guidelines.

Method
We prospectively included 50 orthopaedic post-operative patients from July 20th till July 30th 2023. Adult trauma and elective procedures were included regardless of the type of the procedure. We compared the operative notes included in the audit to the RCS good surgical practice guidelines and collected data using a checklist including the parameters in the RCS guidelines. Areas with deficient documentation were highlighted for auditing.

Results
The first Audit cycle identified poor areas in post operative notes as the documentation of ‘emergency/elective procedure’ (25%), ‘weight bearing status following procedure’ (25%), ‘VTE instructions’ (75%), ‘follow up instructions’ (35%), ‘investigations required after procedure’ (25%), ‘instructions regarding post operative wound care’ (50%). We created a mnemonic to aid memorising the necessary post operative instructions. We’re presenting this audit in the orthopaedic department monthly M&M meeting in November and aiming to do a second Audit cycle to compare the quality of post operative documentation following the interventions implemented following the first cycle.

Conclusions
Post operative surgical documentation plays a pivotal role in ensuring effective patient care, enhancing patient safety, shortens their hospital stay and provides a legal protection for healthcare providers.
490 The Management of Distal Radius Fractures Against BOAST Guideline
Authors: Yip C R , Yang J , Zhou R 
Published: August 2024

Abstract

Aim
Distal radius fractures are common injury that can occur following fall onto an outstretched hand or a direct impact to the wrist. The British Orthopaedic Association Audits Standards for Trauma (BOAST) issued guidelines in 2017 specifically addressing the management of distal radius fractures. The guidance states that surgery should be performed within 72 hours for intra-articular fractures and re-displacement fractures following manipulation, and within one week for extra-articular fractures. The aim of this audit is to assess the compliance in all three groups which required operation.

Method
This is a retrospective study conducted at a single centre over six months duration, from September 2022 to February 2023. The study recorded patient demographics, injury types, injury dates, decision dates for surgery and surgery dates. Exclusion criteria encompassed patients under 18 years old, fractures involving both radius and ulna, concomitant elbow fractures and periprosthetic fractures.

Results
During the study period, surgical fixation of the distal radius was performed on a total of 105 patients. 23 were male, and 82 were female, with a mean age of 60 years (ranging from 20-92 years). The overall compliance was 75%. 34 cases were extra-articular, all of which were compliant. For the 67 intra-articular cases, 23 did not adhere to guidance. The remaining 4 cases involved re-displacement fractures following manipulation, all of which were intra-articular; among these, 3 were not compliant.

Conclusions
The overall non-compliance rate is 25%. This rate is notably higher among patients with intra-articular fractures, possibly attributed to instances necessitating the expertise of upper limb specialists.
492 Enhancing Trauma Documentation Accuracy: A Closed-Loop Analysis at a Major Trauma Centre in North Scotland
Authors: Tong E , Tolia M , Lim J W , Roberts S , Baliga S 
Published: August 2024

Abstract

Aim
Aims to evaluate the documentation accuracy of Mechanism of Injury (MOI) and Neurovascular Status (NVS) for trauma patients within a Trauma and Orthopaedic (T&O) ward at a Major Trauma Centre in North of Scotland.

Method
Review of admission and ward notes spanning two weeks included trauma cases with varying mechanisms of injury, excluding elective cases.

Results
Results from two cycles revealed a total of 67 patients. Noteworthy improvements were observed in MOI documentation rates, rising from 85.3% to 87.9% for Foundation Year (FY) doctors and 76.5% to 97% for Registrars. Equally significant improvement in NVS examination documentation were identified, increasing from 23.5% to 42.4% for FY doctors and 20.6% to 42.4% for Registrars. However, the documentation rate of "NVI" remained relatively static at 50% to 49%.

Conclusions
While overall documentation of MOI and NVS improved between foundation doctors and registrars, the study underscores suboptimal "NVI" documentation and the inadequacy of relying solely on acronyms. The proposed plan involves continued formal teaching on NVS examination, incorporating it into the FY teaching package, and a scheduled third cycle in 2024 for ongoing assessment and improvement.