bluuebunny/crossref_metadata_2025_split huggingface dataset:
312 Foreign Bodies in the Urinary Tract - Can We Learn Something from the Pandemic?
Authors: Pinnamaraju P. , Warner R. , Pai A. 
Published: February 2022

Abstract

Aim
We aim to quantify the morbidity and resource utilisation from patients presenting with foreign bodies in the urinary tract and analyse the effect of the coronavirus pandemic on the numbers. Often these patients have co-existing mental health issues, which necessitates coordinated multi-disciplinary care. It is important that patient care is assessed holistically, with assessment of whether changes in mental health care impact urological morbidity.

Method
We performed a 2-year, retrospective, single-institution study of patients requiring removal of foreign bodies from their urinary tract.

Results
There were 49 episodes of patients needing removal of foreign body; all were inpatients at the regional mental health hospital.8% of patient episodes presented with urinary sepsis. All patients had successful general anaesthetic, endoscopic removal of the foreign body from their urinary tract. There was significantly more episode’s pre-pandemic (38 episodes, mean 2.7 per month) than during the pandemic (11 episodes, mean 1.1 per month). During the pandemic, staffing levels within the mental health hospital have been increased to enable isolation procedures to be conducted when necessary. It was felt that the reduction in foreign body insertion episodes was a consequence of this. The resultant reduction in acute hospital admissions and procedures is estimated to have saved £400,256 per annum.

Conclusions
Patients presenting with a foreign body in the urinary tract utilize a considerable number of resources and are a source of morbidity. Urosepsis and retention are common sequelae. Reduced episodes during the pandemic have shown that increased staffing levels have a positive effect and could be cost-effective. It is imperative that this data is used to appropriately allocate resources to reduce patient morbidity.
313 Importance of Surgical Approach and Resection Status on Outcomes of Patients with Adrenocortical Carcinoma (ACC)
Authors: Wong W.Y.K. , Pitfield D. , Challis B. , Casey R. , Kosmoliaptsis V. 
Published: February 2022

Abstract

Aim
Adrenocortical carcinoma (ACC) is a rare endocrine malignancy with overall poor prognosis. We aimed to examine the relationship between tumour resection margins (R0/R1), surgical approach (laparoscopic vs. open) and clinical outcomes in our practice.

Method
We conducted a retrospective review of patients diagnosed with histology-proven ACC (01/2015–12/2020) who proceeded to surgery and were followed up at Addenbrooke’s hospital (n = 24). We examined overall and progression-free survival (PFS) censored at date of death or at last follow-up.

Results
Patients had a median(SD) age at presentation of 58.5(11.0), were female in 62.5%; median(SD) length of follow-up was 29(20.1) months. The tumour histology was oncocytic variant in 50% of cases. R0 resection was achieved in 16/23 cases and was associated with better PFS [median(SD): 28.5(19.3) months for R0 vs. 8(25.0) for R1] and overall survival [median(SD): 33(18.4) months for R0 vs. 29(22.6) for R1]. 15/16 and 1/7 patients with R0 and R1 resection respectively were alive at end of follow-up. R1 resection status and survival were associated with ENSAT stage (85.7% stage III-IV for R1 vs. 25.1% for R0) although tumour size was not significantly different. A greater proportion of R1 patients (57.1%) had laparoscopic surgery (3 of those had tumour size&gt;6cm) than R0 patients (25%). Outcomes for oncocytic ACC tumours were not different.

Conclusions
R0 resection is of paramount importance for ACC outcomes. Careful pre-operative work-up of indeterminate adrenal lesions to raise suspicion for ACC and consideration of open surgery for large tumours may help improve outcomes.
314 Biodegradable Temporising Matrix (BTM) Use in a Traumatic Chest Wound: A Case Report
Authors: Carrington-Windo E. , Leong S. , Ibrahim N. , Hepburn T. , Pope-Jones S. 
Published: February 2022

Abstract
We describe the innovative use of biodegradable temporising matrix (BTM) in a large traumatic chest wound in a 23-year-old lady at the Welsh Centre for Burns and Plastic Surgery. The wound was sustained after the patient fell from a tractor into a large silage rake, resulting in injuries to her chest and limbs. Following meticulous debridement, the resulting full thickness skin defect measured 30x30 cm extending from the sternal notch to the upper abdomen, with bone, muscle, and breast tissue exposure. No donor sites for free flap reconstruction were available due to the limb injuries.
BTM is a recently developed synthetic dermal substitute and has been utilised to achieve soft tissue coverage in complex wounds i.e., post debridement in burns, traumatic injuries, and necrotising fasciitis. It was used in this case as it confers a number of advantages against skin graft alone such as reduced susceptibility to contracture and the ability to cover small areas of exposed bone. It also demonstrates reduced susceptibility to infection compared with other dermal substitutes.
To our knowledge, this is the first use of BTM to cover breast tissue. The central chest is a difficult anatomical region to reconstruct due to the importance of maintaining breast contour and avoiding wound contracture and deformity. The patient was closely followed up in dressing clinic and application of split skin autograft over the delaminated achieved an aesthetically excellent and functionally result, with breast contour maintained and full range of movement at the axilla.
319 G-Master: A Novel 3D Printed ACL Graft Preparation System That Improves Speed and Autonomy
Authors: Dela Cruz N.J.M. , Papavasiliou T. , Gibbons C. 
Published: February 2022

Abstract

Aim
One of the most commonly performed procedures in orthopaedics is anterior cruciate ligament reconstruction. Autograft hamstring tendons are mostly used. The preparation of a hamstring autograft varies on patient factors and clinician choices. The use of a bulky, and expensive metal platform is usually involved, or an assistant is tasked to hold the other end of the graft. We aim to produce a 3D-printed sterilisable preparation system (G-Master) that improves autonomy and speed of the surgeon preparing the ACL graft.

Method
A stereolithography file (.stl) of the device was designed on Blender program and then manufactured on a commercial Fusion Deposition Modelling Ender 5 3-dimensional (3D) printer using a polylactic acid variant. The 3D printed parts include an attachable platform, two pillars whereby the attached pillar is where the endobutton (SN) holding the autograft sits in tension. These were autoclaved at 121°C under 15 psi of steam pressure for 30 minutes before the operation. Approval for device use was subjected to a rigorous process as class I devices as per the UK government Medicines and Healthcare Products Regulatory Agency guidelines and was then successfully used in vivo.

Results
We found the bespoke device to be beneficial in reducing graft preparation time and overall cost while increasing the autonomy of the surgeon and efficiency of the knee operating theatre list.

Conclusions
This is, to our knowledge, the first ACL graft preparation system that was produced using rapid prototyping and 3D printing. Other applications of 3D printing in manufacturing orthopaedic surgical instruments should be explored.
321 Surgery Induction Guidebook – an Aid to a Successful Transition
Authors: Abbas M.K. , Gurung G. , Lim E. , Umar R. , Sharmadaal A. , Zehra S. 
Published: February 2022

Abstract

Aim
There is a 4–12% increase in mortality following the August change over in the National Health Service (NHS) UK. A well-structured induction programme is mandatory to improve both the competency and confidence of new junior doctors. This activity was designed to evaluate and improve the induction process in Pilgrim Hospital by introducing an induction guidebook. It aimed to provide a sustainable and reliable source of information to junior doctors.

Method
An initial survey in the department assessed the needs and identified the information required for the guidebook. An induction guidebook was designed and circulated during the changeover. A feedback survey was conducted after the six months of the initial Induction guidebook release, to know the usefulness of components of the induction guidebook and identify any gaps to improve the guidebook.

Results
A total of 15 participants completed the feedback survey. 47% (7) found the induction guidebook beneficial and 53.3 % (8) found it ‘slightly beneficial'. Similarly, only 1 participant (6.7%) rated the guidebook to be “of minor importance”, while 53% (8) rating it “very important” part of induction. The feedback for the contents of the book was also encouraging with suggestions.

Conclusions
The guidebook proved to be a valuable source in helping new doctors during times of transition to adjust to the local system and improve the induction process. It provided information about local guidelines, job overview, team structure, IT, useful contacts, and other relevant information. We recommend the departmental guidebook as a vital part of local departmental induction during the changeover.
322 Feasibility of Loupe Assisted Subinguinal Varicocelectomy in Treatment of Male Infertility
Authors: Kale S. , Rashid T. , Cardoza F. 
Published: February 2022

Abstract

Aim
To study the impact of loupe-assisted subinguinal varicocelectomy on semen quality, serum testosterone level, and spontaneous pregnancy rate.

Method
The data were prospectively collected for 102 infertile men with clinical varicocele. The preoperative values of semen analysis parameters and serum testosterone level were compared with postoperative values at 6 months. Spontaneous pregnancy was assessed at 6 months.

Results
The mean age of patients was 31.56 ± 4.31 years. Primary infertility was reported in 86 patients, while 16 had secondary infertility. Bilateral varicocele was seen in 79 patients while 23 had a unilateral varicocele. The total sperm concentration (x106/ml) before and after varicocelectomy was 12.82 ±3.91 and 20.06 ±2.13 respectively (p&lt;0.0001). The total sperm motility (%) before and after varicocelectomy was 37.67 ±7.23 and 55.46 ±4.51 respectively (p&lt;0.0001). The sperm morphology (Kruger/Strict morphology criteria, %) before and after varicocelectomy was 3.11 ±0.80 and 3.70 ±0.78 respectively (p&lt;0.0001). The serum testosterone level (ng/dl) before and after varicocelectomy was 323.90 ±67.81 and 396.74 ±40.88 respectively (p&lt;0.0001). The Spontaneous pregnancy rate in couples with primary and secondary infertility was 18.60% and 31.25% respectively. The difference in their rates was not significant (p = 0.251). The overall spontaneous pregnancy rate was 20.5 %.

Conclusions
Loupe-assisted sub-inguinal varicocelectomy is a safe and effective modality for treating infertile men, particularly when provision for microscopic surgery is unavailable. However, only large-size comparative studies or multi-centric trials can confirm this.
324 Improving Consenting Practices in a Breast Surgery Unit
Authors: Senn D. , Grover K. 
Published: February 2022

Abstract

Introduction
Gaining consent, defined as “the process of providing the information that enables the patient to make a decision to undergo a specific treatment,” is a key part of a patient’s journey when having an operation. Consent forms serve as a significant medico-legal document; it is therefore imperative that they are completed accurately. The aim of this audit was to assess the current consent practice in a breast surgery unit, to monitor compliance with RCS and GMC guidelines and local policy on consent.

Method
Consent forms for all patients undergoing an operation over a three-week period within the breast surgery unit were reviewed. Data collected included use of abbreviations, patient and surgeon details and adequacy of procedure-specific complications. Interventions were then made in an attempt to improve compliance with guidelines. A repeat audit over another three-week period was performed to assess for improvement.

Results
The first cycle identified issues including incomplete documentation and inadequate complications listed. Targeted teaching and procedure-specific complication stickers were introduced to improve consent accuracy. Data was collected three-months post-intervention to evaluate for sustained improvement in consenting practices. Correct documentation of essential items (patient and surgeon name) increased from 83% to 100% (p&lt;0.05). Results revealed a statistically significant improvement in consent form accuracy. Use of abbreviations reduced from 14% to 3% and record of procedure-specific risks improved.

Conclusions
The interventions employed significantly improved consenting practice within our unit. The insight gained from this audit can be applied across other trusts to improve compliance with the consent process.
328 Renal Cell Carcinoma (RCC) Metastasis to the Coracoid Process
Authors: Patel M. , Wignakumar A. , Deshpande A. 
Published: February 2022

Abstract
A 51-year-old man was diagnosed with renal cell carcinoma (RCC) of the left kidney seven years ago. The tumour was staged as T2N0M0 and the patient underwent an uncomplicated open left radical nephrectomy. The RCC was classified as clear cell and he was kept on biannual renal surveillance thereafter.
Six years after the nephrectomy, the patient had reported a 5-month history of worsening pain and globally restricted movement in their right shoulder. A palpable mass on the coracoid process was noted. MRI imaging had shown a 27x30x17mm lesion suggestive of an expansile osseous mass in the coracoid process. An ultrasound guided biopsy was performed for definitive characterisation. Histology had reaffirmed that the lesion was in fact metastatic clear cell carcinoma in keeping with the patient’s renal primary. CT chest/abdomen/pelvis and NM-Bone SPECT CT scanning had shown no other sites of metastasis. A marginal resection of the lesion was performed with a good macroscopic clearance.
The common sites within the skeleton implicated in RCC include the spine, pelvis and femur. Tumours of the coracoid process are exceedingly rare. From the literature, only four cases of metastasis to the process have been noted: two from breast carcinoma, one from hepatocellular carcinoma and the other from basal cell carcinoma. Thus, this case denotes an extraordinary presentation for a metastasis of RCC many years after the nephrectomy. Furthermore, it emphasises the criticalness of regular follow-up and early intervention as delays could lead to systemic metastasis and a poorer prognosis.
337 Are Surgical Trainees Reviewing Their Post-Operative Patients in Cardiothoracic Surgery?
Authors: Ijaz A. , Hunter S. , Sadeque S. 
Published: February 2022

Abstract

Aim
Operating surgeons should review their post-operative patients regularly. They are responsible for decision-making on further management and planning discharge. Trainee surgeons who have operated should be reviewing their patients and encouraged to make independent decisions to develop their clinical judgement and responsibility for patient care. There are no specific guidelines on the number of recommended reviews in the post-operative patient

Method
40 patients taken from cardiothoracic operating lists. Patients selected where the documented 1st operator was not a consultant. This was done using operative notes recorded on Infoflex. Operation date, type of operation, total days as inpatient, discharge date and number of days reviewed by the 1st operator were recorded. The results were presented to both consultants and registrars locally and an open discussion was held to make improvements. The audit was repeated 6 months later.

Results
Average inpatient stay post-operatively was comparable: 6.4 vs 6.9 days. There was a significant increase: 2.7 vs 0.6 days of average reviews by the lead operator. 9% to 39% increase. In phase 1, only 42% of patients were reviewed at all by the lead operator. In phase 2, this increased to 100%.

Conclusions
Open discussion and joint planning between consultants and registrars has led to an improvement in surgical trainee engagement in post-operative management. There is still scope for further improvement on documentation and communication with the on-call consultant. On multiple occasions the patients were reviewed but this was not documented or communicated with the consultant.
338 Medical Student Engagement with Surgery and Research During the COVID-19 Pandemic: Supporting the Future Workforce for Post- Pandemic Surgical Recovery
Authors:   Student Audit and Research in Surgery (STARSurg) Collaborative
Published: February 2022

Abstract

Introduction
Medical students have lost invaluable exposure to surgery and research during the COVID-19 pandemic, resulting in missed opportunities and mentorship essential to career decision-making. This study aimed to explore the impact of COVID-19 pandemic and the influence of regional educational events on student engagement with surgery and academia.

Method
A series of virtual regional events on academic surgery were delivered in 2021 across the UK and Ireland. Attendees completed post-event feedback, including questions on their experience of engagement with surgery and research during the pandemic, and the impact on career interests. 5-point Likert scales were used to assess agreement (from 1 [“strong disagreement”] to 5 [“strong agreement”]). Data were summarised using mean and standard deviation (SD), and mean differences (MD) compared using parametric tests.

Results
Of ∼850 attendees across 31 events between January and May 2021, 393 students responded. The pandemic had made engagement with surgery (mean: 3.95, SD: 1.01) and research more challenging (mean: 3.79, SD: 1.03). Those undecided on a surgical career reported a significantly larger increase in knowledge (MD: 0.42, 95% CI: 0.25–0.59, p&lt;0.001) and intention to consider a surgical career (MD: 0.41, 95% CI: 0.26–0.56, p&lt;0.001) after the event, than those who had already decided.

Conclusions
Accessible opportunities are needed to combat the lack of surgical and research experience caused by the pandemic. Concrete efforts at grass-root and national levels are required to continue encouraging a representative and research-active surgical workforce.
339 Single Use Flexible Scopes in Percutaneous Renal Surgery
Authors: Olaitan O. , Pinnamaraju P. , Nemade H. , Pai A. 
Published: February 2022

Abstract

Introduction
Flexible nephroscopy is performed at the end of percutaneous nephrolithotomy (PCNL) to confirm stone clearance. Flexible cystoscopes are commonly used to perform nephroscopy through the PCNL tract, however reusable scopes can provide limited optics due to procedural factors such as renal bleeding and scope factors such as fibre-optic damage. The Ambu® aScope™ 4 Cysto (AmbuScope) is a single-use disposable, video flexible cystoscope which has been solely used in the outpatient setting for bladder visualisation. We describe the first experience of the single use scope in nephroscopy during PCNL.

Method
Retrospective data was collected and analysed in a 6-month period from 13 consecutive patients undergoing PCNL using the AmbuScope for flexible nephroscopy. Stone free rates on nephroscopy, post-op complications, surgeons’ useability scores and theatre staff opinions were collated.

Results
All procedures were completed without complication or scope malfunctions. One patient died 27 days post operatively from urosepsis and osteomyelitis: unrelated to the single use scope. All other cases had an uncomplicated recovery. Surgeon useability scores rated the scope as easy (40%) or very easy (60%) to access, very user friendly (100%) and had good (20%) and very good (80%) image quality. 60% of respondents preferred to use the Ambu® aScope™ over the reusable scope. The single scope was found to be more cost-effective at £135 compared to £166 for reusable scopes.

Conclusions
This study is the first to show that single use scopes are safe, user friendly and cost effectively used during percutaneous nephroscopy.
343 Medical Teaching in the Covid Era: The Rise of the Webinar
Authors: Baig A. , Parwez R. , Rahman S. , Itum H. , Khoudir M. 
Published: February 2022

Abstract

Background
Since the emergence of COVID-19, virtually the whole world has been forced to into lockdown and adapt to a way of life not seen in living memory. Although pandemics are not new, nor will this likely be the last, the modern era has one major advantage that our ancestors did not have: the internet.
Through the usage of modern technology and the internet, we have been able to continue our professional lives through a virtual medium through programs like Zoom. As part of this virtual shift, medical teaching is also mainly online. A QI study was conducted on webinars.

Aim
To determine whether medical students and junior doctors find online teaching to be an effective medium of learning, as well as to determine the advantages and disadvantages, including mental health impact.

Method
A webinar series was created, entitled back2basics (B2B) surgery, which was run for around 2 months with weekly, 1-hour long webinars on a surgical topic. Feedback was collected following each session specific to that week’s webinar as a general opinion of our participants on webinars.

Results
Both qualitative and quantitative data was collected. The majority (83%) of participants agreed by the 8th week that webinars were an effective mode of medical teaching compared to 48% in the 1st week. Participants pointed out that webinars are ‘low pressure’ and ‘less competitive’ than in person lectures, so good for mental health.

Conclusions
Participants agree that the webinars are effective for medical teaching and that there are mental health benefits.
346 Accuracy of Tympanic Versus Digital Infra-Red Thermometers for Measuring Core Body Temperature in Critical Care Department - a Quality Improvement Project During Covid-19 Redeployment at a District General Hospital in Surrey, England
Authors: Kesharwani D , Thacker J , Dsouza W , Somasundaram K 
Published: February 2022

Abstract

Aim
Accurate determination of core body temperature in critically ill patients is required for initiating diagnosis and management. (1) Ideally, temperature measurement should be non-invasive, hygienic, convenient, and affordable. Infrared thermometers are convenient and non-invasive but sensitive to environmental factors. Alternatively, tympanic thermometers are cost effective but invasive. Various observational studies have concluded that tympanic thermometers have high specificity/sensitivity compared to infrared thermometers (2,3). We aimed to demonstrate accuracy of tympanic over infrared thermometers.

Method
In this observational prospective study, eighty patients (forty each) admitted in intensive care from February 2021 – July 2021 were included. Temperature measurements with were conducted - measuring differences between digital and tympanic thermometers. A Plan Do Study Act cycle was used to facilitate change. Excel and SPSS software were used for data analysis.

Results
Our study concluded a statistically significant (p&lt;0.01) difference in readings with mean difference of 1.18°C (highest -6°C, lowest- 0.5°C). Pyrexia was undetected in 4 of 40 patients with digital thermometers. Additionally, two patients undergoing hypothermia correction were not adequately measured. Therefore, infrared thermometers were significantly less sensitive and were replaced with tympanic thermometers. A second cycle conducted again demonstrated significant (p&lt;0.01) difference with mean difference of 1.92°C. (highest -6.5°C, lowest -1°C).

Conclusions
Tympanic thermometers have higher accuracy and precision over digital thermometers. We managed to establish change during our audit with concluding evidence showing infrared thermometers procure false observations affecting patient care, hence, unsafe. In conclusion, tympanic thermometers should be encouraged in critical care settings for vigilant care.