bluuebunny/crossref_metadata_2025_split huggingface dataset:
1086 Improving the Use of Chest Drains in Trauma - Small but Perfectly Formed
Authors: Awadalla M , Marsden M , Bernard F , Sasikumar S , Mohammed M , Nikolopoulos I , Sorelli P 
Published: August 2023

Abstract

Aim
The Western Trauma Association (WTA) advocates using small-bore chest drains (e.g., 14Fr) in haemodynamically normal trauma patients for management of small Haemothoraxes (HTX) or Pneumothoraxes (PTX). This quality improvement project aimed to assess implementation of this guidance.

Method
We compared the use and outcomes of small-bore chest drains for management of HTX or PTX before (Cohort 1) and after (Cohort 2) adoption of WTA recommendations in a District General Hospital in London. We included all patients admitted under the General Surgeons with rib fractures.

Results
All patients were admitted with blunt chest injuries. Cohort 1: 60 patients [36 males, mean age 72 years (range 31-96)] admitted from May–December 2021. Cohort 2: 78 patients [42 males, mean age 73 years (range 23-102)] admitted from May–December 2022.
In cohort 1, 10 patients (16%) required chest drains, all were surgically inserted large bore drains (median size 28 Fr) there were no peri-procedural complications.
In cohort 2, 11 patients (14%) required chest drains; 5 were surgically placed large bore drains (median size 28 Fr) and 6 were small-bore drains inserted by Seldinger technique (median size 18Fr). Two large-bore drains had periprocedural complications and both required re-insertion. The mean age was 60 years. In the small-bore group, there were no peri-procedural complications, no drains occluded and the mean age was 75 years.

Conclusions
After the implementation of this policy, small-bore drain use increased and appeared safe. This audit supports recent literature suggesting small-bore drains are as effective as larger bore and better tolerated.
1158 Outcome of Hot Laparoscopic Cholecystectomy Service Evaluation in Morriston Hospital, SBUHB
Authors: Qadir R M A B , Gwilym B L , Yuksek A , Robine-Durnell L , Shingler G , Mortimer M 
Published: August 2023

Abstract

Aim
Symptomatic Gall Bladder disease is a common general surgery presentation. NICE guidelines recommend performing laparoscopic cholecystectomy (within 1 week of diagnosis) for patients with acute cholecystitis. Patients who had gall stone pancreatitis should have laparoscopic cholecystectomy on the index admission. Historically poor availability of theatre slots has resulted in unacceptable delays in our health board. The objective of this study was to evaluate adherence to these recommendations before and after an intervention to improve theatre access.

Method
A retrospective study of inpatient laparoscopic cholecystectomies between 20/06/2022 and 28/11/2022 was undertaken in Morriston Hospital. On 20/09/2022, dedicated theatre lists for laparoscopic cholecystectomy were moved from afternoon sessions to morning or all-day sessions with the intention of minimising delays. Baseline patient and operative details were captured from electronic health records. Outcomes were adherence to recommendations from NICE and time to procedure from booking and number of procedures done before and after the intervention.

Result
85 patients were included (42 patients before (Group 1) and 43 after the intervention (Group 2). 100% of patient from group 1 received cholecystectomy within a week of booking compared to 86% from group 2 (P = 0.09). Mean time to procedure was 2.5 days and 3.5 days for group 1 and group 2 respectively (P = 0.076). 3.5 patients received cholecystectomy per week in group 1 as compared to 4.4 in group 2.

Conclusions
Changing the timing of Theatre lists from Afternoon to Morning/all day resulted in more patients receiving cholecystectomies without compromising time from booking to procedure
1223 Physiotherapy’s Crucial Role in Early Elective Post-Operative Orthopaedic Discharge - One More Night?
Authors: Mills R , Sohail Z , Bansal M 
Published: August 2023

Abstract

Aim
Physiotherapy (PT) is essential post operatively in optimizing patient mobility. However, patients admitted to the wards in the evening may not benefit from same day post-operative mobilization. Subsequent overnight hospital stays are common.
We aimed to investigate whether same day mobilization with physiotherapy reduced length of hospital stay. We hypothesized that failure to reach mobility milestones delayed discharge and earlier physiotherapy intervention could reduce overnight stay/hospital duration.

Method
We retrospectively evaluated patient records and operating notes for all patients undergoing elective lower limb arthroplasty procedures under one operating hospital team, during April 2022. 38 patient records were analysed.

Results
Medical complications (particularly fatigue, wound issues, pain, and blood pressure control) commonly delayed discharge (31.6%) and affected engagement with physiotherapy. 55.3% experienced post operative pain affecting engagement with physiotherapy, blood pressure and fatigue being other factors. 92.1% of patients had same-day physiotherapy input of some form (such as pre-operative assessment), whilst 76.3% had same day post-operative PT assessment. Most patients required further PT assessments (92.1%) - of the patients who stayed overnight (92.1%), only 17.1% had same day post-operative physio assessment.

Conclusions
Optimising commonly encountered post operative complications is vital as medical complications often delayed discharge and affected engagement with physiotherapy.
Notably, the majority of patients (68.4%) were discharged from hospital less than a day after being discharged from inpatient PT, suggesting that patient mobility/PT engagement may be the limiting factor affecting discharge.
1238 Audit of Immediate Management and Self-Reported Confidence When Attending Tracheostomy Emergencies
Authors: Marples T , Nicely L , Kalyal N , Wang D , Hasegawa H , Selway R 
Published: August 2023

Abstract

Aim
To examine staff knowledge and confidence in the initial management of tracheostomy emergencies.

Method
Staff from six predetermined occupation groups within King’s College Hospital London, were identified and asked to complete a survey designed to test their knowledge of the initial management of tracheostomy emergencies and evaluate their self-reported confidence in doing so. As well as collecting role information for data stratification, the survey utilised a 1-10 scale for assessing confidence, fields for listing signs of airway obstruction and initial management of emergencies, and yes/no questions for having prior formal training and for awareness of the NTSP algorithm. Completed surveys were compiled and analysed.

Results
Seventeen members of staff completed surveys (Health care assistants n = 2, Nurses n = 7, nurse associates n = 1, Senior house officers n = 2, Physician associates n = 5, Specialty registrars n = 0). Responses to the immediate management question were accepted as appropriate if they included ‘call for help’, ‘apply oxygen’, ‘ABCDE approach’, or similar. Members from medical professional groups (SHO, PA, SpR) had an appropriate response rate of 71.4% (n = 5), whereas member of the healthcare professional groups (HCA, Nurse, Nurse Assoc.) had an appropriate response rate of 50% (n = 5). Self-reported confidence scored, on average, 3.6/10 for medical professionals and 7.4/10 for healthcare professionals.

Conclusions
According to the design of this survey, appropriate knowledge of the management of tracheostomy emergencies does not necessarily correlate to self-reported confidence. The next steps for this project are to implement MDT teaching at King’s, covering tracheostomy care and emergencies, promoting the algorithm, and encouraging confidence via reassessment.
1307 Infection After Surgical Fixation of Fractures – a Multidisciplinary Approach in the Prevention and Early Detection of Fracture-Related Infections
Authors: Quek F F 
Published: August 2023

Abstract

Aim
Infection after surgical fixation of fractures is a serious complication in Trauma and Orthopaedic surgery. A recent study has reported that the incidence of fracture related infections (FRI) may be as high as 30% in patients with open fractures post-surgical fixation. FRI can have significant and devastating impact on the patients as well as causing a huge financial burden on the national healthcare system in the United Kingdom. According to the British Orthopaedic Association (BOA) guideline, all patients with surgically managed fractures should have readily available guidance on how to respond in the event of suspected fracture related infection. The purpose of this audit was to evaluate the standard of practice in the prevention of FRI at a large teaching hospital.

Method
Patient notes and discharge documentation for all Trauma and Orthopaedic patients with surgically managed fractures between 01/10/2022 and 31/10/2022 were reviewed and results analysed.

Results
During this study period, 58 patients underwent surgery for surgical fixation of fractures. Among these 58 patients, only 5 patients (9%) had readily available information on how to respond in the event of suspected fracture related infection in their discharge documentations.

Conclusions
The results from this first cycle of audit shows that our current standard of does not meet the BOAST guideline. Actions must be taken to address this critical issue promptly. We are currently implementing interventions such as patient information leaflets and multidisciplinary approach with the aim to improve our standard of practice. We plan to reaudit the effectiveness of these interventions in January 2023.
244 Major Laparoscopic Versus Robotic Surgery – a Systematic Review of Randomised Controlled Trials
Authors: Kawka M , Fong Y , Gall T 
Published: August 2023

Abstract

Aim
To systematically review randomised controlled trials comparing robotic and laparoscopic surgical approaches in major surgery.

Method
Embase, Medline and Cochrane Library were searched from their inception to September 2022. Included studies were randomised controlled trials comparing robotic and laparoscopic surgery in major general surgical, urological and gynaecological procedures. Short-term, health-related quality-of-life, surgical ergonomics, and long-term outcomes were compared. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results
Forty-eight studies, across fifteen procedures, involving 7588 patients were included. All of the studies reported non-significant differences in mortality between robotic and laparoscopic surgery. In selected studies, robotic surgery was associated with a lower rate of complication (8.3%, n = 4), shorter length of postoperative stay (10.4%, n = 5), and lower conversion rate (6.3%, n = 3), while laparoscopic surgery was associated with shorter operative time (37.5%, n = 18) and lower total cost (20.8%, n = 13). Eight studies found robotic surgery to be associated with superior health-related quality-of-life outcomes. Only six studies included long-term outcomes, with no significant differences between groups, while two studies reported on surgical ergonomics, one each reporting benefits in laparoscopic and robotic groups.

Conclusions
Robotic surgery is at least non-inferior in terms of short-term mortality and morbidity when compared to laparoscopic surgery, with potential benefits in post-operative recovery, and patient-reported outcomes, especially apparent in complex resection procedures. Future studies should focus incorporate metrics of surgical ergonomics, long-term outcomes and formal quality-of-life assessment, to further elucidate where the robotic platform can lead to patient benefits, as its adoption increases.
42 Can Cross-Sectional Imaging Reliably Determine Pathological Staging of Right Sided Colon Cancers and Select Patients for More Radical Surgery or Neo-Adjuvant Treatment?
Authors: Shekleton F , Courtney E , Bunni J , Andreou A 
Published: August 2023

Abstract

Aim
Cross sectional imaging with CT scanning is the most commonly performed imaging modality to stage right sided colon cancers. There is increasing evidence for the use of neo-adjuvant chemotherapy in selected patients and debate about the role of complete mesocolic excision (CME) and central vascular ligation (CVL) in the management of locally advanced colon cancers. Predicted tumour stage and presence of nodal by CT is often used to select patients for neo-adjuvant chemotherapy and those that may benefit metastases from CME.
This study aims to compare predicted radiological T and N staging with final pathological T and N staging in elective patients having potentially curative surgery for right sided colon cancer.

Method
Retrospective analysis of a prospectively gathered database of all patients who had undergone (true) right hemicolectomy between 02/01/13 and 21/05/20. Sensitivity, specificity, positive predictive value, and negative predictive value for CT scanning with regards pathological nodal metastases were calculated and analysed.

Results
The sensitivity and specificity of radiology staging for predicating nodal status were 76.4% and 65.5% respectively. The positive predictive value of CT staging for correctly identifying nodal metastases was 55.3%, with a negative predictive value of 77.3%.

Conclusions
This large series adds further evidence that CT, even when reviewed by expert GI radiologists, has limited accuracy at identifying lymph node metastases in colon cancer.
188 Incidence and Root Causes of Surgical Site Infections After Gastrointestinal Surgery at a Public Teaching Hospital in Sudan
Authors: Hassan R , Osman S , Mohamed W , Hassan R , Mohamed S 
Published: August 2023

Abstract

Aim
Surgical site infections (SSIs) are common healthcare-associated infections and associated with prolonged hospital stays and additional financial burden. Patients undergoing gastrointestinal tract procedures carry a high risk of SSIs. This study aimed to determine the prevalence, associated factors, and causing microorganisms of SSIs among patients undergoing gastrointestinal tract surgeries.

Method
A hospital based, cross-sectional study conducted at Soba University Hospital in Khartoum, Sudan. We included all patients from all age groups attending the gastrointestinal tract surgical unit between September-December 2017. A Chi-square test was conducted to determine the relationship between the independent categorical variables and the occurrence of SSI. The significance level for all analyses was set at p &lt; .05.

Results
80 participants were included in the study. (67.5%) did not have any chronic illness prior to the surgical operation. Most of them (46.3%) underwent large bowel surgery. 27.5% developed SSI post operatively and superficial SSI was the most common type of SSIs (81.8%). Occurrence of SSI was found to be associated with long operation time (p &gt; .001), malignant nature of the disease (p &gt; .001), intra-operative blood loss (p &gt; .001), and intra-operative hypotension (p = .013). The most prevalent microorganism isolated was E coli (47.8%), followed by Enterococcus faecalis (13.0%) and combined Pseudomonas aeruginosa + E coli infection (13.0%).

Conclusions
The results showed a high prevalence of SSIs among patients attending the gastrointestinal tract surgical unit and the most prevalent microorganism isolated from them was E coli. Measures should be taken to reduce the magnitude of SSI by mitigating the identified associated factors.
408 Actinomyces Species Microbiology Proven Infection – an Increasingly Recognised Emerging Implicated Pathogen: An Observational Study
Authors: Kiang J , Venkatesha S , Sanghera A , Raja N , Ahmed J , Ayantunde A 
Published: August 2023

Abstract

Introduction
Actinomyces species, gram-positive filamentous anaerobic microaerophilic organisms, are commensals of the human oropharynx, gastrointestinal and urogenital tracts. Actinomycosis infection is rare and occurs when tissue integrity is compromised, typically in a polymicrobial fashion. There is an emerging rise in Actinomyces species associated infections with their therapeutic challenges.

Aim
To evaluate the pattern, presentation, and risk factors of Actinomyces species associated infections.

Method
Blood culture, tissue, fluids, bone, and swab samples with isolated Actinomyces species were evaluated between July 2016 and April 2021. The antibiotic susceptibility of the isolated Actinomyces was obtained as per EUCAST guidelines. Electronic medical records were retrospectively evaluated for demographic and clinicopathological data relating to the patients.

Results
145 patients were evaluated. The mean age was 49 years, 63 males and 82 females. 52.4% and 59.3% had co-morbidities and risk factors for Actinomyces species infection susceptibility respectively. The most common presentations were infected sebaceous cysts (25.5%) and pilonidal abscess (11.7%). Actinomyces species were isolated from swabs (78), pus(32), blood cultures(26), body fluids(6), soft tissues(2) and bone fragments(1). Eleven different Actinomyces species were isolated. The commonly isolated species were Actinomyces neuii(24.8%), Actinomyces turicensis(22.8%) and Actinomyces europaeus(13.8%). 57.2% of samples had mixed microorganisms isolated. 26/29 blood culture samples yielded Actinomyces and 6/29 yielded mixed microbial agents. 78.6% of patient received empirical antibiotics and 79% of antibiotic choice was appropriate.

Conclusions
Actinomyces species isolates, and infections are increasingly reported, potentially attributed to improved culture techniques. We recommend epidemiology and resistance surveillance in Actinomyces species associated infections.
283 The Impact of Augmented Reality Laparoscopic Simulator in Improving Performance Metrics in General Surgical Trainees
Authors: El-Bahnasawi M , Rawaf D , Street E , Luthra P 
Published: August 2023

Abstract

Aim
To assess the impact of simulated laparoscopic trainers on improving surgical trainees’ technical ability in completing a laparoscopic appendicectomy by measuring effect on completion time and distance travelled with standard instruments.

Method
Six CT1 (early-stage) trainees with little prior operative exposure were selected from the North-West of England Deanery to perform x10 appendicectomy simulated exercises with the Augmented Reality Laparoscopic Simulator (LapAR™), interspersed by x3 Lapass exercises. Metrics including ‘Time of completion’ and ‘Distance travelled’ were collected by the simulators and analysed.

Results
Repeated laparoscopic appendicectomies with the LapAR™ improved performance time for 100% of trainees, with an average of 55% (Regression coefficient -0.65) and improved distance travelled for 75% of the trainees with an average improvement of 39% (Coefficient -2.67). Improvement in instrument smoothness, acceleration and ambidexterity were also observed.

Conclusions
LapAR™ use has improved all performance metrics for most surgical trainees and proves to be an invaluable tool for surgical training.
657 Evaluating the Effectiveness of Virtual Reality for Arthroplasty Training in Orthopaedic Trainees: A Systematic Review
Authors: Adebayo O , Beedham W , Millward I , Gandhi M 
Published: August 2023

Abstract

Introduction
Virtual Reality (VR) provides high-fidelity simulation, enabling trainees to practice surgical procedures whilst reducing patient risk. The focus in orthopaedic literature has been on basic surgical skills and arthroscopic procedures. Research into arthroplasty simulation resources is under-represented.
This systematic review assesses current literature on the effectiveness of VR for arthroplasty training.

Method
A systematic literature search was conducted across all relevant bibliographic databases. Randomised controlled trials (RCTs) meeting the inclusion criteria were selected and assessed by three independent reviewers. The primary outcome was the standardised mean difference (SMD) in either the global rating score or task-specific checklists at pre/post-intervention. This outcome was extracted using a piloted data extraction tool. Studies were assessed for risk of bias using a piloted risk of bias tool.

Results
628 studies were identified, of which 624 did not meet the inclusion criteria. The four studies included in the meta-analysis displayed a trend that VR improved surgical competence more than existing methods (SMD 1.57, 95% CI [-0.45 to 3.59]; P = 0.13).
Secondary outcomes in all studies showed VR improved trainee confidence and provided a more enjoyable experience.

Conclusions
VR improved surgical competency and improved trainee confidence in performing arthroplasty procedures, therefore indicating that this training modality could benefit both trainees and patients in the future. However, there is a paucity of evidence for VR in arthroplasty training, making results less precise and creating significant inter-study heterogeneity. This highlights the need for further high-quality RCTs to be produced assessing the effectiveness of VR for arthroplasty training.
67 Surgical Foundation Doctor Placements: Does Team Structure Alter Training and Support?
Authors: Nadama H , Sullivan L , Mungroo S , Stephens N 
Published: August 2023

Abstract

Aim
Surgical foundation placements lay the groundwork for a surgical career. Many units run individual teams comprising consultants and trainees in the same subspecialty whilst others have adopted ward-based placements where foundation doctors are responsible for patients belonging to several teams.
Belonging to a ‘firm’ is said to increase trainees' access to professional and emotional support. To accommodate for COVID-19 pressures, foundation doctors in our unit became ward-based as opposed to team-based.
Our aim was to explore what impact this pandemic-enforced change in team structure had on foundation doctors’ training experiences.

Method
We conducted a single-center, cross-sectional study. We sent out a questionnaire to foundation doctors who had undergone both pre-COVID and COVID surgical placements. Domains such as training opportunities, support from seniors, and whether their experience impacted their interest in pursuing a surgical career were measured using Likert Scales (1 = low; 5 = high). Statistical analysis was conducted using Microsoft Excel.

Results
A total of 30 foundation doctors completed the survey. Foundation doctors felt that they were significantly more supported when team-based (p = 0.005) and found they had greater training opportunities (p = 0.002). Despite this, there was no impact on their interest in pursuing a surgical career (p = 0.255). Furthermore, for foundation doctors already interested in surgery, their COVID experience did not impact their career aspirations (p = 0.104).

Conclusions
Foundation doctors subjectively preferred individual team-based placements. The change to ward-based work led to perceived fewer training opportunities and less support. However, despite this negative impact on training, there was no impact on whether they would pursue a surgical career.