bluuebunny/crossref_metadata_2025_split huggingface dataset:
349 Improving Surgical Teaching for Junior Trainees Internationally in Light of Covid-19
Authors: Turner B. , Jasionowska S. , Bakko F. , Huttman M. , Hall R. , Doshi A. , Agarwal T. 
Published: February 2022

Abstract

Aim
During the Covid-19 pandemic there has been a gross effect on surgical training at all grades. A cohort that has been affected but reported less frequently are medical students and foundation doctors (junior trainees), whose interest in the field and clinical skills may have been affected by reduced service provision.

Method
A survey of junior trainees was conducted to analyse their perceived adequacy of surgical teaching in light of the effect of Covid-19. An online teaching course was then designed to target areas of weakness identified in the survey. The content was designed with the Imperial College London surgery curriculum and was vetted by a consultant surgeon.

Results
Of the 713 people surveyed, 393 (55%) had received little or no surgical teaching and 496 (70%) respondents said they were “not” or “slightly” confident in managing common and emergency surgical presentations. A free text box highlighted that deteriorating patients, clinical decision-making, and initiating management were the greatest concerns. This was used to design an international online teaching course for junior trainees, that focused explicitly on clinical care. The sessions were run live on MindTheBleep via Facebook live, to answer questions in real time and examine cases with live audience participation, receiving feedback after every session. This model has reached trainees in &gt;30 countries with &gt;200 feedback responses and an average rating of 4.5/5.

Conclusions
Junior trainees are a key cohort whose interest and education in surgery has suffered due to the pandemic. An innovative, online, clinically orientated course is assisting to re-engage trainees internationally.
353 The Rise of the Exoscope
Authors: Parwez R. , Baig A. , Rahman S. 
Published: February 2022

Abstract

Introduction
An exoscope is a next generation HD telescope video monitoring system used to perform microsurgeries that is now a formidable rival to the existing operating microscope in neurosurgery. While the microscope revolutionised neurosurgery with its advent in 1957, the exoscope allows surgeons to operate utilising high-definition images enhancing the field of vision and focus. The exoscope opens new avenues with regards to ergonomics, teaching in theatre and enhances the surgeon’s experience.

Method
We will do a literature review on available literature on the use of exoscope in neurosurgery with regards to the operating microscope. Both qualitative and quantitative data will be reviewed. Personal experience of Neurosurgeons in our unit will also be reviewed using questionnaires.

Results
The exoscope has many benefits when compared to the operating microscope where it surpasses its predecessor in many ways. 15 studies were reviewed where the exoscope was compared to the operating microscope which concluded the exoscope equal or superior in many aspects such as teaching, ergonomics, image definition and being user friendly. There were some pitfalls of the exoscope reported such as the image being in 2D which limited the surgeon’s stereoscopic vision and the costs involved.

Conclusions
The exoscope is a revolutionary advent in neurosurgery and may soon make the operating microscope obsolete but there is still room for improvement.
354 Virtual Consultation in Vascular Practice: The New Normal
Authors: Lo N. , Khan M. , Sadia U. , Jaipersad A. 
Published: February 2022

Abstract

Aim
Face to face vascular clinics were suspended at a major trauma centre at the beginning of the COVID-19 pandemic, however Royal Stoke Hospital Vascular team were still undertaking emergency vascular operations. Consequently, virtual telephone consultations were set up and delivered to facilitate post-operative follow ups. The objective of this improvement study is to compare the virtual clinic documentation against The Royal College of Surgeons of England (RCS Eng) Best Practice Guidance on Conducting Virtual Consultations, which was published in June 2020. This is important as good documentation is vital to patient care as well as being a medico-legal document.

Method
We retrospectively identified 30 vascular patients operated between May 2021 and June 2021; 10 of which had had a virtual telephone clinic and the majority underwent an amputation. We audited the clinic note documentation against the RCS Eng guidelines.

Results
Total of 9 RCS Eng guidelines were identified and audited. The first cycle revealed poor areas in documentation of the surgeon introducing themselves, confirmation of patient details, obtaining consent to proceed, summary of consult and plan discussed.
Findings were presented at the trust governance meeting. Areas which required improvement in documentation were highlighted. In addition to education of surgeons, it was decided to introduce a checklist as a requirement.

Conclusions
Clinic note documentation is of paramount importance as it has legal and medical ramifications. The education of surgeons and introduction of a checklist to ensure compliance with RCS Eng guidelines and we will re-audit to ensure improvement.
357 A Novel Protocol for Post-Operative Bloods Following Elective Colorectal Cancer Resections - a Re-Audit of a Closed Loop
Authors: Matwala K. , Iqbal M.R. , Walton S.J. 
Published: February 2022

Abstract

Aim
Indications for blood tests are often poorly considered. Appropriate blood requests reduce trauma for patients, improve laboratory workflow and reduce costs. We therefore created a novel protocol for bloods requested in the post-operative period for patients undergoing elective colorectal cancer resections.
We performed two audit cycle loops to assess protocol adherence and evaluate financial savings.

Method
The protocol was agreed locally by consultant consensus, presented locally in February 2021, and displayed on surgical wards in May 2021.
Bloods requested were reviewed retrospectively for patients undergoing elective colonic resection with an uncomplicated post-operative course. Data was collected prior to the local meeting between September-November 2020 (audit 1, cycle 1), after the meeting between March-April 2021 (audit 2, cycle 1), then after distribution of the protocol to wards between July-August 2021 (cycle 2).

Results
The locally agreed protocol was post-op day 1,5,7 FBC, U&E, CRP; day 3 FBC, U&E, CRP, LFT; day 2,4,6 no bloods.
In audit 1 (cycle 1) 100% protocol adherence would have saved £15.96 per patient (n = 20). In audit 2 (cycle 1) the protocol was followed on 21.4% of days with further savings of £14.21 per patient (n = 23) had there been 100% adherence. In cycle 2, there was 40.74% protocol adherence with £6.62 further potential savings per patient (n = 15).

Conclusions
Following the post-elective colorectal resection bloods protocol may save our hospital £1700 per annum. Protocol adherence improved when displayed on surgical wards. With these exciting results, we are working with Medway EPR to create an order set containing this protocol.
358 An Anatomical Study of the Sylvian Fissure Using a Large Number of MRI Data Sets
Authors: Chia C.W.L. , Shastin D. , Gray W. 
Published: February 2022

Abstract

Introduction
Accurate manoeuvring of the Sylvian fissure borders to provide an optimal operating corridor is vital for minimising retraction. The anatomy of the fissure can pose technical challenges impacting the overall success of the procedure. Yaşargil previously proposed a classification distinguishing four anatomical variants correlating with surgical difficulty. We aim to utilise the open-source Human Connectome Project MRI data set to provide a computational classification of the fissure based on morphology.

Method
MR images of 2226 hemispheres were included in this study. Morphometrical parameters were designed and refined in MATLAB simulations. Combinations of parameters were analysed using K-Means Clustering.

Results
Following segmentation and removal of outliers, 1693 fissures remain for analysis. K-Means Clustering revealed three clusters with sulcal bulk displacement measure (deviation of the fissure towards the frontal or temporal lobe) and sulcal distance (width of the fissure) (silhouette score = 0.383).

Conclusions
Analysis of a large neuroimaging cohort suggested the existence of three weakly separated anatomical variants. We propose that looking at the quantitative scores rather than class allocation would be more informative for preoperative planning.
362 Neurological Outcomes in Patients Presenting with a Low GCS Due to CSDH
Authors: Edwards B. , Zolnourian A. , Sadek A.R. 
Published: February 2022

Abstract

Introduction
Chronic Subdural Haematoma (CSDH) is a common neurosurgical pathology. Neuroprognostication remains a challenge and evidence remain limited, particularly in patients presenting with a low GCS (8 or lower). Further clarification on neuroprognostication is important to inform surgical decision making.

Method
1278 patients who had CSDH surgically evacuated were retrospectively reviewed for GCS at presentation. 77 patients with GCS of 8 or less were detected. Mortality at discharge and 6 months, GCS, Glasgow Outcome Score (GOS) on discharge, discharge destination and other relevant clinical information were recorded from their paper and electronic notes.

Results
35 patients (45.4%) had a good neurological outcome (GOS 4 or 5). Inpatient mortality was 7.8% (n = 6). 6-month all-cause mortality was 20.7% (n = 16). Only 21.1% were discharged directly to their usual place of residence, with the remainder being discharged to local hospitals or rehabilitation units. Overall GCS (p = 0.003) and motor score (p = 0.013) at presentation was significantly associated with neurological outcome. Only overall GCS was associated with inpatient mortality (p = 0.037) but there was no association with mortality at 6 months (p = 0.603).

Conclusions
GCS of 8 or less in patients with CSDH is an important finding, with significant subsequent neurological morbidity and mortality. Although it is not the only prognostic indicator, a large number of patients had a good outcome despite this, indicating that intervention is not futile in all.
363 Developing an International Clinical Teaching Programme for Final Year Medical Students for the COVID Pandemic and Beyond, an Italian Experience
Authors: Vijayagopal K.A. , Wa Katolo H. 
Published: February 2022

Abstract

Introduction
During the COVID-19 pandemic medical students’ time in a clinical setting in the University of Pavia (UNIPV) had been greatly reduced for justifiable safety concerns.

Aim
Providing clinical teaching to medical students with an international network of UNIPV alumni.

Method
We recruited a cohort of UNIPV alumni, now working as junior-doctors throughout the UK and Ireland to teach and share their experience in assessing patients and creating management plans for commonly encountered scenarios on-call. 12 sessions were held over Zoom Online Videoconferencing and covered a broad surgical and medical syllabus via clinical cases. Pre- and post- teaching questionnaires were used to review the outcomes of intervention.

Results
Students reported an average confidence increase from 4.48/10 to 6.63/10 in patient assessment. Encouragingly, confidence in history taking stood at 8.38/10 after participating in the course. 37.5% of participants were interested in becoming tutors when running the course again next year and overall, 75% of participating students would recommend this course to students in successive years.

Conclusions
From our results the significant increase in confidence of students in assessing, examining, and patients as expected of day one junior doctors is notable. One limitation was the inability to substitute the practical skills aspect of clinical teaching due to the online delivery of the course. A future ‘blended’ delivery may overcome this. Given its positive response, we hope that this course can leave a lasting impact with further courses being run in the future for successive years by the future UNIPV alumni.
364 A Novel Preparation of Bone Cement for Vertebroplasty: Can Strontium Folate Improve the Mechanical and Biological Properties of Calcium Phosphate Cement?
Authors: Heer B. 
Published: February 2022

Abstract

Aim
Bone cements currently used for vertebral body augmentation procedures lack biological properties that allow them to osseointegrate. Strontium folate (SrFo) has been shown to increase the viability of human osteoblast (HOb) cells. The potential of a novel preparation of calcium phosphate cement (CPC) with added SrFo is explored to investigate whether SrFo can increase its biocompatibility.

Method
Brushite-forming CPCs with 0% (negative control) and 5% and 10% weight-weight additions of SrR (positive control) and SrFo were formulated. Initial (Ti) and final (Tf) setting times were measured. Mechanical analyses included ultimate compressive strength and plane strain fracture toughness. Topography and distribution analyses occurred during materials characterisation and in vitro analysis using scanning electron microscopy (SEM).

Results
There was no significant difference in the Ti between the CPCs, but significantly greater Tf for all SrFo-CPCs. There was no significant difference in the compressive strength between the CPCs, but a significantly decreased fracture toughness in all SrFo-CPCs. SEM revealed non-homogeneous structures in all SrFo-CPCs. Whilst the pH of the HOb cell culture medium remained the same for all CPCs, the proportion of dead cells was significantly higher than that of alive cells.

Conclusions
The addition of SrFo did not produce any significant differences in the material characteristics of the cements, nor the in vitro properties, except for a prolonged setting time. Future studies should seek to determine the osteogenic nature of SrFo by altering the formulation of the CPCs to a non-toxic preparation, such as apatite-forming cements which are known to have superior mechanical properties.
365 Local Anaesthetic Transperineal Template Biopsy in the Outpatient Setting: A More Sustainable Option in the NHS?
Authors: Olaitan O. , Abdelqader B. , Butt U. , Shrestha S. , Nemade H. , Pai A. 
Published: February 2022

Abstract

Introduction
Transperineal prostate (TP) biopsies have traditionally been performed under general anaesthesia using a grid plate, ultrasound probe and access cannula. This requires theatre heavy resources. Novel techniques and equipment allow TP biopsies to be performed under local anaesthetic (LA) and are well tolerated. However, this equipment tends to be single use and disposable.
Our urology department uses the re-usable BK Medical® needle guide and biplanar probe in the outpatient department (OPD). We present outcomes from patients who have undergone LA prostate biopsies using a re-usable system.

Method
Data was collected from 92 patients who had TP biopsies in the OPD from November 2020 – August 2021. Clinical parameters including MRI Prostate Imaging-Reporting and Data System (PI-RADS) score, prostate specific antigen (PSA) level, histopathological outcomes, re-biopsy and post-procedure complications were collated. Patient Reported Outcome Measures were collected prospectively.

Results
Median (range) PSA level was 7 (2.28–59.3)ng/mL. Mean prostate core samples taken were 24(17–40). All procedures were successfully completed under LA. 93% of patients reported a pain score of 3 or less on the visual analogue scale. 93% of patients would recommend this method of biopsy. 44/92(47.8%) had clinically significant prostate cancer (Gleason ≥3+4). Two patients required repeat biopsies, one was benign, the other clinically significant prostate cancer.

Conclusions
TP biopsies with the re-usable BK Medical® needle probe are effective, safe and well tolerated with an overall one-off cost of £1400 per grid versus £200 per single use kit, and an environmental advantage by being re-useable thereby contributing to NHS sustainability goals.
366 An Audit of Electronic Discharge Summaries and the Impact of Dedicated Teaching and Training in an Emergency Surgical Unit
Authors: Clements J. , Kakos C. , Clements B. 
Published: February 2022

Abstract

Introduction
Electronic discharge summary forms a vital part of a patient’s journey. As established in GAIN Guidelines 2011 ‘Clear and complete documentation in a patient’s health record is directly linked to the quality of the care they receive’. By improving the quality of E-Discharge summaries this will help to improve patient outcomes.

Method
In the Emergency surgical unit [EMSU] there are over 3500 completed consultant episodes per annum. We audited the quality of E-Discharges using 33 separate parameters included in the Trust’s dedicated discharge proforma. An E-Discharge summary was considered acceptable if &gt;90% of the information was recorded accurately. Discharge failure rate was audited in a randomised sample of 20 discharges in November 2019 and one year later in November 2020 following implementation of specific training and teaching at induction on E-Discharge compilation.

Results
In November 2019 the discharge failure rate was 60%. Common failings were in general omission of data, lack of follow-up planning and inaccurate pharmaceutical arrangements. In November 2020, following dedicated teaching at induction, failure rate was 15%. Where accurate recording of demographic information and pertinent inpatient detail improved, shortcomings remained in inadequate recording of follow-up care and ongoing involvement of the primary healthcare team.

Conclusions
E-Discharge recording is sub-standard. It is often the remit of the least experienced member of the medical team, as is the case in our unit. We have shown that dedicated teaching and training in this area can improve the quality of discharge summaries.
367 Comparing Mortality Rates in Patients with Gastric Cancer in a Single Tertiary Centre: What Can We Learn from the Numbers?
Authors: Thu K.T. 
Published: February 2022

Abstract

Aim
Over 6500 of primary gastric cancer diagnoses are made each year in the United Kingdom. Depending on the suitability of a surgical intervention and the patient’s choice, the treatment plans for such patients can be generally divided into curative, palliative, and no treatment. Recently, a tertiary Upper Gastrointestinal (UGI) Department has noticed an increase in mortality rates after a curative intervention and therefore, the aim of this study is to compare mortality rates in the three aforementioned subgroups with respect to the TNM staging in this tertiary centre.

Method
Patients who were discussed at an UGI disciplinary team meeting between 1st January 2013 and 31st December 2020 were identified. Among them, patients with a primary gastric cancer were selected and patients with metastatic gastric cancer at the time of diagnosis were excluded. In addition, patients without histological staging were excluded as well.

Results
279 patients with primary gastric cancer were included in this study. Patients who received palliative treatment have higher mortality rates in all T stages apart from T1 where the 90 days mortality rate was 16.67% and 0% for curative and palliative treatment respectively.

Conclusions
As it has been shown that the majority of patients who received palliative treatment has higher mortality rates, clinicians should continue to consider curative surgical resection in patients who are suitable. In addition, other precautions including consideration of dual consultant operation in patients with borderline respectability or patients with borderline fitness for surgery need to be taken to reduce the mortality rates further.
370 Scrotal Ultrasound in Young Men with Acute Scrotal Pain: A Retrospective Consecutive Case Series Audit
Authors: Sultana A. , Sandhar P. , Obeida M. , Dunk S. , Kitchen M. , Kalejaiye O. 
Published: February 2022

Abstract

Introduction
Although not recommended by EAU guidelines, many men with acute scrotal pain undergo ultrasound (US) to screen for occult tumours. This has low diagnostic yield and must be weighed against the increased risks of coronavirus due to additional hospital attendances, inconvenience for the patient, and demand on NHS resources. We evaluated our case series to determine current practice and diagnostic yield.

Method
141 consecutive cases of scrotal pain and/or swelling were identified from our Trust’s Surgical Assessment Unit (September-December 2020). Clinical diagnosis, and where performed, timing, indication and outcome of scrotal US was recorded.

Results
109/141 patients underwent scrotal US; the only urgent clinical indications were suspected collection/abscess (5 cases) or testicular mass (4). Relative indications included uncertain diagnosis (27 cases), suspected missed testicular torsion (6) and suspected hernia (1). 66/109 US performed were for ‘soft’ indications, however one occult testicular tumour, one acute testicular torsion and two inguinal herniae were unexpectedly found.

Conclusions
Scrotal US changed immediate patient management in 1/109 cases (acute testicular torsion). Early outpatient US would be sufficient to diagnose occult testicular tumour, missed testicular torsions and groin herniae. There is too much reliance on US; more focus on history and examination is needed.
373 Treatment Escalation Plan Completion in DNACPR Patients in Trauma & Orthopaedics
Authors: Elbayyar O. , Al Kharouf K. 
Published: February 2022

Abstract

Introduction
A Treatment Escalation Plan (TEP) is a communication tool which is helpful when a person with serious illness has a potential for acute deterioration. This policy fully supports the national guidance and recommendations published in a joint statement by the Resuscitation Council (UK) and the Royal College of Nursing (2016) and the latest Gerneral Medical Council guidance (2010) relating to the treatment and care towards the end-of-life decision making. Crucially, a TEP provides on-call hospital staff with immediately accessible guidance about how to respond to an individual in times of crisis, especially out of hours and at weekends.

Aim
To assess and improve the TEP completion in DNACPR patients.

Method
Parameters examined included: patient identifiers, age, sex, comorbidities, DNACPR completion of the form.
1st cycle: 30 patients included were analysed in May 2021.
Implementation: Education session at the department for staff about importance of form completion.
2nd cycle: 30 patients were included and analysed in July 2021.

Results
1st cycle showed only 30% adherence to the form completion. It was discussed in the session and various ways for improvement were implemented.
2nd cycle showed great improvement of 70% form completion for DNACPR patients.

Conclusions
A TEP becomes particularly important when there is agreement that interventions or referrals for more intensive care that are contrary to a person's wishes or are futile shouldn't be undertaken. Equally in many patients who may have an agreed DNACPR, a TEP clarifies all the treatments and care that should continue. This has improved with local education.