bluuebunny/crossref_metadata_2025_split huggingface dataset:
928 Can Medical Students Learn Urethral Catheterisation Through an Escape Room?
Authors: Hanson Mark , Coleburt Damien , Badenoch Thomas 
Published: November 2022

Abstract

Aim
Escape rooms are an exciting way to learn through team-based challenges, particularly lending themselves to practical clinical skills. We sought to understand if escape rooms are beneficial for teaching urethral catheterisation to medical students.

Method
12 third year medical students were given an initial knowledge assessment, before completing the escape room in groups of three. The room consisted of a number of tasks including labelling anatomy, checking patient details, and gathering equipment, and culminated in successfully catheterising a model. On completion they were given a post escape room knowledge assessment, which was repeated two weeks later to assess retention. This was compared to a control group undertaking a traditional teaching method.

Results
Initially, on a Likert scale of 1–5, 69% (n=9) stated that they were a 1 for confidence in performing a urethral catheterisation. After the escape room, all students recorded a 3 or 4, and two weeks later confidence remained at an average of 3 (n=8). 34.6% of questions were answered correctly in the pre assessment, improving to 90% at the post assessment, and two weeks later remained high at 84.1%.

Conclusions
Students' knowledge of urethral catheters significantly improved following the escape room, mirrored by their increase in confidence. Despite having never observed or inserted a urethral catheter, all groups successfully catheterised the model, and found the active learning process more engaging.
520 Augmented Reality (AR) Presents a Novel Approach to Improving Surgical Training for Medical Students
Authors: Aziz Khawaja , Chong Dolly Li , Haq Taha , Falconer Stuart , Lewington Andrew 
Published: November 2022

Abstract

Aim
Surgical specialities are underrepresented in medical schools with students often feeling that anatomy teaching is suboptimal. Augmented reality (AR) presents a novel approach of improving anatomical knowledge. This study aims to evaluate AR as a method of preparing students for their surgical placements through a series of surgeon-led anatomy tutorials.

Method
The Microsoft HoloLens 2 was used to project a 3D anatomical model and deliver small group renal anatomy tutorials, with a focus on transplant surgery. Questionnaires and MCQs were completed by participants before and after tutorials, assessing key themes of anatomical knowledge, self-perception of renal anatomy knowledge and a comparison of AR to traditional methods. All responses were anonymised, and qualitative feedback evaluated u­­sing a 5-point Likert scale.

Results
Nineteen medical students, from a variety of year groups, were recruited from a single medical school. 63% were in their 4th year of study. Average MCQ results improved by 18% before and after the tutorial. Self-perceived confidence regarding renal anatomy improved from 2/10 pre-tutorial to 8/10 post-tutorial. 95% of students preferred AR teaching ­to traditional methods such as slide-based teaching. 85% preferred it over dissection-based methods. Technical limitations of the HoloLens were discovered during the study and nearly half of participants reported some symptoms of cybersickness.

Conclusions
AR based anatomy tutorials offer a more interactive and engaging experience than traditional methods and are positively received by medical students. As an adjunct alongside traditional methods, AR offers innovative opportunities of improving anatomy education and surgical training within medical schools.
1016 Assessing the Impact of Axillary Lymph Node Dissection on 30-Day Breast Cancer Surgery Outcomes Across Global Income Settings
Authors: Shiell Bethany , Knight Stephen , Harrison Ewen 
Published: November 2022

Abstract

Aim
To determine the impact of axillary lymph node dissection (ALND) for breast cancer on 30-day mortality and complication rates across different income settings.

Method
GlobalSurg3 was a multicentre, international prospective cohort study of patients undergoing surgery for breast cancer. Primary outcomes were death, major complications (Clavien-Dindo III/IV) or surgical site infection (SSI), as defined by the CDC criteria, within 30 days of surgery. Income levels were defined using the World Bank classification. Patient characteristics, presentation and disease factors were analysed across income levels. Multivariate logistic regression models were used to determine the impact of ALND across income group.

Results
This analysis included 8,406 patients undergoing surgery for breast cancer. Most patients presented with invasive ductal carcinoma (75%). The number of lymph nodes within resection samples were higher in low-lower middle-income countries (mean 13.3, SD 7.8) than in high income countries (mean 4.6, SD 6.3). Mortality and major complication rates were similar across country income groups. However, SSI was elevated in low/lower middle groups (aOR 2.33, 95% CI 1.75–3.12) than in upper middle income (aOR 1.86, 95% CI 1.34–2.59) and high-income groups when ALND was performed. The risk of readmission was also higher.

Conclusions
Major outcomes following ALND in patients with breast cancer were similar, however the high rate of SSI seen in LMICs is likely to significantly impact patient quality of life and potentially delay adjuvant treatment when available. Higher lymph node clearance within this setting may reduce the risk of recurrence but to the detriment of short-term outcomes.
309 Sonograhic Appearances of Hobnail Thyroid Carcinoma: A Rare Tumour
Authors: Karunaratne Nisal , Kirkland Paul , Zhang Ting Ting , Shiekh Ali Zainab Al , Howlett David 
Published: November 2022

Abstract

Background
Hobnail papillary thyroid carcinoma is a rare, recently described papillary thyroid carcinoma variant, with potential for a more aggressive clinical course of disease and poorer prognosis1. The ultrasound features of papillary thyroid carcinoma variants can differ from known traditional features1 and the specific sonographic findings of the hobnail variant itself have not been previously described in the literature.

Case report
A 53-year-old man presented with a left thyroid mass. The ultrasound features of this mass included a predominantly cystic appearance with mobile internal echoes, vascularised internal septations, and murally based solid material. These ultrasound features were deemed benign by classification standards, which led to the patient being managed with active surveillance and interval imaging. However, the mass grew quickly, and the patient underwent diagnostic hemithyroidectomy which led to hobnail variant papillary thyroid carcinoma being found on pathology. Given that papillary thyroid carcinoma variants can lead to aggressive disease, the patient underwent completion thyroidectomy and level VI lymph node clearance, on multidisciplinary team recommendation.

Discussion
The ultrasound features of the hobnail variant of papillary thyroid carcinoma have not been previously described in detail in the literature and, in this case, are features that would be deemed benign by classification standards. The rapid growth of the mass is what led to clinical suspicion of malignancy and resulted in diagnosis. Therefore, careful clinical correlation is advised in order to discern this difficult diagnosis and to facilitate appropriate treatment.
499 A 15-Year Experience of Colorectal Pulmonary Metastasectomy in a High-Volume Tertiary Referral Centre
Authors: Taylor M , Singhania A , Biswas S , Grant S W , Krysiak P , Fontaine E , Granato F , Joshi V , Rammohan K S 
Published: November 2022

Abstract

Aim
PulMiCC trial results have challenged the role of pulmonary metastasectomy as part of the management of metastatic colorectal cancer in contemporary practice. We aimed to review short and long-term outcomes for patients undergoing surgical resection of pulmonary colorectal metastases.

Method
Retrospective analysis of electronic-patient-record data was performed. All patients undergoing lung resection for pathologically confirmed colorectal pulmonary metastatic disease from November-2005 to May-2021 were included. In-hospital, 90-day, 1-year, 2-year, 5-year and 10-year mortality rates were analysed. Cox proportional hazards regression analysis was used to identify factors associated with reduced overall survival. Statistical analysis was undertaken using SPSS version-28.

Results
619 patients underwent surgery during the study period. Mean age was 66.0 years (±10.0) and 61.2%(n=379) were male. 68.7%(n=425) underwent open surgery. 151(24.4%) had multiple metastases resected. Median follow-up time was 45(IQR 23–87) months. In-hospital mortality was 0.3%(n=2) and median post-operative length of stay was 4(IQR 3–5) days. 90-day, 1-year, 5-year and 10-year mortality rates were 1.1%(n=7/619), 4.5%(n=26/580), 40.6%(n=165/406) and 74.0%(n=208/281), respectively. After multivariable analysis, advanced age (HR 1.026, 95% CI 1.011–1.043, p&lt;0.001) and resection of more than one metastasis (HR 1.524, 95% CI 1.108–2.097, p=0.010) were independently associated with reduced overall survival.

Conclusions
Although there is inherent selection bias associated with patients referred for surgical management of colorectal cancer, our results demonstrate extremely low short-term mortality and encouraging longer-term outcomes for these patients. Advanced age and the presence of more than one metastasis at the time of surgery were associated with worse prognosis.
8 The Impact of Early Surgical Training on MRCS Performance
Authors: Ellis Ricky , Cleland Jennifer , Lee Amanda J , Scrimgeour Duncan SG , Brennan Peter A 
Published: November 2022

Abstract

Aim
Surgical training experiences differ across Foundation Programme (FP) and Core Surgical Training (CST) deaneries in the UK. We, therefore, assessed whether MRCS success is associated with FP and CST deaneries.

Method
UK FP (n=553) and CST (n=1104) trainees who attempted MRCS over a three-year period were included. Chi-squared tests examined univariate associations. Multivariate logistic regression identified the likelihood of MRCS success depending on deanery, adjusted for socio-demographic factors.

Results
MRCS Part A success was associated with FP deanery (P&lt;0.01). Part A and Part B success was associated with CST deanery (P=0.01). FP trainees from Thames Valley (Odds ratio [OR] 5.75 (95%CI 1.57–20.99) and North, Central and East London (OR 3.66 [95%CI 1.14–11.80]) were more likely to pass Part A than their peers. CST trainees from Thames Valley (Odds Ratio [OR] 2.52 (95%CI 1.00–6.42), North Central and East London (OR 2.37 [95%CI 1.04–5.40]) and South London (OR 2.36 [95%CI 1.09–5.10]) were more likely to pass Part A. CST trainees from North Central and East London were also more likely to pass Part B (OR 10.59 [95%CI 1.23–51.00]). There was no significant correlation between MRCS performance and National Training Survey satisfaction scores.

Conclusions
MRCS success is associated with FP and CST deanery; however, MRCS performance does not correlate with subjective assessment of teaching or training quality. Academic ability likely has a larger impact on MRCS performance than training experiences with the more popular deaneries attracting the highest performing candidates. These results will be of interest to trainees, trainers, and training deaneries.
291 Virtual Classroom Proficiency-Based Progression for Robotic Surgery Training (VROBOT): A Prospective, Cross-Over, Effectiveness Study
Authors: Nathan Arjun , Patel Sonam , Georgi Maria , Mullins Will , Fricker Monty , Asif Aqua , Ng Alexander , Hang Man Kien , Light Alexander , Francis Nader , Kelly John , Collins Justin , Sridhar Ashwin 
Published: November 2022

Abstract

Aim
Robotic surgical training has historically lacked evidence-based standardisation. The Fundamentals of Robotic Surgery (FRS) curriculum addresses this by incorporating proficiency-based modules which certify trainees’ skills. However, the curriculum is self-directed and non-interactive. We aim to determine the effectiveness of interactive virtual classroom training (VCT) as an adjunct to the FRS curriculum for robotic skills training.

Method
11 novice surgical trainees were randomly allocated to two groups. Both groups completed a one-week robotic skills induction. In week two, Group A received training with the FRS curriculum and adjunctive VCT; Group B only received access to the FRS curriculum. In week three, the groups received the alternate intervention. The primary outcome was measured using the validated robotic-objective structured assessment of technical skills (R-OSAT).

Results
11 participants completed the training curriculum; all were included in analyses. Both groups demonstrated significantly improved proficiency upon completion of the training. At time point 1 (end of week two) Group A achieved a statistically significant greater mean proficiency score compared to Group B (44.80 vs 35.33 points, p=0.006). At time point 2 (end of week three), there was no significant difference in Group A's mean score from time point 1. In contrast, Group B showed significant improvement in mean proficiency by 9.67 points from time point 1 (95% CI 5.18–14.15, p=0.003).

Conclusions
VCT is an effective training adjunct to the FRS curriculum for the learning of basic robotic skills. With the steep learning curve in robotic surgery training, VCT offers interactive learning and can increase training effectiveness.
388 Patient-Specific 3D Printed Talus Truss Cage with Hindfoot Nail Arthrodesis – a Novel Salvage Procedure for Complex Post-Traumatic Talus Avascular Necrosis
Authors: Morris Richard , Cheruvu Manikandar Srinivas , Lingnau Leonie , Mumtaz Haroon 
Published: November 2022

Abstract

Background
Post-traumatic avascular necrosis (AVN) following talus fracture can be a devastating injury, with subsequent destruction of the tibio-talar-calcaneal articulations resulting in joint degeneration and compromised mobility.
Tibio-talar-calcaneal arthrodesis is a salvage procedure where large bone voids can present significant challenges. Whilst a range of arthrodesis techniques have been described, we present a unique case of patient specific 3D-printed talus truss cage with navicular articulation and hindfoot nail fusion.

Case Presentation
We present a case of an 80-year-old fit and well gentleman who was a delayed presentation with a Hawkins 3 talar neck fracture and a Mueller AO / OTA C3 talar body fracture. The patient opted for a trial of conservative management over primary fusion, but at 3 months post-injury there was talar body collapse and progression of subtalar degeneration, therefore he underwent talus fixation with subtalar fusion.
At 6 months post-injury, there was collapse of the tibio-talar joint with AVN of the talus. The patient had ongoing discomfort and a decision was made to proceed with custom implant arthrodesis. At 7 weeks post-operatively the patient's wounds have healed without complication and talus height is maintained. Follow-up is ongoing.

Discussion
The mainstay of treatment for severe post-traumatic talar AVN has been arthrodesis of the hindfoot and ankle with complication rates as high as sixty percent, including mal-union and loss of bone height. This case highlights the potential of a patient specific 3D-printed talus truss cage to manage complex bone defects and these challenges of arthrodesis.
946 Transforming the Morbidity and Mortality Review Process: Customised Digitalisation Helps Us Learn from Mistakes
Authors: James Eleanor , O'Shea Kathryn , Kwok Chun , Partridge Roland , Taylor Josef , Almond Sarah 
Published: November 2022

Abstract

Aim
Morbidity and Mortality (M&M) review is an important component of clinical governance in surgical practice. Constructive discussions are crucial for improving patient outcomes and quality of care. We aimed to transform the M&M review process within the paediatric surgical department of our tertiary referral centre.

Method
A critical assessment of our previous system identified weaknesses which we addressed by sequential changes in software and meeting organisation. Clinical staff developed a customised web-based reporting platform, followed by a more sophisticated mobile application for smart phones/tablets, allowing users to explore all reported cases and discussions, and to monitor actions from previous cases. The introduction of triage meetings structured the agenda and content for M&M meetings and monitoring of agreed recommendations/proposed actions ensured service improvement.

Results
The introduction of the reporting platform increased case reporting (11 vs 21 cases/month). The subsequent development of our mobile application standardised the recording of case discussion with contributing factors recorded for 100% of cases discussed. Recommendations are logged and tracked within the app's dashboard which shows every report coded by key words so case series can be identified, and audits easily facilitated.

Conclusions
M&M meetings are crucial in improving patient safety and quality of care and are pivotal to surgical training. Our mobile application simplifies, and encourages, case reporting and provides a platform to facilitate structured M&M conferences. This project demonstrates innovative uses of technology can facilitate quality improvement from M&M meetings, support audits and enhance education of surgical trainees.
200 Online Trauma Care Learning Helped Young Myanmar Doctors Managing War-Wounded
Authors: Oo Khaing Khant , Soe Aung Pyi 
Published: November 2022

Abstract

Aim
Myanmar military's brutal crackdowns on pro-democracy protestors after Feb-2021 coup resulted in a staggering number of death and wounded. An on-line trauma care series was launched in March 2021 for general practitioners and young medical graduates with limited trauma care experience.

Method
A pilot study was conducted to assess the effectiveness of online learning and address the demands of the medical personnel in the frontline areas. Pre- and post-assessments were sent out via anonymised Google forms and analysed.

Results
Among 106 participants, 65% graduated between 2011 and 2020. 46% worked in a hospital setting before the coup while 19.2% were GPs. Trauma first aid (70.8%), wound ballistics (68.8%) and ATLS updates (62.5%) were the most demanded topics. Average confidences grew in managing all 4 components (24.3% to 85.4% in Trauma First Aid, 23.5% to 72.9% in Trauma Wound Management, 12.5% to 81.3% in Wound Ballistics and 27.2% to 85.5% in Red Cross Wound scoring).

Conclusions
This pilot study highlighted an urgent demand for training and education in trauma care among young Myanmar doctors. With ongoing public hospital closures due to civil disobedience movement, care of war-wounded would still be largely dependent on makeshift casualty care chain in community setting.
792 Association of Dietary and Obstetric Factors with the Type of Gallstone
Authors: Arham Muhammad , Arish Muhammad , Khan Jahangir Sarwar , Malik Jamal Nasir , Malik Ahmed Mujtaba , Humayun Talha 
Published: November 2022

Abstract

Aim
Dietary and many other factors have been shown to increase the risk of gallstones, but their association with stone type is poorly understood. This study aims to assess the association of dietary and obstetric factors with the type of gallstone.

Method
116 consecutive patients requiring cholecystectomy due to gallstone disease, admitted in our hospital, from January 2019 to December 2020 were included in this study. Demographic details, medical history, lifestyle and dietary habits, obstetric history and laboratory parameters were recorded using a data collection form developed by the researchers. Removed gallstones were classified as being cholesterol or pigment by gross visual inspection.

Results
Cholesterol gallstones were found in 76 (65.5%) and pigment stones in 40 (34.5%) of 116 total patients. Drug use was significantly higher in pigment stone group as compared to cholesterol group (p=0.002). Patients with cholesterol stones consumed significantly higher beef, fish and confectionery items than patients with pigment stones with a p-value of 0.043, 0.017 and 0.041, respectively. Parity was significantly higher in patients with pigment stones as compared to patients with cholesterol stones (p=0.023). A logistic regression model to assess the effect of beef, fish and confectionery item consumption and age at first pregnancy with the likelihood of having cholesterol gallstone was statistically significant (p=0.017) and showed that risk is higher in patients with age ≤ 20 years at first pregnancy [OR 6.89 (95% CI 1.24–38.15), p=0.027].

Conclusions
This study concludes that diet and obstetric factors can influence the type of gallstone.
835 F.I.T for Discharge? Role of Faecal Immunochemical Testing (FIT) in Ruling Out Primary Bowel Cancer: A Review of Current Outcomes
Authors: Krishna Arun , Ferrara Giovanni , Edwards Joshua , Lala Anil 
Published: November 2022

Abstract

Aim
NICE recommends a FIT &lt;10 may not warrant an Urgent Suspected Cancer(USC) Referral. We aim to assess current outcomes at a local level. Secondary aims included whether a high FIT(&gt;100) determines increased cancer risk and whether a moderate FIT(10–100) warrants a USC referral.

Method
We retrospectively looked at patients who received a FIT between June-December 2020 in North-West Wales. These were divided into 3 groups: negative FIT(&lt;10), moderate FIT(10–100) and high FIT(&gt;100). They were followed-up for a year to determine the result of further investigations such as Endoscopies, CT Colons or CTs. The histology results from polyps/biopsies/specimens from Endoscopy/Surgery were recorded.

Results
A total of 909 patients received a FIT, 180 excluded due to no result. 557 were negative, 125 moderate and 47 high. 2 of 557(0.36%) in the negative FIT group had cancer, however histology of both showed Squamous Cell Carcinoma from Anal Cancer. 4 of 125(3.2%) in the moderate FIT group and 10 of 47(21.27%) in the high FIT group had cancer. Polyp histology demonstrated high-grade dysplasia in 1(2.13%) in the high, 3(2.4%) in the moderate and 0 in the negative Group.

Conclusions
Inappropriate investigations and delayed diagnosis can both have drastic clinical and financial implications. Our results show that a negative FIT, with a thorough history and examination, should prevent a need for a USC referral for primary bowel cancer. Patients with high FIT could proceed to investigation, while moderate FIT may need further assessment.