bluuebunny/crossref_metadata_2025_split huggingface dataset:
1248 DELPHI Consensus Study - Splanchnic Venous Thrombosis in Acute Pancreatitis
Authors: Scott M , Bekheit M , Ghazanfar M , Ramsay G 
Published: August 2023

Abstract

Aim
A DELPHI consensus process was conducted to identify new areas for research in the largely understudied territory of Splanchnic Venous Thrombosis (SpVT). The overarching purpose was to help establish at-risk patient subgroups, current expert therapeutic practices and key outcome measures of SpVT in the short-, medium- and long-term care of patients.

Method
Duration: 2021-2022. International pancreatitis experts designed Redcap software surveys following DELPHI consensus methodology. Stakeholder distribution was via international networks, extending outreach to SpVT experts from intensive care, pancreatology, and general/HPB surgical backgrounds, who work in tertiary centres worldwide. Question design targeted at-risk subgroups, optimal diagnostic and management modalities, and order-ranked outcomes. Blinded data analyses were performed using Redcap software.

Results
ROUND 1 n(respondents) = 73/153. ROUND 2 n(respondents) = 53/73.
75% of experts agree that SpVT increases mortality among patients with acute pancreatitis. By Round 2, there was overwhelming consensus that therapeutic anticoagulation was beneficial for Portal Vein SpVT (90.4%) and Superior Mesenteric Vein (92.3%) thromboses (SpVTs), provided there were no significant patient bleeding risk factors. No consensus was reached regarding duration of anticoagulation.

Conclusions
There exists significant heterogeneity for optimal duration of therapeutic anticoagulation to treat SpVT in acute pancreatitis. While consensus clearly suggests a role for therapeutic anticoagulation, this must achieve equipoise against risks. Our DELPHI process identified upper GI bleeding, liver ischaemia and bowel ischaemia as important outcomes of anticoagulation-based SpVT management for the short, mid- and long-terms of patient follow-up. Future DELPHI rounds will involve further enquiry into the optimal duration of anticoagulation for SpVT.
102 An Audit of Phimosis Management at Primary Care Level
Authors: Siah Q Z , Martin J 
Published: August 2023

Abstract

Aim
To audit the appropriateness of phimosis management and adherence to paediatric surgical referral guidelines at the primary care level against the Royal College of Surgeons (RCS) recommendations.

Method
A search of paediatric patients with diagnoses of phimosis, paraphimosis and Balanitis Xerotica Obliterans from January 2016 to October 2021 was performed at one General Practice (GP) surgery with a population size of 14,315 patients. Data on the frequency of urological symptoms reported, the medical treatment initiated, the number of paediatric surgical referrals and waiting times, and outcomes were recorded.

Results
A total of 35 patients with ages ranging from 1-17 years old were included. The most common symptom reported was dysuria (n = 21, 60%). Twenty-five (71.4%) paediatric patients with phimosis were referred. The paediatric surgical referral waiting times ranged from 3–232 days (mean = 111.4). Fourteen of the referred patients (73.7%) who had been reviewed by the surgical team were diagnosed with physiological phimosis and discharged back to the GP. Thirty-two per cent of the referrals (n = 8) were done without trialling on topical steroids. In terms of potency, 53.5% of the steroids (n = 15) prescribed by the GP were weaker than is recommended by the RCS.

Conclusions
Variation in practice was seen in phimosis management, including the types of steroids initiated and decisions on surgical referrals. Only pathological phimosis generally requires a referral. Therefore, a clear management and referral pathway and additional training on phimosis management within primary care providers can help optimise the patient management and appropriateness of secondary care referrals.
321 Transfer of Care to a Clinical Nurse Specialist Pathway for Patients Undergoing Exogen Therapy Improves Outcomes, Compliance, and Refund Rate
Authors: Hadi H , Ibrahim Y , Alligan K , Gheorghe A , Rongavilla W , Malhotra K , Patel S 
Published: August 2023

Abstract

Aim
Exogen (low-intensity pulsed ultrasound) has been shown to improve union rates following delayed/non-union. It is accompanied by a money-back guarantee in unsuccessful cases, dependent on adequate patient compliance. Using a clinician-run pathway, our unit’s results were poor, so our aim was to create a clinical nurse specialist (CNS) pathway with protocols for recording outcomes, collecting data, and claiming refunds for unsuccessful cases.

Method
This was a single-centre, retrospective, multi-cycle audit performed over 60 months on patients undergoing Exogen treatment for delayed/non-union following elective foot and ankle arthrodesis. Data was collected on union rates, Exogen compliance, and refund collections. Results were compared (Chi-squared test) for the original cohort (n = 55) and the CNS-led cohort (n = 18).

Results
In the original cohort, 24 patients (43.6%) united (mean time 225 ±145 days). Only 14 (25.5%) had treatment compliance accurately recorded and compliance rate &gt;95%. Of 31 patients whose Exogen treatment failed, only 7 (22.6%) were eligible for a treatment cost refund due to lack of compliance / record of compliance.
In the CNS-led cohort, 12 (66.7%) patients united (mean time 190 ±77 days, p = 0.089). Sixteen patients (88.9%) had compliance accurately recorded (p&lt;0.001), with increased compliance rates (&gt;99%). Exogen treatment costs were refunded for 5 patients (83.3%) with residual non-union (p = 0.004).

Conclusions
Transferring patient care to a dedicated CNS-run pathway led to a non-statistically significant increase in union rates, and significantly improved compliance and fiscal return rates. Establishing dedicated protocols with paramedical staff can be cost-effective and improve outcomes, whilst reducing out-patient burden in surgical clinics.
767 A 5-Year Retrospective Review of “Code Red” Traumas Requiring Immediate Surgery in a Regional Major Trauma Centre
Authors: Winter J , Canny J , Harbinson D , Yoong S 
Published: August 2023

Abstract

Aim
Trauma is a major cause of mortality leading to over 16,000 deaths annually in England and Wales alone. Code red traumas are the most extreme of these and a proportion will require immediate operative intervention. The aim of this study was to review the outcomes of patients presenting to a regional major trauma centre as code red traumas requiring immediate transfer to theatre and to identify a pathway to facilitate this process.

Method
Data were reviewed for all Code Red Traumas requiring immediate operative intervention between April 2017 and April 2021. Electronic records were searched to identify aetiologies, transfer times and post-operative morbidities and mortalities. Datasets were collected and analysed using Microsoft Excel software.

Results
57 patients were identified and included. The average age was 39 years old. CT was performed in 52/59 patients (88.1%) and median time to CT was 32 minutes. All patients proceeded to theatre with an overall median time to theatre of 144.5 minutes. In hospital mortality was 19.3% (n = 11). Primary operating speciality varied with general surgery making up the majority with 30 cases. A consultant surgeon was present in 72% of cases and a consultant anaesthetist in 81% of cases. 84% (n = 48) of patients were admitted to ICU post-operatively.

Conclusions
Major trauma remains a significant cause of mortality in our cohort. We have developed a pathway for those requiring direct access to theatre. It is envisaged that this will facilitate expediated transfer to theatre and lead to improved patient outcomes.
1038 Introducing a Patient-Initiated Follow Up (PIFU) Pathway to a District General Hospital’s Urology Department: A Two-Cycle Quality Improvement Project Following the First 100 Patients
Authors: Hirniak J , Spurr S , Banerjee S 
Published: August 2023

Abstract

Aim
Outpatient appointments have almost doubled from 54 to 94 million in the last 10-years: 68% follow-up visits, costing £8 billion yearly. Patient-Initiated Follow Up (PIFU) enables patients to initiate follow up ‘as needed’ rather than attend routine follow-up. This project aims to introduce and improve a PIFU-pathway to reduce the 7% yearly increase in local follow-ups and improve patient satisfaction.

Method
Using Plan-Do-Study-Act (PDSA) quality improvement methodology, a PIFU-pathway for new patients under a single consultant was established in a district general hospital’s urology department. Patients in clinic were given a letter with contact number should they request review. Those within 4-to-12 months of PIFU were quantitatively evaluated through retrospective health record analysis. A further PDSA cycle sought to improve the service by acting on patient opinions collected via telephone.

Results
100 patients were evaluated with an average 6-months on PIFU. Mean age 58 years, 41% were female. PIFU indications: lower urinary tract symptoms (57%), stones (12%), UTI (9%), other (22%). Only 2% utilised PIFU, 98% sought no further appointments, 97% reported preference of PIFU over routine follow-up and improved satisfaction. 43% were unaware how to utilise PIFU; 91% either forgot about PIFU or lost PIFU contact information. Subsequent interventions include development of introductory and reminder texts, an email address, and specific webpage.

Conclusions
The project suggests PIFU can reduce the number of unnecessary outpatient appointments in secondary care, whilst improving patient satisfaction and without compromising care across numerous chronic urological conditions. Clinicians can subsequently target active problems or waiting list control.
968 Participant Experience from the Portsmouth Basic Robotic Surgical Skills Course – Addressing an Unmet Need in Robotic Surgical Training
Authors: Yiu A , Stefan S , Mykoniatis I , Niccolò Piozzi G , Naqvi S , Siddiqi N , Khan J 
Published: August 2023

Abstract

Aim
The increasing utilisation of and patient preference for robotic surgery (Aggarwal et al., 2022) has been reflected by surgical trainees desiring greater access to robotic training, as recently demonstrated in a large pan-specialty snapshot study led by ASiT (Fleming et al., 2022). The Portsmouth Basic Robotic Surgical Skills (BRSS) course aims to leverage experience from a leading European robotic centre to address this training gap.

Method
The Portsmouth BRSS course (6 CPD points, ASGBI) has two components. The virtual component introduces the daVinci® (Intuitive Surgical, USA) platform, robotic instruments, and port placement principles. The hands-on component teaches theatre setup, docking, and teamwork, and provides experience of robotic dissection, suturing, and stapling using simulation and synthetic models. 129 participants have successfully completed the course, which ran 14 times in the last 5 years. This study quantitatively analysed course feedback to understand the value and impact of the robotic training provided.

Results
101 feedback forms were analysed (28 pending). 87.1% (n = 88) rated the content as excellent. 84.2% (n = 85) thought they had made quite an or a major improvement in their robotic skills. 97.0% (n = 98) felt more capable using the robot after the course. 54.5% (n = 55) thought it would be &gt;3 months before implementing their skills, due to needing more training (46.5%, n = 47) and/or lacking resources (45.5%, n = 46).

Conclusions
The Portsmouth BRSS course effectively addresses an important unmet need facing current trainees. Future work to address wider barriers in robotic training, such as a lack of higher skill training and accessible robotic resources, is needed.
1155 Role of Robotic Approach in Ileal Pouch-Anal Anastomosis (IPAA): A Systematic Review of the Literature
Authors: Jamal Z , Khawaja Z , Zafar N , Adnan N , Haider I 
Published: August 2023

Abstract

Introduction
Restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) has become the standard surgical treatment of choice in patients with ulcerative colitis (UC) and familial adenomatous polyposis (FAP) in which the medical management fails. Despite the wide use of the laparoscopic method, the enhanced and innovative features that come with the robotic platform, such as endo-wrist technology, 3D visualization, surgeon-controlled camera, and motion scaling, make it an appealing choice.

Aim
This study aims to investigate the feasibility and safety of robotic approach for proctectomy or proctocolectomy with IPAA as compared to conventional laparoscopic approach.

Method
A systematic review was completed for studies done between 2010 and 2022 comparing the robotic approach with the laparoscopic approach. Nine studies were found to be feasible to be included in this review.

Results
In terms of the outcomes, although the mean operating time was slightly higher than the laparoscopic approach, the other outcomes, such as mean blood loss, return of the bowel movement, mean hospital stay, and conversion to open, were found to be significantly lower in the robotic approach as compared to both laparoscopic and conventional open techniques. Despite the overall increased rate of complications combined from all the studies, the rate of significant complications such as anastomotic leaks requiring readmission and return to the theater was also found to be substantially less.

Conclusions
This study concludes that although the robotic approach is in its initial stages for pelvic surgeries, it can be safely employed due to improved dexterity and visibility.
545 Optimal Surgical Approach for Mid-Transverse Colon Cancer; a Systematic Review and Meta-Analysis
Authors: Elkomos B , Baqar S , Bhatti M , Mazhar M , Hassan M , Nuno A , Ebeidallah G , Elkomos P 
Published: August 2023

Abstract

Background and Aim
The incidence of cancer colon below the age of 50 has increased dramatically. in addition, the database lacks a review to analyze the outcomes of surgeries for mid-transverse colon cancer with several recent controversial studies. Our aim was to compare the outcomes of extended hemicolectomy versus transverse colectomy for mid-transverse colon cancer.

Method
PubMed, Scopes, Web of Science and Cochrane library were searched for eligible studies from inception to 1 May 2022 and a systematic review and meta-analysis were done to detect

Results
according to eligibility criteria 8 studies (2237 patients) were included in our study. The pooled results of the included studies showed no difference in the 5-year OS, 3-year DFS and 5-year DFS between the two types of surgery (5-year OS, RR = 1.15, 95% CI = 0.94-1.39, P = 0.17), (3-year OS, RR = 0.96, 95% CI = 0.88-1.06, P = 0.42) and (5-year DFS, RR = 1.21, 95% CI = 0.91-1.62, P = 0.20). In addition to that, the recurrence rate and the incidence of complications were similar in the two groups (Recurrence rate, RR = 1.08, 95% CI = 0.62-1.89, P = 0.79) and (Complications, RR = 1.07, 95% CI = 0.74-1.54, P = 0.72). however, the number of LN harvest and the time of the operation was more in case of extended hemicolectomy.

Conclusions
Despite harvesting less LN, transverse colectomy has similar oncological outcomes to extended hemicolectomy for mid-transverse colon cancer. Moreover, no significant difference in the incidence of complications.
705 Assessment of a Novel Low-Cost Abdominal Box Simulator for Laparoscopic Skills Training
Authors: Kulkarni Y , Kulkarni S , Bligh C , Redpath N , Sule M 
Published: August 2023

Abstract

Aim
To create a low-cost abdominal box simulator and assess its validity for Hassan’s entry technique and visiport.

Method
A low-cost abdominal box simulator was created using a metal box skeleton. This was covered in a layer of cling-film simulating the peritoneum. Red and blue tubing was placed over this creating the inferior epigastric vessels. A posterior rectus sheath was created on either side using a white cotton sheet whilst thick red woollen socks were used to simulate the rectus abdominus muscles. The entire surface was then wrapped in a thick canvas to simulate the anterior rectus sheath. Finally, a commercial skin with subcutaneous tissue was affixed and the umbilicus demarcated using a pen. This simulator was used by 30 surgical trainees (ST3 to ST7) attending a laparoscopic skills course who were asked to provide feedback on the simulator for both Hassan’s entry technique, visiport entry and the introduction of secondary ports.

Results
The simulator was rated 10/10 for validity as well as ease of use for Hassan’s open entry technique, visiport and secondary port insertion by all 30 of the trainees.
Feedback highlighted that using the simulator trainees were able to see all layers of the abdomen and gain excellent haptic feedback. The model was described as realistic as trainees were able to identify each layer of the abdomen as they performed open or visiport entry.

Conclusions
A low-cost abdominal box simulator can easily be reproduced using our technique and used to train trainees effectively.
13 Surgical Priming Improves Operative Performance in Surgical Trainees: A Crossover Randomised Control Trial
Authors: Feeley A , Feeley I , Merghani K , Sheehan E 
Published: August 2023

Abstract

Aim
The aim of this study was to evaluate the impact of a surgical warm-up using a virtual reality simulator on operative performance.

Method
This was a single-blinded cross-over randomised control trial in a single tertiary Orthopaedic training centre. Orthopaedic trainees were recruited, and each morning participants rostered to theatre were randomised to either undergo a simulated surgical procedure on a virtual reality simulation system prior to their first case as primary operator (priming arm), or to perform their usual preparatory routine for surgery (control arm). Consultant orthopaedic trainers were recruited within the orthopaedic unit to carry out subjective surgical performance assessments using a validated global rating scale tool on the first case the participant performed on 46 the list as primary operator.

Results
Over 3 study periods a total of 151 datapoints were collected, with 49 matched datapoints across priming status and procedural level of difficulty. Subjective assessment tools consistently demonstrated improved operative performance by participants following surgical priming (p = 0.001).

Conclusions
This study highlights that introduction of preoperative priming to improve operative preparation and optimises operative performance. This has not only implications for improved resident training, but also signals towards beneficial downstream effects on patient outcomes, and theatre list planning.
644 Closed Loop Audit: Introducing a Teaching Program and Improving Surgical Teaching in a Major Trauma Centre
Authors: Nour H M , Janakan G 
Published: August 2023

Abstract

Aim
The aim of the project is to introduce a surgical teaching program for surgical registrars/SHO’s/F1’s in a major trauma center and to improve the current teaching practice in Royal Sussex County Hospital (RSCH).

Method
We undertook two cycles over a period of 6 months. These cycles aimed to assess the teaching practice in RSCH using a questionnaire filled by surgical doctors in the department. Multiple teaching session was conducted including journal clubs, case presentation, practical session and high-fidelity simulation course. Hybrid methods including was used to maximize the numbers attending the sessions from home.

Results
A total of 41 doctors were involved in the study (first cycle: 23, second cycle 18). Following the introduction of multiple teaching sessions, 55.5 % of the doctors think they have enough teaching in comparison to 8.7 % in the first cycle. In addition, there was a high level of satisfaction with the teaching sessions. 44.4% of doctors were unable to attend half of the teaching session due clinical commitments such as being scrubbed or doing the ward rounds.

Conclusions
Regular teaching session can be a great challenge in a busy major trauma centre however, introducing a teaching program can improve the practice and the satisfaction between the surgical trainees. Novel methods need to be used to maximize teaching opportunities such as teams and recorded sessions for viewing at later stage. We also recommended that teaching session to be conducted in the morning before handover and this will ensure that most doctors will be able to attend.
756 Improving the Experiences of Surgical Specialties and Career Choices for Trainees. Can We Use a Virtual Platform for Surgical Taster Days?
Authors: Davies B , Gaddah M 
Published: August 2023

Abstract

Aim
Exploring surgical specialities is not something easily achieved as a trainee. With foundation trainees having only five taster days to explore specialities, and COVID-19 causing disruption within surgical training, the opportunities to explore potential career options have further diminished. Inadequate knowledge or experience of the different surgical sub-specialities, alongside increasing competition ratios and portfolio requirements, can make career decisions difficult for trainees.

Method
One-hour insight into surgical specialities (OISS) is a teaching series aimed to bridge the gap and allow future surgeons to experience surgical sub-specialities from behind their computers, i.e., virtually. This voluntary series runs on the platform; Medall, an online organisation that helps to run medical events. Through structured sessions, trainees explore a specialty, gaining insight into the daily job, commitments, potential cases, and portfolio tips.

Results
Over 70 trainees have registered since the series began, with over 40 trainees attending the latest session and over 20 of them being international. The use of a virtual platform, videoconferences, and telemedicine has helped to bridge the gap in hands-on experience, as well as, providing a platform for international trainees and physicians to gain an insight into UK surgical practices.

Conclusions
The series highlights that there is a place for virtual taster days and although, not completely replacing surgical opportunities, the use of technology can be used much more widely in surgical training.
842 Core Surgical Training- Are the Next Generation Prepared?
Authors: Samuels S , Holden P 
Published: August 2023

Abstract

Aim
The application process for core surgical training (CST) is one in which preparation is paramount to success yet knowing where to start can be a major challenge. There is a myriad of papers, books, and online material to read but is this information as good as an interview course. The aim of this project was to assess the demand for courses that support junior doctors applying for core surgical training.

Method
A one-day core surgical training interview course was designed and delivered virtually. Seven faculty members, who were all core surgical trainees, were recruited. The ten candidates recruited were foundation year two or equivalent. The format included lectures and timed practical sessions under the fundamental interview categories: portfolio, clinical and leadership/management. The final station was a mock interview that combined all skills learnt throughout the day. Feedback forms were collected.

Results
Nine out of ten candidates completed the feedback form. 100% rated excellent for the overall course content, the organisation of the course and final mock interview station. 89% rated the portfolio lecture as excellent, the remaining 11% as good. 89% rated the leadership/management lecture as excellent, the remaining 11% as good. 78% rated the clinical lecture as excellent, the remaining 22% as good. Qualitative data collected suggested the course was an excellent example of the interview day. Improvements included having the course earlier to allow for portfolio adjustments.

Conclusions
CST courses are an asset to interview success and better prepares candidates for the CST interview day.