bluuebunny/crossref_metadata_2025_split huggingface dataset:
776 “Doses of Human Anatomy”: A Telegram Channel Augmenting Anatomy Education
Authors: Ali A , Awad K 
Published: August 2023

Abstract

Introduction
Telegram has become one of the most popular messaging applications. Its multiple features enable its use for different educational purposes. This study aimed to explore the role of a Telegram’s channel in Anatomical education.

Method
A Telegram channel was created and shared to first year medical students of University of Khartoum. Subscription to the channel was optional. The Thorax module was covered through different types of daily online posts and quizzes which were posted over one month, in line with the formal practical sessions. At the end of the module, an online test shared to both subscribers and non-subscribers, a feedback questionnaire and focus group discussion were used to assess the effects of the channel and students’ reflection on it.

Results
336 students subscribed to the channel by the time of the test. There was a significant association between subscription status and test score (p = 0.01, t = 2.79). Frequency of viewing did not affect test score. Students reported that written posts with images and quizzes were the two most helpful types of posts. Students reported that the channel made it easier for them to understand anatomy (86.4%), aided retention of information (92%) and encouraged engagement (81.6%). Continuation of the channel was recommended by 95.2% of students.

Conclusions
The channel provided concise and structured material that acted as a blueprint for students during studying and exam preparations. It proved itself as a useful complementary tool for students in the anatomy module. We recommend formal integration of Telegram channels in anatomy curricula.
617 External Validation of the IDENTIFY Risk Calculator for Predicting Urinary Tract Cancer in Patients with Haematuria
Authors: Khadhouri S , Orecchia L , Banthia R , Piazza P , Mak D , Pyrgidis N , Narayan P , Abad Lopez P , Nawaz F , Thanh T T , Claps F , Hogan D , Gomez Rivas J , Chibuzo I , Kulkarni M , Anbarasan T , Gallagher K , Kasivisvanathan V 
Published: August 2023

Abstract

Aim
Risk-stratification for patients referred with haematuria is important in diagnosing cancer early and for health resource efficiency. A recent prediction model developed from the IDENTIFY study created a cancer risk calculator that aimed to help clinicians with their decision-making in the investigation of patients with haematuria. We aimed to externally validate this model in a separate cohort from the development population.

Method
Data were collected on patient characteristics used for the risk calculator, and the cancer outcome recorded. Patients with a previous or existing urological malignancy were excluded. Development and validation cohort demographics were compared. The area under the receiver operating characteristic curve (AUC), calibration slope, calibration-in-the-large (CITL), and Brier’s score were used to assess external validation.

Results
There were 3483 patients from 111 hospitals across 27 countries. 12 countries were new countries not used in the development cohort. The development and validation cohorts were well matched. When comparing the observed vs predicted outcomes of the prediction model on the validation cohort, the calibration slope was 0.97 and CITL was 0.33. AUC was 0.79. Brier’s score was 0.15.

Conclusions
External validation of the IDENTIFY risk calculator shows good accuracy and discrimination for predicting urinary tract cancer in patients referred with haematuria. The model underestimates the risk slightly and this can be recalibrated by adjusting the intercept of the regression equation. The recalibrated risk calculator can be introduced into diagnostic haematuria pathways to improve risk stratification and health resource allocation.
598 Video-Assisted Thoracoscopic Surgery Versus Robot-Assisted Thoracoscopic Surgery in Early-Stage Lung Cancer: A Systematic Review and Meta-Analysis
Authors: Shirke M , Soh V , Azmi A , Wee A 
Published: August 2023

Abstract

Aim
Video-assisted thoracic surgery (VATS) remains the main surgical procedure for lung cancer resection. However, it is associated with technical limitations and a steep learning curve. Hence, alternative approaches like robot-assisted thoracic surgery (RATS) have been explored. This review aims to compare the clinical outcomes of VATS versus RATS in early-stage lung cancer patients.

Method
A systematic, electronic search was performed according to PRISMA guidelines to identify relevant articles that compared outcomes of the VATS versus RATS procedures in patients with early-stage lung cancer.

Results
Seventeen studies were identified, enrolling 17,111 patients. The mean tumor size was 12.58±7.21cm in the RATS group and 5±2.5cm in the VATS group, with most patients in the Stage 1 cancer group. The primary outcomes, length of hospital stay (MD 0.37, 95% CI [-0.15, 0.89], and conversion (OR 0.99, 95% CI [0.68, 1.43]), were not statistically significant. Although more lymph nodes were retrieved during the RATS procedure (MD -0.70, 95% CI [-1.18, -0.21]), no significant differences were observed in other secondary outcomes such as operative duration (MD -0.14, 95% CI [-1.00, 0.73]), reintervention (OR 1.47, 95% CI[0.22, 9.79]), infection (OR 0.89, 95% CI [0.52, 1.54]), and bleeding (OR 1.15, 95% CI [0.52, 2.55]).

Conclusions
The RATS and VATS procedures have comparable outcomes, thus proving the RATS procedure to be a safe alternative. However, the technical feasibility and cost-effectiveness need to be thoroughly studied. This review calls for robust trials comparing the two techniques to further evaluate the value of the RATS procedure in early-stage lung cancer.
828 Real-Time Artificial Intelligence Instruction in Comparison to Human Expert Instruction in Surgical Technical Skills Teaching – a Randomized Controlled Trial
Authors: Yilmaz R , Bakhaidar M , Alsayegh A , Abou Hamdan N , Fazlollahi A M , Del Maestro R 
Published: August 2023

Abstract

Aim
Surgical simulators equipped with artificial intelligence (AI) systems provide risk-free training on realistically simulated complex patient cases, objective performance assessment, and tailored error avoidance feedback. This study compared the efficacy of real-time AI instruction with human instructor-mediated training in surgical technical skills teaching.

Method
Medical students (n = 98) were randomly allocated into three feedback groups. Everyone repeated a virtual brain tumour resection five times. The first repetition was done without receiving feedback to assess their baseline performance. Students in Group 1 did not receive real-time feedback, and they were shown visual feedback only after each procedure based on expert benchmarks. Students in Group 2 were instructed in real-time by the AI system. After each task, the students were shown their error-video clips generated by this system alongside the expert-level demonstrations relating to each error. Students in Group 3 were instructed by human instructors during the tasks. After each task, instructors summarized the areas of improvement and demonstrated correction techniques. All participant data was scored using a composite-score. Statistical analysis was conducted to compare learning from the first to the last task repetition.

Results
Students in Group 2 and Group 3 significantly improved in the performance score by the third and second repetition, respectively (p&lt;0.01, p = 0.01) compared to their baseline performance. Students in Group 2 achieved significantly higher scores than those in Group 3 in the fifth repetition (p&lt;0.01).

Conclusions
Artificial intelligence systems may provide competency-based curricula in surgical training with efficient surgical technical skills teaching methodologies.
69 Is CT Urogram Screening Necessary in All Patients with Visible Haematuria in Both the Immediate and Short-Term Follow-Up Period?
Authors: Mallalieu K 
Published: August 2023

Abstract

Introduction
A standardised specific investigation protocol for visible haematuria (VH) screening remains a debate. A recent regional audit highlighted our department as an outlier for the high useage of CT urogram (CTU). We sought to determine the incidence of upper tract cancer (UTC) in a VH cohort, exploring the benefit of routine CTU versus the possibility of developing a selective patient-centred approach.

Method
Retrospective case-note review of all 2-week-wait patients referred for VH from May-October 2018. Data was analysed to describe the incidence of bladder transitional cell carcinoma (TCC), upper tract transitional cell carcinoma (UTTCC) and renal cell carcinoma (RCC); the detection rate of CTU and the missed rate of UTC over the following four years.

Results
437 patients (334 men, 103 women; age range 21-95 years, median age 71 years; 35% smokers, 45% non-smokers, 18% smoking status unknown) underwent VH screening with a cancer detection rate comparable to previous literature (18% TCC, 1.4% RCC, 1% UTTCC). 73% (n = 321) underwent CTU, 52% (n = 229) underwent CTU and ultrasound (USS). USS missed one RCC subsequently detected by CTU. 72.7% and 63.6% of those diagnosed with UTC (age range 57- 86, mean age 71 years) were male or smokers, respectively. 43% (n = 189) received further upper tract imaging during the subsequent four years, with one further RCC detected.

Conclusions
The additional detection rate of CTU and subsequent development of UTC was minimal within our cohort suggesting the use of CTU in VH screening could be selective rather than routine.
91 Introduction of a Simple Proforma Improves Documentation of Neuro-Vascular Status in Paediatric Supracondylar Humerus Fractures (Closing Loop Audit)
Authors: El-Gendy M , Hassan A , Soliman E , Deierl K 
Published: August 2023

Abstract

Introduction
Supracondylar fractures of the humerus are the most common fracture around the elbow in children. There is a risk of significant complications including nerve injury, vascular compromise, compartment syndrome and clinical deformity. BOAST (British Orthopaedic Association Standards for Trauma) published guideline 11 in 2014 (updated in Oct 2020) which lists criteria that should be assessed and documented for each child with this injury.

Aim
Assess whether an introduction of a simple proforma will Improve documentation of the neuro-vascular status in paediatric supracondylar humerus fractures.

Method
a closing loop Audit to review the accuracy of documentation of the neuro-vascular status in the admission clerking against the standards published in the updated BOAST guidelines both before and after introduction of a simple documentation proforma.

Results
In the first audit cycle 30 patients were included and detailed documentation of the Neuro-vascular status as per the BOAST guideline was less than 40 %. After the proforma was introduced, the second closing loop cycle included 31 patients and detailed documentation of the Neuro-vascular status as per the BOAST guideline was 70 %.

Conclusions
The introduction of a simple proforma has improved significantly the documentation of the neurovascular status in children presenting to the ED with a supracondylar humerus fracture.
139 “Never Event, Never Again” - a Closed Loop Audit on the Documentation of Nasogastric Tube Position Following X-Ray Confirmation
Authors: Iosif G , Tan C H , McCadden L 
Published: August 2023

Abstract

Aim
Nasogastric feeding is common among ENT patients with dysphagia. CXRs are performed to confirm tube position before feeding. However, communication failure from poor documentation potentially leads to feeding through a misplaced tube into the lungs which is a "Never Event". This audit aims to reduce risk of patient harm by encouraging the use of nasogastric tube documentation sticker on clinical notes in Royal Victoria Hospital ENT ward.

Method
An initial study was conducted in June 2022 evaluating the quality of documentation of NGT position following CXR. Subsequently, several interventions were implemented including teaching doctors on utilising the documentation sticker that comes with each NGT pack, placing posters on the ward and reminding the nursing staff to check the documentation before starting feed. Further re-audit was carried out in August 2022 post-intervention.

Results
58 CXRs were performed. Use of the documentation sticker rose from 42.1% to 85%. This led to verification of patient identity increasing from 39.5% to 100% and confirmation that the x-ray was most recent for the patient from 44.7% to 100%. 85% of the x-rays had time and date verified compared to 34.2% previously. Documentation of the position of NGT and instructions for feeding improved from 63.1% to 75% and 65.8% to 75% respectively. Record of the staff who confirmed tube position increased from 60.5% to 75%.

Conclusions
This audit demonstrated an increased use of the documentation sticker resulting in improvements in confirmation and documentation of NGT position. These positive changes reduce risks of significant patient harm thereby improving patient safety.
185 Improving Care and Outcomes with One-Stop Haematuria Clinic
Authors: Klyvyte G , Fernandes M , Nelson A 
Published: August 2023

Abstract

Aim
To compare the outcomes of pre and post implementation of a Faster Diagnostic Standard (FDS) at 28 and 62 days before and after implementation of the One-Stop Haematuria Clinic in James Paget University Hospital.

Method
The data for the retrospective audit was collected from the Somerset cancer registry and Ullyses. All patients referred on 2 week-wait haematuria pathways were included from July 2020-October 2020 (pre-implementation of the one-stop clinic, n = 132) and from September 2021 – January 2022 (post-implementation of the one-stop clinic, n = 269). The data points were 2 week-wait, referral to flexible cystoscopy, imaging, 28-day and 62-day targets. The data was analysed using unpaired T-test.

Results
Following implantation of the one-stop clinic, the mean number of days for referral to flexible cystoscopy reduced from 27 to 19 (p&lt;0.0001) and referral to imaging reduced from 27 to 19 (p&lt;0.0001). The mean number of days to reach 28-day target decreased from 47 to 31 (p&lt;0.0001). Days from referral to TURBT (Transurethral Resection of Bladder Tumour) decreased from 61 to 57 (p = 0.60). The patients meeting the 62-day target of TURBT as FDT increased from 66% to 83% (p = 0.35).

Conclusions
The introduction to one-stop haematuria clinic led to shorter time from referral to flexible cystoscopy, imaging and diagnosis. However, time from referral to TURBT was similar. A greater percentage of patients met the 62-day target of TURBT as FDT. Therefore, one stop haematuria clinics provide a more efficient diagnostic pathway for this group of patients.
237 Delay in Ankle Fracture Fixation Against BOAST Guidelines for Ankle Fractures
Authors: Hassan R , Divekar M 
Published: August 2023

Abstract

Aim
Ankle fractures are common, and the majority are the result of low energy torsional trauma. The aim of treatment is to restore and maintain stability and alignment of the joint, ideally with normal anatomy of the ankle mortise. According to BOAST guidelines for ankle fractures, Early fixation within 24-48 hours is recommended in the majority of patients under 60 years when the ankle mortise is unstable. This study aimed at assessing our practice in managing ankle fractures against BOAST guidelines and infection rate assessment.

Method
Data was collected respectively from electronic patient records for three months period and entered excel. First cycle results were presented in a departmental audit meeting and recommendations to improve practice were acted upon. Second cycle data was collected three months later and for three months period. Final re-audited results were presented in a departmental audit meeting.

Results
First cycle results: only 11% of patients had their ankle fractures fixed within 48 hours and none of them had surgical site infection. 65.2 % of patients had their operations over a week with an Infection rate of 10.6%.
Second cycle results: 19% of patients had their ankle fractures fixed within 48 hours and none had surgical site infection. 47.6 % of patients had their operations over a week with an Infection rate of 4.8%.

Conclusions
Second cycle results showed improvement in operative timing and surgical site infections rate against BOAST guidelines compared to initial first cycle results. Early fixation for ankle fractures is associated with lower infection rates.
331 Improving Equity of Access in a Post-Covid World: A Closed Loop Audit of the Varicose Vein (VV) Referral to Treatment (RTT) Pathway
Authors: Farndon D , Bennett P 
Published: August 2023

Abstract

Aim
Restrictions in clinic, investigations and theatre capacity following COVID-19 led to a change in local CCG VV referral criteria meaning those with advanced venous disease were seen. However, it was noted that many patients attending clinic didn’t meet these new CCG criteria.

Method
Following a change in CCG criteria in April 2021, all VV referrals to vascular surgery between 01/04/21-28/02/22 (AC1) were audited and differences between the consultants’ acceptance practice was reviewed. Results were presented at clinical governance in 09/03/22, with change implemented and referrals between 01/04/22-31/07/22 (AC2) re-audited.

Results
250 VV referrals were made in AC1, 43.5% Male, mean (±SD) age 54.8 (16.9) years, by GPs (82.8%), other HCP (11.6%). 158 (63.2%) failed the criteria and should have been rejected. However, the actual rejection rate was 44.9%, with significant differences (P&lt;0.001) in consultant practice demonstrating inequity for patients’ acceptance to be seen in clinic. 62.9% of ineligible patients attending clinic had subsequent investigations, increasing the waiting list time for all patients.
153 VV referrals were made in AC2, 43.1% Male, mean (±SD) age 55.3 (17.7) years, by GPs (86.3%), other HCPs (12.4%). 96 (63.7%) failed the criteria. However, in AC2 there was a 15.5% improvement (p = 0.02) in consultants appropriately rejecting outright and no significant differences in consultant practice (P = 0.46).

Conclusions
There is now less variation between consultants and a greater adherence to CCG criteria in AC2 demonstrating improved equity of access. There are fewer inappropriate clinic attendances, therefore less investigations and treatment booked, decreasing overall wait time and unnecessary downstream costs.
388 “Day Case Laparoscopic Cholecystectomy – Are We Getting It Right?”
Authors: Zeng L , Joglekar S 
Published: August 2023

Abstract

Introduction
About 66,660 cholecystectomies are performed in the UK annually, of which majority are laparoscopic, costing NHS about £ 111 million. As per GIRFT, 80% eligible patients should have cholecystectomy within 8 days of hospital admission. Cholecystectomy quality improvement collaborative was established nationwide to support surgical teams and improve patient outcomes. At our hospital, we have established a twice weekly HOT LAP CHOLE list to manage these patients.

Aim
To analyze outcomes after day case laparoscopic cholecystectomy.

Method
Records of 100 patients over 3 months undergoing elective or emergency cholecystectomy were retrospectively analyzed. Data collection included demographics, diagnosis, length of stay (LOS), complications, conversion rate, and re-admission rate.

Results
Among 100 cases (26 males, 74 females, with an age range of 22 – 89), 80 were elective and 20 were emergency. All emergency cases were operated on within 8 days of hospital admission. 73 were successfully performed as day cases (69 elective, 4 emergency), making the elective day-case rate 86%. LOS ranged from 1 to 34 days, and the reason of stay was mainly post-op pain/vomiting or drain left intraoperatively. 3 cases were converted to open (2 electives, 1 emergency). The re-admission rate was 6% (4 electives, 2 emergencies), mainly because of post-operative pain. 9 patients had complications (3 - bleeding, 5 - bile leak, 1 - wound infection).

Conclusions
The successful day-case rate meets the recommendation by the British Association of Day Case Surgery (&gt; = 60%). And our HOT LAP CHOLE list has effectively improved the management of emergency cholecystectomy. However, post-op pain control should be optimized.
463 Adherence to Extended Venous Thromboembolism Prophylaxis for Post Operative Resection of Colorectal Malignancies
Authors: Yeung T , Ng S , Sidhu R , Ali M 
Published: August 2023

Abstract

Aim
Patients undergoing cancer resection abdominal surgery are at high risk of developing venous thrombo-embolism (VTE) in the post-operative period. To reduce this risk, these patients should be considered for extended pharmacological VTE prophylaxis for 28 days post-surgery as per NICE guidelines (NICE NG89). In our surgical department, we give all colorectal cancer resection patients 5000 units of Deltaparin for 28 days post resection unless it is contraindicated. We aimed to evaluate adherence to this guideline.

Method
This is a single-centre retrospective audit study. We included 100 colorectal cancer resection cases between 1st October 2021 and 28th February 2022 (n = 100). Retrospective data was collected including the type of procedure, histology and whether post-operative Deltaparin was prescribed for 28 days. All consecutive colorectal cancer resections were included in the study. The data was collected from the patient electronic records, electronic prescribing system and the electronic discharge summaries.

Results
The most common operation was anterior resection of the rectum (42%) followed by right hemicolectomy (40%). The Adherence to the NICE guidelines for extended VTE prophylaxis was 87%.

Conclusions
The adherence to the NICE guidelines in our department falls below the national target of 90% adherence. To improve the compliance, we will carry out staff education on appropriate anticoagulation prescribing and also display informative posters in the surgical wards to increase the awareness. We will aim to re-audit the adherence to the guidelines after implementing these measures.
472 An Audit on the Optimal Timing of Imaging in Acute Pancreatitis
Authors: Patel M , Khawaja A , Oki T , Eigbefoh R , De Silva K , More A , Lascelles S , Troller R 
Published: August 2023

Abstract

Aim
Acute pancreatitis (AP) is an inflammatory process of the pancreas with varied aetiology, commonly gallstone disease (50%) and excess alcohol. We aimed to assess the compliance of our trust in diagnosing and imaging against IAP/APA and BSG guidance.

Method
Patients diagnosed with AP between 05/2022 and 12/2022 were retrospectively collected. We investigated factors based on guidelines including correctly diagnosing AP within 48 hours of admission, adherence to optimal timing for ultrasonography (&lt;24 hours of diagnosis) and CT (within 72-96 hours after onset of symptoms or 48 hours of admission).

Results
65 patients were analysed and correct diagnosis within 48 hours was achieved in 90%. The compliance with timing and type of imaging was, unfortunately, extremely low. Only 6.15% of patients had a CT after 48 hours of admission, 29.23% within 72-96 hours after the onset of symptoms and only 17% had ultrasonography within 24 hours of diagnosis. CT was the initial imaging modality for 75% of patients despite it diagnosing pancreatitis secondary to gallstone disease in only 17% of all cases.

Conclusions
We demonstrated that our trust is proficient at timely diagnosis of AP, however, has poor compliance with both the timing and type of imaging. BSG recommends ultrasonography as initial imaging in suspected AP over CT due to ultrasonography’s low cost, accuracy and sensitivity. Additionally, early CT’s underestimates final disease severity and do not improve outcomes. Improvements to our service can be made by educating staff regarding the current guidelines and working with the trust to increase ultrasonography availability.