bluuebunny/crossref_metadata_2025_split huggingface dataset:
713 The Application of Artificial Intelligence for Digital Imaging in the Operating Theatre: A Systematic Review and Narrative Synthesis
Authors: Hardacre Conor , Fowler George , Quek Fang Fang , Skilton Anni , Blencowe Natalie , Macefield Rhiannon 
Published: November 2022

Abstract

Introduction
Promising applications of artificial intelligence (AI) in healthcare are emerging. This systematic review aims to identify and synthesise applications of digital-imaging AI in surgery and inform future work.

Method
Systematic database searches (Medline, Embase, CENTRAL) were undertaken. Studies concerning digital-imaging AI within the operating theatre were identified from title and abstract screening. Selection was further refined to identify video-based AI models with direct supportive output to the surgeon within the operating theatre.

Results
48 studies were included. Studies spanned 13 specialty groupings, with n=42 utilising a pre-specified dataset and the remaining n=6 using AI with human participants. The most common field using AI was urology (n=9 studies). Applications were most commonly for navigation and visualisation support (n=26 studies across 10 surgical specialties) and AI-based intelligent detection systems, intended to identify and highlight useful surgical information using computer-vision pattern recognition (n=18 articles across n=6 specialties). Other applications included video-processing algorithms (n=3 studies across 2 specialties), and a novel imaging modality for visualising blood perfusion (n=1 study), proposing operating theatre-based application. High-performance models were identified across a range of pathologies. This manifested as minimal overlay errors and acceptable frame rates for navigation tools, and high diagnostic performance for detection systems (determined by area-under-the-receiver-operating-characteristic-curve, sensitivity/specificity, negative/positive predictive values).

Conclusions
There is evidence to suggest AI for intraoperative surgeon-support has potential, particularly through augmented-reality navigation and AI-enabled information awareness. Further research and optimisations are required to produce clinically robust models, which remain high-performance despite case variability. Such AI may support improved surgical access, efficiency, and outcomes.
7 Differential Attainment at the Intercollegiate Membership of the Royal College of Surgeons (MRCS) Examination
Authors: Ellis Ricky , Cleland Jennifer , Scrimgeour Duncan , Lee Amanda , Brennan Peter 
Published: November 2022

Abstract

Aim
The recent Kennedy review on diversity and inclusivity highlighted concerns that some groups of individuals are facing barriers to progression in surgical careers. Differential attainment in performance at MRCS has been identified but not investigated. This study aimed to explore the relationship between socio-demographic differences and MRCS success.

Method
UK graduates attempting MRCS Part A (n=5,780) and Part B (n=2,600) from 2013-2019 were identified using the UKMED database. Univariate associations with MRCS performance were identified using chi-squared tests. Multiple logistic regression identified independent predictors of MRCS success at first attempt, adjusted for medical school performance.

Results
Differences in MRCS pass rates were statistically significant according to graduate status, sex, ethnicity, socio-economic status, and educational background (all P&lt;0.05). After adjusting for prior academic attainment, men (odds ratio [OR] 2.34, 95%CI 1.87–2.92) and non-graduates (OR 1.98, 95%CI 1.44–2.74) were significantly more likely to pass MRCS Part A. Non-graduates (OR 1.77, 95%CI 1.15–2.71) and those who attended a fee-paying school (OR 1.51, 95%CI 1.08–2.10) were significantly more likely to pass MRCS Part B. Black and minority ethnic groups were significantly less likely to pass MRCS Part B at their first attempt (OR 0.41, 95%CI 0.18 to 0.92 for Black candidates and OR 0.49, 95%CI 0.35 to 0.69 for Asian candidates) compared to White candidates.

Conclusions
We found significant differential attainment at MRCS that cannot be attributed to learner deficit. Training institutions and Royal Colleges now have a responsibility to identify and address the causes of these attainment differences to facilitate equitable career progression for surgical trainees.
549 A Study Exploring the Impact of Gender and Ethnicity Diversity on the Experience(s) and Career Development of Surgical Trainees
Authors: Shakoor Zainab , Smith Sue 
Published: November 2022

Abstract
Despite notable ethnic diversity amongst doctors in the UK, female surgeons from an ethnic minority background are particularly under-represented. It is not known if they experience additional challenges and difficulties during surgical training and or with their career progression due to any possible impact of their gender and ethnicity.
A qualitative research methodology was employed, and seven one-to-one interviews were conducted with female participants from ethnically diverse backgrounds. An intersectional approach was used to assess any possible impact of gender and ethnic diversity on experience(s) of surgical trainees and whether or not they had any implications for career progression. Interviews were subsequently transcribed and coded for thematic analysis and for construction of possible theories.
Several themes emerged to account for participants' experiences of negative workplace experiences (NWPE) including racism, sexism, and discrimination throughout surgical training. In addition to these factors, unconscious and explicit forms of bias also had the potential to impact a trainee's career progression through reduced access to senior support, mentorship, theatre cases, and research opportunities. Participants detailed other direct contributors affecting career progress including a lack of senior support, reduced access to role models/mentors, conflicting family and cultural pressures, and institutional forms of racism, sexism and discrimination encountered in their job role as a surgeon and the NHS.
Further research is needed to explore the intersectional experiences of surgical trainees in order to improve the training environment, retain trainees and encourage diversity within surgical careers.
161 Gender Representation Within Editorial Leadership Roles of United Kingdom Surgical journals
Authors: Reeves Samuel , Walker Kieran , Brennan Peter 
Published: November 2022

Abstract

Introduction
Women remain under-represented in surgery in the United Kingdom. Representation on journal editorial boards is a key metric of gender representation within academic surgery.

Aim
To quantify the gender representation within editorial leadership of journals affiliated with United Kingdom surgical specialties.

Method
A list of surgical specialties was obtained from the Royal College of Surgeons England. A web search for United Kingdom specialty associations was conducted. Each association webpage was then searched for an affiliated journal. Once identified, the gender of the editor-in-chief and other leadership positions including associate, section and deputy editors was collected. Gender classification was completed by first name recognition and verified by a web search using the name and institution provided. Managing editors without a clinical background were excluded.

Results
9 journals were identified for the following surgical specialties: General Surgery, Trauma & Orthopaedics, Neurosurgery, Cardiothoracic, Urology, Paediatric Surgery, Ear Nose & Throat, Oral & Maxillofacial, Plastic & Reconstructive Surgery. There was no journal associated with the United Kingdom vascular society.
A total of 195 positions were identified. 164 were occupied by males (84%), and 31 by females (16%). There were no female editor-in-chiefs. The average female proportion of editorial leadership per journal was also 16%. One journal did not have any female representation.

Conclusions
Women are under-represented in surgery and this trend translates to leadership roles within academic journals. If initiatives designed to promote gender parity are to be effective and sustained, surgical journals should scrutinise their own imbalances and seek to rectify them.
943 Gender Inequalities in Surgery: A Literature Review and Social Media Analysis.
Authors: Chrystal Anna , Morgan Heather May 
Published: November 2022

Abstract

Aim
This study identified the current barriers to women in surgery in the UK and evaluated the hashtags that are broadcast via Twitter to expose gender bias within surgery.

Method
A literature review was conducted using key terms to identify the barriers to women in surgery. A Twitter search was conducted via NVivo and Ncapture using keywords to identify the hashtags categorising gender bias and sexism in the surgical profession. Tweet content was qualitatively evaluated to assess gender-based inequalities in surgery in the UK. Tweets were further evaluated to identify evidence of trolling or dismissive behaviour towards surgical sexism.

Results
The literature review identified work-family imbalance, lack of female surgical role models, inflexibility of working hours, the gender pay gap, and female objectification as key barriers to women in surgery. Twitter analysis demonstrated evidence of surgical gender bias throughout UK surgical training using #Surgical#Sexism #HammerItOut #CutItOut and #NHSMeToo, with minimal evidence of trolling and dismissive comments. Twitter provided a platform to support and praise users that speak out against surgical gender bias, including whistleblowers.

Conclusions
Twitter as a social media platform can provide an environment to support users who may be experiencing gender-based bias within their surgical workplace. Twitter may also demonstrate further purpose as a useful aid in whistleblowing within healthcare.
503 The Impact of ‘Golden Local Anaesthetic (GLA)’ Principal on Emergency Theatre Efficiency - Analysing 232 Hand and Plastic Trauma Operations
Authors: Freethy Alexander , Hennessy Conor , Tucker Sarah , Teo Isabel 
Published: November 2022

Abstract

Aim
‘Golden local anaesthetic’ (GLA) principals are known to improve theatre efficiency. This first GLA case should be suitable to be completed unsupervised by a registrar and confirmed 12 hours prior to the start of the list with a negative COVID PCR test. This allows for list to be started, whilst the consultant is able to see and consent the remainder of the patients for that list, maximising theatre efficiency.

Method
Operative timings was gathered in real time in our electronic database (TIMS). Initially, retrospective analysis was performed for cases in November 2020, comparing lists whereby a potential GLA first case was present, versus lists that did not. After remodelling this process, lists in October 2021 were analysed. Statistical analysis was carried out using Mann Whitney U Test.

Results
Initially (PDSA-1), 110 trauma cases (58% GA and 42% LA) were performed [3.67/day] whilst post refinement (PDSA-2) 122 cases (52% GA and 48% LA) were performed [3.94 /day]. In PDSA-2, there was a 29% (9/31) uptake of GLA list principals. The average GLA list start time was 09:27hrs in PDSA-1 and 09:08hrs in PDSA-2 [Δ 19 mins, p&lt;0.05] whilst the average non-GLA list start time was worse (09:53hrs and 10:12hrs). By refining the GLA principal, £470.63 was ‘saved’ with a further £445.86 potentially able to be saved when starting at the earliest recorded start time (1)

Conclusions
The GLA model is a simple and sustainable method to improve theatre efficiency which could be adopted by other units.
(1) Ang WW et al. 2016 - doi:10.1016/j.amsu.2016.03.001
840 PSMA PET/CT in Prostate Cancer (PCa) Management: Outcomes from a high-volume tertiary NHS centre
Authors: Mubarak Mohamed , Tanguay Jacob , Rees John , Narahari Krishna 
Published: November 2022

Abstract

Introduction
PSMA PET-CT (PSMA) is a relatively new development in PCa imaging. We report the role and impact of PSMA in the management of both primary and recurrent PCa since our service's inception in January 2020.

Method
A retrospective analysis of PSMA database was conducted. All patients underwent conventional imaging (CI) [CT/MRI & Bone scan] as well. Indications for PSMA were:
Data collected included demographics, PSA, ISUP grade, D'Amico risk classification, and TNM staging. Data are expressed as median (range) and analysed using SPSS v25.

Results
Overall, 454 scans were reviewed; 175 (38.5%) and 279 (61.5%) scans were offered to evaluate primary and recurrent disease, respectively.
On reassessment with PSMA, 54.2% of all scans showed nodal or metastatic involvement that led to re-staging. More specifically, 56%% of primary cases and 77.1% of recurrent cases had their stage, and consequentially, management plan modified. ISUP, cT3 stage, and D’Amico risk classification were not associated with upstaging (p &gt;0.05).
Overall, there was poor agreement between CI and PSMA when evaluating nodal (k = 0.216, p &lt;0.005) and metastases (k= 0.171, p&lt;0.005) in staging either primary or recurrent disease.

Conclusions
PSMA is superior to CI in staging PCa and significantly alters management in these patients. It should be offered as the first line of staging imaging for primary (high-risk) and prior to salvage therapy.
907 Total Ankle Arthroplasty Versus Arthroscopic Ankle Arthrodesis: A Novel Comparison of Clinical Outcomes and Cost-Utility
Authors: Kurar Langhit , Shah Vinay , Grice John 
Published: November 2022

Abstract

Aim
End-stage ankle arthritis poses numerous healthcare challenges, not least given its high prevalence but also significant limitations in treatment modality. This study compares functional outcomes following total ankle arthroplasty (TAR) versus arthroscopic ankle arthrodesis (AAA). Secondary objectives were to compare complication rates and perform a health economic analysis to estimate cost-effectiveness to the NHS.

Method
A prospective, single centre cohort study of TAR versus AAA in patients diagnosed with end-stage ankle osteoarthritis between 2015 and 2020 with homogenous characteristics. Primary outcomes were assessed through comparing Manchester-Oxford Foot Questionnaire (MoxFQ) scores taken pre-operatively and at specific intervals post-treatment up to one year. A cost-utility analysis via decision tree modelling was performed to derive an incremental cost effectiveness ratio (ICER).

Results
The study involved 42 patients. TAR (22 patients) demonstrated a better functional improvement following cast removal at 3 months (Ẋ = 19.1 [TAR]/ 7.4 [AAA], p= 0.044, CI 95%) and 6 months (Ẋ= 26.1 [TAR]/ 11.5 [AA], p= 0.031, CI 95%). The average improvement of MoxFQ scores over the study was greater following TAR. Values derived from cost-utility analysis produced an ICER of £8,639.51/QALY (quality of life year) for TAR implying that the procedure is cost-effective compared to AAA with respect to the NICE treatment threshold of £20,000/QALY.

Conclusions
TAR provided improved patient reported outcome scores following cast removal. Although overall treatment costs are greater with TAR, reduced complications and better functional outcomes demonstrated greater economic benefit with TAR compared to AAA.
814 Evaluating the Impact of Neurosurgical Rotation Experience in Africa on the Interest and Perception of Medical Students Towards a Career in Neurosurgery: A Continental, Multi-Centre, Cross-Sectional Study
Authors: Dada Olaoluwa Ezekiel , Yang Ooi Setthasorn Zhi , Bukenya George William , Kenfack Yves Jordan , Le Chi , Ohonba Efosa , Adeyemo Emmanuel , Narain Kapil , Awad Ahmed Khaled , Barrie Umaru , Sichimba Dawin , Ogunfolaji Oloruntoba , Kitonga Lilian Mwende , Oriaku Adaeze Juanita , Bamimore Michael Abayomi , Okor Douglas Emeka , Rominiyi Ola 
Published: November 2022

Abstract

Introduction
Africa has the second-highest neurosurgical workforce deficit globally, and many medical students in Africa lack exposure to the field. This study aims to assess the impact of a neurosurgical rotation during medical school in shaping the perception and interest of students towards a career in neurosurgery.

Method
This is a continental, multi-centre, cross-sectional study. A Google form e-survey was disseminated to African clinical medical students between February 21st and March 20th, 2021. Data was analysed using descriptive statistics and adjusted logistic regression modelling.

Results
Data was received from 539 students in 30 African countries (n=30/54, 55.6%). The majority of participants were male (n=289/539, 53.6%) and were from Kenya (n=83/539, 15.4%). Most students had undertaken a clinical neurosurgery rotation (n=278/539, 51.6%); the majority reported a rotation length of four weeks or less (n=181/278, 65.1%). Students with clinical experience were less likely to pursue the specialty (p=0.02) and had a stronger perception that it is more difficult for women to pursue neurosurgery (p=0.0001) when compared to those without clinical experience. However, after adjusting for other factors, students with greater than four weeks of neurosurgical exposure were more likely to express a career interest in neurosurgery (odds ratio [OR]=1.75, p&lt;0.04) and men were more likely to express interest in a neurosurgical career compared to women (OR=3.22, p&lt;0.001).

Conclusions
Our findings support standardised, continent-wide, curriculum development, and advocacy supporting improved gender inclusivity in education and policymaking to improve the quality of neurosurgical exposure during medical school and help tackle the neurosurgical workforce deficit across Africa.
820 Management and Outcomes of Traumatic Paediatric Spinal Cord Injuries in Low- and Middle-Income Countries: A Scoping Review
Authors: Dalle David Ulrich , Sriram Smrithi , Bandyopadhyay Soham , Egiz Abdullah , Kotecha Jay , Kanmounye Ulrick Sidney , Higginbotham George , Yang Ooi Setthasorn Zhi , Adeniran Bankole Nourou Dine 
Published: November 2022

Abstract

Introduction
Traumatic spinal cord injury (TSCI) is a subset of neurotrauma, which is a significant contributor to global trauma mortality and morbidity in children. The management and outcomes of paediatric TSCI in low- and middle-income countries (LMICs) is unknown. We conducted a scoping review to characterise the methods of management and outcomes of TSCI in LMICs.

Method
MEDLINE, EMBASE, and Global Index Medicus were searched from database inception to February 15, 2021. Studies reporting management or outcomes of paediatric TSCI in LMICs were included. Pooled statistics were calculated using measures of central tendency and spread.

Results
A total of 1171 studies were identified, of which, five were included. A total of 212 patients were included in our review with age of participants ranging from 2.5 to 18 years old (mean = 15.4 years). Most patients were male (n=162/212, 76.4%, 95% confidence interval [CI] = 70.7–82.1%). The commonest cited cause of injury was falls (n=104/212, 49.1%, 95% CI = 42.3–55.8%). The most common level of injury was cervical (n=83/212, 39.2%, 95 CI% = 32.6–45.7%). The majority of patients underwent surgery (n=134/212, 63.2%, 95 CI% = 56.7–69.7%). The extent of injury was quantified and classified using the ASIA chart in only one paper. Long-term management data was not present in any of the included studies.

Conclusions
There is a scarcity of published studies reporting the management and outcome of paediatric TSCI in LMICs. There is insufficient data to be compared and to draw a strong conclusion. This hinders the development of guidelines to inform best practice.
197 Non-Traumatic Spontaneous Ileal Perforation: Experience With 125 Cases
Authors: Khalid Sadaf 
Published: November 2022

Abstract

Background
Non-traumatic ileal perforation is a common cause of obscure peritonitis in developing and underdeveloped world. The perforation of the ileum is one of the causes of peritonitis that is difficult to diagnose preoperatively. The objective of the study was to determine the increasing frequency of cases of non-traumatic ileal perforations and their subsequent management

Method
This descriptive case-series included 125 cases presenting in surgical emergency of Lahore General Hospital from 1st January 2014 to 1st December 2014. All patients were resuscitated and underwent emergency exploratory laparotomy.

Results
The causes for perforation were enteric fever in 82 cases (65.6%), tuberculosis in 38 cases (30.4%), adhesions and other causes in 5 cases (4%). The main presenting symptom in all patients were severe abdominal pain associated with fever and abdominal distension. Perforations were surgically treated depending upon the number of perforations, general health status of patient and degree of fecal contamination. In total out of 125 cases, primary repair was done in 9 cases, resection, and end to end anastomosis in 19 cases and in 13 patients’ resection and ileotransverse anastomosis was done. In the case of 78 patients loop ileostomy was done and in 6 patients double barrelled ileostomy was performed.

Conclusions
The incidence of terminal ileal perforations due to typhoid and the tuberculosis is high and carries high mortality and morbidity rates in delayed presentations. Therefore, it is high time now that general public health awareness should be created regarding food handling, sanitation, and personal hygiene.
297 The Surgical Trainee Perception of the Operating Room Educational Environment
Authors: Rupani Neal , Evans Ashish , Iqbal Mohammad 
Published: November 2022

Abstract

Aim
Limited hours and service provision are diminishing training opportunities for surgical trainees. It is therefore imperative to maximise each educational event in theatre. The Operating Room Educational Environment Measure (OREEM) evaluates each component of the theatre learning environment; however, it has not been validated in higher surgical trainees in England. We aim to validate the OREEM and evaluate surgical trainees’ objective perspectives of the current operating room educational environment in one region.

Method
Data was collected over one month from surgical trainees within Health Education Thames Valley using an online questionnaire consisting of: demographic data; the OREEM; a global satisfaction score.

Results
54 trainees participated. The OREEM had good internal consistency (α=0.906, variables=40) and unidimensionality. Mean OREEM score was 79.16%. Areas for improvement included better learning opportunities (72.9%) and pre/post-operative teaching (70.4%). Trainees were most satisfied with the level of supervision and workload (82.9%). No differences between gender (p=0.535) or hospital type (p=0.099) were demonstrated. The learning environment favoured senior trainees (p=0.017). There was a strong correlation between OREEM and the global satisfaction score (p&lt;0.001).

Conclusions
The OREEM was shown to be a reliable measure of the educational environment in theatre. It can be used to identify areas of improvement and as an audit tool. Suggested areas of improvement include facilitating pre- and post-operative teaching, reducing service provision, empowering trainees to plan lists, improving teamwork and using tools to optimise the educational value of each operation. There is a favourable attitude regarding the use of such improvement tools, especially for dissatisfied trainees.