bluuebunny/crossref_metadata_2025_split huggingface dataset:
869 Gender Distribution of Invited Speakers at Major Trauma and Orthopaedic Surgery Conferences: A Retrospective Open Cohort Study
Authors: Gargan A , Georgi M , Patel S , Asif A , Fricker M , Khaliq Raja A , Leung K H C , Gargan K , Lee K , Burton O E , Kamboj R , Thamilmaran A , Abdi Z , Haque S , Tse F , Moore C , Nathan A 
Published: August 2023

Abstract

Aim
Females are disproportionately under-represented in surgery despite the upward trend in women entering the medical profession. Visibility of female surgeons at academic meetings has proven to be an important facet of gender equity. We aim to quantify the proportion of female faculty and prevalence of all-male speaking panels (“manels”) at major T&O surgery meetings.

Method
We retrospectively analysed four major annual T&O meetings between January 2016 and December 2021. Data was collected on invited lecturers, panelists and chairs/moderators. Male and female faculty were academically stratified according to mean publications, citations, and H-index. A “manel” was defined as a session with 2 or more speakers, all of whom are men. Sex was defined by gender titles used in the conference program, online speaker biography, or the Gender Balance Assessment Tool.

Results
A total of 968 sessions with 6582 speakers across 18 conferences were identified. The mean percentage of female faculty (invited lecturers, panellists and chairs) was 4.90% (n = 323). Of 775 panel sessions, 568 (73.3%) were manels. No statistically significant difference in the percentage of manels was observed between online (77.8%) versus in-person conferences (72.8%) (p = 0.3195). No statistically significant difference in the proportion of manels was observed over time (from 76.1% in 2016 versus 76.7% in 2021; p = 0.26). Male invited lecturers had a significantly higher H-index than female invited lecturers (p&lt;0.05).

Conclusions
Manels are highly prevalent in major T&O surgery meetings whilst there is poor representation of female speakers. This study highlights the need for greater gender diversity and female representation in T&O.
380 Sustainable Health Care to Provide Good Quality Care in the Surgical Industry- United Kingdom
Authors: Mubarak F S 
Published: August 2023

Abstract

Aim
The surgical industry has a major contribution towards sustainable health care. The aim is to critically evaluate sustainable healthcare to provide good quality care in the surgical industry in the United Kingdom.

Method
A systemic review was conducted using peer-reviewed studies and articles from the United Kingdom related to surgical and anesthetic fields within the last 5 years. The most relevant journal articles were selected based on their relevance to healthcare system performance sustainability, including risks, and subsequently screened using the PRISMA 2020 model screening approach. The findings of the relevant journal articles were then evaluated critically for each theme.

Results
A total of 79 studies were retrieved. Fifteen of the retrieved studies met the inclusion criteria. Ten of the papers evaluated some existing sustainability practices. Only seven papers discussed significant determinants of good quality health care. Only 86.67% of the papers highlighted the implications of sustainability.
The key predictors of high-quality medical care are effective resource management, moral surgical team acquisitions, professional services, integration, short hospital stays, and low mortality and morbidity rates. Conserving water, optimizing treatment routes and transportation, and creating cultural change were found to be the pillars of high-quality sustainable healthcare.

Conclusions
The concept of sustainability varied across these studies and limitations on sustainability through reduced mortality, morbidity, and business services were observed. The most detrimental effect on the sustainability of the surgical industry remains to be anesthetic gas emission from the theatres. A significant discrepancy was noted between the available data and its implication.
74 Retention of Surgical Trainees in England
Authors: Sooriyamoorthy T , Khalil K 
Published: August 2023

Abstract

Background
Surgical training is a competitive process attracting highly motivated clinicians. The National Health Service is currently facing long waiting lists and a workforce crisis yet there is a paucity of data regarding attrition of surgical trainees in England. This study aims to describe the attrition of surgical trainees from 2016-2021 and explore the relationship between specialty competition ratios and attrition rates.

Method
Data was obtained from Health Education England by freedom of information requests. Binary logistic regression analyses explored differences in attrition between surgical specialties. Spearman’s correlation was used to assess the relationship between competition ratios and attrition rates.

Results
From 2016 to 2021, 481 surgical trainees have left surgical training, with an average yearly attrition rate of 2.68%. This number varied considerably across specialties with Paediatric Surgery having the highest rate at 4.20% and Trauma & Orthopaedic Surgery (T&O) the lowest at 1.52%. Compared to General Surgery, trainees in Neurosurgery, T&O and Plastic Surgery were significantly less likely to leave their respective programmes (OR 95% CI 0.53 (0.33 – 0.85) p = 0.009, 0.44 (0.34 – 0.58) p&lt;0.001, 0.51 (0.33 – 0.78) p = 0.002, respectively). Attrition rates were inversely related to competition ratios, with more competitive specialties experiencing less attrition (ρ = - 0.302 (p = 0.078)).

Conclusions
These data highlight the increasing attrition of surgical trainees over recent years, with some specialties experiencing greater rates of attrition than others. Qualitative research and exit interviews are needed to ascertain the causal factors behind the attrition of surgical trainees to improve training and retention of this highly skilled workforce.
686 Transition From Higher Surgical Trainee to Consultant Practice: A PRISMA Scoping Review of Non-Clinical Deficiencies in Training
Authors: Kamran Siddiqui Z , Jayasuriya R , Lewis C , Tomlinson J 
Published: August 2023

Abstract

Background
Higher surgical training (HST) focuses on delivery of clinical knowledge to pass FRCS exams, technical skills to fulfil CCT requirements, and clinical preparedness in the UK. The lack of good quality evidence to characterise the non-clinical challenges during transition from HST to consultant surgical practice, makes it challenging to develop a well-structured intervention to address this gap.

Aim
To identify the gap in current literature, methodologies and analysis of inventions trialled to address the transition from surgical trainee to consultant surgeon.

Method
PRISMA-ScR structured scoping review of literature. Search terms were wider than the specific research question of surgery in the UK. Other medical specialities and overseas healthcare training programmes were included to focus the gap analysis for translatable content and sub analysis to highlight the paucity of literature in surgery.

Results
Databases interrogated: Medline, HMIC, Pubmed, Google Scholar. Papers: identified n = 434, screened n = 276, eligible n = 105, included n = 50. Majority of papers were of poor to moderate quality. The moderate-quality papers included those adopting a mixed methods approach to both characterise the gap in training and utilised this to structure interventional programmes.

Conclusions
This review highlights the need for a mixed methods approach alongside a stakeholder analysis to identify target population for qualitative semi-structured interview (most likely to be newly appointed consultants) for characterising the gap in HST for trainees making the transition to UK NHS consultant practice. The topic guide for interviews would be informed by the deficiencies in training identified in this scoping review.
966 Comparison of Mesh Related Patient Reported Outcomes in Patients Who Have Undergone Abdominal Wall Reconstruction with Synthetic vs Bio-Synthetic Mesh
Authors: Adeboye T , Rajoo J , Kulkarni G , Barnes D , Hammond T 
Published: August 2023

Abstract

Aim
To compare Quality Of Life (QoL) outcomes amongst patients undergoing elective Open abdominal wall reconstruction (AWR) with Synthetic Mesh versus Biosynthetic mesh, using the Carolinas Comfort scale (CCS) questionnaire.

Method
This is a retrospective study with longitudinal prospective questionnaire extension of all patients who have undergone AWR within last four years by the same AWR surgeon and Plastic surgeon team with no recurrence. Four groups of patients were compared based on time from surgery (more or less than eight months) and use of synthetic or biosynthetic mesh. The rationale behind it is based on characteristics of the biosynthetic mesh data showing complete disappearance by eight-months and replacement by a scaffolding tissue as an ingrown matrix and collagen.

Results
There were eight patients in each group (total 32 patients). 16 patients had repair with Bio A mesh and 16 with Dynamesh CICAT. Using two-way ANOVA and post HOC Turkey’s difference test, we found a significantly lower score (p&lt;0.05) in the patients who had a repair with the Bio Synthetic mesh. Maximum score on the CCS is 115 points but except for one outlier of 70 points, none of the remaining 31 patients had a score higher than 50. Patients scored higher on questions related to bending, sitting up and exercise.

Conclusions
This outcome provides a review of current surgical practises and meshes, helping surgeons & patients make better informed decisions. Bio-synthetic meshes have better comfort outcomes for patients with lower CCS scores in the long term.
352 A National Survey of National Emergency Laparotomy Audit (NELA) Leads to Identify Current Nutrition Practices and Pathways in NELA-Eligible Emergency General Surgery Patients
Authors: Ashmore D , Wilson T , Halliday V , Lee M 
Published: August 2023

Abstract

Aim
No nutritional data are collected by the National Emergency Laparotomy Audit (NELA), despite the association of malnutrition with worse outcomes. This study aimed to describe the current practices, pathways and barriers encountered in identifying malnutrition in NELA-eligible patients.

Method
Following piloting and validity assessment, anaesthetic and surgical NELA Leads at hospitals across England and Wales that submitted data to NELA’s 7th report were emailed a survey link. Responses were gathered using Qualtrics. Descriptive analysis and correlation with laparotomy volume and professional subtype was performed in SPSSv26. University of Sheffield ethical approval was obtained.

Results
There were 166/289 NELA Leads and 117/167 hospitals that completed the survey (57.4% and 70.1% response rates, respectively). Respondents reported low rates of nutritional screening (39.2%) and assessment (45.8%) for malnutrition pre-operatively with no awareness of local screening tools (41.6%) despite 68% of units having a Nutrition Support Team. Contrary to guidelines, NELA Leads report albumin levels continue to be used to determine malnutrition risk (73.5%). Post-operative pathways were common (71.7%). Reported barriers to nutritional screening and assessment included a lack of time, training and education, organisational support, and responsibility. NELA Leads indicated nutrition risk is inadequately identified and is an important missing data item from NELA (71.2%). Responses were not correlated with hospital laparotomy volume or professional subtype.

Conclusions
Identifying malnutrition risk in NELA patients requires attention. Barriers are wide reaching and include a lack of time, knowledge, and ownership. Nutrition pathways that encompass the pre-operative phase and incorporation of malnutrition data in NELA may support improvements.
93 Managing paediatric torus fractures at the Royal London Hospital: A Clinical Audit and Cost Analysis
Authors: Papaioannou C , Manoukian D 
Published: August 2023

Abstract

Aim
Torus fractures are extremely common, accounting for up to 25% of all paediatric-related visits to the emergency department (ED). This audit aims to assess the adherence of the Royal London Hospital (RLH) to the NG38 NICE guidelines. These guidelines state that patients should not be given a rigid cast and should be discharged, advising carers a follow-up is not required.

Method
We analysed and retrospectively collected data from a cohort of paediatric patients with torus fractures who presented at the RLH between September 2021 and December 2021. In total 59 patients were included in the audit. Recommendations were later presented at the paediatric orthopaedic meeting of the RLH.

Results
From the cohort, 22% of patients were given inappropriate treatment including rigid casts with or without manipulation, with an average time in cast of 3.8 weeks. 18.6% of all the patients were followed-up in clinic, including 54.5% of the patients who received a rigid cast during discharge from the ED (the rest returned only for cast removal). 63.6% of the patients who returned for follow-up had a repeat X-Ray performed.

Conclusions
Overall, 18 out of 59 (30.5%) cases were not managed according to NICE guidelines (received inappropriate treatment, had a clinic follow-up with a clinician or was referred for &gt;1 X-Ray). This incurred an inappropriate cumulative cost of almost 2000£ only during a 4-month period from one hospital. This audit aims to educate ED staff and update local protocols. A re-audit is going to follow to assess the impact of these recommendations.
143 How Well Are We Managing Acute Pancreatitis?
Authors: Akhtar A , Asarbakhsh M , Schuijtvlot N 
Published: August 2023

Abstract

Aim
To evaluate our practice in comparison with gold standards on the management of acute pancreatitis.

Method
This retrospective audit evaluated the management of patients with acute pancreatitis admitted to our hospital between 01/04/22 and 30/06/22. The gold standards were guidelines published by the World Society of Emergency Surgery (2019) and British Medical Journal (2018). Data collection focused on prognostic scoring, IV fluid resuscitation, nutrition, monitoring of patients, invasive intervention, and performance of cholecystectomy. Data sources included paper notes, imaging and prescribing software.

Results
44 patients presented with acute pancreatitis. A prognostic score was calculated in only 4 patients (9.1%). 40 patients (90.1%) received isotonic IV fluids. However, fluid input and output was poorly documented in 17 patients (38.6%). 14 patients (31.8%) received nutritional support; oral Fortisip supplements in the majority (11 patients, 25%).
Regarding outcomes, 5 patients (13.6%) developed single or multi-organ dysfunction (respiratory and/or renal failure): 2 patients (4.5%) required admission to the High Dependency Unit. 2 patients (4.5%) died.
Regarding intervention, appropriately, no patients underwent endoscopic or percutaneous drainage of pancreatic collections. Where gallstones were the underlying aetiology (12 patients, 27.3%), 10 patients (22.8%) underwent laparoscopic cholecystectomy during, or within 2 weeks of, the index admission.

Conclusions
Our compliance with gold standards was variable, and this could negatively impact patient care. Lack of prognostic scoring and fluid balance documentation may undermine ability to recognise deteriorating patients with severe pancreatitis requiring escalation of care. Departmental teaching for surgical doctors is the proposed intervention.
251 Use of Self-expanding Metal Stents (SEMS) in Emergency Colonic Obstruction (a retrospective study)
Authors: Makhort A , Fouad M 
Published: August 2023

Abstract

Aim
Colorectal cancer is becoming increasingly common in UK, presenting as an emergency in 20% of cases. This carries significantly higher (six-fold) mortality compared with an elective presentation. There is high level evidence that self-expanding metal stents (SEMS) can be successfully used both for palliation (as a definitive procedure) and as a bridge to surgery (BTS) in patients with colorectal cancer. ACPGBI consensus guidelines in emergency general surgery suggest expected success rate of 90% whilst requesting units to audit their figures to evaluate success rates and complications.

Method
We performed a retrospective audit of SEMS placement over nearly 5-year period in our colorectal unit (spanning from July 2016 to May 2021). We accessed local reporting systems and electronic patient notes for pathology, site, results and outcome post attempted stenting.

Results
Total number of SEMS inserted = 30. One patient was excluded due to incomplete data present. Male:female ratio = 1.5:1. Mean age at application = 71.5 (range 37-96). Most common site was sigmoid (48%), followed by descending colon (28%). Success rate was 86%. Majority of SEMS were used as a palliative procedure - 86% vs 10% as BTS. 10% of patients had complications following stent insertion, including blockage and leak, in all cases leading to emergency Hartmann’s procedure.

Conclusions
Data shows significant SEMS use locally particularly for palliation. Success rates are comparable with national and show stenting can be performed by an experienced radiologist. However, complication risks are not insignificant, and patients should be counselled accordingly prior to procedure.
252 Incidental Gall Bladder Cancer in Patients Underwent Cholecystectomy: Do We Need Selective Histological Examination of the Gallbladder Following Cholecystectomy?
Authors: Mena J , Kazemi Esfeh N , Mahmoud R , Moudgil-Joshi J , Selvarajoo V , Tapuria N 
Published: August 2023

Abstract

Background
This study evaluated the incidence of incidental gall bladder cancer in patients undergoing cholecystectomy using the selective histological examination of the gallbladder following cholecystectomy operation (S-GALLOP). In return, the study assessed the value of S-GALLOP in patients undergoing cholecystectomy and the factors that can prompt histological examination.

Method
The present retrospective chart review retrieved the records of 3710 consecutive patients who underwent elective or emergency cholecystectomy due to benign pathologies at through 10-year period.

Results
80.7% of the patients were chronic cholecystitis,6.3% were acute cholecystitis, 1.9% were gallbladder and 1% were gallbladder cholesterolosis. Six cases had incidental GBC (incidence rate = 0.0016%). All patients were females, except two patients, who underwent elective cholecystectomy. The median age 60.5 (range 55 to 70) . The preoperative ultrasound showed multiple gallbladder stones and thickened gallbladder wall in most of these six patients. Four patients had moderately differentiated adenocarcinoma, one had well-differentiated adenocarcinoma, and one had poorly differentiated adenocarcinoma with metastasis. On the other hand, 23 cases had gallbladder dysplasia (incidence rate = 0.006%). The median age was 61 (35 – 73), and 82.3% of the patients were females. Only three cases underwent an emergency procedure. Only one patient had high-grade dysplasia, aged 71 years old.

Conclusions
Incidence GBC is rare in patients undergoing elective or emergency cholecystectomy. Thus, histological examination for all cases is not recommended and S-GALLOP can represent a cost-effective alternative. S-GALLOP is recommended for any gallbladder specimen that seems abnormal on macroscopic examination, especially in old age and patients with suspicious preoperative imaging findings.
341 Safe and Effective Delivery of Anti-Reflux Surgical Standards at a District General Hospital
Authors: Livingstone J , Nanda A , DiMaggio F , Kyrtsonis G , Rock C , Thomas R , Rothnie A , Malik S 
Published: August 2023

Abstract

Aim
Up to 20% of adults in UK suffer from Gastro-oesophageal Reflux Disease (GORD). Surgery offers better short-to-medium term benefit compared to sole medical management. However, practice varies significantly nationwide.
The volume of cases performed in our district general hospital (DGH) has increased from one in 2015, to 24 in 2022. We aimed to establish feasibility and safety of laparoscopic anti-reflux surgery (LARS) at a DGH, by matching our outcomes with the AUGIS national standards.

Method
Data from patients undergoing LARS between January - December 2022 have been collected prospectively and recorded both locally and on National Hiatal Surgery Register (NHSR). Pre-operative symptoms and investigations, intraoperative findings and post-operative short and medium-term outcomes were analysed. Average follow up was 6 weeks.

Results
24 laparoscopic anti-reflux procedures were performed (21 Nissen and 3 Toupet), including 6 paraoesophageal hernia repairs. All patients underwent primary repair and fundoplication. Average length of hiatus hernia preoperatively was 4.1cm for sliding, and 7.6cm for para oesophageal. 23/24 patients were inpatients, 1 was a day case. Mean length of stay was 4 days. Conversion to open rate was 0%. 22 patients had no complications. One patient experienced a mediastinal collection, another patient had post-operative hypotension, both not requiring intervention (Clavien-Dindo 2). 30-day return to theatre rate was 0%, as was 30-day readmission rate.

Conclusions
At our DGH, we significantly increased the volume of LARS performed whilst achieving AUGIS national standards. Anti-reflux surgery can be offered safely and effectively by experienced laparoscopic Upper GI surgeons in a DGH.
375 Introduction of a Physician Associate (PA) Led Surgical Ambulatory Emergency Clinic (SAEC) in the Highlands of Scotland
Authors: Seehafer F , El-Hakim H , Grant A 
Published: August 2023

Abstract

Aim
The delivery of surgical care in the Highlands has changed. SAEC was developed to alleviate bed pressures, improve patient satisfaction, and avoid unnecessary workload. We aim to identify whether SAEC is alleviating pressures in the surgical inpatient department - is it used appropriately and cost effectively.

Method
Attendance was collected prospectively (1/9/22 to 31/10/22) using a dedicated data audit book and booking diary. Patient’s individual review outcomes were gathered.

Results
Of the 165 patients referred to SAEC, 90% were reviewed by the PA, 10% only by the consultant. On average, 3.7 patients were seen per day. The referral reasons were wide ranging: 64 referrals for abdominal pain in addition to abscesses, constipation, weight loss, vomiting, stoma reviews and more. The age of patients ranged from 20-91. 61% were female. 46% had a scan. 85% received a diagnosis. 93% received definitive management. No patients made an unplanned re-presentation within the week following their review. The average time spent in SAEC per patient was 2 hours 48 minutes. 17% of patients were admitted, preventing 116 admissions. This saved approximately £45,820 through admission prevention. In addition, approximately a further £47492 was saved as this was PA led rather than consultant.

Conclusions
Prior to the employment of a PA, SAEC did not provide a consistent service, brought all patients to its surgical ward, and required employment of a second consultant. SAEC has improved patient flow and increased bed capacity whilst providing safe and high-quality care that is cost-effective.