bluuebunny/crossref_metadata_2025_split huggingface dataset:
O166: Safety and Efficacy of Autologous Fat Grafting in the Treatment of Radiation-Induced Fibrosis and Contour Defects in Head and Neck Reconstruction
Authors: Langridge Benjamin , Abul Ahmad , Nagra Raveenjot , Awad Laura , Jasionowska Sara , Bollen Edward , Frommer Marvin , Sinha Deepti , Thompson Anna , Kalavrezos Nicholas , Butler Peter 
Published: March 2024

Abstract

Background
Multimodal treatment for head and neck cancer results in significant functional and cosmetic morbidity, often through contour deformity and radiation-induced skin fibrosis (RIF), affecting head and neck function and cosmesis. Autologous fat grafting is an emerging treatment for RIF. We conducted a retrospective cohort review of patient outcomes following autologous fat transfer for reconstruction of head and neck contour deformity and RIF.

Methods
A retrospective analysis was performed of patients treated at 2 UK centres between 2009-2022. Patient data collated included demographics, oncological treatment, reconstruction, operative details, and pre- and post-operative patient reported outcome measures (PROMs) including University of Washington Quality of Life Questionnaire (UW-QOL), Derriford Appearance Scale (DAS24) and Patient Outcomes of Surgery (POS). Patients were stratified by indication for AFG.

Results
A total of 45 patients were identified. 89% of patients (85% RIF, 92% contour deformity) reported cosmetic or functional improvement. Two patients (4%) reported no improvement, and three (7%) were lost to follow-up. Psychological health scores improved in patients following AFG for both RIF and contour deformity patients (DAS24, P&lt; 0.0001). The UW-QOL scores revealed statistically significant improvements in multiple functional domains including appearance, activity, recreation, mood, and anxiety in both patients with RIF and contour deformities.

Conclusion
This study demonstrates that AFG is an effective technique for the correction of contour deformity and RIF in patients following treatment for head and neck cancer. Patients suffering from RIF demonstrated significant improvements in both functional and psychological domains.
O87: Stratified Evaluation of Large Language Model GPT-4’s Question-Answering In Surgery reveals AI Knowledge Gaps
Authors: Lonergan Rebecca Murphy , Curry Jake , Dhas Kallpana , Simmons Benno 
Published: March 2024

Abstract

Introduction
Large Language Models (LLMs), such as GPT, are artificial intelligence models designed to analyse vast data and generate coherent outputs, changing the way healthcare professionals access knowledge. Critically, LLMs also present incorrect information confidently, a phenomenon known as hallucination, which is particularly dangerous in the safety-critical field of medicine. The validity of LLM responses to medical queries are being explored generally, however, responses to surgical questions remain poorly quantified. Variations between specialties are important to identify to support strategic LLM improvements.

Methods
We assessed accuracy of GPT-3 and GPT-4 in answering surgical multi-choice questions from the MedMCQA post-graduate question bank. We calculated the percentage accuracy of GPT-4 on all surgical questions (n=23025) and compared this to published GPT-4 performance across the whole MedMCQA dataset. We also analysed variations in performance by topic on a randomised sample of questions manually sorted by surgical specialty (n=1000).

Results
Accuracy rates for GPT-3 and GPT-4 were 53% and 64% respectively, demonstrating significant superiority of GPT-4, however GPT-4's surgical performance remained weaker than its overall MedMCQA performance. Notably, accuracy varied significantly by specialty, with strong performances in anatomy, vascular and paediatric surgery but below-average performances in orthopaedics, ENT and neurosurgery.

Conclusion
This study holds significant implications for the expanding use of LLMs in surgery, especially education. GPT has improved accuracy with sequential developments, however, its performance requires further scrutiny. We recommend ongoing attention on factors underpinning subject-variation in performance to aid strategic LLM innovation.
O162: A Surgically Led Quality Improvement Initiative in Surgical Antibiotic Prophylaxis (SAP): A One-year Review of Practice and Change in an Irish Context
Authors: Giblin Katie , Hill Gerard , Weir Niamh , Gash Sadhbh , Bagwe Isha , Stapleton Alex , Stevens Niall , Hill Arnold 
Published: March 2024

Abstract

Introduction
Amongst growing concerns of antimicrobial resistance, surgical site infection (SSI) remains one of the most common healthcare associated infections. Optimal use of Surgical Antibiotic Prophylaxis (SAP) is critical. Quality Improvement (QI) in this area is often led by pharmacists or infection specialists.

Methods
A two-year, surgically led QI initiative was established in two Irish hospitals in July 2022. Baseline level of compliance with local guidelines with regard four aspects of SAP (indication, agent, timing, and duration) was audited. Change interventions aimed at specific aspects of compliance were trialled. Interventions included; guideline education for prescribers, process changes (editing the sign in/time out sheet) and the application of prescribing nudges (antibiotic duration sticker in post-operative drug chart).

Results
A total of 620 patient records were audited over one year. Pre-intervention compliance with all four aspects of SAP was observed in only 72/303 patients (23.7%). Educational interventions with surgical prescribers led to improved compliance with agent choice (43.5% (71/165) to 65.3% (94/144)). Education of anaesthetists showed improved timing of administration with 10.8% (14/129) of SAP administered post-incision post-intervention compared to 18.9% (21/111) pre-intervention. Application of the SAP duration sticker showed an overall decrease in mean SAP duration from 70.4 hours to 28.2 hours in those patients requiring more than a single SAP dose. Overall compliance levels have improved, thus far, from 23.7% to 39.8%.

Conclusion
Increasing compliance with SAP guidance is a challenge. A multi-faceted, institution specific, surgically led approach grounded in QI methodology shows promise.
O120: Knowledge and perceptions of General and Vascular surgeons and the public on antibiotic resistance: a validated questionnaire study
Authors: Kutyla Kamila , Lam Kyle , Acharya Amish 
Published: March 2024

Abstract

Introduction
Antibiotic resistance is a leading cause of death globally. Surgeons are responsible for a significant proportion of antibiotic prescribing with surgical prophylaxis constituting 15% of all antibiotic prescriptions. Despite this, knowledge and perceptions of surgeons surrounding antibiotic resistance are poorly understood and therefore antibiotic stewardship programmes have failed to target this cohort of prescribers.

Methods
Two parallel surveys were created and distributed to surgeons (n=48) and the public (n=115). Content validity was ensured through a systematic review of the literature. Clinical scenarios testing antimicrobial prescribing practice were included in the surgeon survey. Both surveys were further validated by a multidisciplinary panel of surgeons and consultant microbiologists. A multimodal distribution approach was utilised including face-to-face, email, and patient and public engagement platforms.

Results
Surgeons scored poorly across knowledge domains with 7/9 clinical scenarios answered correctly by less than 50% of participants. Key barriers to adequate prescribing identified were knowledge/education, fear of missing an infection, guidelines, and cultural issues. The most useful interventions identified were formal education to prescribers (70.8%), provision of local antibiotic resistance patterns (64.7%) and increased help from Infectious Diseases/Microbiology/Pharmacy (64.7%). Although public participants demonstrated good knowledge surrounding antibiotic use and antimicrobial resistance, medical professionals were reported to be their major information source.

Conclusion
Surgeon knowledge surrounding antimicrobial resistance can be improved through targeted antibiotic stewardship interventions and addressing barriers identified by this study. Although public participants surveyed demonstrate willingness to improve antibiotic use, behaviour change will be predominantly driven by improved practice by surgeons.
O6: Trends in the mortality, incidence, and disability-adjusted life-years of intestinal obstruction and paralytic ileus: an observational study of the Global Burden of Disease database
Authors: Proctor Dominic , Goodall Richard , Borsky Kim , Salciccioli Justin , Marshall Dominic , Mohamed Abdulla , Shanmugarajah Kumaran , Shalhoub Joseph 
Published: March 2024

Abstract

Background
Intestinal obstruction and paralytic ileus place a substantial burden on global healthcare systems despite its aetiology often being amenable to preventative healthcare interventions. Further characterisation of the disease burden in EU15+ countries may help optimise the delivery of healthcare services. This observational analysis assessed the trends in mortality and incidence of intestinal obstruction and paralytic ileus in European Union (EU) 15+ countries between the years 1990 and 2019.

Methods
Sex-specific age-standardised mortality rates (ASMRs), age-standardised incidence rates (ASIRs) and disability-adjusted life years (DALYs) data for intestinal obstruction and paralytic ileus were extracted from the 2019 Global Burden of Disease (GBD) study. Temporal trends across the observation period were analysed using Joinpoint regression analysis.

Results
The median ASMRs across EU15+ countries in 2019 were 1.96/100,000 and 2.16/100,000 for females and males, respectively. Between 1990 and 2019 the median percentage change in ASMR was -8.11% for females and +5.50% in males. The median ASIRs in 2019 for females and males were 150/100,000 and 133/100,000, respectively, with a median percentage change of +18.7% for females and +15.3% for males during the observation period. Decreasing trends in DALYs were observed over the 30-year study period, with median percentage changes of -11.86% and -5.80% for females and males, respectively.

Conclusion
Overall, increasing ASIRs of intestinal obstruction/paralytic ileus were observed across EU15+ countries, with modest overall decreases in ASMRs. Variations in both diagnostic and management strategies for intestinal obstruction/paralytic ileus over the observation period are likely contributors to the changing disease burden.
O188: Progressive specialisation within General Surgery and minimally invasive techniques: how can we prepare today's surgeons for humanitarian work?
Authors: Walsh Nadia , Maitra Sulagna , Wladis Andreas , O’Sullivan Cliona 
Published: March 2024

Abstract

Background
General surgery has evolved from training a surgeon who was able to perform a variety of procedures to an increase in subspecialists and the narrowing of the specialty’s scope of practice. In contrast, the humanitarian field still demands a broad trained specialist who can work with limited resources, adapted to the cultural context. The present study aimed to explore this gap and propose solutions to the existing problem.

Methods
Qualitative approach using one-to-one semi-structured interviews with surgeons with various levels of experience in the humanitarian field.

Results
Thirteen humanitarian surgeons were interviewed. The main challenges of working in humanitarian environments were limited resources, diverse pathology or distinct presentation of common pathology, lack of referral systems and the decision-making process per se. The field demands a broad trained surgeon with experience in emergency procedures in various subspecialties. The learning process in the ground is more practical than the formal surgical education, therefore, adequate preparation is required prior to deployment. Individual and systemic approaches were suggested by the participants for training of surgeons, although barriers are still numerous. Surgeons who plan to have a humanitarian career must identify the gaps in their training and fulfil them accordingly, and organisations must take approaches to aid surgeons to satisfy these requirements.

Conclusions
There is urgent need to develop formal mechanisms of training and to ensure quality of care through professionalization of humanitarian surgery. Collaboration between organisations and leadership are essential for the establishment of training programmes and for the future of humanitarian surgery.
O97: Long term outcomes after negative appendicectomy: does morbidity justify mandatory pre-operative confirmation of appendicitis prior to surgery?
Authors: Hammett Felix , Ghoneima Ahmed , Nasir Uzair , Saha Arin 
Published: March 2024

Abstract

Introduction
Negative appendicectomy is sometimes described as a quality indicator of an acute surgical service. Previous studies have suggested that negative appendicectomy carries an unacceptably high risk of morbidity and advocate pre-operative imaging to confirm a diagnosis in all cases, despite the resource implications this policy carries. This study quantified long term morbidity after negative appendicectomy.

Methods
This retrospective cohort study identified all patients who underwent appendicectomy for suspected appendicitis from June 2010 to August 2015 at a single centre. Patients with a histologically normal appendix were identified and their notes were interrogated to record outcomes; median follow-up was 10.6 (range, 8 – 13) years. Complications after surgery were classified using the Clavien-Dindo system.

Results
1914 patients had an appendicectomy. 181 patients (9.5%) had a negative appendicectomy. There were 40 re-admissions after surgery; half (20 patients) were within 30 days. The most common causes of re-admission were ongoing symptoms with no identifiable cause (15 patients, 37.5%) or post-operative pain (9 patients (22.5%). Overall post-operative complication rate was 11 patients (6.1%). Of these, 6 patients had Grade 1 or 2 complications, 5 patients (3%) had Grade 3 complications (return to theatre for infection, bleeding or hernia) and none had Grade 4 or 5 complications. There was no mortality.

Conclusions
There is low short- and long-term morbidity after negative appendicectomy which suggests that routine pre-operative imaging to confirm a diagnosis of appendicitis before surgery is unwarranted. The concerns around complications after negative appendicectomy appear unjustified and should not be a quality indicator.
O123: External peri-stomal skin granulations in paediatric tracheostomy: incidence, outcomes and a proposed treatment algorithm
Authors: Kawar Luai 
Published: March 2024

Abstract

Background
External peri-stomal skin granulations after tracheostomy in children are common and may interfere with routine tube changes. This study is the first attempt to describe the incidence and outcomes, along with a proposed treatment algorithm.

Methods
A retrospective review of all inpatient children with a tracheostomy between January 2020 and May 2022 at the Royal Hospital for Children (RHC) in Glasgow. The presence of external peri-stomal granulation, date of onset and resolution, recurrence and treatment modalities were noted.

Results
A total of 50 episodes of peri-stomal granulation were identified in 27 children (52%). Median age at the end of the study period was 4.3 years, with younger children experiencing more frequent granulation. 3 episodes interfered with tracheostomy tube changes. Time to resolution of the granulation was significantly longer with topical steroid/antimicrobial ointment monotherapy, but recurrence was less common when this was used a first treatment modality.

Conclusion
Non-invasive measures such as topical anti-microbials should be used in the first instance when managing external stoma-site granulations. More invasive measures, such as silver nitrate cautery and surgical excision, should be considered if the granulation tissue is not improving or when it poses a risk to safe tube changes.
O209: Stress-induced extracellular vesicles promote EGFR-ERK dependent growth and cetuximab resistance in colorectal cancer
Authors: Mason John , Marks Ewan , Fan Shih-Jung , Wilson Clive , Hamdy Freddie , Harris Adrian , Cunningham Chris , Goberdhan Deborah 
Published: March 2024

Abstract

Introduction
Extracellular vesicles (EVs) are nanoized vesicles, which deliver bioactive cargoes to target cells. Our lab has shown that metabolic stress leads to changes in the trafficking and also the cargo and functions of EVs secreted from colorectal cancer (CRC) cells: a so-called “EV switch”. Proteomic analysis revealed that switched EVs carry increased levels of the EGFR-ligand Amphiregulin (AREG). The aim of this work was to investigate the pro-tumorigenic properties of switched EVs in vitro and in vivo.

Methods
Size exclusion chromatography was used to isolate EVs from HCT116 and Caco-2 CRC cells grown under glutamine-replete and -depleted conditions, and their effect on recipient cell growth measured using the IncuCyte Live Cell Imager. Co-incubation assays with an AREG-neutralising antibody were undertaken to test the role of switched EVs. The in vivo role of switched EVs were investigated using a novel chick embryo model. In addition, we tested whether the growth inhibitory effects of cetuximab could be reversed by co-treatment with switched EVs.

Results
Switched EVs from HCT116 and Caco-2 cells contain increased levels of AREG and promote EGFR-ERK dependent growth in recipient cells in vitro and in vivo. These effects were inhibited by co-treatment with an AREG neutralising antibody. Caco-2 (KRAS-wild type), but not HCT116 (KRAS-mutant), cell growth was inhibited by cetuximab, which was partially reversed by co-treatment with switched EVs. AREG neutralisation reversed this EV-induced cetuximab rescue.

Conclusion
Switched EVs mediate CRC cell growth and cetuximab resistance, and could serve as novel biomarkers to predict treatment response.
O214: The tumour immune microenvironment and its response to exercise during treatment for Oesophagogastric cancer
Authors: Casey Patrick , Tarazi Munir , Powell Arfon , Baker Alexander , Ashton Garry , Valpione Sara , Redfern Jennifer , McGrath Stephen , Sultan Javed 
Published: March 2024

Abstract

Introduction
Pre-clinical studies suggest that exercise during cancer treatment may enhance tumour regression and promote an anti-tumorigenic immune microenvironment. Considering the evolution of immunotherapy in oesophagogastric cancer, further understanding of the host-tumour immune response to exercise therapy is of significant interest.

Methods
Using multiplex immunofluorescence, resection specimens of 30 patients with oesophageal adenocarcinoma were labelled for CD3, CD4, CD8, PD-1, PD-L1, FOXP3, CD68, and PanCK to characterise tumour and peri-tumoral immune infiltrate. All patients received the same neoadjuvant chemotherapy prior to oesophagectomy. 14 patients who engaged with a structured prehabilitation exercise program (mixed aerobic and resistance training twice-weekly) were case-matched with 16 control patients who did not.

Results
The prehabilitation group had a significant increase (per mm2 ) in cytotoxic T-cells (99.4 vs 13.8, p=0.003). There was also a significant increase in immune suppressive macrophages, exhausted T-helper and cytotoxic T-cells. The only significant change in the peritumoural sections was an increase in exhausted CD8 cytotoxic-T cells in the prehabilitation group (3.3 vs 1.4, p=0.043). There was no difference in the number of Treg or T-helper cells within, or around the tumour sections.

Conclusions
This study is the ‘first-in-man’ to show that exercise prehabilitation during chemotherapy impacts on the tumour immune microenvironment in patients with oesophageal adenocarcinoma. Exercise results in an increased abundance of both anti-tumorigenic and immunosuppressive cell types. These finding warrant further investigation, especially in the context of modern immunotherapy treatments, to understand the clinical impact that exercise oncology has on tumour regression.
O84: A systematic review of pancreaticoduodenectomy for pancreatic cancer in randomised control trials to examine variations in operative technique
Authors: Malik Abdullah , Karki Bishow , Mahendran Balaji , Shrikhande Shailesh , Moir John , Smith Andrew , Blencowe Natalie , Pathak Samir 
Published: March 2024

Abstract

Background
Pancreatoduodenectomy (PD) is a complex surgical intervention comprising multiple components which, when delivered differently, can impact outcomes, introduce bias into randomised controlled trials (RCTs) and impair accurate interpretation of results. This study aimed to systematically explore and summarise variation in PD description and standardisation amongst contemporary RCTs in pancreas surgery.

Methods
Systematic literature searches for RCTs of PD were undertaken from 2020 to 2023. RCTs including robotic PD, or other types of pancreas resection (e.g. total, distal), were excluded. An established methodological framework was used to deconstruct the technical aspects of PD were deconstructed into constituent components (pre-operative considerations, before skin incision, incision, dissection, resection, haemostasis, reconstruction, insertion of adjuncts, closure and after closure). Trial reports and protocols were scrutinised to examine whether the components/steps were described, and whether (and how) adherence was assessed.

Results
Of 83 screened articles, 29 RCTs were included, reporting on 3440 patients across 16 countries (1 trial compared pre-operative interventions, 18 trials compared intra-operative interventions, and 10 trials compared post-operative interventions). Forty-one PD steps were identified. No studies described all steps and five did not describe any. Fifteen component parts were described in one RCT. Only three RCTs reported that delivery of PD was recorded and assessed, using intra-operative photographs in all cases.

Conclusions
In a contemporary series of RCTs evaluating PD, descriptions of the procedure were inadequate. Clear descriptions of PD using pre-existing methodological frameworks in future trials are warranted to improve outcomes, decrease bias and facilitate cross-RCT comparisons in systematic reviews.