bluuebunny/crossref_metadata_2025_split huggingface dataset:
969 A Quality Improvement Project Centred Around the Introduction of an Exception Reporting Pathway
Authors: Khudr J , Bonsi T 
Published: November 2022

Abstract

Aim
Exception Reporting (ER) is applicable to surgical training so can therefore be used for a variety of reasons. This Quality Improvement Project aims to positively change the attitudes and ease the process of ER.

Method
We conducted a qualitative survey distributed amongst medical and surgical trainees and supervisors from the Royal Liverpool and Aintree Hospitals which focused on assessing their attitudes towards ER. The second measure was a retrospective review in which we compared the number of ER from September-December in 2019 and 2020.
We created a poster showing a clear pathway to ER and the repeated the cycle above including both measures.

Results
We received over a hundred responses to our original survey, with half being trainees and the other being supervisors. It was clear that, huge deficits were discernible in trainee and supervisor understanding of the process and its outcomes.
After introducing the ER pathway, a significant improvement in understanding towards ER was noted with 98.4% (from 84.5%) of trainees and supervisors understanding what ER is and 52.8% (from 42.7%) better understanding outcomes. Despite this, there seems to be a shift in attitude toward ER with a 10.7% increase in exception reporting within a 10-month period.

Conclusions
Our project highlights the importance of exception reporting, and its perception between clinical staff. With the presence of COVID rotas, the introduction of new trainees to the trust, and the higher emphasis on doctor burnout and patient safety in the news, ER measures remain our closest tool to observing such dynamic attitudes and acting on them.
862 Process Mapping of 3D Printing for Complex Limb Problems
Authors: Quang J , Ferguson D 
Published: November 2022

Abstract

Introduction
Difficult limb problems such as complex trauma or re-presentation following orthopaedic revision surgeries can present substantial planning and technical challenges. 3D-printed models built from patient-specific CT scans facilitate creative thinking, problem solving and decision making to find better operative solutions. This quality improvement project aims to map the process of using 3D printers to solve orthopaedic problems.

Method
Stakeholders, including a Consultant Trauma & Orthopaedic surgeon and the Medical Physics team were interviewed to formalise the full structure of their role from start to end, with the support of the Trust's Improvement Team and Innovation Team. A visual representation of the process map was produced using SmartDraw software. Feedback was received from stakeholders and a second cycle of process mapping was completed.

Results
The process map included the chronological steps of the project, the interaction between different roles and the stages of 3D printing. A database template was produced as a shared OneNote, allowing the tracking of each model production. Stakeholders found the map useful for anticipating problems and considering the future process and providing a framework of implementing innovation within the NHS.

Discussion
Unique implants cost the NHS significantly more money than batch-made products. Introduction of 3D models into pre-operative planning allow surgeons to utilise readily available solutions instead of custom, single-use implants, which can be cost saving and prevents unnecessary wastage. The project trialled operations on models, facilitated patient explanations and provided an educational tool. Future aims include roll-out to other specialties and Trusts, encouraging collaboration towards a sustainable internal economy.
626 What Is the Influence of Negative Pressure Wound Therapy (NPWT) on High-Risk Wounds in Pelvic Oncology?
Authors: Al-Aqeel M , Adlan A , Stevenson J 
Published: November 2022

Abstract

Aim
Hindquarter amputation (HQA) has a high incidence of postoperative wound complications. We aim to use the HQA procedure as a model to investigate the potential advantages of negative pressure wound therapy (NPWT) on wound healing complications in high-risk pelvic oncology wounds.

Method
We conducted a retrospective analysis of all patients undergoing hindquarter amputation at a single tertiary centre between January 2009 and November 2020. Patients were divided into groups who had and hadn't undergone neoadjuvant radiotherapy (RT) to the pelvic tumour.

Results
One hundred six patients were included in the study. 43.4% had NPWT. There was no difference in the incidence of reoperation in the patient group without neo-adjuvant RT between NPWT and conventional dressings (odds ratio [OR], 1.01; p=0.983, 95% confidence interval [CI], 0.365–2.8). However, the use of NPWT decreased the incidence of reoperation among the patients who had NPWT who had received radiotherapy [OR], 0.087; p=0.033, 95% CI, 0.009–0.818). The incidence of wound complications has declined with the increasing use of NPWT between 2009–2020.

Conclusions
The application of NPWT reduces the incidence of wound complications in high-risk pelvic oncology wounds. We demonstrated a reduction in the incidence of reoperation due to wound complications in patients who received NPWT following HQA.
636 Impact of the COVID-19 Pandemic on Emergency Admissions with Colorectal Cancer
Authors: Verma A , Payne C 
Published: November 2022

Abstract

Aim
During the first wave of the Coronavirus (COVID-19) pandemic, there was considerable concern that patients with non-COVID pathologies would not seek medical attention, or the healthcare resources to treat these patients would not be available. This may affect the number of patients presenting as an emergency or with more advanced disease. The aim of this study is to establish if admission and outcome patterns changed pre-COVID vs post-COVID.

Method
All patients presenting as an emergency admission with colorectal cancer to our institution were identified from a prospectively collected database. We compared 1 year prior to the national lockdown (April 2019-March 2020) with the subsequent year (April 2020-March 2021). Treatment plans and follow-up were recorded using electronic patient records.

Results
There was no difference between the number of patients attending as an emergency pre-COVID compared with post-COVID (60 vs 67, p=0.474). The proportion of patients undergoing surgery on the index admission fell but did not reach significance (52.5% pre-COVID vs 38.8% post-COVID, p=0.122). No difference observed in the proportion of patients presenting at each cancer stage; I-IV (p=0.881), nor patients proceeding with curative intent (39.0% pre-COVID vs 37.3% post-COVID, p=0.906). The median length of hospital stay was not significantly different (10.0 days pre-COVID vs 9.0 days post-COVID, p=0.128). Finally, no difference in 30-day mortality was observed (25.0% vs 29.9%, p=0.541).

Conclusions
This study appears to show that there was no difference in the number of patients accessing emergency services with acute presentations of colorectal cancer, and that the outcomes have not changed despite COVID.
1060 Surgical Currency - the Link Between Skill Fade and Safe Practice
Authors: St John L , Sandhu A , Baden J 
Published: November 2022

Abstract

Aim
Surgical currency refers to the operating time required per year before a surgeon's skill fade could negatively affect patient outcomes. Increased surgical experience and volume of operating hours directly improves patient outcomes. There is no clear guidance from the NHS or Defence Medical Services on amount of experience needed to maintain current. This paper highlights the importance of surgical currency, investigates if skill fade occurs faster than knowledge, and looks to ensure surgeons are not deployed beyond the point of currency. It explores methods to prevent skill fade and reintegrate surgeons following absence.

Method
A thorough literature search was performed. Currency protocols across Royal Colleges, healthcare systems and other industries were studied, including systems installed to mitigate skill fade during COVID-19.

Results
An average deployment for a military surgeon will be three months, but pre-deployment training can make this six. The AMRC states an absence over three months affects medical knowledge. Skill fade occurs more rapidly than knowledge, but research remains limited for how long a well-practiced skill is retained. The aviation industry clearly stipulates a pilot's currency, and simulator training is provided following absence. US surgical simulator training proved effective in maintaining skills during the pandemic. Health Education England and Royal College of Surgeons Edinburgh provides return programs for trainees but not consultants.

Conclusions
Careful consideration should be given before extending surgical deployments. Surgical simulation could be used while deployed to maintain currency. Return-to-work programs should be available to consultants. Further research should be done on currency and prevention of skill fade.
495 Virtual Reality Simulation Training in Hip Surgery Versus Traditional Surgical Education Method: A Systematic Review of Randomised Controlled Trials
Authors: Tsinaslanidis P , Choudhury A , Smith T , Hing C 
Published: November 2022

Abstract

Aim
The purpose of this study was to perform a systematic review of the effects of orthopaedic virtual reality simulators on surgical skills across randomised controlled trials.

Method
The authors searched PubMed, CINAHL, MEDLINE, AMED, Eric, Embase, Cochrane Central Register of Controlled Trials, TRIP database and grey literature from 1946 to November 2020. Inclusion criteria were all level one studies, specifically randomised controlled trials with orthopaedic training simulators in hip surgery and clear evaluation of skills attained after virtual reality simulation (VR) training. The primary outcome was the reported quantitative assessment of operative skills acquisition. The Jadad scale was used as a tool in order to appraise the methodological quality of the included trials. The data collected were not amenable for meta-analysis as they were too heterogenous and were analysed and presented using a narrative analysis and the Synthesis Without Meta-analysis (SWiM) reporting guideline.

Results
A total of 1095 articles were identified. Four level I studies, all randomised controlled trials, including 86 participants were eligible for the final analysis. There were significant differences in the types of simulators, training structure, validity types, performance scores and outcome measures described in each study. In three out of four studies (75%) the use of VR training simulators led to improved surgical skills acquisition compared to other traditional teaching methods.

Conclusions
Overall, this review showed that the use of VR simulation training is a potential tool that can enhance surgical skills acquisition in hip surgery procedures compared to traditional education methods.
927 An Analysis of the United Kingdom Education Courses for Aesthetic Practice
Authors: Zargaran D , Zargaran A , Caine P , Weyrich T , Mosahebi A 
Published: November 2022

Abstract

Aim
The training of cosmetic and aesthetic practitioners has received national attention since the 2013 Keogh review of the regulations of cosmetic interventions. The 2015 HEE cosmetic guidelines recommended level 7 accreditation in Injectables for Aesthetic Medicine. The Royal College of Surgeons has now established the Cosmetic Surgery Certification Scheme and this analysis looks to identify the cost and availability of courses in the UK.

Method
A review of Google search results using the keywords “Botox”, “Filler”, “Course”, “Certification”, “Level 7”, “Training” and “Foundation” using Boolean operators. The costs of the courses, duration, accreditation, and availability of level 7 certification were extracted from the websites.

Results
A total of 36 courses were identified where a Foundation Course in both Botulinum Toxin and Dermal Fillers were provided. The lowest available cost was £780, a maximum cost of £4,500 and mean cost of £1,557. Mode course duration was 1 day, with a maximum duration of 4 days and mean of 1.4 days. 9 of the 36 providers offered level 7 accreditation.

Conclusions
The provision of education and training has significant implications for patient safety. The completion of foundation courses is often a requirement for insurance companies to provide coverage to practitioners, however, a wide variety of educational quality may account for complications which are experienced by patients. The lack of accreditation beyond CPD points was noted. These findings call for a unified educational approach to ensure, safe training of practitioners
971 Gamification of Education; Can Playable Education Result in Better Learning Outcomes?
Authors: Badenoch T , Benton K , Jacobs E , Curtis A , Law S , Everett S , Ahmed M , Hunter I , Bamford R 
Published: November 2022

Abstract

Aim
Combining traditional simulation (TS) and the emerging field of gamification, to create medical Escape Rooms (ERS) has been used in Nursing to good results but is yet to be widely adopted in medical education. We conducted a pilot study to create ERS for undergraduates to assess their educational value.

Method
Existing Simulation themes of sepsis, post-operative bleeding, trauma, burns and communication in the theatre environment were developed into Escape Rooms by a multidisciplinary team. A cross over study for 4th year students was carried out. Questionnaires were used to evaluate the experience, learning assessed by pre and post quiz and observational tools for teamwork, communication and leadership were utilised.

Results
Qualitative data demonstrated overall good feedback on enjoyment an engagement. Quantitative data collected as pre- and post-exposure learning demonstrated equivocal benefit. Self-assessed teamwork showed equal in all domains and improved in contribution of knowledge and maintaining team focus on the ER group.

Conclusions
Participants find ER enjoyable have similar educational benefits of traditional simulation with the benefits on enhancing non-technical skills amongst a novice group. Escape rooms may be useful as an adjunct to TS particularly at developing non-technical skills.
155 Tibial Malrotation Following Intramedullary Nailing: A Literature Review
Authors: Fernandes A , Sagoo K , Oluku J , Cheema K 
Published: November 2022

Abstract

Aim
The use of intramedullary nail fixation remains the operation of choice for managing unstable and displaced tibia diaphyseal fractures. The literature shows that although commonly performed, there is not a standard approach when performing intramedullary nailing of the tibia; it could be hypothesised that this lack of standardisation may be contributing to the noted complications. This systematic review will look into intramedullary nailing of the tibia in all its parts, from identification of patients through to the surgical procedure techniques and finally the intra- and post-operative complications.

Method
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Search terms included “tibial intramedullary nail” OR “tibial intramedullary rod” OR “tibial IM nail” OR “tibial interlock” AND “malrotation”, and “tibial intramedullary nailing” OR “tibial im nail” OR “tibial interlock” OR “tibial rod” AND “malrotation”.

Results
Eleven studies were considered in the final analysis, with a total number of 425 fractures (n=429, mean ± 95% CI=39 (21.2–56.8)). All included patients were treated with tibial intramedullary nail devices, and 110 showed some degree of malrotation postoperatively (n=110, mean ± 95% CI=10.1 (4.26–15.9)). Expressed as a percentage, a mean of 34.1% of patients had malrotation (mean ± 95% CI: 34.1 (15.8–52)).

Conclusions
This systematic review revealed there are gaps in the literature and in the management process of these patients and suggested that a systematic approach using ‘Get It Right First Time’ (GIRFT), intraoperative assessment, validated assessment tools, and imaging postoperatively should be used to improve outcomes.
268 The Efficacy and Safety of Bariatric Surgery in Patients with End-Stage Renal Disease and Kidney Transplantation: A Systematic Review and Meta-Analysis
Authors: Fernando S , Varma J , Dengu F , Menon V , Malik S , O'Callaghan J 
Published: November 2022

Abstract

Aim
Obesity is associated with adverse outcomes in end-stage renal disease (ESRD) and kidney transplant (KT) recipients. Bariatric surgery (BS) is an effective solution to obesity. The authors aim to summarise the evidence for the efficacy and safety of BS in ESRD or KT.

Method
A literature search was conducted using MEDLINE, EMBASE and Web of Science from inception to date (April 2021). Articles were categorised into patients awaiting waiting list acceptance, awaiting transplantation, undergoing simultaneous BS and kidney transplantation, and undergoing BS following transplantation in the past. Primary outcome was change in BMI with secondary outcomes as adverse events, graft outcomes and KT.

Results
Twenty-eight articles were selected: fourteen on patients awaiting listing (n = 1984), nine on patients listed for KT (n = 196), one on simultaneous BS and KT and ten on patients undergoing BS following KT (n = 198). Mean change in BMI for patients awaiting listing was -10.5 (-4.1 to -17.0, p = 0.001), change in BMI for patients listed for KT was -11.2 (-9.5 to -12.9, p&lt;0.001) and change for patients with prior KT was -11.0 (-7.09 to -14.9, p&lt;0.001). 60.4% of patients undergoing BS were successfully listed for KT. 74.1% of patients listed for KT undergoing BS underwent KT within 17 months (SD = 78.5). Time from KT to BS was 59.2 months (SD = 43.0).

Conclusion
BS is both safe and efficacious on patients with ESRD, those awaiting KT, and those with prior KT and should be considered when obesity is a hurdle to favourable outcomes.
550 A Systematic Review of Aesthetic Outcome Using Dermal Regeneration Templates in Nasal Reconstruction
Authors: Bhatti N , Jamshidi S , Williams G , Wormald J , Wood S , Dunne J 
Published: November 2022

Abstract

Aim
Nasal reconstruction using Dermal Regeneration Templates (DRT) has been proposed due to their ability to reduce contour defects, avoid donor site morbidity, and facilitate reconstruction. This review aims to determine the aesthetic outcomes of DRT's in nasal reconstruction.

Method
A full systematic literature review of DRT use in nasal reconstruction was performed by two authors in December 2021. Cochrane Central Register of Controlled Trials, Ovid EMBASE and Ovid MEDLINE were searched and included papers reporting objective measures of aesthetic outcome. Of the 385 papers identified, 5 were included.

Results
75 patients were included. Defects resulted from excision of skin tumors (74) and vascular malformation (1). 1 study used Hyalomatrix, 1 used Integra or Matriderm and 3 used Integra only. 2 papers using Integra left the defect to heal secondarily without a skin graft and healing time was 6 weeks or less, while 3 studies performed a second stage with a full thickness skin graft at 2 weeks or later. Mean defect size was poorly reported, and several subunits were reconstructed. Using the Vancouver Scar Scale and Visual Analogue Cosmetic Scale, significant improvements compared to pre-operative assessment were observed and good to high patient satisfaction. Complications were infrequent. Subsequent flap reconstruction was performed in 12 patients.

Conclusions
Nasal reconstruction using DRT is reliable however data on aesthetic outcomes are limited. The re-operation rate is reasonably high and data comparing aesthetic outcomes to flaps and skin grafts are lacking. More research reporting objective outcomes is warranted to further evaluate the utility of DRT's.
850 Surgical Versus Non-Surgical Treatment of Unstable Lateral Compression Injuries of the Pelvis with Complete Sacral Fractures (LC1) in Non-Fragility Fracture Patients: A Systematic Review
Authors: Varma J , Foxall-Smith M , Donovan R , Whitehouse M , Rogers C , Acharya M 
Published: November 2022

Abstract

Background
Lateral compression type 1 (LC1) injuries comprise two-thirds of pelvic fractures. Approximately one third of LC1 fractures are unstable and may benefit from surgical fixation to improve stability but it is not clear if this leads to better clinical or cost-effectiveness outcomes.

Method
We performed a systematic review to determine whether surgical or non-surgical treatment yielded better clinical and cost-effectiveness for the treatment of unstable LC1 pelvic injuries with complete sacral fracture, excluding fragility fractures. We searched Medline, Embase and Cochrane databases from inception to June 2021, as well as clinical trials registries.

Results
Five observational studies met the inclusion criteria. 183 patients were treated surgically, and 314 patients treated non-surgically. Patients treated surgically had lower pain levels (Visual Analogue Scale) and fewer days to mobilisation. Quality of life (EQ-5D and SF-36 questionnaires) was better in the surgical group, but not statistically significant. No statistical differences in length of hospital stay or complication rates were found. Formal meta-analysis was not possible due to available study designs and heterogeneity.

Conclusions
This review highlights the low quantity and quality of existing data on patients with unstable LC1 pelvic fractures and the need for a definitive randomised controlled trial to determine whether surgical or non-surgical care should be the preferred treatment in terms of clinical and cost-effective care.
1028 Systematic Review of Outcomes of Applications of Prineo-Dermabond
Authors: Kulkarni S , Stather P , Chowdhury M 
Published: November 2022

Abstract

Aim
The aims of this study are to assess published data regarding infection rates, delayed wound healing, cosmetic appearance and application time compared to conventional wound closure techniques across multiple surgical procedures.

Method
A literature search was conducted according to PRISMA guideline using PubMed, SCOPUS and Science Direct. The primary outcome was the incidence of wound infection after Prineo Dermabond compared to controls. Secondary outcome measures included allergic reactions and time for application. Literature search identified 52 studies, of which 19 were eligible for qualitative synthesis and 12 for meta-analysis.

Results
Studies included reflected a broad range of applications of Dermeo-Prineo to wound closure in Abdominoplasty, Mammoplasty and Arthroplasty.
Overall, all studies reporting on time of application found a positive indicator of Prineo Dermabond reducing time for wound closure.
Meta-analysis identified a statistically significant reduction in rates of the 6 studies that described wound infection (Prineo 1.51%, Control N=2.13%, OR 0.65 (0.46–0.91); P=0.01) and in the 5 studies reporting delayed wound healing (Prineo 0.99%, Control N=1.79%, OR 0.42 (0.18–0.98); P=0.05) in the use of Prineo Dermabond versus controls.
Three studies reported outcomes of scar cosmesis or long-term maturation. All attested to better cosmetic results in comparison to sutures.
Two studies discussed cost-effectiveness of Dermabond with a hypothetical model concluded that Skin Closure System of Prineo Dermabond could achieve savings of $50–76 per patient, whilst a retrospective model found no statistically significant difference in Total Hospital costs or Operating room time.

Conclusions
Prineo Dermabond provides an alternative method of wound closure in reported studies.