bluuebunny/crossref_metadata_2025_split huggingface dataset:
TH5.1 The compliance and utility of Abdominal X-ray in acute general surgical admissions
Authors: Nolan Oscar , Anderson Robert , Gall Lewis , Khan Khurram 
Published: November 2022

Abstract

Aims
Most acute surgical admissions have abdominal symptoms, with many having an Abdominal X-ray (AXR) performed. Primary aim was to audit the indication(s) of AXR against Royal College of Radiologists (RCR) iRefer guidelines. Secondary aim was to analyse the proportion of patients who had further imaging.

Methods
A retrospective cohort study of consecutive adult patients with acute surgical admission who had AXR in a busy tertiary hospital. The study period was from 1st October 2021 to 30th November 2021. Patient's demographics, indication for AXR and further imaging within 7 days were analysed. The indications were audited against the RCR iRefer guidelines (8th edition, 2017).

Results
456 patients were included; 252 (55.3%) were female and median age was 63 years (16–96). 200 (43.9%) were performed out of hours. The indications for AXR were: perforation/obstruction 70.0%; renal stone/foreign body 17.9%, constipation 5.9%, acute exacerbation of IBD 1.3% and palpable mass 0.7%. Overall, 95.2% AXR requests were compliant with iRefer guidelines.
196 (43.0%) patients had further imaging within 7 days of admission: 164 (36.0%) had CT scan, 35 (7.7%) had abdominal and/or pelvic ultrasound and 12 (2.6%) had MRI.

Conclusions
The compliance with RCR iRefer guideline is very high. However, a large proportion of patients had further imaging, with over one third of patients subsequently undergoing a CT scan. We suggest that in cases where further cross sectional imaging is likely, clinicians should consider omitting AXR. This will prevent delays, reduce radiation exposure and maximise the utility of resources.
TH5.6 Communication not technology: How an electronic patient referral process affects patient care in acute general surgery
Authors: Magnisio Simone , Howitt Annabel , Lockwood Sonia Louise 
Published: November 2022

Abstract

Introduction
The Royal College of Surgeons (RCS) high-risk general surgical patient guidelines recommend that a patient who needs emergency surgical assessment must be seen within 30 minutes in the case of a life-threatening emergency, and within 60 minutes for a routine emergency referral. The aim of this audit was to assess the efficiency of a new electronic referral system in expediting surgical assessment compared with direct referrals to the surgical oncall team.

Methods
The study assessed the referral process and time to surgical review over two weeks. We included patients assessed in SAU and excluded patients reviewed in the emergency department (ED). Referrals were received from ED, general practitioners (GP) or surgical outpatient clinics.

Results
A total of 214 patients were included, 54% (116) referred from ED, 32% (69) from GP, 12% (26) from outpatients clinic, 1% (3) self -presenting. The median waiting time was 108 minutes. Direct referrals had a median waiting time of 84 minutes (RR 0–347). Patients allocated to the electronic transfer list waited for a median of 120 minutes (RR 6–720).

Conclusion
All patients waited longer for review than recommended by RCS guidelines. The electronic transfer system failed to expedite surgical review and may have contributed to delays in some cases. Communication between colleagues, not technology, is imperative to ensure timely assessment of the acute surgical patient.
1019 Collaborative Surgical Team Training in Virtual Reality Is Superior to Individual Learning: A Randomised Controlled Trial
Authors: Edwards Thomas , Gupta Shubham , Soussi Daniella , Patel Arjun , Khan Sikandar , Liddle Alexander , Cobb Justin , Logishetty Kartik 
Published: November 2022

Abstract

Aim
This study aimed to assess if multiplayer virtual reality training was superior to single player training for acquisition of both technical and non-technical skills in learning complex open surgery.

Method
40 participants (20 novice surgeons and 20 novice scrub nurses) were enrolled in this study and randomised to solo or team virtual reality training learning anterior approach total hip arthroplasty. Solo participants trained with virtual avatar counterparts, whilst teams trained in pairs (surgeon and scrub nurse). Both groups underwent 5 VR training sessions over 6 weeks. Subsequently, they underwent a real-life assessment in which they performed AA-THA on a high-fidelity model with real equipment in a simulated operating theatre. Teams performed together and solo participants were randomly paired up with a solo player of the opposite role. Videos of the assessment were marked by two blinded expert assessors. The primary outcome was team performance as graded by the NOTECHs II score. Secondary outcomes were procedure time, technical errors from an expert pre-defined protocol and acetabular component positioning.

Results
Teams outperformed solo trained participants in non-technical skills in the real-world assessment (NOTECHS-II score 50.3 ± 6.04 vs 43.90 ± 5.90, p=0.0275). They completed the assessment 28.11% faster than solos (31.22 minutes ±2.02 vs 43.43 ±2.71, p=0.01), and made close to half the number of technical errors when compared to the solo group (12.9 ± 8.3 vs 25.6 ± 6.1, p=0.001).

Conclusions
Multiplayer training appears to lead to faster surgery with fewer technical errors and the development of superior non-technical skills.
760 Investigating Theatre Cancellation Rates in a London Hospital
Authors: Giles R , Murray CE , Basu A , Dharmasekara B , Surendran S 
Published: November 2022

Abstract

Aim
Theatre cancellations are a major source of system inefficiency, placing an unnecessary financial burden on the NHS. The aim of this audit was to investigate the reasons for cancellations in elective surgery at a London hospital and to assess the general preoperative process.

Method
We undertook a retrospective audit of all elective theatre cancellations from the day surgery unit over a three-month period in 2021. 78 cancellations were identified, and their cause was investigated. Furthermore, we reviewed theatre lists over one month to calculate the proportion of cancelled procedures per specialty. Also, to gain a further understanding of the present protocol, we reviewed the current preoperative process.

Results
The main reason for cancellations was patients being physiologically unfit for surgery, accounting for 28.2% of all cases. The next biggest reason for cancellation, at 16.7%, was failure to comply with COVID protocol. The specialty with the largest proportion of cancellations was General Surgery, at 17.7%.

Conclusions
We believe many reasons for cancellations were avoidable. Therefore, we propose a change to the preoperative process to target multiple reasons for cancellation. We suggest a more comprehensive pre-admission phone call five days prior to surgery which includes discussions around medication compliance and changes in condition. We also suggest a set of observations and routine bloods are taken when patients come in for their COVID swab. This allows any potential cause of cancellation to be identified and rectified, or the patient could be rescheduled. This should increase efficiency of the day surgery unit.
889 An Audit of Indications for Emergency Abdominal X-Rays
Authors: Masoodi S , Van PTM , Farzaneh SB , Cribb E , Pawa N 
Published: November 2022

Abstract

Background
Historically, abdominal X-rays (AXRs) have played an essential role in diagnosis of the acute abdomen. With the advent of other imaging modalities and the increasing need for efficiency in time, the utility of AXRs has been clarified by the RCR iRefer guidelines.

Aim
To assess the congruence between indications of AXR requests and the recommendations provided by the RCR iRefer guidelines.

Method
All AXRs performed over a 6-week period in the trust were identified retrospectively from our electronic database. Initial indications were subsequently compared with the current guidance and consultant radiologist reports.

Results
Out of 575 AXRs performed, 36 (6%) had no indication documented on the request. Of the remaining 539, 364 (68%) of AXRs performed met the RCR iRefer guidance. Furthermore, 496 (86%) of AXRs performed were reported as normal. 35% of AXRs that met the guidance underwent further imaging, of which 60% showed abnormality. Of those that did not meet the current criteria, abdominal pain and toxic megacolon were the most frequently documented indications.

Conclusions
One third of AXRs did not meet the RCR iRefer guidelines and were therefore requested inappropriately. Despite the remaining two thirds of requests being appropriate, over one third required further imaging in the form of CT/US. Moreover, less than one fifth of the total scans were interpreted as abnormal. This questions whether the current guidance requires revision and whether this imaging modality is over utilised with little effect on clinical outcomes.
552 Benign Pilomatricoma with Osseous Metaplasia: A Rare Case
Authors: Bhatti N , Ramchandani J , Chong W , August S 
Published: November 2022

Abstract
Pilomatricomas are a frequently misdiagnosed benign neoplasm of the skin derived from hair matrix cells. Pilomatricomas may undergo calcification and ossification although the latter is rare and poorly documented, with only eight cases reported since 2006. We present a case of pilomatricoma with osseous metaplasia arising from the scalp in an 87-year-old female patient. She was referred by her general practitioner via the two-week pathway, for a suspicious lesion.
On examination, there was a 2×1cm nodule, with protruding hardened yellow sebaceous material, on the right side of the patient's occipital scalp. The lump was hard, non-tender and had been present for 17 years. The surrounding area was bleeding and slightly ulcerated. A clinical diagnosis of a ruptured epidermal cyst was made, and the patient was prepared for excision under local anaesthetic.
The excised lesion of 23×18×10mm with 22×9mm of skin was sent for histology. This revealed a partially ulcerated dermal lesion composed of islands of keratin with ‘ghost cell’ outlines. Foreign body granulomas, transition to mature lamellar bone and foci of calcification were noted. There were no definite populations of basaloid cells and features of malignancy were not seen. These findings are consistent with benign pilomatricoma with osseous metaplasia. The patient was discharged 4 weeks later with satisfactory wound healing.
Differentiating this tumour from other commonly encountered benign masses remains a challenge, as seen in this case which was initially mis-diagnosed as a ruptured epidermal cyst.
959 A Double Case Review: Arteria Comitans Nervi Ischiadici, Two Rare Presentations of Persistent Sciatic Artery Aneurysm
Authors: Ford A , Downing R 
Published: November 2022

Abstract

Background
In the embryo, the blood flow of the lower limb bud originates from the umbilical artery and becomes the sciatic artery following the course of the sciatic nerve. By the 12th week, the sciatic will involute, in rare instances that this fails it is referred to as ‘arteria comitans nervi ischiadici’. This variant is rare with an incidence of 0.01%-0.05% is of the utmost surgical significance as failure to accurately diagnose and treat can ultimately threaten limb loss.

Cases
1. A middle aged gentleman who presented with a 9-month history of posterior thigh pain with sensations of pressure related to posture and back pain following heavy lifting. Initially this patient was managed conservatively for claudication symptoms until they represented to clinic 4 years later with a 5month history of left buttock discomfort when sitting in the absence of claudication. An endovascular intervention with coil embolisation was undertaken reasons with a satisfactory outcome.
2. A young female with AVM to the left thigh and bilateral PSA's, presented with a painful swelling of the upper inner aspect of the mid-thigh, with a normal venous examination. On representing, despite repeated sclerotherapy, the patient had developed increasingly severe discomfort at the site of the thigh malformation, posterior aspect of the left leg. The patient was referred to a tertiary centre for reassessment.

Conclusion
Due to the variety and evolving nature of clinical presentations, a high degree of clinical suspicion is an important factor in providing a diagnosis. We also highlight the advantages of endovascular intervention.
9 Complications of Bone-Anchored Hearing Aids (BAHA) in Patients
Authors: Omar A , Khan H 
Published: November 2022

Abstract

Aim
BAHA implants utilise bone conduction to treat hearing loss. The aim of the study was to understand the complication rate of patients receiving the implant compared to other studies and to identify any causative factor. Recommendations would therefore be made to reduce these complications.

Methodology
A retrospective cohort study was undertaken on 134 patients who received a BAHA implant performed by a single surgeon at Salford Royal NHS Foundation Trust between 01/01/2016 to 31/12/2018. Data collected identified complications of the surgery, whether or not the abutment was still in situ and whether the patient had any comorbidities or history of smoking

Results
33.6% of the patients had no complications after surgery with the remaining 66.4% having at least one complication. BAHA connect devices had a 67.2% complication rate, attract devices had a 33% complication rate. 13.6% of BAHAs were extruded. There was no positive correlation between either smoking or diabetes and poorer complication rate.

Conclusion
Implant extrusion can be prevented with irrigation cooling of the drill site. Immobilisation of the implant, proper wound care with brushing and using an Allevyn Acticoat 7 wound dressing improves outcomes. Attract systems have fewer complications rates so must be maximised where appropriate.
154 ‘You’ve Lost Your Tuning Form’ – Don't Worry I Have the Solution…
Authors: Chaudhry N , Qureishi A 
Published: November 2022

Abstract

Background
Patients are frequently referred to ENT emergency services with sudden hearing loss. Differentiating sensorineural from conductive losses is paramount in establishing the urgency of review and when to commence urgent steroid therapy. Tuning fork tests are useful for this, but they are not always readily available in primary care or the emergency room.

Aim
To identify and evaluate an alternative method to Weber's test for differentiating conductive from sensorineural hearing loss.

Method
A pilot prospective diagnostic accuracy study was designed to include 10 individuals with unilateral conductive and 10 with asymmetrical sensorineural hearing loss. Each individual was subjected to a pure tone audiogram (PTA), Weber's test and the new index test.

Results
The new index test showed 100% correlation (r=1) with Weber's test and 90% sensitivity, specificity and overall accuracy when compared to Weber's test for diagnosing conductive and sensorineural hearing loss.

Conclusion
This new test may be used as an alternative to Weber's test when a tuning fork is not available. It might even replace the need for Weber's test when PTA testing is readily available. This test could be used to triage referrals and differentiate conductive from sensorineural hearing loss.

Conflicts
There are no conflicts to declare.
596 Can Improved Awareness of Intersectionality in Surgery Make Us Better Allies to Female Surgeons?
Authors: Abdul Kader N , Morrison TEM , Islam R , Suresh S , Palepa A , Mohamed S , Gooch D , Burns S , Dixon S ,   Support Us Group
Published: November 2022

Abstract

Aim
Presently, 38% of trainees and 14% of Surgical Consultants are female. Despite progression from 3% female Consultant Surgeons in 1991, with over 50% of medical students now identifying as female, gender equality in Surgery still lags. While female surgeons may share this minority intersection and statistic, the experience of every female surgeon is unique. Therefore, while we seek gender equality, it is important to consider the role of intersectionality and how the simultaneous possession of other under-represented characteristics may present significant barriers to female surgeons.

Method
Female surgeons of various grades were approached about their experiences and barriers they have faced as women in surgery. Additionally, healthcare providers were asked for their opinions on how we can be effective allies to female surgeons.

Results
Positive use of power and privilege, equitable access to opportunities, mentorship and professional, personal or peer support were cited as important contributors. The importance of cultural competency, creating an inclusive environment of mutual respect, avoiding assumptions, addressing bias, listening to the barriers to progress and experiences of women in surgery, improving adaptability of the workplace, self-education, raising the profile of organisations who support the progression of female surgeons and normalising the place of women in leadership positions were quoted.

Conclusion
To achieve effective allyship, as well as identifying shared needs and concerns, we must acknowledge and embrace individual differences and recognise that everybody has different starting blocks. More research is needed on the barriers for and outcomes of female surgeons who possess under-represented characteristics.
50 A Closed-Loop Clinical Audit on Surgical Documentation at a Tertiary Level Hospital in India: Where Do We Stand?
Authors: Sinha AV , Kadam S 
Published: November 2022

Abstract

Aim
To perform an audit to check Quality & Compliance of Surgical documentation using STAR Score at a tertiary hospital in India.

Method
A total of 90 case files were studied and assessed in detail from all surgical departments. The audit was done for a period of 1 month at a tertiary hospital in India. The “STAR: Surgical tool for auditing records” tool was used to collect data accordingly. The results were then compared with standard guidelines and analyzed. A series of departmental training and implementation meetings were carried out. After 2 weeks, a re-audit was performed.

Result
The overall compliance score of the hospital was found to be 74%. Departments of General surgery and orthopedics showed a higher rate of compliance, each constituting 82% while the Department of Neurosurgery showed the least compliance of 62%. It was also seen that the maximum percentage of missing information consisted of anesthetic records and subsequent entries. After the re-audit, a considerable improvement was observed, with the compliance rate improving to 90% in all departments.

Conclusion
We believe that compliance and implementation of the STAR Score is mandatory, as it can significantly improve the quality of documentation and can be implemented universally.
673 The Role of the First Postnatal Ultrasound Scan to Predict Outcome in Children with Antenatally Diagnosed Hydronephrosis
Authors: Zia BB , Godse A , Niyogi A 
Published: November 2022

Abstract

Aim
We aimed to determine if the renal pelvic diameter on the first postnatal scan can predict the need for surgical intervention in children with antenatally diagnosed hydronephrosis.

Method
Data of all babies with antenatal hydronephrosis born in our centre from 2009–2015 were obtained from the National Congenital Anomaly and Rare Disease Registration Service (NCARDRS). The medical records were analysed retrospectively for diagnosis, investigations, and interventions. Mean follow-up was 7 (4–10) years. The results were expressed as mean and percentage. Statistical data analysis was performed on GraphPad.

Results
224 babies were included in the study. 162 (72%) were males, and 92 (39%) had bilateral hydronephrosis. 163 (73%) had spontaneous resolution of hydronephrosis. The resolution rates were similar for unilateral and bilateral cases. The mean renal pelvic diameter was 6.2mm in the resolved group and 16.2mm in the persistent group (p&lt;0.01). The highest renal pelvic diameter undergoing spontaneous resolution was 24mm. Of the 61 (27%) children with persistent hydronephrosis, 38 (17%) children required surgery. Pyeloplasty for pelviureteric junction obstruction was the most common procedure. 23 (10%) patients continued to have persistent dilatation but needed no intervention. Renal duplex was the most common diagnosis in this group, followed by vesicoureteric reflux. All babies with a pelvic diameter of 25mm or above on their first postnatal ultrasound required surgical intervention.

Conclusion
The majority of antenatal hydronephrosis resolves spontaneously. However, interventions are necessary if the pelvic diameter is above 25mm.
130 Surgical Repair of Cleft Lip: Comparison of Neonatal and Standard Time Repair
Authors: Walsh K 
Published: November 2022

Abstract

Aim
Cleft lip and palate (CLP) abnormalities are the most common congenital orofacial anomalies, affecting 1 in 700 live births per year in the United Kingdom. Cleft lip is present in approximately 55% of all CLP deformities. The aim of this study is to compare standard and neonatal cleft lip repair.

Method
Advanced literature searches were carried out using Medline ALL (1946 to date) and Embase (1974 to date), 11 articles were deemed relevant and included in this study.

Results
Aesthetic results showed excellent outcomes with neonatal repair with regards to the appearance of the scar, facial (lip and nasal) symmetry but those aesthetic results are no better than those achieved at standard time.

Conclusions
Early intervention can be beneficial as early repair takes place when the cleft is less severe and when the tissues are more malleable, making the surgery less challenging and when some aspects of foetal scar healing remain. Early repair has a positive impact on the development of the alveolar projections and can assist in reducing an alveolar cleft if present, improving the aesthetic outcome. Neonatal surgery carries with it no greater risk than surgery carried out at 6 months and will allow feeding to begin at an early stage promoting recovery. Early repair also brings with it a positive psychosocial impact where infants and mothers can build a normal relationship from an early stage. Later in life, children and adults will be less self-conscious following good aesthetic repair. In conclusion, neonatal repair may be recommended over standard time repair.