bluuebunny/crossref_metadata_2025_split huggingface dataset:
654 Laparoscopic Cholecystectomy in Class III (Morbid) Obesity
Authors: Warrell D , Pessoa L , Oh K E , Manson D , Nageswaran H 
Published: July 2024

Abstract

Background
High Body Mass Index (BMI) has been associated with increased operative-time, conversion to open-surgery and poorer outcomes. Criteria for day surgery often includes BMI, with centres excluding patients with BMI&gt;40kg/m2 . However, as cholecystectomies are routinely performed laparoscopically with low complication rates in patients with higher BMI, this cut-off is being reviewed.

Aim
To examine outcomes of Laparoscopic Cholecystectomy in patients with increased BMI, particularly when comparing patients with morbid obesity (Class-III;BMI&gt;40 kg/m2) to those with lower BMI.

Method
Data was collected between 01/01/2022 and 31/07/2023 from hospitals throughout the Aneurin-Bevan University Health-Board, South Wales, UK. Data on BMI, surgical indication, operative duration, length of admission and 30-day complications, amongst others, was collected.

Results
This study included a total of 1007 patients (77.92% female, 22.08% male). Patients were placed into 5 BMI categories: BMI&lt;25(n=117),25-29(n=284),30-34(n=285),35-39(n=193), and&gt;40(n=135). The median BMI was 31kg/m2 and overall complication-rate 5.36%. There were three 30-day mortalities, one in BMI category &lt;25(p=0.19) and two in 25-29(p=0.06).
When comparing patients with BMI&gt;40 to those with lower BMI there was no significant difference in complications including bile-leak (0%vs1.79%;p=0.35), significant bleed (0.10%vs0.20%;p=0.41) or bile-duct injury (0%vs0.1%;p=0.71). The duration of surgery was increased, almost reaching statistical significance (83.5vs78mins;p=0.05). Due to existing Health board admission criteria, length of admission was significantly raised for BMI&gt;40 (median1vs0days;p=0.00).

Conclusions
This retrospective study finds Laparoscopic Cholecystectomy safe in patients with Class-III obesity with no increased association with intraoperative or post-operative complications. Criteria for day-surgery based solely on BMI&gt;40 appears inappropriate.
1021 Accuracy of Clinical Coding in General Surgery and Its Financial Impact
Authors: Singh A , Adhya S , Khan N , Perera H , Janakan G , O’Hara E , Udall A 
Published: July 2024

Abstract

Aim
To analyse the clinical coding performed at a tertiary centre after patient discharge and compare it with the clinical summary to identify any inconsistency and its financial implications.

Method
Fifty patient episodes were selected randomly between June 2023 and August 2023 under the general surgery department. Clinical notes, discharge summaries and existing clinical codes were scrutinized by liaison with the clinical coding department. Financial losses were noted, and the summary was later presented at the local clinical governance meeting.

Results
A total of £38,760 was lost in 50 patients. Loss incurred was primarily due to incomplete information in the discharge summary, related to the patient’s comorbidities, incomplete diagnosis, and procedure/investigations. These results were discussed in a clinical governance meeting and a poster was made to disseminate the conclusion and improve the quality of the discharge summary.

Conclusions
A total of £38,760 of funding was lost due to discrepancies in the clinical coding. An intervention in the form of a poster and teaching session was conducted for junior doctors and a repeat cycle is planned in the due course of time to improve the quality and minimise the loss of funding.
278 Outpatient "Did Not Attend" Episodes: A Cohort Study Investigating Influencing Factors
Authors: Peter B , Hughes J , Kourounis G , Kanakala V 
Published: July 2024

Abstract

Aim
Outpatient "Did Not Attend" (DNA) episodes represent a significant financial burden to healthcare systems, with an estimated cost of £1 billion for the NHS. Understanding factors that contribute to DNA episodes is crucial for optimizing healthcare resource utilization. We examined a cohort of outpatient clinics within the general surgery department at South Tees Hospitals NHS Foundation Trust to identify factors associated with DNA episodes.

Method
A prospectively collected database of all outpatient clinics was interrogated from 01/01/2021, to 31/03/2023. Information on patient age, gender, appointment type (new vs. follow-up, face-to-face vs. remote), index of multiple deprivation (IMD) decile, and driving distance was recorded for each clinic attendance.

Results
Of 19,769 clinic appointments, 1,509 (8%) resulted in DNAs. Disproportionate number of patients with DNAs resided in the lowest IMD decile (19%), compared to other deciles (range: 6.4%-10%). Driving distance did not differ between attended (median: 16 km, IQR: 6-30 km) and DNA groups (median: 15 km, IQR: 5-30 km). DNA rates did not vary between remote (8%) and face-to-face (7%) clinics. Multivariable binary logistic regression found older age, IMD, and hospital site as predictors of outpatient DNA. Individuals who were younger and from the lowest IMD decile were more likely to DNA.

Conclusions
Outpatient DNA is multifactorial. Travel distance/duration and remote consultations did not influence attendance in our cohort. Working-age patients and those residing in lower IMD deciles were more likely to DNA. Solely relying on remote consultations may not be sufficient to effectively address DNA episodes.
765 Enhancing the Quality of Referrals to Vascular Surgery at a District General Hospital: A Closed-Loop Quality Improvement Project
Authors: Boyce L 
Published: July 2024

Abstract
This quality improvement project aimed to improve the completeness of referrals to vascular surgery from in-patient wards and the Sameday Emergency Care unit at a UK district general hospital. We implemented a comprehensive vascular surgery proforma to enhance the quality of referrals to the department.
Referrals made between 01/01/23 and 01/03/23 were assessed according to Professional Record Standards Body (PRSB) guidelines, which outlines the necessary information to be included in clinical referrals. The new proforma was introduced to all hospital clinicians, enabling them to email completed referrals to a dedicated vascular surgery inbox. To evaluate the impact of the new system, referrals were re-audited between 12/05/23 and 13/07/2023 using the same PRSB criteria.
Significant improvements were observed in the completeness of referrals, as indicated by the percentage of fulfilled PRSB criteria: patient demographics (60% vs. 100%), referrer details (51% vs. 100%), reason for referral (93% vs. 100%), relevant clinical risk factors (60% vs. 95%), medication history (60% vs. 100%), family history (40% vs. 84%), social history (47% vs. 93%), patient ideas concerns and expectations (40% vs. 81%), examination findings (60% vs. 93%), and investigation findings (63% vs. 91%). The median number of fulfilled criteria per referral increased from 2.5 to 9 (out of 10), demonstrating a substantial improvement (p &lt; 0.0001).
Our dedicated vascular surgery referrals proforma had a significant positive impact on the completeness of referrals to the department. This change has the potential to enhance continuity of care, improve clinical prioritisation, promote patient safety, and enhance the overall efficiency of our service.
835 FAMiSH: Fasting Prior to Emergency General Surgery in Hospital – Quality Improvement Project Protocol
Authors: Khirfan H , Shams O , Alexiadis A 
Published: July 2024

Abstract

Aim
This study was conducted to evaluate adherence to preoperative fasting guidelines at the Royal Devon University Hospital, focusing on safety and reducing prolonged fasting particularly in geriatric, diabetic or co-morbid patients.

Method
Data were gathered anonymously over 2 cycles for 4 weeks through patient records and questionnaires to access patient given instructions for fasting to solids and fluids. All patients with emergency surgeries more than 6 hours later were included, excluding emergency operations (NCEPOD) 1 or 2a/2b classification. Issues such as inadequate communication, excessive fasting and medication mismanagement were addressed.

Results
Cycle one revealed that 25% of patients fasted for more than 6 hours, 56.25% did not consume liquids for more than 12 hours, and 25% abstained from drinking for more than 8 hours preoperatively. It was noted that guidelines were not thoroughly adhered to. Some patients missed medications, besides diabetics with prolonged hours of fasting. We have provided a session for junior doctors and nurses, educating on ASA guidelines, and encouraging individualised fasting plans for patients. Information leaflets were distributed to patients for surgery. In the second cycle only 20% and 24% of patients didn’t follow fasting guidelines for solids and liquids respectively compared to 68.75% of patients receiving inappropriate instructions in first cycle, showing significant improvement in care.

Conclusions
In our study we have noted improvement in departmental focus on adherence to fasting guidelines, which advise abstaining from solids up to 6 hours and drinks up to 2 hours prior to surgery, aiding patient safety and improvement of quality of care.
61 Investigating Barriers to Surgical Careers and Addressing the Growing Need for Diverse Role Models in Surgery Through a Mentoring Event
Authors: Hussain S , Jaffar-Karballai M , Beni R , Bridgens A , Gelfer Y 
Published: July 2024

Abstract

Aim
Attrition of females during surgical training remains a significant problem; only 14.7% become consultants. This project aimed to assess barriers to surgical careers and provide diverse role models to support uptake.

Method
A mentoring event was held, first-of-its-kind locally, including surgeons from diverse backgrounds and career stages discussing career journeys, work-life balance, parenthood, and less-than-full-time training. Surveys were disseminated before (“pre-event”), immediately after (“post-event”), and five months later (“follow-up”), to assess longevity of impact. Surveys involved open-ended and Likert-scale questions (‘10=very-much’; ‘0=not at all’) across a series of statements assessing opinion regarding surgical careers. Descriptive statistics and thematic qualitative analysis were undertaken.

Results
Students identifying as female across all year-groups from London completed pre-event (n=25), post-event (n=25), and follow-up (n=11) surveys. More students were considering surgical careers following the event (score ≥7/10: pre-event 76%; post-event 92%; follow-up 91%). The most common uncertainties and worries reduced after the event: work-life balance (pre-event 48%; post-event 24%); and parenthood (32%;24%). However, remaining concerns included the training pathway (32%;36%) and competitiveness (20%;36%), with 18% citing sexual harassment as a deterrent at follow-up. 84% scored ≥8/10 stating the event strengthened their decision to become a surgeon. The event met all expectations, exceeding in 28%. The format was well received (60% scoring 10/10), and 96% signed for additional mentoring.

Conclusions
The value of mentoring through a single evening and early support in decision making is potentially beneficial to career progression for aspiring surgeons. Continuous support in the form of further evenings and long-term mentoring should be explored.
261 PLASTICS-UK (Plastic Surgery Teaching in the Undergraduate Curriculum of Medical Students - United Kingdom): A UK National Collaborative Evaluation of Plastic Surgery in the Undergraduate Medical Curriculum
Authors: Gupta S , Luu J , Shah V , Barnes S ,   PLASTICS-UK Collaborative, Miranda B 
Published: July 2024

Abstract

Aim
Plastic surgery incorporates all anatomical regions, age groups and tissue types; clinical challenges vary from trauma and burns to congenital defects and cancer. Although ∼50% of workload is trauma, it is often misperceived to revolve around cosmetic work. This study investigated national undergraduate plastic surgery exposure and perceptions amongst UK medical students.

Method
Ethical approval was granted. Permission was obtained from 27 UK medical schools. A national survey was conducted (31/03/23-07/07/23). National trends were analysed, with comparisons between established and new medical schools, and surgical and non-surgical aspirants.

Results
Data included 2513 students from 27 UK medical schools. 29.2% had surgical career aspirations. Students perceived plastic surgery as challenging, competitive, and impacting quality-of-life, however most had no formal teaching (56.3%); merely 6.2% had clinical exposure. Breast reconstruction was the most recognised procedure; the least were head and neck cancer surgery, fasciotomy, and hand fracture repair. Students at new medical schools were more likely to overestimate private practice and pursue the profession, but less likely to have sutured (22.2% vs 34.7%). Surgical aspirants were less likely to overestimate private practice, but more confident in their understanding of plastic surgery, and more likely to pursue it (p&lt;0.001).

Conclusions
This was the largest UK national plastic surgery undergraduate curriculum survey to-date. A greater need for undergraduate plastic surgery teaching was determined. Significant heterogeneity across medical schools was identified. Formation of a national undergraduate plastic surgery curriculum, led by professional bodies, may tackle disparities amongst medical schools, improve accessibility and facilitate knowledge in hand trauma and burns.
948 Learning Curve for Single Surgeon Approach of Laparoscopic Peritoneal Dialysis Catheter Insertion Using Freehand Robotic Assistant
Authors: Stephenson J , Sivaprakasam R , Praveen K 
Published: July 2024

Abstract

Introduction
A single surgeon approach to laparoscopic peritoneal dialysis catheter insertion can offer improved efficiency to surgical lists as well as freeing up surgeons to complete other operations or ward jobs. Simple, low risk laparoscopic procedures which can be completed quickly with the aid of a robotic assistant can help hospitals improve efficiency of surgical departments. This study aims to assess the learning curve of a single surgeon approach using the Freehand robotic assistant in peritoneal dialysis catheter insertion.

Method
Seventy-two cases were analysed over a period of three years from 2020-2023, operations involving the Freehand robotic assistant were performed by a single consultant surgeon. The duration of the procedure was one of the main factors evaluated for assessing learning curve. Other factors considered were re-do procedures and post-operative complications.

Results
Total mean operating time was 30.23 minutes. The peak point of the CUSUM chart for operating time was found at case 30, from this point onward trend began to decrease. From the 72 cases 6 had post-operative complications due to peritonitis and 2 had to be re-done due to inadequate positioning.

Conclusions
CUSUM chart indicated proficiency was gained at operation 30. There were minimal replacements necessary and only 6 cases that had post-operative complications all within the first 25 operations. This implies a short learning curve with great potential for improving efficiency with the use of the Freehand robot in simple laparoscopic procedures such as peritoneal dialysis catheter insertion.
599 From Classroom to Theatre: Analysis of an Undergraduate Surgical Mentorship Scheme to Support Tomorrow’s Surgeons
Authors: Kerdegari N , Tandanu E , Lee K , Zakri R , Chandak P , Dasgupta P 
Published: July 2024

Abstract

Aim
Exposure to surgery during medical school is limited. We ran a mentorship scheme pairing students at a medical school with local surgeons to improve undergraduate insight. We evaluated the effectiveness of mentorship in increasing surgical exposure and drivers for students seeking surgical mentorship.

Method
35 surgeons across 7 specialties were recruited and matched with 37 students in years 2-4 for 7 months. Quantitative and qualitative evaluation was done with pre-, mid-and post-scheme questionnaires. Students rated confidence across pursuing a career in surgery, surgical exposure, career insight, understanding the application process, contacts, portfolio development, research knowledge and pursuing extra-curricular activities related to surgery using a 5-point Likert scale. Paired t-tests were performed to measure students’ confidence before and after the scheme.

Results
Of students that completed all 3 questionnaires (n=21), conducting research/audit was most frequently selected as a main goal (81.0%), followed by theatre experience (66.7%) and career progression support (28.6%). The number of students that had assisted in theatre increased by 50%. There was a statistically significant improvement (p&lt;0.05) in confidence ratings across all domains. The greatest improvement was seen in understanding of the application process from 2.33 to 3.52 (p=0.00). 95.2% would recommend the scheme.

Conclusions
Students seek mentorship to develop their clinical and academic skills. Students gained significantly more surgical experience and were better equipped with the knowledge required to pursue a surgical career. Mentorship schemes are invaluable in supplementing the undergraduate curriculum and empowering students.
63 Developing a 3D in Vitro Schwann Cell Model of Myelination for Peripheral Nerve Injury
Authors: Christou A 
Published: July 2024

Abstract

Aim
This study investigated the effectiveness of fabricating engineered neural tissue (EngNT) to develop a 3D in vitro model of myelination for peripheral nerve injury. Additionally, the effect of metformin and sulindac sulfide in nerve regeneration was evaluated by assessing neurite growth in both monolayer and 3D co-culture systems.

Method
Neuronal cells (NG108-15 and SH-SY5Y cell lines) were treated with metformin for 72 hrs in an Incucyte® live-cell analysis system. EngNT cellular collagen gels were fabricated using Schwann cells (SCL4.1/F7), SCL4.1/F7:NG108-15 (1:1) cells or harvested rat dorsal root ganglion cells. NG108–15 cells were co-cultured with SCL4.1/F7 cellular gels. 3D EngNT co-cultures were treated with metformin and sulindac sulfide for 72 hrs. EngNT cellular gels were analysed with transmission electron microscopy (TEM).

Results
TEM evaluation of EngNT co-cultures demonstrated the enfoldment of neurones by Schwann cells resulting in cell-cell contacts and myelination was identified. NG108-15 and SH-SY5Y cells exhibited significant neurite growth with 100 μM metformin being the optimal dose (151.4 ± 3 μM and 108.0 ± 12 μM respectively). Increased neurite growth of NG108-15 neurones was demonstrated with 100 μM (179.3 ± 2 μM) metformin treatment in 3D EngNT. Additionally, significant neurite growth was demonstrated following treatment with 100 μM (203.9 ± 32 μM) sulindac sulfide.

Conclusions
A 3D EngNT in vitro co-culture model of Schwann cell myelination was developed illustrating the cell-cell interaction between Schwann cells and neurones and the formation of myelin in the peripheral nervous system. Metformin elicits significant positive results on neurite growth in vitro highlighting its therapeutic potential in PNI.
522 A Snapshot Audit of Incisional Hernia Rates Following Colorectal Cancer Resection
Authors: Hughes A , Smith L 
Published: July 2024

Abstract

Aim
Incisional hernia is a common complication of colorectal surgery. Recent European Hernia Society guidelines recommend strategies such as small bites closure and off-midline incisions to reduce incisional hernia rates. We aimed to evaluate our centres incisional hernia rate and performance against these categories

Method
All patients undergoing surgery for colorectal cancer in 2020 were included. Operative details including incision location and closure method were collected. Post-operative CT scans were assessed and correlated with clinic letters to determine presence of incisional hernia. Patients were excluded if they underwent re-operation through the midline within 12 months, or if had no imaging after 12 months.

Results
118 patients were included. The incisional hernia rate was 31.4% at a mean follow-up of 24.9 months. Large bites closure (Hughes or loop PDS, n=80) had a higher incisional hernia rate compared to small bite closure ( n=38) (35.0% vs 23.6%). Incisional hernia rates were 44.1% in laparotomy incisions, 37.2% in midline extraction sites, 8% in Pfannensteil extraction sites and 0% in transverse extraction sites. Overall, IH rates in midline incisions were 40.7%, compared to 6.3% in off-midline incisions.

Conclusions
Incisional Hernia rates remain high following colorectal cancer surgery in our institution. Small bites closure and off-midline incisions appear to reduce this risk, but use of these techniques remains low. Work is ongoing to identify and implement strategies to improve uptake of small bites and off-midline incisions.
197 Burden of Traumatic Spinal Cord Injury in SubSaharan Africa: A Scoping Review
Authors: Jesuyajolu D , Ayantayo T , Oyesiji E , Bakare S , Okere M , Adewale O , Zubair A , Ekennia-Ebeh J 
Published: July 2024

Abstract

Introduction
With a varying incidence across populations, traumatic spinal cord injury (TSCI) remains a public health concern of utmost importance, especially in developing countries with an incidence rate ranging from 12.7 to 29.7 per million people and a postulated increase in the number of patients living with the complications of this condition. We reviewed the literature to bring to light the epidemiology, burden, management, and outcomes of TSCIs across Africa.

Method
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used in this study. We included descriptive studies with data on the incidence, presentation, management, and outcomes of TSCIs in African surgical centers. We conducted our search on PubMed and OVID Embase and supplemented it with an extensive review of African Journal Online and Google Scholar.

Results
Thirteen papers were identified from our search. Most papers were from Nigeria (n = 4) and Tanzania (n = 3). In total, our review included 1332 persons across the different centers. There were more males than females (n = 1029/1332, 72%). The most common etiology was road traffic accidents, constituting 44%, while falls and other mechanisms like assault and sports injuries had 28% each. The incidence of TSCI varied from 13 per million population per year in Botswana to 75.6 per million population per year in South Africa.

Conclusions
The incidence of the traumatic condition in certain parts of Africa is significantly higher than in other parts of the world, suggesting the need for an urgent call to action regarding addressing its key drivers.