bluuebunny/crossref_metadata_2025_split huggingface dataset:
944 Would You Like a Pus Swab Sent?
Authors: Hu K , Lingam G 
Published: August 2023

Abstract

Aim
The Association of Coloproctology of Great Britain and Ireland (ACPGBI) consensus guidelines in emergency colorectal surgery states that microbiology sampling is of limited value in the management of anorectal abscesses. Several centres continue to send intra-operative swabs routinely for microbiology. This study aims to identify (1) if sampling changed postoperative management and (2) quantify the financial cost of sending unnecessary swabs within a district general hospital setting.

Method
Retrospective study investigating intraoperative clinician use of microbiology swabs. Study sample included patients who underwent an incision and drainage of an anorectal abscess at Princess Alexandra Hospital from 1st October 2021 to 1st October 2022.

Results
A review of patient data obtained 59 patients who underwent an incision and drainage of an anorectal abscess. Swabs were taken in 54 (91.5%) cases. At 2 months, 40.7% of the swab results had not been reviewed by a clinician. 89% of swab results were reported after the patient was discharged. No documentation mentioned reviewing microbiology results in a follow-up clinic. There was no documented change of antibiotics nor management following the microbiology report. Each microbiology swab costs £3 and labour costs are a minimum of £10 per swab analysed by a band 6 biomedical scientist or senior. Total cost incurred per year was therefore estimated at £702.

Conclusions
Surgeons tend not to review microbiology results at follow-up appointments. Furthermore, there was no evidence that microbiology sampling resulted in change in patient management. Unnecessary use of swabs contributes to the NHS economic burden with no additional clinical benefit.
969 The Kara: Working Together Towards Active Inclusion Within Surgery
Authors: Sidki A , Panesar S , Sayeed S 
Published: August 2023

Abstract

Aim
During surgical scrubbing, Sikhs in healthcare are often expected to remove their kara, a religious metal bangle. This seems inconsistent with policies permitting rings. As some Sikhs feel they cannot do this, they are refused entry to theatres. The aim of this quality improvement project is to explore if and how this exclusion might affect Sikhs and propose an inclusive solution accordingly.

Method
Working with MedRACE (a student-staff EDI group), we reviewed local and national infection and surgical scrubbing policies. We also distributed a survey nationally to explore Sikh medical students’ experiences in theatres, sharing our findings with local Trust leadership.

Results
We found variations in the policies reviewed, some permitting the kara, and others proposing removal or impossible solutions (‘secured…above the elbow’). Of 11 survey respondents, 9 had been told to remove their kara before entering theatres; 7 felt that wearing a kara limited their opportunities. Students reported that some Trusts (or staff) allowed them to wear a kara, whilst others did not. On presenting these findings to our local Trust, they updated the policy to permit the kara, and communicated this update to staff.

Conclusions
The national variation on wearing a kara in theatres is excluding some Sikhs from theatres. This may impact attainment and deter Sikhs from pursuing surgical careers. It is also at odds with the Royal College of Surgeon’s vision of creating a more inclusive surgical environment. We are thus planning further work to ensure greater consistency on this matter across the UK.
630 Diversifying a Surgical Workforce Starts from Creation of an Inclusive Medical School Application Process
Authors: Asim N , Ravinthiran S , Sureshkumar A 
Published: August 2023

Abstract

Aim
The Royal College of Surgeons from England identified 20% of their surgical leadership were from BAME communities. This underrepresentation precedes core surgical training, stemming from unique barriers to medical school admissions encountered by students from widening participation (WP) backgrounds. Recent application data states only 12% of total medical applicants identified as BAME.
St George’s Medical Education Society aims to equalise the platform by supporting aspiring widening participation medics via the formal establishment of our ‘WP Zone’ in 2021.

Method
Over two years, we have taught these students over different elements of the medicine application through outlets such as social media, interview preparation webinars and an in-person mock multiple mini-interview (MMI).
Feedback forms using 5-Point Likert Scales measured changes in student confidence before and after sessions.

Results
Combined engagement on social media rose by 40% upon introduction of WP posts. There was an increase of 53% observed in the subsequent month during inauguration of interview webinars and the mock MMI.
The MMI webinar (n = 169) demonstrated a 20% mean increase in understanding. Furthermore, 57% of students found the support by our WP zone more helpful than individual school resources. The in-person mock MMI session (n = 68) displayed a 50% increase in students feeling more prepared for MMI interviews.

Conclusions
The above results demonstrate the WP zone making positive strides in creating an inclusive medicine application process. This has implications not only for increasing representation in surgery but strives to tackle structural injustices that prevent administration of optimal health care in minorities.
719 Barriers and Facilitators Towards People Experiencing Homelessness When Accessing Surgical Care: A Critical Review of the Literature
Authors: Javed M , Manchip G , Chiara Corriero A , Limbu T , Wellington J 
Published: August 2023

Abstract

Aim
People experiencing homelessness (PEH) are a vulnerable group in which physical health morbidities are much more common than the general population. Despite this, the inability to access healthcare remains a main concern. This literature review aims to identify the barriers and facilitators PEH face towards accessing safe surgical care, and to provide actionable strategies.

Method
A literature search was carried out on multiple databases. Thematic analysis of the included papers identified themes relating to barriers, facilitators, and actionable strategies.

Result
Twelve papers were identified. Eleven themes related to barriers and facilitators were identified and five for actionable strategies. The themes related to barriers included access to community care, fragmented follow-up care, transportation, lack of recovery shelters, infections, and post-operative complications. Themes related to facilitators included street medicine programmes and the utilisation of patient navigators. Actionable strategies identified for health workers included the improvement of education, enhancing existing social safety nets, improved screening, tailoring discharge and surgical plans with the view of unfeasible follow up.

Conclusions
Current papers are not based on UK data and there are limited data sources available. However, analysis of the available data has shown many barriers and limited facilitators towards surgical care, highlighting the need for further studies. With a rising population of PEH in the UK these findings highlight the need for further research to create strategies that allow for safe surgical care in this population.
503 Post-Pandemic Elective Surgical Activity: A Focus on Day-Case Laparoscopic Cholecystectomies Across England
Authors: Ayyaz F , Gray W 
Published: August 2023

Abstract

Aim
To investigate the association between post-pandemic activity levels and day-case rates for laparoscopic cholecystectomies in England.

Method
We examined data from HES (Hospital Episode Statistics) on adult elective laparoscopic cholecystectomies for the period January 2019 to September 2022 (inclusive). Activity levels in the first six months of 2022 were compared to activity levels for the whole of 2019 (the baseline). Day-case activity was identified where the length of stay record in HES was zero days. Data were summarised at an Integrated Care Board (ICB) level for analysis.

Results
Data were available for 168,811 patients across the 42 ICBs in England. By April–September 2022, activity levels had returned to 89% of pre-pandemic levels for the whole of England. The South West Region stood out as having recovered activity levels to the greatest extent, with activity at 102% of pre-pandemic levels by April–September 2022. The South West also had the highest post-pandemic day-case rate at 75% of all patients seen as day-cases during April–September 2022; this compares to an England average of 66%. All other regions had day case rates between 62 and 68%. At an ICB level, there was a significant correlation between day-case rates and post-pandemic activity levels (r = 0.327, p &lt; 0.035).

Conclusions
Recovery of elective laparoscopic cholecystectomy activity has been better in South West England than in other regions. Day case rates may be important if ICBs in other regions are to increase activity levels.
553 Healing Patient, Harming Planet? Review of Waste Production and Recyclability of Surgical Instrument Packaging
Authors: Lee Y K , Hariri A , Ghedia R , Tikka T , Kim D 
Published: August 2023

Abstract

Aim
In November 2022, the three UK Surgical Royal Colleges had issued an Intercollegiate Climate Emergency Declaration acknowledging that “climate change and anthropogenic environmental degradation pose a major threat to both human health and planetary health”. We reviewed the waste production and recyclability of surgical instrument packaging used in a common ENT procedure (thyroidectomy) and suggest strategies to improve surgical waste and make surgery more sustainable.

Method
We prospectively audited packaging waste from 20 thyroidectomies performed at the Royal Marsden Hospital, UK between July and December 2022. All the packaging was weighted, categorised, and analysed after the operation. Recycling labels were recorded if present.

Results
On average, each thyroidectomy produced packaging waste of 183 g (34%) of plain paper / cardboard, 167 g (31%) of soft plastic film, 142 g (26%) of laminated paper, 37 g (7%) of hard plastic and 11 g (2%) of metal foil. Of all packaging items we have collected, only one item had a recycling label.

Conclusions
Despite only one item of packaging having a recycling label, in its current form, 41% of the packaging we collected is easily recyclable. Product manufacturers should place clear labels on packing that can be recycled, switch to recyclable materials where possible and remove unnecessary information booklets that can be easily accessed digitally. Local waste audit and analysis can be the simple steps to make surgery more sustainable and reduce the environmental impact whilst treating patients.
751 Incidence and Risk Factors of Postoperative Cardiac Complications: An International Prospective Cohort Study
Authors: Chaudhry D 
Published: August 2023

Abstract

Aim
Postoperative cardiac complications (PCC) after major surgery remain heterogeneously reported. This international prospective cohort study aimed to define incidence and risk factors for PCC after major abdominal surgery in Europe, Ireland, and UK.

Method
A prospective, international cohort study was performed between January 23 and May 1, 2022. Data were collected on consecutive patients undergoing major abdominal surgery in 446 hospitals from 28 countries of Europe. The primary outcome was postoperative cardiac complications (PCC) as defined by Standardised Endpoints and COMs for Perioperative and Anaesthetic Care (STeP-COMPAC) to 30-days after surgery. The secondary outcome was 30-day postoperative mortality.

Results
This study included 24,260 patients, of whom 611 (2.5%) developed PCC and 458 (1.9%) died within 30-days of surgery. Of patients who died, 123 (26.9%) were related to cardiac causes. Mortality rates were higher in patients who developed PCC than those who did not (19.8% vs 1.4%, p&lt;0.001). On adjusted analyses, age &gt;65 years (OR: 2.47, 95% CI: 1.99-3.06), ASA grade III-V (OR: 1.95, 95% CI: 1.58 - 2.40), emergency surgery (OR: 1.62, 95% CI: 1.31 - 2.00), and contaminated/dirty surgery (OR: 1.60, 95% CI: 1.15 - 2.23) were risk factors for PCC.

Conclusions
PCC are infrequent after major abdominal surgery, yet death from cardiac causes was higher than previously reported in adults undergoing major abdominal surgery. Targeting high-risk groups at risk of PCC and death warrant holistic interventional trials as future research focus.
1185 SADHemi Study: A Service Evaluation of Operative Treatment of Dislocated Hip Hemiarthroplasty in the UK – Initial Results
Authors: Brennan C , Haruna M , Simpson R , Kent B , Middleton R G 
Published: August 2023

Abstract

Aim
Hip hemiarthroplasty is a common orthopaedic procedure for intra-capsular neck of femur fracture. Dislocation is a rare but serious complication with a reportedly high mortality, but the literature and guidance for management is sparse. This study aims to evaluate the prevalence and determine the UK’s current management of dislocated hip hemiarthroplasty.

Method
A national collaborative was established to undertake a retrospective evaluation of patients aged ≥60 years with dislocation of a hip hemiarthroplasty carried out between January 2015 to December 2020. Eligible patients were identified by a site lead at each participating centre and data including patient demographics, management and mortality was entered on to REDCap for analysis.

Results
16 centres have been recruited and 137 patients entered: 65% female; average age 84 years and ASA grade 3. Median time to first dislocation was 22 days. Only 25.9% failed initial closed reduction. 57 patients re-dislocated (45.9%) and of these 64.9% had a successful closed reduction, and 46.4% had further dislocation episodes. Only 20% of patients were still alive at the time data entry.

Conclusions
The initial results show the rate of successful closed reduction of first time dislocation was higher, and the rate of re-dislocation was lower, amongst the SADHemi patients than previously estimated in the limited existing literature. There was more success with second closed reduction than previously reported. Early results suggest a high associated mortality. By expanding the national collaborative to gain more data we hope to further this evaluation and perhaps update the current protocols for management.
390 The Validity of Bench Top Simulators for Arthroscopic Surgical Skills Training: Does It Work?
Authors: Fennelly J , Hughes T , Patel R , Baxter J 
Published: August 2023

Abstract

Aim
The traditional model of surgical training has evolved significantly in recent years in response to the reduction in hours worked by junior doctors and the overall shortening in length of training. To compensate for the decreased exposure to surgical procedures, much has been done to develop techniques for skills training outside of the operating theatre. This paper aims to identify the current evidence for the use of bench top arthroscopic simulators and their validity for the purpose of surgical training.

Method
The PUBMED, MEDLINE via PUBMED and EMBASE databases were comprehensively searched for articles that described the investigation of bench top arthroscopic simulators and the methods for providing evidence to support their validity, from inception to April 2022. The search strategy employed the following terms: arthroscop* and valid* and simulat* or bench* or fundamentals. References of articles were searched for further studies.

Results
Twenty studies evaluating the use of bench top arthroscopic simulators and their validity for surgical training purposes were identified.

Conclusions
Evidence has been presented supporting the efficacy of low fidelity, bench top simulators in the training of basic arthroscopic skills, especially for those early in the training process. This includes evidence that such training on a bench top simulator combined with a stack viewing system, can indeed result in improved performance in real-life arthroscopic surgery. Further research to validate such a model in combination with a portable viewing system could facilitate increased access to arthroscopic skills training for surgical trainees and incorporation into the surgical curriculum.
670 Transition From Higher Surgical Training to Consultant Surgical Practice: What We Don’t Know but Need to Know
Authors: Kamran Siddiqui Z , Jayasuriya R , Lewis C , Tomlinson J 
Published: August 2023

Abstract

Background
Higher surgical training (HST) focuses on delivering clinical knowledge and technical skills to fulfil day-one consultant clinical competencies. Introduction of capabilities in practice (CiPs), shifts curricula to outcome-based assessment related to direct clinical care. To aid the transition into consultant surgical practice, we must identify deficiencies in HST related to wider professional capabilities outside of direct clinical care.

Aim
To identify deficiencies in HST by exploring challenges faced by recently appointed T&O consultants.

Method
The experience of T&O consultants, appointed in the last five years, was explored using a phenomenological approach. Field notes from unstructured interviews with five consultants (convenience sampling), was used to develop a topic guide for semi-structured interviews with six new consultants (purposive sampling). Interviews were transcribed and thematically analysed.

Results
Consultants transitioning into the new role emphasized comprehensive clinical knowledge, technical and non-technical skills as attributes required to be a good day-one consultant. Further identifying various deficiencies in their non-clinical training; categorised into two themes and further sub-themes:

Adapting identity
Practice management, Building a reputation, Leadership identity, Trainer identity, Awareness of limitations, Independence vs support

Discovering responsibilities
Job planning, Management structure, Service provision and procurement, Complaints and complications.

Conclusions
This study provides an in-depth account of deficiencies in professional capabilities outside of direct clinical care required by day-one consultants. Furthermore, highlighting the pressing need to equip trainees for transition to consultant-surgical practice. We make recommendations on how stakeholders such as surgical-trainees, newly appointed consultants and employing organisations can modify identified deficiencies at different training levels.
786 A Collaborative, Online, 'Near-Peer' Teaching Programme for Medical Schools with Short Breast Surgery Rotations
Authors: Tai J C J , Sangha M S , Ahmed M 
Published: August 2023

Abstract

Aim
The quality of teaching for breast surgery, a niche specialty that medical schools dedicate little placement time to, can vary from hospital to hospital. This single-centre cross-sectional study investigated whether a new near-peer teaching programme could improve this.

Method
An online teaching programme was created and executed by final year medical students (‘near-peers’) for penultimate year students rotating through a week-long Breast Surgery placement at a major teaching hospital in London, United Kingdom. It consisted of asynchronous pre-tutorial Single Best Answer questions and an online small group tutorial and was conducted every three weeks for a year. A mix of qualitative and quantitative data were collected using feedback forms.

Results
Thirty students opted in. The pre-tutorial SBAs were rated 4.07 out of 5, while the near-peer interactive tutorial scored 4.77 out of 5. Students’ self-reported confidence, on a scale of 1 to 5, increased significantly by an average of 1.5 points (p &lt;0.001). Students also rated this programme either the same or more highly than all other teaching modalities available during these their clinical placements. Thematic analysis of free-text responses showed that students enjoyed the interactivity of the sessions, the exam relevance of the content covered, and the utility of this programme in consolidating information at the tail-end of their placements.

Conclusions
This novel interactive teaching programme was designed and executed relatively easily by near-peers, was received favourably in our pilot, and can be easily implemented for other 'short-rotation specialties' in medical school (e.g., urology, vascular surgery, ENT).
847 Risk Factors Related to Preterm Birth Among Mothers Who Gave Birth in Gynecology and Obstetrics Department of Services Hospital, Lahore, Punjab: A Case-Control Study
Authors: Khalid K , Hayat K 
Published: August 2023

Abstract

Introduction
Preterm labor remains one of the most important problems faced by obstetricians globally, because of the high rates morbidity and mortality in preterm infants. It is said to be caused by interplay of multiple factors that include inadequate nutrition, antenatal care, low income, lack of education, multiple gestations, chronic illnesses, hypertension, anemia, infections, and substance abuse. Thus, understanding of these factors is crucial for reducing morbidity and mortality due to complications of preterm birth.

Aim
To determine maternal, fetal, and socioeconomic factors leading to preterm birth in patients delivering in the Gynecology and Obstetrics Department of Services Hospital, Lahore.

Method
A case-control study was conducted on 226 mothers delivering in Gynecology and Obstetrics Department of Services Hospital, Lahore in November 2020. A well-designed structured questionnaire was used to collect data about the sociodemographic profile, past gynecological and obstetric history, history of current pregnancy, past medical history, and the newborn. SPSS version 25 statistical tool was used to enter and analyze data.

Results
Height of respondent ≤155cm, parity &gt;3, previous preterm birth, twin pregnancy, hypertensive disorder in pregnancy, hospitalization during pregnancy, hemoglobin level &lt;11g/dl during pregnancy, history of UTI during pregnancy, fetal distress, cephalopelvic disproportion, oligohydramnios, polyhydramnios, PROM, no use of iron and multivitamins during pregnancy use of alcohol or other drugs during pregnancy, psychological stress during pregnancy and history of dental problems were found to be statistically significant.

Conclusions
In our study it was found that characteristics of current obstetrical history were the most important factors contributing to preterm birth.
1319 Case Report: Volunteering Overseas with Medical Volunteers International
Authors: Cook H , Politis A 
Published: August 2023

Abstract

Background
Medical Volunteers International (MVI) is a non-government organisation (NGO) founded in Germany in 2016. Its mission is to provide medical care to asylum seekers and refugees in Europe. This is a volunteer case report from Athens, Greece. Scope of Practice: In Athens, volunteers work within three categories – triage – allocating patients to clinics and assessing for emergencies, street outreach – wound care and first aid to patients sleeping rough, and clinic – consulting room with diagnostic tools and translators.

Patient Story
Many patients do not have access to health cover from the Greek government or lack the language skills to access care. Patient A was an undocumented asylum seeker sleeping rough. He had a discharging dorsal foot abscess but refused to attend hospital for fear of cost or arrest. After persuasion he allowed MVI volunteers to clean his foot and express the abscess. With oral antibiotics and regular dressings, he improved. MVI helped arrange legal aid to assist with an asylum claim.
Impact of Volunteering: The main impact is directly from volunteers to patient care. Longer term, individuals can contribute by sharing skills with permanent members of NGO staff and helping write guidelines e.g., wound care.
How can this benefit the NHS and surgical trainees? MVI provides volunteer opportunities for doctors at all levels of training. Working with an international team provides opportunities to communicate and learn from others. Working in a less-economically-developed setting encourages resourcefulness and hones clinical diagnostic skills. Volunteers often report feeling part of a ‘bigger cause’.