bluuebunny/crossref_metadata_2025_split huggingface dataset:
FTP4.5 ANKI digital flashcards: an effective tool for undergraduate musculoskeletal revision
Authors: Laurent Edward , Ensor David , Vusirikala Anuhya , Phillips Staton 
Published: August 2023

Abstract

Introduction
ANKI is a programme that allows users to produce digital flashcards consisting of text, pictures and/or videos. It is based on the principle of active recall and spaced repetition creating an effective revision tool.
This study investigated the benefits of ANKI digital flashcards used by 2nd year medical students when revising their musculoskeletal (MSK) module.

Method
A prospective study of 121 2nd year medical students at the Anglia Ruskin University. Learning objectives were stated at the start of each MSK lecture. Each student created ANKI flashcards for the learning objective assigned to them. These flashcards were combined to create a crowdsourced complete MSK deck available to the entire cohort.
Anonymised student feedback was obtained at the beginning and end of the module.

Results
The mean value of a Likert scoring system (1least – 5most) from both surveys was used.
Pre-assignment questions assessing students’ familiarity and aspiration towards ANKI: Use cards as part of revision =3.24; Comfort with IT systems=3.82; Familiar with ANKI system=4.04, Interest in using ANKI =3.88.
Post assignment questions to assess the outcome success: Would you use ANKI for revision =4.55, Use ANKI in other modules =3.95.
Free text responses included praise towards communal effort, manageable workload and creation of a revision resource.

Conclusion
ANKI provided an additional useful digital resource learning and revision for medical students. The cards created by students, for students, provided autonomy. However, this effected the quality of some slides. Overall, the feedback was positive with this assignment expanded to other modules.
FTP5.10 Predictors of re-intervention following index cholecystectomy
Authors: Kho Jason , Kuan Jen Yee , Shetty Vinutha , Date Ravindra , Rajendran Ilayaraja 
Published: August 2023

Abstract

Aim
Index Cholecystectomy (IC) is safe and reduces patient morbidity. However, IC can be challenging due to inflammation of hepatocystic triangle, increasing the risk of postoperative complications. Study was conducted to evaluate factors influencing postoperative complications following IC.

Method
Retrospective review of consecutive IC performed as a primary procedure was carried out between February 2021 and July 2022 in our trust. Primary outcome was postoperative Grade 3 Clavien-Dindo (CDC) complication, in comparison to patients with uncomplicated recovery. Pre-operative factors including age, CRP, WBC, LFT, surgeon grade, modality (laparoscopic/open) and number of previous admissions were included for analysis. Categorical and continuous data were analysed using Chi-Square and Mann-Whitney-U tests respectively. P-value &lt;0.05 was statistically significant.

Results
100 IC were included. Most IC were consultant-led [80/100(80%)]. 11/100(11%) patients developed Grade 3 CDC complication; 4/100(4%) bile leak requiring ERCP and stent insertion, 3/100(3%) post-operative collection requiring radiological-assisted drainage, 2/100(2%) retained bile duct stones requiring ERCP, 1/100(1%) incision and drainage of port site seroma and 1/100(1%) biloma requiring laparoscopic washout. Re-intervention was common in older patients (61±18years vs 55±22years, p=0.04) and higher median peak CRP levels (312±178 vs 154±284, p=0.01). There were no differences in LFT parameters, number of previous admissions or timing of operation from day of admission between the two groups.

Conclusion
Age&gt;65 and higher pre-operative CRP were associated with increased risk of postoperative procedural intervention. Larger prospective studies are needed to confirm these findings. Surgeons should consider these factors for consenting and risk assessment purposes.
FTP7.7 Does bilateral combined Transversus Abdominis Plane (TAP) and rectus sheath block reduce postoperative pain after “hot laparoscopic cholecystectomy” compared to trocar site local anaesthetic infiltration?
Authors: Yang Peiming , Khan Saadia , Daniels Sarah , Jalal Qaiser 
Published: August 2023

Abstract

Introduction
Post-operative pain is the commonest reason for prolonged hospital stay and readmission following laparoscopic cholecystectomy. We aim to assess whether bilateral transversus abdominis plane (TAP) and rectus sheath block reduces post-operative pain compared to local anaesthetic (LA) wound infiltration following “hot” laparoscopic cholecystectomies.

Methods
Prospective study involving 15 patients who underwent laparoscopic cholecystectomy in dedicated “hot lists” between October and December 2022. Post-operative pain scores were recorded 4 hours, 3 days, and 5 days post-procedure. Pain scores of patients who received bilateral TAP and rectus sheath blocks were compared with those who received LA wound infiltration with 0.5% Levobupivacaine.

Results
9 patients received TAP and rectus sheath blocks, and 6 patients received LA infiltration. The time from start of anaesthesia to start of surgery in the TAP block group was significantly higher than the LA group (P=0.039). There was no statistical difference in pain scores on the pain analogue scale (1-10) between groups at 4 hours (P=0.73), 3 days (P=0.27), or 5 days (P=0.33) post-surgery. There was no statistical difference between the 2 groups in length of hospital stay post-procedure (P=0.75), or in re-admission rates due to poorly controlled post-operative pain (P=0.58).

Conclusion
Bilateral TAP and rectus sheath blocks do not significantly reduce pain post “hot laparoscopic cholecystectomy” any more than LA wound infiltration. Given the extra time taken to perform TAP and rectus sheath blocks, a larger study population would be required to more reliably assess their benefits, given the importance of avoiding overrunning of the “hot list”.
FTP8.14 Outcomes and complications of simple layered closure of persistent tracheocutaneous fistula after tracheostomy in childhood
Authors: Wong Tiffany , Macpherson Orla , Docherty Sophie , Gray Joyce , Clement Andy , Kubba Haytham 
Published: August 2023

Abstract

Up to half of all children with a tracheostomy develop persistent trachea-cutaneous fistula (TCF) after decannulation. Surgical closure of it is technically easy but post-operative complications can be immediate and life-threatening. We reviewed our experience in TCF closures to identify potential risk factors for complications.

Methods
Retrospective case records review of all children (0-16 years) who underwent surgical TCF closure between January 2010 and December 2021 following the development of a persistent TCF after decannulation of a tracheostomy.

Results
67 children were identified. They ranged in age from 14 months to 16 years (median 3 years 10 months) at the time of the TCF closure. Major medical comorbidities were present in 90%. Pre-operative pulse oximetry with the fistula occluded was used in 29 children (43%). An underwater leak test was performed in 28 (42%). A non-suction drain was used in 29 children (43%). Prophylactic antibiotics were prescribed for 30 children (45%). Post-operative complications occurred in 15 children (22%): life-threatening air leak occurred in the immediate post-operative period in 2 children (3%) and respiratory distress in 3 children (4%) in the recovery area immediately after surgery. None required re-tracheostomy. Three children suffered post-operative pneumonia (4%), and wound infections occurred in 8 children (12%). We were unable to show a significant association between patient or surgical factors and complications.

Conclusion
Further analysis of the potential associations between patient factors, surgical factors, and complications is necessitated in guiding future practice.
4 How we do it: laparoscopic cholecystectomy in patients with severe obesity
Authors: Russell Thomas , Aroori Somaiah 
Published: August 2023

Abstract

Aims
The number of patients with obesity is set to rise, as is the proportion with severe obesity. These patients are a high-risk subgroup who present additional challenges to the surgeon when performing laparoscopic cholecystectomy (LC). It is important that all surgeons who perform this procedure have a safe strategy they can revert to so that morbidity is minimised. Here we outline our approach.

Methods/Results
After obtaining a pneumoperitoneum via a supra-umbilical incision, we advise placing a fascial suture before proceeding with the operation. This allows for high-quality closure, reduces the incidence of incisional hernia, and reduces the risk of an inadvertent bowel injury. We also advise the repositioning of the patient on the operating table prior to port placement such that an ergonomic set-up can be achieved. In addition to the standard ports, we use an additional twelve millimetre port in the left upper quadrant (LUQ). A fan retractor can then be inserted via this port and used to gently retract the duodenum inferiorly. This provides adequate exposure for Calot’s dissection and arguably reduces the risk of injury to a fatty liver. This technique can also be used in non-obese patients in whom Calot’s dissection is particularly challenging e.g., those who undergo delayed LC.

Conclusions
When performing LC in obese patients, one can consider placing an additional twelve millimetre port in the LUQ. A fan retractor can then be used to gently retract the duodenum inferiorly to improve access and reduce the risk of injury to a fatty liver.
62 Does vitamin D deficiency lead to poorer health outcomes after (total) knee arthroplasty? A systematic review and meta-analysis
Authors: Vivek Kavyesh , Kamal Rayan , Perera Edward , Gupte Chinmay 
Published: August 2023

Abstract

Aims
Vitamin D deficiency is a predictor of poorer musculoskeletal disease outcomes and affects approximately 1-in-4 people. Prior literature has assessed the effects of vitamin D deficiency in joint arthroplasties. This updated systematic review and meta-analysis aims to evaluate and collate evidence available on vitamin D supplementation in total knee arthroplasty (TKA).

Methods
A targeted terms search related to vitamin D and TKA outcomes was conducted (data inception until 01/09/2021). PubMed, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov, American Academy of Orthopaedic Surgeons and British Orthopaedic Association databases were used. Analyses consisted of forest plots with I2 heterogeneity statistics, pooled effects with 95% confidence intervals (CI) and, p-values. A p &lt; 0.05 was considered statistically significant.

Results
10 studies fitted inclusion criteria for narrative description and 3 for meta-analysis. 6 studies showed improved outcomes in revision surgery risk, joint infection incidence and postoperative function. Additionally, there were poorer outcomes in postoperative stiffness, prosthesis explanation and postoperative vascular events. Meta-analysis of the length of hospital stay (LOS) demonstrated a significant decrease in LOS between vitamin D sufficiency versus deficiency (standard mean difference = -0.54, 95% CI [-0.69, -0.38], p&lt;0.00001) favouring vitamin D sufficiency.

Conclusion
Vitamin D supplementation demonstrated a statistically significant benefit for TKA patients regarding LOS. Most studies found positive effects of vitamin D supplementation improving patients’ health, reducing hospital resource use, and decreasing the burden on surgeons. Further research with standardised assessment scores is required to definitively prove the vitamin D screening and supplementation benefits in TKA.
113 Exploratory laparoscopy in suspected bowel obstruction secondary to a transmesenteric hernia
Authors: Aguilera Beatriz Carrasco , García Miguel Martinez-Cachero , del Val Ruiz Pablo , Prieto Andres Cembellin , Rodicio Miravalles Jose Luis , Granero Trancón Jose Electo 
Published: August 2023

Abstract

Background
Transmesenteric hernias (TH) in adults are an uncommon subtype of internal hernia that can be life-threatening because of the risk of bowel ischemia if not correctly diagnosed.

Case report
A 79-year-old man came to the emergency department with abdominal pain associated with vomiting and constipation for 24 hours. Physical examination showed no alarm signs. However, due to the presence of leukocytosis with neutrophilia and an abdominal X-ray with suspected obstruction, an abdominal CT scan was requested. Given the radiological finding of a defect in the mesentery through which a portion of the mesentery and several loops of bowel were introduced, an exploratory laparoscopy was indicated on suspicion of TH. Intraoperatively, 150 cm from the ileocecal valve, a 30 cm congestive segment of jejunum was observed, which was inserted in a 4 cm long eyelet in the omentum. Reduction of the herniated small bowel loops through the eyelet was performed without difficulty, observing good viability of the loops, and the eyelet was opened with scissors leaving the omentum open at the distal end. The patient was discharged on the 5th postoperative day tolerating oral diet, with transit and the surgical wound without signs of infection.

Conclusion
Although CT is the best diagnostic test for TH its preoperative diagnosis remains difficult. In the case of suspected TH, early exploratory laparoscopy is a correct technique that can preserve the viability of the bowel.
177 Impact of Covid Pandemic on Cholecystectomy Waiting Lists in NHS Highland: Lessons and Opportunities
Authors: Brown Jasmine , Grant Alan , Aboutaleb Esam 
Published: August 2023

Abstract

Aims
The standard waiting time for elective surgery is 18 weeks. However, it continues to face pressure. We aimed to look at:

Methods
Retrospective data of patients listed for a cholecystectomy throughout the health board from April 2019-June 2022 were collected using electronic records. Patients removed from the list were excluded. Data was collected on patient demographics, hospital listed/performed, waiting list length, surgical approach and post-operative outcomes.

Results
278 patients were included. 79% operations were listed centrally with 52% performed there. 72% were female and 28% male. The average age was 53.6 years (22-91).
Of those listed 45% underwent surgery. The average waiting time was 106 days overall (5-1024), 110.5 in 2020, 156 in 2021, 57.5 in 2022, 78% being performed within target. 98.4% were laparoscopic and 1.6% converted. 88% of operations were elective and 12% emergency. 1 patient had malignancy on pathology. 15 patients had complications with 3 bile leaks (2.4%).
22 patients were admitted whilst waiting for a total of 36 days, costing an estimated £14,400. 64% received an emergency operation during admission, all which were performed centrally (p=&lt;0.05)
Length of stay was shorter at C (p=&lt;0.05) and equivalent at B. Complications were lower at C (7.7%) and B (11%) compared to centrally (13%).

Conclusions
Patients are waiting longer for cholecystectomies with increased financial burden. Complications rates have increased, especially bile leaks which needs to be investigated further. Rural hospitals can be safely used to alleviate pressures.
361 A comparison of confidence at the start of a general surgical rotation between first and second rotations of foundation year one doctors in a busy district general hospital
Authors: George Jayan , Savage Daniella , Wafai Ahmad Hisham , Vasas Peter , Yeluri Sashidhar 
Published: August 2023

Abstract

Aims

Methods
FY1 doctors were surveyed in December 2022. Ten questions used Likert scales (1 to 5: not at all confident to very confident) to assess general surgical patient management. One question focused on education methods and one open question. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results
10 FY1 doctors (10/10) completed the pre-questionnaire in their first rotation. 6 FY1 doctors (6/9) completed the pre-questionnaire in their second rotation.
All second-rotation respondents had a previous medical rotation.
Confidence levels were higher for FY1 doctors at the start of their second rotation in surgery than those in their first rotation.
Areas, where FY1 doctors in their first rotation had higher confidence levels, were: maintenance fluid therapy, managing biliary disease, managing non-specific abdominal pain and speaking to a patient about their management when their condition is unknown.
Most FY1 doctors in the first rotation felt that case-based discussions would be the preferred method to increase understanding in general surgery whereas most second rotation FY1 doctors preferred method was group teaching would be.

Conclusions
Confidence levels were higher in the doctors on their second rotation than in their first. Further targeted teaching may support increasing confidence before the rotation.
482 A closed loop audit showing learning from the National Audit of Small Bowel Obstruction at a District General Hospital
Authors: Mallon Aoife , Gallagher Charles 
Published: August 2023

Abstract

Aims
The National Audit of Small Bowel Obstruction (NASBO) was a prospective study in 2017 that gave recommendations for small bowel obstruction (SBO) management. Those were; early CT, increased use of water soluble contrast for prognostic and therapeutic purpose, early assessment of nutritional status and involvement of nutritional specialists. Our DGH had not been part of this study so we wanted to compare our practice.

Method
We identified 35 patients from admissions records with SBO over an eight week period and reviewed their online records. We presented the findings of our practice in comparison to NASBO at an Audit and Governance meeting, reiterating the recommendations of NASBO. We closed the loop on this audit one year later, identifying 18 patients on reaudit.

Results
Referrals; ED: (NASBO/ 1st Audit/ Reaudit) 68%/91%/95%, GP: 18%/6%/0%.
Aetiology; herniae 19%/50%/16%, adhesions: 54%/25%/61%.
Management; early surgery: 24%/33%/22%, Conservative: 49%/58%/66%, Delayed surgery: 20%/9%/11%.
Radiology Assessment; CT: 80%/88%/94%, AXR + CT: 65%/75%/88%, Water soluble contrast: 21%/12%/44%, Average days to CT: 2.2/0.18/0.43.
Nutrition; Identified as Malnourished: 32%/6%/5%, No oral intake &gt;5days: 49%/44%/17%, Parenteral Nutrition: 14%/6%/17%.
Outcomes; Death: 8%/9%/10%, Readmission: 13%/0%/22%.

Conclusion
Our results show a lot of similarity to NASBO's despite low admissions. Our department improved upon already high CT rates although we increased our percentage receiving both AXR + CT, ergo higher radiation received. There was a marked increased percentage receiving water soluble contrast, our standout improvement. There was no improvement with our nutritional assessment though an increased percentage received parenteral nutrition.
500 CT imaging requests in Major Trauma Patients
Authors: Marzouqa Natalie 
Published: August 2023

Abstract

Introduction
There is a correlation between adequate CT Trauma orders and accuracy of radiological reporting. In this audit, the aim is to improve accuracy of reporting by following the Royal College of Radiologists (RCR) indications for polytrauma CT imaging in the document ‘Standards of practice and guidance for trauma radiology in severely injured patients, 2nd edition’. Standard 7 in this guidance states that a CT request in the trauma setting should comply with the Ionising Radiation (Medical Exposure) Regulations justification regulations in the same way as any other request for imaging involving ionising radiation.

Method
Clinical information in CT orders of 57 major trauma patients in the East Midlands Major Trauma Centre were reviewed against ‘Standards of practice and guidance for trauma radiology in severely injured patients, 2nd edition’. The request should have two essential pieces of information: mechanism of injury and suspected injuries. In these 57 patient, 96% had appropriate requests. Since the target is 100%, an email was sent out and a teaching session was carried out to improve practice. A second cycle including 80 patients in the same centre was carried out.

Results
Before intervention, 96% of the CT in major trauma patients were compliant with guidelines. After intervention, this improved to 100%.

Conclusion
Compliance with RCR criteria improved after intervention, this surely helped avoid unnecessary radiation exposure and enhanced radiological reporting in major trauma patient scans.
556 Bolam law for medical negligence, external factors and exceptional circumstances: Is this law still fit for the 21st Century? A literature based review
Authors: Magsi Abdul Malik , Qasim Muhammad , Umair Musab Bin , Singh Krishna K , Sajid Muhammad S , Sains Parv 
Published: August 2023

Abstract

Objective
The objective of this article is to evaluate the fitness of Bolam law (1957) for medical negligence under times of great change in healthcare provision, scarcity of resources, rapidly changing technologies, and exceptional circumstances of a pandemic.

Methods
An extensive review of medical and legal literature was undertaken that detailed the Bolam and Bolitho tests of negligence.

Results
For the medical professional, Bolam enhanced certainty by providing medical professionals with confidence that contradictory perspectives would not necessarily be seen in law as evidence of substandard care. From a patient’s perspective, however, Bolam was perceived to have established a climate of deference to the medical profession with an arguable abdication of responsibility to clinicians as the experts. The House of Lords decision (Bolitho v City) in 1997 signalled a shift away from Bolam, possibly having restored it back to its proper limits. Bolitho moved away from the second part of the Bolam test, that of the ‘responsible body of medical men”, ensuring that peer professional opinion which was said to represent evidence of responsible medical practice could be departed from, if that opinion was determined by the court to be “not capable of withstanding logical analysis,” or was otherwise “unreasonable” or “irresponsible.”

Conclusion
Medical negligence is a complex situation that is underpinned by the setting of a standard of care through various mechanisms involving the surgical community, hospital leaders and management, the judiciary, lawyers, and expert witnesses. The current system is adversarial and arguably lacks compassion for all parties.
598 Expediting the journey of venous disease management by adopting (one stop vein clinic)
Authors: Ashoor Yasser 
Published: August 2023

Abstract

Introduction
As a third of the UK's population is estimated to be affected by varicose veins, which cause around 10% of complications, varicose veins represents a significant part of the surgical workload.
To receive their diagnosis and be listed for treatment, patients must attend two outpatient appointments interrupted by ultrasound scans provided by radiographers.
Statistical analysis indicated that there was a significant delay from referral to treatment exceeding eight months as a result of a shortage of radiographers which resulted in a delayed ultrasound.

Aims
Speeding up the management can be achieved by incorporating diagnostic imaging input within the outpatient department by creating a One Stop Clinic where the patient will be examined in the clinic and undergo ultrasound scan by the same vascular surgeon before receiving the management plan in the same setting.

Methods
A project was started on March 2022 by allowing a vascular surgeon to scan patients under supervision of a radiologist till he is confident to perform it independently. Data showed that 111 patients were scanned in 8 months and were provided the decision plan to intervene immediately following the scan. Treatment was received within 6 weeks following the clinic visit.

Conclusion
In addition to benefitting patients by providing immediate management plans and early treatment, one-stop vein clinics will also assist in saving the NHS resources, clinic spaces, and costs. Furthermore, it will reduce the workload of radiographers and assist vascular surgeons in mastering the skills of ultrasound, which are becoming a cornerstone of modern vascular surgery.