bluuebunny/crossref_metadata_2025_split huggingface dataset:
1005 Core Surgical Training Applications: Moving Goalposts and the Introduction of the MSRA
Authors: Tincknell L , Spazzapan M , Pasha T , Fortune-Ely M , Songra L , Ogunmwonyi I , Sarsam M 
Published: August 2023

Abstract

Aim
The core surgical training (CST) application has changed year-on-year for the past 3-years. The 2023 application cycle saw the inclusion of the Multi-Specialty Recruitment Assessment (MSRA) for long-listing. Our aim was to assess the impact of the new CST application requirements on applicants.

Method
A questionnaire was distributed to attendees of a CST preparation course. Demographic data were collected. A Likert scale was used to determine agreement with a series of statements regarding the CST application and inclusion of the MSRA. Respondents were also given free text to express opinions regarding CST applications.

Results
One hundred fifty-eight (158) responses were collected, 67 [42.4%] were FY2 doctors, 66 [41.8%] were FY3/out of training in the UK, 8 [5.1%] outside of the UK, 14 [8.9%] FY1s and 3 [1.8%] were in another non-training post.
Eighty-nine (89) [56.3%] respondents applied to CST only, with 60 [38.0%] stating that inclusion of the MSRA made them more likely to apply to other specialties requiring the exam. 16 [10.1%] applicants felt that the MSRA was a fair addition to the application progress.
The common themes of qualitative data included: frustration at the short notice given to criteria changes, as applicants felt they spent years preparing their applications. Concern was expressed that candidates with no interest in surgery may consider applying due to inclusion of the MRSA.

Conclusions
Changing the CST application criteria had an overall negative effect on applicants. Most respondents reported the need for changes to applications to be communicated earlier in advance.
1018 Emergency Urology Crash Course: Teaching Non-Urologists Pays Back
Authors: Desouky E , Koura M , Ibrahim M , Dallash M , Kalsi J 
Published: August 2023

Abstract

Aim
To improve the knowledge, practical skills as well as professional skills of non-urologist health care professionals and bridge the gap between different specialties.

Method
One-day emergency urology crash course has been organised by urology team in our trust. The course is provided by 4 urology SpR under supervision of a urology consultant. Our course includes alternating sessions between lectures and practical skills. Lectures include interactive talks about common emergency urology case scenarios including obstructive uropathy, urinary infections & sepsis, andrological emergency, urologic trauma etc. Hands-on training using mannequin models includes difficult catheter, bladder wash out, 3-way catheter irrigation, flexible cystoscopy, foreskin problems, SPC insertion etc. Pretest and posttest questionnaires as well as a feed-back forms have been used to collect data used to analyse performance and the overall outcome of the course. We ran the course 3 times so far.

Results
Candidates included 60% A&E, 20% General surgery, 10% medical, 10% others. 70% were SpR,25% SHO and F1 or 2, 5% Nursing staff. 80% of candidates were from our trust and 20% from other trusts who got interested to attend. Candidate to faculty ratio was 5:1. Pre and post test result showed increase in knowledge by 4 points and increase in practical skills of 3 points.

Conclusions
One-day emergency urology course can achieve a lot on practical grounds as candidates feel more confident dealing with emergency urology cases after bridging the gaps in their knowledge and practical skills. This reflects on the overall service provided to urology patients presenting in the acute settings.
1050 Application of Bloom’s Taxonomy and Kolb’s Experiential Learning Theory While Designing Low-Cost Surgical Skills Courses for Junior Doctors & International Medical Graduates (IMGs) in the NHS
Authors: Karki B B , Basamh M , Sinha A , Walshaw J , Loubani M 
Published: August 2023

Abstract

Aim
To design a surgical skills course underpinned by Bloom’s & Kolb’s learning theory for junior doctors in the NHS. To develop an affordable skills course for the acquisition of the necessary skills & confidence among junior doctors.

Method
RCSEd CPD approved 1-Day Surgical Skills Course with course fees of £95 was designed based on the learning theory and was attended by 12 foundation-level doctors (&gt;60% IMGs). The course contents were Knot Tying, Suturing Technique, Skin-Lesions excision, Bowel Anastomosis & Tendon Repair. All six levels of Bloom’s Taxonomy were adopted for the Knot Tying session and Kolb’s for designing the remaining skills sessions.

Results
There was the flexibility of learning for the delegates as someone with good clinical knowledge and skills was able to reach level 6 Taxonomy (e.g one-finger knot-tying techniques) rather than limiting to Level 3(Apply) as seen in the conventional courses. Kolb’s learning theory helped the delegates to enter the learning cycle through any stage adopting any learning cycle complementing IMGs with their wide concrete experience. 100% n = 11 delegates responded their course expectations were met. Avg.54.5%n = 6 strongly agreed & 45.5%n = 5 agreed on improvement in their post-course surgical skills.

Conclusions
The low cost of the surgical skills course was found to be one of the confounding factors for the wide participation by junior doctors & IMGs (54.5% n = 5 scored 5/5 & 45.5% n = 6 scored 4/5 for appropriateness on course fees). Adapting these learning theories helped enhance the course outcomes by widening the horizons of skills acquisition.
1132 UseBeforeSurgery-Practical Tips (UBS-PT) Initiative: Enhance Patient Safety with Tips Inspired by Military and Civil Aviation
Authors: Di Stasi L L , Sánchez Carrión J M , Mawhin B , Diaz-Piedra C 
Published: August 2023

Abstract

Aim
The healthcare system, to improve its culture of safety, often have looked at high-reliability organisations including the aviation industry. However, while some flight-safety tools have been slowly introduced into perioperative procedures (e.g., Surgical-Safety Checklist), many guidelines related to Non-Technical-Skills for Surgeons (NOTSS) have obtained low adherence. The apparent time-consuming nature of their implementation have represented a major barrier to the flourish of the NOTSS system. Thus, complementary initiatives, such as the UBS-PT presented here, are needed. The UBS-PT is a list of practical tips aimed at improving patient safety and surgical performance.

Method
By applying a reiterative evidence-based developing process involving healthcare professionals, military pilots, human factors, and legal experts, we identified several practical tips to enhance surgical performance. The developing process and operationalization were complemented by a deep literature review to weight tips’ efficiency, cost-effectiveness, usability, and ease of implementation.

Results
Within NOTSS system framework, we defined ten practical tips promoting the use of (1) group chair-flying, (2) colour-coded stickers, (3) standardised layouts, (4) closed-loop communication, (5) labelled and colour-coded surgical caps, (6) cross-checking and (7) two-challenge rule procedures, (8) the sterile cockpit rule, (9) self-checklist, and (l0) tactical napping.

Conclusions
In an attempt to meet the increasing standards of quality and safety in patient care, the UBS-PT initiative might encourage surgical teams and patient safety boards to find more suitable initiatives for each specific context. The UBS-PT initiative might represent the first step towards a tailored approach, offering concrete measures for the development of safety practices at individual and team levels.
1192 Optical Neuroimaging and Neurostimulation in Surgical Training & Assessment: A State-of-the-Art Review
Authors: Goble M , Caddick V , Patel R , Modi H , Orihuela-Espina F , Leff D 
Published: August 2023

Abstract

Aim
Understanding surgeons’ cognitive patterns may improve surgical training and patient outcomes. Functional near-infrared spectrometry (fNIRS) is a non-invasive optical neuroimaging method increasingly used in surgical training measuring cerebral cortical blood flow using the principle of neurovascular coupling. This review outlines the effect of expertise and stress on surgeons’ neural activation patterns and highlight key progress areas required in surgical neuroergonomics to modulate training and performance.

Method
A literature search of PubMed and Embase was conducted to identify neuroimaging studies using fNIRS in surgeons. This data formed a narrative review.

Results
Novices exhibit greater activation of the pre-frontal cortex than experts when performing simple tasks. Decreased pre-frontal activation correlates with a decline in performance in response to stress; an understanding of neural pathways paves the way for interception of stress upstream of the subsequent deterioration of performance. Trends in fNIRS include measurement of systemic (e.g. heart rate) and regional (e.g. scalp perfusion) physiology to account for confounding factors in cerebral blood flow. FNIRS may be more accurate than current metrics in being able to reliably distinguish levels of expertise between trainees and provide a picture of global cognitive state during surgery which could lead to the development of cognitive benchmarks of expertise. Advances in machine learning facilitating improved data processing will aid bedside fNIRS use, offering the possibility of live feedback on the surgeon’s cognitive state during training or operating.

Conclusions
fNIRS is a burgeoning technology with multiple applications to surgical training with the potential to improve operative outcomes.
1295 To What Extent Would an Augmented Reality Surgical Skills Mobile App Effectively Supplement Surgical Skills Training for UK Medical Students and Foundation Doctors?
Authors: Sule E , Ghaderi R , Tariq S , Kamel Y , Maliyil J 
Published: August 2023

Abstract

Aim
Augmented Reality (AR) has been identified as having high potential to provide early, focused and satisfactory surgical skills education for UK surgical trainees. AR overlays digital information onto the physical world, providing an interactive experience. Mobile applications are effective, low-cost methods of delivering technology-enhanced learning (TEL). This study aimed to determine the viability and efficacy of augmented reality (AR) mobile applications for immersive simulation training for surgical trainees in the UK.

Method
A systematic search using pre-determined terms and criteria was used to identify and screen relevant literature on seven major databases, including EMBASE, MEDLINE, CENTRAL and JBI. Further search of citations, dissertations, and theses (ProQuest) were also conducted. Identified publications were further screened using pre-defined criteria.

Results
34 unique publications were identified in total, from database searches (n = 31) and review of reference lists (n = 3). Following detailed review of abstracts, 14 publications were omitted from ongoing analysis. All remaining publications (n = 20) discuss TEL. Five positive themes emerged: widespread acceptance, improved surgical accuracy, reduced time wasted, telementoring and real-life scenario replication. 2 barriers of AR identified were the lack of tactile feedback, and accessibility, particularly AR implementation.

Conclusions
As a digital technology, AR has the potential to supplement and enhance surgical training. Current literature suggests wide acceptance, skill improvement and time efficiency of digital compared to traditional training and educational methods. However, little research exists specifically evaluating the efficacy of AR mobile applications in delivering surgical skills to early surgical trainees. More research is therefore needed to inform appropriate adoption of this emerging technology.
92 UK Medical Students' Perceptions of Trauma and Orthopaedics as a Specialty, Career and Culture
Authors: Woods J 
Published: August 2023

Abstract

Aim
In 2022, Trauma and Orthopedics’ waiting lists grew to their largest for over a decade. Therefore, the specialty of T&O must ensure that no medical student is dissuaded from pursuing their interest in T&O because of perceptions of the specialty that cause them to doubt their ability to succeed in their career on non-meritocratic grounds. This study seeks to understand and characterise:The reasons why students are / are not attracted to a career in T&OThe perceived barriers and challenges to pursuing a career in T&O

Method
Medical students were invited to share their ambitions, experiences and concerns about challenges and barriers to a career in T&O online.

Results
18 students from multiple medical schools participated. 16 participants stated they were considering T&O as a future career; their reasons included positive placement experiences, diversity of working environments and caseload, innovation, and practical application of skills. The perceived barriers to medical students pursuing their interest in T&O included competition, work-life balance, male domination of the specialty and a hostile working environment.

Conclusions
T&O appeals to many medical students as an exciting career. Unfortunately, students have concerns about being held back by characteristics with no bearing on their performance. However, negative perceptions of the specialty may be remediable by publicising up-to-date competition ratios; raising the profile (including on social media) of female T&O surgeons as role models and mentors; and increasing awareness of support structures available to students and trainees.
758 Green Surgery: Save the Suture, Save the Future
Authors: Ong C S , Rahman K R , Saqib M W , Jesudason E 
Published: August 2023

Abstract

Background
The health sector is pivotal to mitigate climate change due to its responsibility for 4-5% of global greenhouse gas emissions. In 2019, the carbon footprint of NHS England totalled 25 megatonnes of carbon dioxide equivalent (CO2e).

Aim
To reduce the number of the unnecessary opening of suture packs and suture wastage to reduce environmental, social, and financial costs in general surgical procedures.

Method
A prospective audit was conducted at a District General Hospital by collecting data on the number of suture packs opened and unused for general surgical procedures for 2 weeks in November 2022. Intervention was done by raising awareness using posters and sustainability education. The data was collected again for 2 weeks and analysed using GraphPad Prism.

Results
For laparoscopic surgery, there was a reduction in redundant suture packs opened (P = 0.86) and subsequently unused (P = 0.86) but the result was insignificant. In contrast, for open surgery, the reduction in suture pack opened (P = 0.028) and subsequently unused (P = 0.034) was significant. The financial savings were extrapolated to be £2799 yearly. The yearly environmental savings including transport and waste incineration totalled approximately 367kg CO2e. The survey used for social impact showed improved staff sustainability awareness and development of new sustainable practices.

Conclusions
The building of global regime for the mitigation of climate change is vital but the small scales of positive action like reducing suture wastage need to also be encouraged. The emergence of a polycentric system to reduce greenhouse gas emissions will become the inspiration for the national ambition of delivering a net zero NHS.
206 Outcome Measures Reported Following Feminising Genital Reconstructive Surgery for Gender Affirmation in Transgender Women and Gender Diverse Individuals: A Systematic Review
Authors: Iakovou D , Pidgeon T , Franchi T , Lo A C Q , Matthew G , Shah H V , Borrelli M R , Sohrabi C , Rashid T 
Published: August 2023

Abstract

Background
The comparison of differing methods of gender affirming feminising genital reconstructive surgery (fGRS) in transgender women and gender diverse individuals may be confounded by variable outcome reporting and the use of inconsistent outcomes and definitions.

Method
This systematic review examined all outcomes and outcome definitions reported in published studies after gender affirming fGRS in transgender women. Candidate studies were sourced via an electronic, multi-database literature search. Search terms were broad to maximise capture of fGRS procedures. All primary, clinical research studies were included with no date limits. Paired collaborators screened each study for inclusion and performed data extraction.

Results
After screening 1225 studies, 93 studies proceeded to data extraction, representing 7681 patients. 2621 separate individual outcomes were reported, 857 (32.7%) were defined, and the time of outcome assessment was given for 1856 outcomes (70.8%) but relied on wide, non-specific ranges of follow-up dates. 24 discreet outcomes were reported 10 or more times and comprised 20.7% of all outcomes reported. Profound heterogeneity existed in the definitions used for these and for all outcomes reported in general. Only 6 studies declared a primary outcome.

Conclusions
Outcomes and outcome definitions reported following fGRS in transgender women and gender diverse individuals were varied and heterogenous. Improved outcome definitions and the adoption of a consistent Core Outcome Set will aid the fair comparison of future studies evaluating the outcomes of fGRS. This review is the first step in the process of developing such a Core Outcome Set.
223 Comprehensive Geriatric Assessment (CGA) in Perioperative Care: A Systematic Review of a Complex Intervention
Authors: Miller R , Barnes J , Mouteon R , Braude P , Hinchliffe R 
Published: August 2023

Abstract

Aim
Comprehensive geriatric assessment (CGA) is a complex intervention applied to older people with evidence of benefit in medical populations. The aim of this systematic review was to describe how CGA is applied to surgical populations in randomised controlled trials. This will provide a basis for design of studies focused on optimising CGA as a complex intervention.

Method
A systematic review of randomised controlled trials. A systematic search was performed for studies of CGA in the perioperative period across Ovid MEDLINE, Ovid EMBASE, CINAHL and Cochrane CENTRAL, from inception to March 2021. Any randomised controlled trials of perioperative CGA versus 'standard care' were included.

Results
12 121 titles and abstracts were screened, 68 full-text articles were assessed for eligibility and 22 articles included, reporting on 13 trials. 10 trials focused on inpatients with hip fracture, with 7 of these delivering CGA on a geriatric medicine ward, 3 on a surgical ward. The remaining three trials were in elective general surgery all delivering CGA on a surgical ward. CGA components, duration of intervention and personnel delivering the intervention were highly variable across the different studies. Trials favoured postoperative delivery of CGA (11/13). Only four trials reported data on adherence to the CGA intervention.

Conclusions
CGA as an intervention is variably described and delivered in randomised controlled trials in the perioperative setting. The reporting of both the CGA and standard care is often poor with little focus on adherence. Future research should focus on clearly defining and standardising the intervention and measuring adherence within trials.
350 Identifying Malnutrition in Emergency General Surgery (EGS): A Systematic Review
Authors: Ashmore D , Rashid A , Wilson T , Halliday V , Lee M 
Published: August 2023

Abstract

Aim
Emergency general surgery (EGS) practice is high risk. Surgery is a key part of treatment, with resultant catabolic stress and frequent need for nutritional support. Aims of this study were to examine the current methods of defining and determining malnutrition in EGS. This included examining the use of nutrition screening and assessment tools, and other measures of malnutrition.

Method
Medline, Embase, CINAHL, trial registries and relevant journals published between January 2000 and January 2022 were searched for studies of adult patients with any EGS diagnosis, managed operatively or conservatively with an assessment of nutritional status. Mixed populations were included if more than 50% of patients were EGS or EGS results could be separately extracted. Studies whereby patients had received nutritional support were excluded.

Results
From 6,700 studies screened, 324 full texts were retrieved, and 31 were included in the analysis. A definition of malnutrition was provided in 75% (n = 23) of studies, with nutritional status being determined by a variety of methods. Seven nutrition screening tools and nine ‘assessment’ tools were reported. To define malnutrition, the most commonly used primary or secondary marker of nutritional status was body mass index followed by albumin level.

Conclusions
Wide variation exists in approaches to identify malnutrition risk in EGS patients, using a range of tools and nutrition markers. Future studies should seek to standardise nutrition screening and assessment in the EGS setting as two discrete processes. This will permit better understanding of malnutrition risk in surgical patients.
879 The Review of Autologous Fat Grafting Utilizing Negative Pressure for Breast Augmentation
Authors: Bin Mohamed Ebrahim M E , Taghavi S M J , Sidiqi M , George R 
Published: August 2023

Abstract

Aim
There may be a role for topical negative pressure in autologous fat grafting to breasts since it enhances angiogenesis during wound healing for open and closed wound. Here, we present a review of the literature on this topic.

Method
Medline and Embase were utilised, with searches ranging between 1960 – 2019. Terms (“Liposculpting” OR “Fat grafting” OR “Lipofilling” OR “Lipograft” OR “Fat transfer”) AND (“Negative Pressure” OR “Brava” OR “Kiwi”) AND (“Breast”) were merged as keywords. Inclusion criteria were females, autologous fat graft to breast with negative pressure prior to procedure. Studies were excluded if there was no primary endpoint or non-original article. Primary outcome measured was fat graft survival post breast augmentation with post-operative morbidity as a secondary outcome.

Results
Upon reviewing 219 articles, 2 met inclusion criteria. A total of 611 breasts were treated using negative pressure devices, with each cohort having different pre- and post-operative pressure settings. Khouri et al. cohort had higher graft survival (79%) compared to Del Vecchio et al. cohort (64%), however the latter had fewer complications compared to Khouri’s cohort e.g. fat necrosis, pneumothorax and infection.

Conclusions
There is still limited evidence regarding the use of topical negative pressure for fat grafting to the breasts. Autologus fat grafting to breasts without the use of negative pressure is shown to have graft survival of 60-70%. Given its potential benefits, more future studies are needed to fully understand the impact of this technique.