bluuebunny/crossref_metadata_2025_split huggingface dataset:
109 Enhanced Recovery Program – Impact of ASA Grade on Length of Hospital Stay in Patients Undergoing Hip and Knee Arthroplasties
Authors: Ahmad M. , Chaudhry M.N. 
Published: February 2022

Abstract

Introduction
Total hip and knee arthroplasties are two of the most quality of life enhancing orthopaedic procedures performed. Enhanced recovery (ER) programs have been implemented in orthopaedics surgeries to reduce the physiological and psychological stress of surgery. The American Society of Anaesthesiologists classification system is now the most widely used for measuring physical health status by hip and knee arthroplasty registries worldwide. The aim of the study is to determine whether the ASA score is a predictive of length of hospital stay in patients undergoing hip and knee replacements.

Method
Retrospective data is collected from a consecutive series of 441 charts and Irish National Orthopaedics Register for patients who underwent primary hip & knee replacements from January 1, 2018, to December 31, 2018, in our hospital. All these patients were assigned either ASA Class 2 or 3 in preoperative assessment.

Results
Patients with ASA 2 (319 patients of the total patient for the same period), average length of hospital stay was 4.8 days, whereas for patients with ASA 3 (122 patients of the total), length of hospital stay was 6.5 with mean difference between two groups was 1.7 days (95% confidence interval of this difference).

Conclusions
Patients with ASA 2 stayed shorter in the hospital compared to patients with ASA 3. Therefore, we recommend that pre-operative patients’ optimization to downgrade a patient from an ASA 3 to ASA 2, but prospective analysis would be beneficial to examine the resource implications of such an initiative as well as patient outcomes with longer term follow up.
134 Do Virtual Conferences Provide Similar Educational Benefit to In-Person Conferences?
Authors: McVeigh J. , Williams M. 
Published: February 2022

Abstract

Aim
The “Future of Surgery Report” by RCS England concluded that exposure to technological developments and surgical innovation should take place early in medical education to ensure that future surgeons have the broadest skillset possible. In line with these recommendations, in 2019, we developed a platform for the dissemination of knowledge surrounding surgical innovation: the annual Oxford Surgical Innovation (OxSI) Conference. The 2021 OxSI Conference was hosted virtually due to the impact of the COVID-19 pandemic.

Method
We sought to compare this event with the previous year to identify if there was any difference in the educational benefit between a virtual conference and an in-person conference. Feedback from delegates was collected using a four-point Likert scale.

Results
In 2021, the average scores for the plenary sessions and the workshops were unchanged compared to 2020 (3.6 and 3.5, respectively, p = 0.999). We saw significant differences in our two-outcome metrics, with statistically significant improvement in understanding the practicalities of engaging in safe surgical innovation (Pre 2.70, Post 3.43, +0.73 (P&lt;0.001)) and in awareness of current innovations in surgical practice (Pre 2.77, Post 3.42, +0.65 (P&lt;0.001)).

Conclusions
Our data suggest that the virtual format of the conference provided the same educational benefit as the previous in-person iterations of OxSI whilst reaching delegates all over the world. We plan to conduct future OxSI events using a hybrid model and would recommend other conferences consider the same to allow for continued international attendance in conjunction with the benefits of in-person networking and interaction.
167 Threshold for Intervention in Females with Asymptomatic Abdominal Aortic Aneurysm (AAA)- a Literature Review
Authors: Imad M. , Zarifa M. Abu , Hassona G. , Ayyash I. , El-Nakhal T. 
Published: February 2022

Abstract

Introduction
UK Small Aneurysm Trial, a study conducted in the late 90s, showed that the threshold for asymptomatic abdominal aortic repair in females would be &lt; 5.5 cm. However, this threshold remained debatable. Our aim is to search for the most recent evidence in regard to the AAA repair threshold in females, and factors affecting the decision to intervene.

Method
PRISMA Flow from 2011–2021 was utilized using keywords on PubMed resulted in 913 articles. Upon further review by and full paper, 2 Cohort studies (n = 10102) and 11 narrative and retrospective reviews were found.

Results
2 cohort studies (n = 10102), as well as 2 other studies, showed that the threshold should be 5 cm. There was a split in opinions between another retrospective (n = 4) reviews which argued for a cut-off between &lt; 5 cm and 5.2 cm. The others, showed evidence of better outcomes repairing asymptomatic AAA at a threshold &lt; 5 cm. Meanwhile, 3 studies recommended using ASI diameter &lt; 5.5 cm^2. Overall, the Intervention threshold being 5 cm or less is reasonable for females since they have a 4-fold men risk of rupture rates at 5.5 cm in addition to significant physiologically smaller aortic diameter (1.75 cm) compared with males (2.4 cm).

Conclusions
The threshold for operating on female asymptomatic AAA should be lower than males, with some evidence suggesting &lt; 5 cm compared to 5.5 in men. Patient tailored and risk assessment approach is recommended. Hence, this will be our standard for upcoming clinical audit.
202 VTE Prophylaxis Post-Laparoscopic Cholecystectomy
Authors: Ashcroft K. , Theocharidou L. 
Published: February 2022

Abstract

Introduction
VTE refers to a clot that causes stenosis or blockage of the blood flow in a vein. VTEs are classified as hospital-acquired if they occur within 90 days of hospital admission. Recent hospitalisation and associate immobilisation are well-acknowledged risk factors also included in Well’s score, which is used as part of the diagnostic work up.
NICE guidelines state that patient over 16 years old must be offered VTE prophylaxis either in the form of LMWH or fondaparinux for at least 7 days after an abdominal surgery.
The aim of the audit is to explore whether NICE guidelines regarding the VTE prophylaxis post-laparoscopic cholecystectomy are followed.

Method
The data from all the patients who had laparoscopic cholecystectomy in a two-month period was collected and discharge summaries and TTOs were reviewed to identify whether thromboprophylaxis was prescribed for 7 days following the operation. A second cycle was completed after results of first cycle presented to the surgical team.

Results
Increased in compliance with VTE prophylaxis guidelines observed, although though still suboptimal. 14% of patients received prophylaxis in first cycle, and 34% in the second.

Conclusion
Increased compliance with VTE guidelines observed, however the second cycle only included a small sample of patients which limited reliability. Furthermore, as highlighted by the surgical team, NICE guidelines are vague. There is no clarification regarding types of abdominal operations. No VTE incidences are yet to be identified post-operatively. Medico-legal aspects were also considered.
215 BCC Management in the UK and Overseas. an Audit of a Single Surgeon's Experience
Authors: Abdelaty M. , Ashfaque F. 
Published: February 2022

Abstract

Aim
To compare the management of BCC in a single surgeon’s practice and audit of practice against the British Association of Dermatologist (BAD) recommendations.
To see any differences in terms of management in two different setups and patient population.

Method
Retrospective data collection and statistical analysis comparing the practice in Pakistan between 2011–2014 and recent practice in the NHS at Bradford Teaching Hospitals Foundation Trust from August 2020 to March 2021

Results
53 BCC patients were identified in the UK with a mean age of 71 compared to 64 overseas patients with a mean age of 62. The most common anatomical region for both groups was the face. The histology reports showed a discrepancy to the number of details enlisted. In the overseas group the BCC subtype was not mentioned in 72% of the reports as well as no reporting of clark's level or TNM staging. The mean reporting time was 5 days in the overseas group compared to 8 days in the UK group.

Conclusions
The British Association of Dermatologists has set standards for management of Basal Cell Carcinoma including surgical margins and histological reporting. Areas of improvement have been identified according to those guidelines.
223 Development of Online Surgical Skills Education
Authors: Soleimani-Nouri P. , Komor J. , Das Bibek. , Fadel M. , Ahmad M. 
Published: February 2022

Abstract

Introduction
Online teaching rapidly emerged as a viable alternative to traditional face-to-face education. However, how to teach surgical skills in the online environment has not been established nor evaluated yet.

Method
An international one-day online surgical skills course consisting of lectures, pre-recorded virtual workshops, live demonstrations, and surgical skills teaching in breakout rooms was organised. Simultaneously, a traditional face-to-face surgical skills teaching was held and used as benchmark. Skills development assessed by trained demonstrators and self-reported competency scores were compared between the online and face-to-face event.

Results
In total, 553 participants from 20 different countries attended the online course, 64 were trained in breakout rooms with a 1:5 demonstrator to candidate ratio whilst the remaining candidates participated in didactic skills development sessions. In a separate face-to-face course 20 candidates were trained with traditional methods. Post course competency ratings by demonstrators in suturing, tendon repair and vascular anastomosis were not significantly different between students receiving online breakout room or face-to-face teaching (ps&gt;0.05). The development of the same skills to “articulation” were not different between formats (ps&gt;0.05). Post course self-rated competency scores improved for all technical skills (p&lt;0.001). Small group sessions, both online and face-to-face, received higher satisfaction ratings compared to large group sessions in terms of clarity of instructions, answers to questions and demonstrator feedback.

Conclusions
Online teaching of surgical skills for early training years is an appropriate alternative to face-to-face teaching with the ability to define clear learning objectives, effectively teach surgical skills and achieve similar learning outcomes.
275 Undergraduate Career Aspirations in Northern Ireland - a National Qualitative Study
Authors: Madden S. , Clements J.M. , Martin N. , Kirk S.J. 
Published: February 2022

Abstract

Introduction
Undergraduate career aspirations are accurately translated to chosen career paths. Understanding what influences these decisions has implications for future workforce planning. The aim of this study was to identify future career intentions in Northern Irish Medical Students.

Method
An anonymous voluntary survey consisting of binominal, Likert and free text responses was distributed to all medical students registered at Queen’s University Belfast (QUB). Data was collected over 6 weeks in April-May 2021. The primary outcome was future career aspiration and secondary outcome was the reported attrition rate from medicine. Local Ethical approval was obtained.

Results
202 responses were received (Response rate 15%). Two thirds (n = 135) were female. One third of respondents remained undecided about their future career choice, with senior students demonstrating greatest certainty in future career choice. Respondents were least likely to choose a career in Surgery (33%). Factors influencing these decisions were a lack of academic interest in the speciality, perceived workload, and the length of the training scheme. 10% of respondents were unsure or unlikely to pursue a career in Medicine after they graduated. Thematic analysis demonstrated, fear of making mistakes, poor work life balance and poor working environments as reasons for leaving medicine.

Conclusions
Uncertainty over future career intention remains common with surgery the least popular speciality. The rate of potential attrition is concerning which warrants further investigation.
281 Impact of Using Risk Communication Tools in Counselling Patients with Newly Diagnosed Non-Metastatic Prostate Cancer
Authors: Oxley C. , Thankappannair V. , Saeb-Parsy K. , Lamb B. , Shah N. , Kastner C. , Geoghegan L. , Fox H. , Gnanapragasam V. 
Published: February 2022

Abstract

Introduction
There have been substantial advances in risk communication tools that help patients understand prognosis associated with prostate cancer and the benefit/gain from treatment. Over the last three years, two tools; Cambridge Prognostic Groups (CPG), and Predict Prostate (https://prostate.predict.nhs.uk), along with decision-making consultations with clinical nurse specialists (CNS) have been integrated into the new diagnosis pathway in our unit.

Method
Treatment decisions for patients with new non-metastatic prostate cancer were audited after (2019–2020) and before (2016–2017) new risk communication tools were implemented. Data were compared between the two time periods and also benchmarked against national level data from the National Prostate Cancer Audit (NPCA) (Parry et al 2020; PMID: 32460859). The main outcome measured was comparison of rates of over and under-treatment of disease.

Results
168 and 95 patients were included in the 2019–2020 and 2016–2017 cohorts, respectively. Following implementation there was a reduction in over-treatment (use of radical surgery/radiotherapy) in patients with low risk/CPG1 (23% to 4%). These rates were also better than the national average from NPCA data (4% vs 11%). In parallel, there was an increase in use of radical treatment (reduced under-treatment) in high risk and very high-risk/CPG4-5 disease (84% vs 73%). Again, these rates were also superior to national level data from the NPCA (84% vs 76%).

Conclusions
Incorporating personalised risk-communication tools and dedicated CNS counselling in our unit has reduced over-treatment of early disease and under-treatment of advanced disease. Wider uptake could enhance risk-appropriate treatment of patients with a new prostate cancer diagnosis.
286 Are Telephone Reviews the Future in Outpatient Clinic Consultations?
Authors: Karagiannidis G. , Mallidis E. 
Published: February 2022

Abstract

Aim
The COVID-19 pandemic posed many challenges to healthcare system in the UK. Attempts were made to ensure the provision of treatment, continuity of care and follow-up of the patients. As a result, implementation of telephone consultations was started for most of the outpatient appointments. The aim of this study was to evaluate patient satisfaction and views on this alteration in service.

Method
The first 150 patients who had breast clinic appointments delivered by telephone consultation at Ipswich hospital during the pandemic in early 2020 were retrospectively identified and sent a postal survey. The satisfaction levels were assessed through a degree of agreement with statements (four items), yes/no answers (two questions), and space for comments.

Results
142 survey responses were included (94.7% response rate). The majority of patients (n = 130) were satisfied with the care they received. Even though almost half of the patients stated that they would like to be seen face-to-face in the hospital, only 10% (n = 4) of them stated that they would not like a second phone consultation. Surprisingly,78% (n = 117) of patients stated they would be happy for further breast clinic appointments to be carried out in the same way.

Conclusions
Our study has shown that telephone consultations are a safe and rapid method of adaptation to the COVID-19 pandemic, achieving high satisfactory rate amongst patients. Our findings suggest that this tool has benefits in post pandemic healthcare delivery. Can telephone reviews be the future in outpatient clinic consultations?
326 The Incidence and Prevalece of Unruptured Intracranial Aneurysms in Sickle Cell Disease Patients: A Systematic Review
Authors: Essiet E. 
Published: February 2022

Abstract

Aim
To estimate the prevalence, incidence, and characteristics of Unruptured Intracranial Aneurysms (UIAs) in (sickle cell disease) SCD patients and compare same with the metrics and features in the general population.

Method
The Data repositories, Medline (PubMed), Embase and Web of science were systematically searched from January 1st, 1990, to July 31st, 2021. Publications that passed an inclusion test were reviewed for data on the incidence and prevalence of UIAs, aneurysm characteristics and outcomes in SCD patients extracted. Findings from the included studies were appraised, using the Methodological Index for Non-randomized studies score (MINORS). The results were descriptively analysed. Given the marked heterogeneity of retrieved data, results were reported as standardized values, including the mean weighted annual incidence rate.

Results
105 SCD patients with 186 UIAs were identified in 10 retrospective studies. Mean age ranged from 10.5 to 40.18 across studies with adult (&gt;18 years) predominance. Prevalence of UIAs in SCD was 4.1% (95%CI 3.6 and 4.6) incidence rate was 1290.3/100,000 patient-years (95% CI 1018.0 to 1562.6). Aneurysms tended to be small (60%), anterior (76.1%), multiple (45.7%), managed conservatively (62%) with mostly good outcomes (95%). Average MINORS score was 9.4 ±3.1 for non-comparative studies (n = 8) and 19.5 ±0.7 for comparative studies (n = 2).

Conclusions
UIAs have a definite relationship with SCD, with higher incidence figures relative to the general population. Aneurysmal characteristics although largely similar, tend to be smaller in SCD patients. The low methodological quality of reviewed studies informs the need for well-designed prospective randomized controlled studies to better understand the mechanics of this relationship.
341 Consenting Practices in Plastic Surgery
Authors: Noton T. , Benshetrit G. , Bradley A. , Mitchell C. 
Published: February 2022

Abstract

Introduction
Informed consent is a vital aspect of safe patient care within any surgical specialty, and if not completed thoroughly, may result in misinformation and patient dissatisfaction.
Traditional paper consent forms are notoriously poorly completed by medical professionals, with common issues ranging from ineligible handwriting, to missing key components of the form.
The aim of this audit was to assess our departments’ compliance with standard trust consent forms and compare adherence to local and national consenting policies.

Method
All elective and emergency plastic surgical procedures carried out over a one-week period from 17/05/2021 to 23/05/2021 were identified using eTrauma and Cerner operative records. In total, 40 procedures were identified. Consent forms were then reviewed and assessed for completion in key areas. 4 procedures were excluded due to the consent form not being available for review, and 1 procedure was excluded due to a cancellation.

Results
The risks and benefits of procedures were generally documented to a high standard. Providing written information to patients, confirmation of consent if the procedure was being performed on a different day, and possible additional procedures were poorly completed throughout. 90% of consent forms screened, failed to include confirmation of the surgical site within the specific section of the form.

Conclusions
Overall, the department demonstrated good compliance with completing trust consent forms. Electronic consent forms would likely address the shortcomings identified in this audit and should be adopted. Continued responsibility from the whole team should be highlighted and maintained to ensure a high standard of consenting.
371 Use of Trello as a Project Management Tool for Collaborative Surgical Research and Audit
Authors: Khoury A. , Bucknor A. , King I. , Kerstein R. , Nduka C. 
Published: February 2022

Abstract

Introduction
Managing surgical research projects alongside clinical commitments requires organisation, prioritisation, and communication. Our unit is a tertiary plastic surgery centre with a large workforce, high volume case load and abundant research opportunity. In a busy department, co-ordination and communication is imperative for timely high-quality research and audit output and maximum productivity. Tools can be used to support this output; we trialled use of Trello project management software to increase productivity in this context.

Method
We set up a Trello account for our unit’s plastic surgery department. All consultants and trainees have access, and each project has a timeline and standardised progress checklist to support completion of projects to a uniform high standard.

Results
Our Trello for Surgical Research pilot has promoted organised collaborative working and reduced duplication and partial completion of audit and research projects within our department. It has encouraged engagement between smaller subgroups within the unit, and a platform to monitor progression through key stages of project development with oversight of an appointed Research Lead, resulting in an increase in completion of closed loop audits and research projects.

Conclusions
Similar experiences have been described in mathematics and engineering research groups, and delivery of educational material for English Literature study, but we have not identified description of Trello as a tool for medical research. Use of such platforms increases productivity and likelihood of completion of projects, as well as providing a clear outline of a departments’ research priorities and accessible opportunities for rotating juniors.
384 Local Closed Loop Audit: COVID-19 Screening Before Endoscopic Ultrasound
Authors: Thu K.T. , Wilson S. 
Published: February 2022

Abstract

Aim
Endoscopic Ultrasound (EUS) is one of the important diagnostic tests in patients with probable hepatobiliary or lung diseases. As it is an airborne procedure and due to the current COVID-19 pandemic, British Society of Gastroenterology and NICE guidelines have stated that patients who are undergoing EUS must be tested for COVID-19 within 3 days before the procedure. EUS must be considered deferring if the patient tests positive. The aim of this audit is to increase the proportion of patients being swabbed within 3 days/72 hours of the procedure to &gt; 90% by the end of 2021.

Method
A list of patients who underwent elective EUS in January (initial audit) and mid-May to mid-June (re-audit) were collected using Endosoft software. Afterwards, electronic patient record system was checked for the date of the COVID-19 swab and its results. This data was then recorded in a password-protected Excel spreadsheet and the proportion of the patients meeting the standard was calculated.

Results
The results of the initial audit indicated that although 95.7% of swabs were done within 3 days of the procedure, only 40.9% were done within 72 hours. These results were discussed at a mortality and morbidity meeting, and recommendations were. Hence, in the re-audit, 98.4% of the swabs were done within 3 days of the procedure and the percentage of swabs being done within 72 hours increased to 95.2%.

Conclusions
The target of increasing the proportion of patients being swabbed within 3 days/72 hours of the EUS procedure to &gt; 90% was met in mid-2021.