bluuebunny/crossref_metadata_2025_split huggingface dataset:
311 The Surgical Modern Apprentice – Preparing Final Year UK Medical Students for Foundation Year 1 Using Targeted Small Group Tutorials During an Apprenticeship-Style Placement
Authors: Gandhi S , Santos-Paulo S , Khera G 
Published: August 2024

Abstract

Aim
Apprenticeship-style placements for final year (F0) medical students act as a bridge between the education focused nature of medical school placements and the practical nature of the Foundation Year-1 (FY1) job. We aimed to deliver and evaluate a programme of in-person small group tutorials for F0’s to complement a contemporaneous apprenticeship-style placement in general surgery.

Method
Four F0's spent eight weeks on placement in general surgery at a UK University teaching hospital. Students were encouraged to undertake ward jobs under supervision and within the constraints of their unregistered status. Alongside this, four interactive, in-person tutorials focusing on the practical aspects of working as a general surgical FY1 were delivered by current surgical FY1’s. Post placement, free-text, anonymous and voluntary feedback was collected from the F0’s. We performed a thematic analysis to understand which aspects of the programme F0’s felt were useful, and what they felt could be improved.

Results
The following key themes emerged from analysis of the F0’s evaluation of the sessions: 1) Teaching relating to the real working environment 2) Interactive teaching 3) How to prioritise ward tasks 4) How and when to escalate 4) Understanding FY1 work-life balance.

Conclusions
Supplementing apprenticeship-style placements with targeted small group tutorials can help F0’s appreciate and practice non-technical skills (such as task management and team working) which are key to practicing as an FY1. F0’s benefited from being encouraged to think in the context of the real-world environment of their apprenticeship - this approach should be considered when designing similar surgical apprenticeship teaching programmes.
323 Acquiring Technical Surgical Skills During Orthopaedic Surgical Training in the UK: A Qualitative Study
Authors: Al-Jasim A , Williams C 
Published: August 2024

Abstract

Aim
The study question is “What are the experiences and opinions of orthopaedic surgical trainees and educators in the UK regarding the acquisition of technical surgical skills during postgraduate surgical specialty training?’’

Method
This is a qualitative study following the principles of grounded theory. It was conducted in the East Midlands region between May and September 2023 with a purposive sample of six surgical trainees and four trainers using individual semi-structured interviews. Data analysis applied the constant comparative approach with open, axial, and selective coding of data to develop themes.

Results
Four overarching themes arose from the data collected. These included the role of the trainer, the shape of the training curriculum, theatre experience, and service delivery challenges. These themes were found to be interconnected.

Conclusions
The findings of this study provide an understanding of the process of acquiring technical surgical skills. Insights gained from the experiences and opinions of orthopaedic surgical trainees highlighted the pivotal role of trainers, the necessity for an adaptable curriculum, the nature of varied theatre experiences, and the effects of service delivery challenges, which have continued since the COVID-19 pandemic. These insights shed light on surgical education and training, offering a basis for further investigation and refinement in training approaches, curriculum formulation, and instructional settings.
957 Lightness of Touch, Firmness of Teaching
Authors: Copperwheat A , O’Regan D 
Published: August 2024

Abstract

Aim
Correct surgical instrument hold is one of the first steps to being a surgeon. This project assessed the correctness of forceps handling in social media posts advertising basic surgical skills courses. This is an important topic as injudicious use of the surgical forceps, such as pinching, can damage tissue.

Method
Over a period of 4 months, X (Twitter) and Instagram were prospectively scanned twice a week for images of forceps handling. The images were analysed for posture of the hand, grip, application of multiple fingers and flexion of the interphalangeal joints. Images were categorised based on the body (college, professional, surgical or student society) that produced them.

Results
109 images were saved, of which 50 contained forceps. Overall, only 32.4% of images contained evidence of a good hold, with pinching occurring in 7.0%. A good hold was less prevalent, and displacement of the forceps or aberrant hold more prevalent in student advertised courses. Flexion of the proximal interphalangeal joint and pinching was present across all bodies except the college.

Conclusions
If we wish to teach with the correct technique, then advertisements must show this in their images. This project demonstrated that all bodies show incorrect technique in at least some of their images, with student run bodies advertising poorer technique. This suggests that bodies with more senior members may teach with a greater technique. However, the project also leads to a bigger question- if bodies are not advertising with the technique are they really teaching in the correct way?
1158 The Impact of COVID-19 on Cardiothoracic Surgical Training- an Insight from the GMC National Training Surveys
Authors: Raven-Gregg T , Chan J , Angelini G , O’Hanlon J 
Published: August 2024

Abstract

Background
Coronavirus disease (COVID-19) leads to a significant impact to the cardiothoracic surgical practice and training. The number of procedures logged by trainees in the esurgical logbook is yet return to the pre-pandemic level. The GMC national training surveys was first started in 2006, with an aim to determine the quality of the national training standard. We aimed to evaluate cardiothoracic trainees’ satisfaction pre and post pandemic and determine the impact of COVID-19 on cardiothoracic surgical training.

Method
The national training survey report in cardiothoracic surgery from 2018 to 2022 was obtained from the General Medical Council website. Both trainees and trainers’ survey were included for analysis. Overall satisfaction for both trainees and trainer were compared pre (2018,2019) and post (2021, 2022) pandemic.

Results
Thirty cardiothoracic centres are included in this study. There is a significant reduction in trainee satisfaction pre and post pandemic (76.82 vs 74.53, p= 0.019). However, no differences in trainers’ overall satisfaction were found (67.41 vs 70.41, p=0.52). There was a low correlation between trainee and trainers’ satisfaction pre and post pandemic.

Conclusions
There was a significant impact of COVID-19 on cardiothoracic trainee satisfaction. Individual hospital and deanery should reflect on trainees’ evaluation on the national training surveys report and improve on specific areas if deemed unsatisfactory.
1183 IV Fluid Prescribing: How Can We Improve?
Authors: Campbell L , Kwok K , Leitch F 
Published: August 2024

Abstract

Aim
Intravenous (IV) fluid therapy is frequently utilised in conditions affecting fluid/ electrolyte balance. Its inappropriate use can worsen outcomes. Foundation Year 1 (FY1) doctors often prescribe IV fluids. Understanding IV fluids is therefore key in promoting optimal administration and minimising associated risks. We aim to assess fluid prescribing knowledge amongst our FY1s, and for differences between those who received IV fluid teaching from the Intestinal Failure (IF) Team, and those who did not.

Method
General Surgery FY1s attended IV fluid teaching from the IF Team, subject to availability. A survey was composed of questions regarding daily requirements, fluid composition, clinical scenarios, confidence levels, and relevant teaching. FY1s were surveyed, and the results analysed.

Results
Each FY1 (15) answered 16 questions- the total number answered was 240 98 (41%) questions were answered correctly, 142 (59%) incorrectly Those who received IF teaching answered 43/80 (53.8%) questions correctly, versus 55/160 (40.8%) for those who did not 75% of daily requirement questions were correct among those who received teaching, versus 47.5% among those who did not 50% of fluid preparation questions were correct among those who received teaching, versus 26.3% Clinical scenario answers were 45% correct in those who had teaching, versus 40% Confidence in prescribing maintenance/ replacement fluids was 3/3.2 out of 5 respectively among those who received teaching, versus 2.3/2.8.

Conclusions
Those who received the teaching outperformed their peers, highlighting the session's efficacy. Fluid prescribing continues to pose challenges. Areas for development include more clinical scenario-focused teaching, and production of a ward resource to aid fluid prescribing.
523 Systematic Review of Total Hip Arthroplasty Outcomes in Cerebral Palsy
Authors: Costa C , Moniati F , Chatzimatthaiou M , Chatzimatthaiou M , Papaioannou C , Athanasakopoulou S 
Published: August 2024

Abstract

Aim
Total Hip Arthroplasty (THA) in patients with cerebral palsy (CP) is considered high-risk due to neuromuscular instability, contractures and altered muscle tone. The purpose of this systematic review is to investigate the surgical indication, surgical approach, and clinical outcomes of THA in CP patients.

Method
A systematic review was undertaken in accordance with PRISMA guidelines, encompassing original articles that investigated the outcomes of THA in CP patients and compared it with controls. The systematic literature search was conducted using COVIDENCE® software (Melbourne, Australia). The primary endpoints of interest included: surgical indication, clinical outcomes (complications, survivorship) and surgical approach (cementing, additional procedures, bearing surfaces).

Results
The initial search generated 190 studies out of which 21 met the inclusion criteria. The most frequently reported indication was painful hip dislocation or subluxation followed by treatment failure for prior femoral neck fractures and secondary arthritis. The most frequently reported complication was dislocation affecting overall 7.5% (0-28%) of all patients followed by periprosthetic fractures 5.6% (0-21%) and heterotrophic ossification 4.2% (0-37.8%). The survival rates of primary THAs ranged from 85%-100% at 5 years and from 73%-86% at 10 years.

Conclusions
The current literature suggests that THA is a beneficial procedure for patients with CP through pain reduction and functional improvement. However, the increased rates of potential complications compared to the general population require careful consideration. We suggest that further investigations on the most appropriate time of procedure, implant type and procedure type are needed.
691 The Efficacy of the Transversus Abdominis Plane Block in Abdominoplasty: A Systematic Review and Meta-Analysis
Authors: Taha N , Hodson L , Tong K , Zahari F , Hoo Z L , Wong Y W , Rahman S 
Published: August 2024

Abstract

Aim
The transversus abdominis plane (TAP) block is a regional abdominal anaesthetic technique frequently used within non-cosmetic abdominal surgery. The literature is devoid of a meta-analysis to quantitatively amalgamate the results of individual reports analysing the efficacy of TAP block compared to alternative analgesic methods in abdominoplasty surgery. The authors aimed to conduct the first meta-analysis within the literature to evaluate this technique’s effectiveness in abdominoplasties.

Method
PRISMA guidelines were referred to conduct this systematic review and meta-analysis. All observational and randomised controlled trials (RCTs) comparing the postoperative outcomes of patients who underwent abdominoplasties with TAP blocks versus no TAP blocks were included in this study. The time taken to first analgesia and the amount of analgesia used were the primary outcome measures. The secondary outcome measures include severity of pain, time to mobilisation, and length of stay. Random effect modelling was used for the analysis.

Results
The time taken to the first analgesic was significantly lower in the TAP cohort (p &lt;0.05). In addition, there was a lower incidence of postoperative nausea/vomiting (OR 0.18, 95%CI 0.04 - 0.90, p=0.04). Mean total opioid use and operative time were comparable between the TAP and no TAP groups. A qualitative review of the visual analogue scale for pain amongst the included studies showed that it was lower in the TAP group.

Conclusions
The authors report the first meta-analysis within the literature showing the efficacy of the TAP block in abdominoplasties. Further high-quality trials are recommended to further the current evidence base.
792 Long-term outcomes of laparoscopic versus open gastrectomy for the treatment of localised gastric cancer: a systematic review and meta-analysis
Authors: Chansiriwongs A , Wong P Y , Lau S , Sng D , Wong Q N , Ganesh P , Marini P 
Published: August 2024

Abstract

Aim
As localised gastric cancer (LGC) is one of the most common cancers worldwide, the choice of curative laparoscopic (LG) over open gastrectomy (OG) is widely studied. Yet, the literature surrounding the long-term outcomes of LG remain inconclusive. Therefore, this systematic review and meta-analysis aimed to evaluate the long-term efficacy of LG as compared to OG in the treatment of LGC.

Method
A search strategy was used to identify studies from MEDLINE ®, Embase, Web of Science Core Collection, and the Cochrane Centre for Registered Randomised Controlled trials that investigated the long-term outcomes of LGC treated by LG or OG. All-cause mortality and disease recurrence were defined as the primary outcomes. Secondary outcomes included post-operative complications, length of hospital stay, and pain control. Quality of evidence was assessed using the Cochrane risk of bias tool.

Results
14 studies that compared LG and OG outcomes were included. Pooled long-term mortality (RR 0.96, 95% CI 0.82-1.13) and recurrence (RR 1.16, 95% CI 0.95-1.41) of both groups were similar and did not reach statistical significance (p&gt;0.05). Qualitative analysis also showed comparable post-operative complication rates, however, LG had shorter admissions and reduced analgesia requirements. Generally, the quality of evidence was low with trials at risk of potential bias.

Conclusion
Overall, this review suggests that LG may be preferable over OG in treating LGC, with improved short-term outcomes and noninferior long-term outcomes. However, given the quality of evidence, further studies are required prior to implementing LG as the gold standard treatment option.
838 Review of the Literature on Iris Implantation in Aniridia Patients: Techniques and Clinical Outcomes
Authors: Stobiecka R 
Published: August 2024

Abstract

Aim
This review aims to identify a variety of implantation techniques and their effect on clinical outcomes, and the surgical technique and prosthesis with the most favourable outcomes.

Method
Advanced searches were performed on PubMed, Scopus, Cochrane and Web of Science for studies up to and including 2021, using a set of pre-defined search terms. 17 studies were included in this review.

Results
The most common post-operative complications amongst the studies in this review were secondary glaucoma (47%), corneal endothelial decompensation (35%), retinal detachment (18%), prosthesis decentration (18%), limbal stem cell failure (12%) and vitreous haemorrhage (12%). 53% of studies included best-corrected visual acuity (BCVA) deterioration, of these; 67% used an iris-lens prosthesis, 33% used an artificial iris and none used an endocapsular capsular tension-like ring. 78% included the trans-scleral suture approach, 33% included sulcus implantation and 33% included in the bag implantation. 35% of studies showed all patients had experienced an increase in BCVA; 55% had used the ArtificialIris, 45% had used an iris-lens diaphragm.

Conclusions
There appears to be no definitive answer on which surgical technique and iris prosthesis has the most favourable outcomes. The ArtificalIris has slightly better outcomes throughout this review, however, longer follow-up times are needed. The trans-scleral suture technique is most commonly used, therefore, no real comparisons against other techniques could be made. Overall, iris implantation is beneficial as visual acuity is likely to be improved. Further research into mechanisms of complications, especially glaucomas, is recommended to prevent their formation in the future.
970 The Effect of Diabetes on the Fusion Rate of Spinal Fusion Surgery: A Comprehensive Systematic Review and Meta-Analysis
Authors: Luangboriboon J , Gibson I 
Published: August 2024

Abstract

Aim
Spinal fusion surgeries address back pain by limiting intervertebral movement, but pseudarthrosis, a frequent complication, necessitates further interventions. Diabetes mellitus, known for impairing bone health, may negatively impact fusion rates. This systematic review and meta-analysis were carried out to assess the relationship between diabetes and spinal fusion failure.

Method
A comprehensive literature search was conducted on Cochrane Library, Embase, PubMed, and Web of Science databases for case-control and cohort studies examining the effect of diabetes on the fusion rate of spinal fusion surgery. Data was extracted based on the pre-defined inclusion and exclusion criteria. The Review Manager software, version 5.4, was used to perform all statistical analysis.

Results
Nine studies with 2117 patients were included in the meta-analysis. The pooled odds ratio from nine studies was 0.53 (95% confidence interval 0.37-0.77, P = 0.0008), indicating a significantly lower fusion rate in diabetics. Stratifying studies by operative site showed a non-significant odds ratio for cervical but significant for lumbar. Stratification by graft type revealed a significant odds ratio for autograft and a non-significant odds ratio for allograft/synthetic.

Conclusions
The findings of this study suggest that diabetes could be a risk factor for fusion failure in spinal fusion surgeries. A comprehensive understanding of the role diabetes plays in fusion rates may help refine preoperative risk assessments and patient selection, potentially leading to improved surgical outcomes. This evidence highlights the necessity for further investigations and developing more effective strategies for diabetic patients undergoing spinal fusion.
1105 Patient Satisfaction Using Wide Awake Local Anaesthesia No Tourniquet (WALANT) in Adults Undergoing Hand Surgery: A Systematic Review and Meta-Analysis
Authors: Sze Wong R S , Siu A , Ahmed Z , Talwar C , Nikkhah D 
Published: August 2024

Abstract

Aim
Wide-awake local anaesthesia no-tourniquet (WALANT) is an anaesthetic technique which has grown exponentially within hand surgery. However, evidence is unclear on whether patient satisfaction differs when comparing WALANT with anaesthesia with tourniquets (local, regional, or general).

Method
A systematic review and meta-analysis comparing patient satisfaction in WALANT to anaesthetic techniques with tourniquets amongst adults undergoing elective hand surgery procedures was performed following PRISMA guidelines (PROSPERO registration number CRD42023479937). PubMed, Embase, and Cochrane databases were searched for observational and randomized controlled trials (RCT) studies up to June 2023. Standardised mean difference (SMD) scores for patient satisfaction were computed using the random effects model.

Results
904 articles were identified initially and 18 met the inclusion criteria to be included in the meta-analysis. This yielded a total of 1638 surgeries, 823 surgeries of which were performed under WALANT (50.2%). Patient satisfaction was significantly higher in patients receiving WALANT (SMD 0.58, 95%CI 0.13 - 0.84, p&lt;0.01, I² = 0.86). Subgroup analysis by type of surgery revealed significant differences only in carpal tunnel release (SMD 0.50, 95%CI 0.06 - 0.93, p = 0.03).

Conclusions
This systematic review supports the use of WALANT in elective hand surgery from a patient experience perspective. From our results, patient satisfaction using WALANT for elective hand surgery is equivalent or superior to anaesthesia with tourniquets including general and regional anaesthesia. We can infer that higher patient satisfaction can also be achieved with patients undergoing semi-elective or urgent surgery for traumatic injuries, which can be explored in future studies.
1089 Factors That Influence Cold Ischaemia Time in Deceased Donor Simultaneous Pancreas and Kidney Transplants: Results of a National Transplant Access to Theatre (NTACT) Audit
Authors: Mujeeb M , Borbas B , Tanase A , Aroori S 
Published: August 2024

Abstract

Aim
Various factors prolong cold ischaemia time (CIT) during simultaneous deceased donor pancreas and kidney (SPK) utilisation across the UK, impacting graft survival. However, there is a lack of data on these obstacles; therefore, this multicentre national audit aims to identify the factors that occur between the organs’ arrival at the implanting centre and transplantation.

Method
A prospective audit examining adult deceased donor SPK transplants across five UK transplant centres from February to September 2022. Precise time intervals between pre-transplantation checkpoints and perceived reasons for delays post-arrival at the implanting centre were recorded on RedCap platform. Descriptive statistics were used for analysis.

Results
Data from 29 SPK transplants were collected, with five exclusions for incomplete/incorrect data. Among these, 12 involved donations after brainstem death (DBD) organs and 12 donations after circulatory death organs (DCD). Median CIT for DBD kidneys and pancreas were 12:08 (IQR: 10:45-12:59) and 10:13 (IQR: 8:28-10:33), respectively. For DCD organs, corresponding figures were 10:30 (IQR: 09:13-12:17) and 07:44 (IQR:07:12-09:37). 17% of DCD and 0% of DBD pancreas and 17% of DCD and 4% DBD kidneys exceeded national CIT recommendations. Median times from organ arrival to knife to skin, warm ischemia (WIT) for pancreases, and patient arrival at the theatre were 03:17 (IQR: 03:00-03:48), 00:38 (IQR 00:31-00:43), and 01:41 (IQR: 00:52-01:57), respectively. Delays were reported in 96% of transplants.

Conclusions
This audit highlights significant proportions of organs exceeding national CIT cut-offs and identifies delays in organ utilisation requiring improvement.