bluuebunny/crossref_metadata_2025_split huggingface dataset:
O026 The surgical datathon - a high-yield learning model for students: a mixed methods analysis
Authors: The C , China M , Jain R , Joshi S , Pandit A 
Published: May 2023

Abstract

Introduction
Datathons are high-yield research events where cross-disciplinary researchers collaborate to investigate pertinent healthcare problems by analysing multimodal electronic patient data. This paper aims to demonstrate the value of a surgical datathon as a learning model in students using both objective and qualitative assessments.

Methods
Fifteen individuals were recruited for the 24-hour datathon with representation from medicine, psychology, and clinical neurosciences including two postgraduate neurosurgery faculty. All reported interest in learning more academic skills. The aim was to solve a pertinent neurosurgical challenge, namely the prediction of intracranial pressure based on brain MR-imaging, with the goal of completing a full manuscript within 24 hours.
Participants were trained and split into smaller open working groups, supervised allowing real-time specialist feedback. Groups intermittently merged to cross-collaborate. Surveys with mixed-methods analysis explored participant opinions and the value of developing research skills at multiple time points.

Results
Participants’ knowledge were tested showing an increased mean test score post-datathon (69.92%) compared to pre-datathon scores (57.31%). Wilcoxon signed-rank test results demonstrated a significant change for these results (p=0.04, 95% CI -27.21 - -0.04). Likert-scales showed that majority of participants strongly agreed that the datathon accelerated their productivity (58.3%). Data collection was rated particularly useful (100%) despite majority being less than confident in analysing neuro-radiological images (84.6%) pre-datathon. Time pressures were the largest barrier participants faced (47.1%).

Conclusion
A full manuscript was produced and the datathon goal was met with conference acceptance. Surgical datathons represent a pragmatic learning model for students of all backgrounds.
O027 Exploring the educational value of the general surgery handover – an international survey of surgeons and surgical trainees
Authors: Egbe A , Gerogiannis I 
Published: May 2023

Abstract

Introduction
Restrictions in working hours for trainee doctors across the globe have led to an increased number of patient handovers. Little is known about the educational value of handover meetings in general surgery. This international study aims to evaluate surgeon and trainee perceptions regarding the educational value of handover meetings in general surgery, and to identify factors that influence the educational value of handover meetings.

Methods
A 19 item online survey was distributed to surgeons and surgical trainees internationally. The survey questions consisted of demographic information, questions requiring a Likert scale response, and free text responses. Free text responses were analysed using thematic analysis.

Results
There were 79 initial responses to the survey, however there were 44 eligible respondents who completed the full survey. 90.1% of respondents stated that the handover meeting was valuable to them in learning about post-operative complications. 93.2% of respondents stated that the handover meeting was valuable to them in learning about surgical decision making. Key themes included time pressures as a barrier to the educational potential of handover, and the importance of feedback during handover.

Conclusion
This study suggests that there is substantial educational value to the general surgery handover meeting for surgeons across the world. It appears to be particularly useful to surgeons in learning how to make management decisions, learning about post-operative complications, utilising case-based education techniques, and engaging in effective and meaningful feedback around patient management. We recommend that these findings should be used to prioritise education in surgical handover meetings.
O029 Adverse renal outcomes following endovascular or open repair of infra-renal and supra-renal abdominal aortic aneurysms: a systematic review and meta-analysis
Authors: Tsai J , Brown T , Pouncey A , Powell J , Bicknell C 
Published: May 2023

Abstract

Introduction
This study aims to quantify the risk of permanent renal dialysis for AAA repair, with comparison between endovascular (EVAR) and open repair (OAR) techniques for suprarenal (SR) and infrarenal (IR) AAA.

Methods
Systematic review, meta-analysis and meta-regression of post-operative, permanent dialysis outcomes were performed, following PRISMA guidance (Prospero registration: CRD42021272422). Database searches were conducted on MEDLINE, Embase, CENTRAL using ProQuest Dialog. We included data published after 2011, reporting primary elective AAA repair, for a minimum of 100 patients with &gt;75% of operations undertaken after January 1, 2000.

Results
Seventy-nine studies (IR AAAs: 54877 EVAR & 7145; SR AAAs: 4241 EVAR & 1723 OAR) were included (n=67986). Overall, low rates of permanent dialysis were reported: 0.35% of IR-EVAR, 0.68% IR-OAR, 0.82% SR-EVAR, and 0.59% SR-OAR. No significant difference in the risk of permanent dialysis for endovascular and open repair was observed (EVAR vs. OAR: odds ratio (OR) 0.52 95% CI[.06, 4.78], for IR, 2.14 [.46, 10.05], for SR). A lower risk of permanent dialysis was observed for IR vs. SR EVAR (OR .05 [0, .46]). Meta-regression indicated that post-operative permanent dialysis decreased over time as determined by study midpoint for IR-EVAR and IR-OAR. For IR-OAR, increased dialysis rates were significantly associated with study participants’ ages.

Conclusion
The rate of permanent dialysis &lt;1% for all modalities of SR and IR AAA repair. For EVAR, the risk of dialysis was higher for SR compared to IR AAA. The likelihood of permanent dialysis has decreased with modern practice yet increases among older patients.
O032 Gastrointestinal and satiety responses to oral feeding in participants with obesity compared with those of healthy weight: an MRI study
Authors: Althubeati S , Simpson E J , Bush D , Hoad C , Elgdeghaidy S , Gowland P , Macdonald I A , Lobo D N 
Published: May 2023

Abstract

Introduction
Satiety is regulated by behavioural and physiological mechanisms. This study aimed to investigate the effects of food ingestion on subjective satiety, gastric emptying, mesenteric blood flow, and blood glucose concentration.

Methods
Twenty healthy males (10 Lean:10 Obese) were recruited to the study. Gastric content volume (GCV) and superior mesenteric blood flow (SMABF) were measured by magnetic resonance imaging (MRI) (Philips 3T Ingenia and dStream Anterior Coil at baseline) during fasting and immediately after a standard meal (2.5MJ, 78g Carbohydrate, 24g Protein, 21g Fat) and then every 30-minutes for four hours. Gastric emptying rate (GER) was derived from GCV. Blood glucose (BG) and combined satiety scores (CSS; 0–100 mm visual analogue scale) were measured. Data were presented as mean (SD).

Results
Participants in the lean (age: 38(14) y, BMI: 24(2) kg/m2) and obese (age: 38(13) y, BMI: 34(3) kg/m2) groups showed no statistically significant differences in fasting CSS [39.1(22.6) vs. 30.9(13.5) mm], GCV [59(32.6) vs. 58(29.6) ml], SMABF [7.7(2.5) vs. 6.5(2.6) ml/s], and BG [4.5(0.8) vs. 4.2(0.5) mmol/l]. In response to eating, no differences were seen in CSS, GCV, BF, and BG between the groups. Postprandial CSS correlated positively with GCV (R2=0.42, P&lt;0.001 vs. R2=0.30, P&lt;0.001). GER did not differ between the groups (1.7 vs. 1.8 ml/min). Participants with obesity reported lower satiety scores immediately after eating [85(22.6) vs. 67(22.7) mm] and across the 4 hours (P&lt;0.05).

Conclusion
Participants with obesity reported lower postprandial subjective satiety. However, this did not appear to be related to gastrointestinal function.
O033 Intraoperative margin assessment in breast conserving surgery using immunoguided labelling with Tenascin-C antibody
Authors: Kanth S , Sunggoro D , Ngai V , Tai J , El Sheikh S , Ahmed M 
Published: May 2023

Abstract

Introduction
Extracellular matrix protein tenascin-C (TNC) is a new potential target for visualising tumours and their response to neoadjuvant chemotherapy (NACT). The application of chemotherapy and radiotherapy to cancers, results in an elevation of tenascin-C. This retrospective cohort analysis investigates whether Tenascin-C can be used as a predictor of responsiveness to chemotherapy and in intraoperative margin assessment in breast conserving surgery post chemotherapy.

Method
A feasibility study with Twenty-four breast cancer patients who had received NACT recruited from a single centre. The distribution and intensity of TNC expression in paraffin embedded breast specimens were analysed using a pre-determined scoring system. These scores were then correlated with the patients’ clinicopathological characteristics and ‘PREDICT’ scores.

Results
TNC was strongly expressed in the cancer tissue post NACT and was greater in the tumour-associated stroma than in the tumour cells. PR-positive cancers and patients with better post-surgical ‘PREDICT 10’ tended to have greater TNC expression. More invasive cancers eg triple negative breast cancer had TNC expression that was more pronounced at the tumour invasive border. Increased TNC expression in the center of tumour was corelated with a better pathologic response to NACT.

Conclusion
This study shows that TNC is strongly expressed in the stroma of post-NACT breast cancer tissue, and may be linked to pathologic response to NACT, tumour phenotype, and prognosis. There are many potential clinical applications. TNC can be used a s (1) predictor of responsiveness to NACT and/or adjuvant therapies, (2) therapeutic target and (3) prognostic marker.
O034 Exploring neutrophil-lymphocyte ratio as a predictor of postoperative breast cancer overall survival
Authors: Jaffer A , Cullinane C , Feeney G , Jalali A , Merrigan B , Baban C , Buckley J , Tormey S 
Published: May 2023

Abstract

Introduction
Neutrophil-lymphocyte ratio (NLR) is an established strong predictor of mortality in colorectal, hepatocellular, gastric, pancreatic and lung cancers, however there is limited evidence regarding breast cancer. The relationship of the host immune system and tumour biology plays a known integral role in oncological outcomes. The NLR provides an approximate quantification of host inflammatory response in advancing or more aggressive tumours. Routine inclusion of the full blood count in preoperative workup thereby offers a possible cost-effective prognostic biomarker. This project explores the association between preoperative NLR and breast cancer overall survival.

Methods
This retrospective cohort study reviewed an institutional database of breast cancer patients undergoing primary curative surgery at University Hospital Limerick from January 1, 2010 to June 1, 2017. The primary endpoint studied was overall survival. Log-rank testing examined overall survival between groups of patients with NLR &lt;2.5 and NLR ≥2.5.

Results
In the included cohort of 579 cases, the mortality rate was 18% (n=105). The cohort had a median preoperative NLR of 2.63 (SD 1.42). Patients with NLR ≥ 2.5 were significantly associated with poorer overall survival (HR 1.71, 95% CI 1.12 to 2.60, p=0.011). Median survival time is not available for this dataset at this time and will be reported upon longer follow up.

Conclusion
Preoperative NLR ≥2.5 was found to be an independent predictor of breast cancer overall survival. Analysis of this data is ongoing to adjust for confounders, as well as evaluate recurrence free survival.
O044 The PI-RADS 3 lesion. Can we use a higher PSA density to reassure patients with MRI PI-RADS 3 score?
Authors: Natarajan M , Yousaf A , Abou Chedid W , Moschonas D , Patil K , Kusuma M , Langley S , Perry M 
Published: May 2023

Abstract

Introduction
Prostate cancer has the second highest cancer incidence worldwide. Diagnosis of clinically significant prostate cancer (CSPC), defined as Gleason ≥3+4 or ≥ISUP 2, is underpinned by Prostate Imaging-Report and Data System (PI-RADS) scoring on MRI and serum PSA, with confirmation with prostate biopsy. Positive predictive value of PI-RADS 3 for CSPC is 13%. A PSA-density threshold of 0.15-0.18 ng/mL/cc is commonly utilised to justify biopsy vs PSA monitoring for PI-RADS 3.

Methods
Retrospective analysis of MRI, PSA and pathology results for consecutive patients undergoing diagnostic investigations for prostate cancer between November 2021 and March 2022.

Results
Average age of 200 males was 66.4 (SEM 0.62). MRIs reported 6% ≤PI-RADS 2, 61.5% PI-RADS 3 and 32.5% ≥PI-RADS 4. Among the PI-RADS 3 (n=123), average prostate volume was 70.0cc (SEM 3.21) and PSA density was 0.12 (SEM 0.01). 17.9% PI-RADS 3 patients underwent prostate biopsy although just 8.9% had PSA-density &gt;0.18 ng/mL/cc. 40.9% biopsies identified CSPC with average PSA-density 0.23 (SEM 0.06). Conversely, for the 59.1% biopsies with no cancer or non-CSPC, average PSA-density was 0.14 (SEM 0.03) (p 0.078).

Conclusion
Almost 3/5 prostate biopsies carried out in patients with PI-RADS 3 lesions revealed non-CSPC or no cancer. There was a notable difference in PSA-density among PI-RADS 3 patients with biopsy-proven CSPC vs. non-CSPC or benign histology. Based on our institutions experience, we would propose a 0.2 ng/mL/cc PSA-density threshold when recommending biopsy over PSA monitoring for MRI reported PI-RADS 3 to improve patient selection for biopsy to identify CSPC.
O049 Interleukin-16 in flush effluent fluid as a biomarker for kidney viability prior to transplantation
Authors: Dobbins J , Cheemungtoo G , Tingle S , Mahendran B , Bates L , Amer A , Sen G , Hammond J , Figueiredo R , Talbot D , Manas D , White S , Sheerin N , Ali S , Wilson C 
Published: May 2023

Abstract

Background
Kidney transplantation is limited by the number of transplantable organs. Biomarkers that can predict organ viability will reduce the number of organs currently discarded (13% UK, 2021-22, NHSBT). The kidney microcirculation can be flushed, prior to transplantation, with preservation solution as part of the back-table preparation. The effluent fluid is usually discarded, but we propose this as a source of potential biomarkers. Interleukin-16 (IL-16) is a pro-inflammatory cytokine previously shown to predict viability in liver grafts. Here we examine IL-16 in the context of kidney viability.

Methods
IL-16 concentration was measured, in the flush effluent, using an electrochemiluminescent multiplex assay. The total protein content of each sample was concurrently measured to normalise the concentration. IL-16 concentrations were then compared to donor characteristics and early transplant outcomes.

Results
Samples were collected from 30 transplanted kidneys (10 DCD, 10 DBD, 10 live donor) and 5 declined kidneys (4 DCD, 1 DBD). IL-16 concentration was significantly higher in DCD kidneys (mean 81.8+/-38 (SD)) compared to live donor kidneys (17.7+/-18 pg/ml) (p=0.0001). CIT did not affect IL-16 concentration (β=-0.014, p=0.4), nor was IL-16 able to predict delayed graft function. However, IL-16 was significantly higher in kidneys declined for transplantation (transplanted: 54.7+/-30 vs non-transplanted: 98+/-43, p=0.03).

Conclusion
Flush effluent is a rich source of potential biomarkers. IL-16 concentration in flush effluent fluid correlates with organ quality. With real-time assessment, it will be possible to identify kidneys currently discarded; that are either transplantable directly or would benefit from advanced therapy prior to transplantation.
O055 Robotic appendicectomy: a systematic review of feasibility
Authors: Arang H , El Boghdady M 
Published: May 2023

Abstract

Introduction
Acute appendicitis is known to be one of the most common abdominal surgical emergencies. Laparoscopic appendicectomy is considered the gold-standard management. There has been an increasing trend in the routine use of robotic surgery in abdominal surgery. However, it remains underutilised in emergency surgeries. We aimed to systematically review robotic appendicectomy (RA) procedures in elective and emergency settings and study its indications and feasibility.

Methods
A 20-year systematic review was performed in compliance with the PRISMA guidelines. The search was performed on PubMed, ScienceDirect and the Cochrane-Library databases. For quality assessment, Amstar 2 and MERSQI score were applied. The research protocol was registered with PROSPERO register for systematic reviews (CRD42022324582).

Results
A total of 1346 resulted from the systematic search, of which a final 9 articles were included in this study. A total of 174 procedures were included, 161 elective, 12 emergency and one interval RA. MERSQI mean score was 10.72 (SD= 2.56), with 4 high quality, 2 moderate and 3 low quality studies. The endpoints across the studies were: rate of conversion to open surgery, length of hospital stay, intra-operative blood loss and operative time.

Conclusions
Robotic appendicectomy is considered a safe and feasible technique with minimal blood loss and without conversion. The operating time and the hospital stay were within acceptable limits. Future studies are recommended to further evaluate RA with a focus on its application during emergency settings and on its cost-effectiveness.
O056 The impact of surgical risk factors on the development of stump appendicitis
Authors: Lodhia M , Ahmed H , Hargest R 
Published: May 2023

Abstract

Introduction
Stump appendicitis (SA) is a post-operative complication where inflammation occurs in the residual appendix following incomplete excision. Diagnosis is delayed due to the history of appendectomy, leading to a higher risk of complications such as perforation and peritonitis. This study aimed to investigate the incidence of SA and the surgical risk factors contributing to its development.

Methods
A literature review was conducted using Ovid Medline and Embase to evaluate the literature surrounding SA. A retrospective study was conducted at our centre to investigate the incidence of SA between June 2012 and June 2022.

Results
Literature review revealed 43/12,989 (0.33%) patients with SA. In the local cohort of 5401 patients who underwent appendectomy or right hemicolectomy for appendicitis, 15 developed SA (0.28%). Laparoscopic appendectomy was identified as a risk factor, with 66.67% of SA patients in Cardiff undergoing laparoscopic surgery for their primary appendicitis. Complicated primary appendicitis was reported in 53.33% of SA patients compared to 19.33% of the wider cohort. An appendicolith was present in 33.33% of SA patients compared to 12.11% of the total cohort. Residual stump length above 1.5cm was also acknowledged as a risk factor with a stump length ≥1.5cm reported in all local SA patients.

Conclusion
SA is associated with modifiable and non-modifiable risk factors. Care should be taken to identify the appendiceal base clearly at primary operation. Complicated appendicitis and the limitations of laparoscopic appendectomy present challenges in identifying the appendiceal base, thus contributing to the development of SA.
O057 The impact of urgency of umbilical hernia repair on adverse outcomes in patients with cirrhosis: a population-based cohort study from England
Authors: Adiamah A , Rashid A , Crooks C , Hammond J , Jepsen P , West J , Humes D J 
Published: May 2023

Abstract

Introduction
Umbilical hernia is common in patients with cirrhosis, however, there is a paucity of dedicated studies on postoperative outcomes in this group of patients. This population-based cohort study aimed to determine the outcomes after emergency and elective umbilical hernia repair in patients with cirrhosis.

Methods
Two linked electronic healthcare databases from England were used to identify all patients undergoing umbilical hernia repair between January 2000 and December 2017. Patients were grouped into those with and without cirrhosis and stratified by severity into compensated and decompensated cirrhosis. Length of stay, readmission, 90-day case fatality rate and the odds ratio of 90-day postoperative mortality were defined using logistic regression.

Results
In total, 22163 patients were included who underwent an umbilical hernia repair and 297 (1.34%) had cirrhosis. More patients without cirrhosis had an elective procedure 86% compared with 51% of those with cirrhosis (P&lt;0.001). In both the elective and emergency settings patients with cirrhosis, had longer hospital length of stay (elective: 0 vs 1 day, emergency: 2 vs 4 days, p&lt;0.0001) and higher readmission rates (elective: 4.87% vs 11.33%, emergency:11.39% vs 29.25%, p&lt;0.0001) than those without cirrhosis. The 90-day case fatality rates were 0.16% and 2% in the elective setting and 2.96% and 19% in the emergency setting in patients with and without cirrhosis respectively.

Conclusion
Emergency umbilical hernia repair in patients with cirrhosis is associated with poorer outcomes in terms of length of stay, re-admissions, and mortality at 90-days.
O059 Introduction of the SHOUT protocol in the early post-operative period following carotid surgery
Authors: Faisal M , Morshed A , Baker D , Agu O , Benaragama K 
Published: May 2023

Abstract

Introduction
The SHOUT protocol acts as a tool for assessing risk to the airway following anterior neck surgery. While this tool is commonly used in other specialities, we have introduced the protocol for regular use in the post-operative period in carotid surgery.

Methods
The SHOUT protocol was included in the operative notes of all patients undergoing carotid intervention, allowing all members of the post-operative team to be aware of major warning signs. A Retrospective review of all patients undergoing carotid artery intervention between November 2018 and June 2022 was completed.

Results
A total of 216 patients underwent carotid artery intervention, 100 had intervention before the application of the SHOUT protocol (Group A), all having endarterectomies. 116 patients were treated after the introduction of the protocol (Group B), consisting of 112 endarterectomies and 4 stents. In Group A, 9 patients (9%) required reimaging for urgent neurological symptoms, and 2 (22%) of them had new stroke findings and were managed medically. 3 patients underwent urgent surgical re-intervention; 2 returned to theatre without imaging due to significant hematoma. In Group B, 11 patients (9.4%) required reimaging, 3 (27.2%) had new stroke findings and were managed medically, while only one patient (0.8%) needed surgical re-intervention for haematoma evacuation.

Conclusion
The SHOUT protocol is a simple tool that aids all members of the post-operative team in the early recognition of potential time-sensitive complications. Early recognition allows for more time to formulate and execute the appropriate management plan.