bluuebunny/crossref_metadata_2025_split huggingface dataset:
219 The Opportunities and Challenges of Robotic Surgery: A Surgeon and Robotic Company Perspective
Authors: Ramesh N. , Talajia K. , Anwar M. , Arshad S. , Xu S. , Brar G. , ter Wal A. 
Published: February 2022

Abstract

Introduction
As an increasing number of specialties have begun to adopt robotic surgery (RS), its prevalence within the NHS is continually rising. This study aims to establish stakeholders’ opinions on the opportunities and challenges of the widespread adoption of RS.

Method
Participants were recruited through social media platforms such as LinkedIn or via university affiliations and current RS research. Semi-structured interviews of eight surgeons and five company representatives were conducted online. Transcripts were analysed to formulate themes surrounding the opportunities and challenges of RS.

Results
This study identified six common themes amongst shareholders: Perspective, Ethics, Impact of Robotics, Training, Adoption and Finances. The success rates and quality of results offered by RS make it a recognised future surgical staple amongst interviewees. However, the technology remains a contentious subject amongst surgeons, with many doubting whether the benefits outweigh the costs associated with implementation. Such reservations are further exacerbated by the absence of a formal training pathway. National guidelines are necessary to embed RS within the NHS infrastructure, allowing greater standardisation for patients and surgeons. The importance of patient education to address misconceptions was emphasised. Despite current high costs, robotic technology is forecasted to become cheaper with greater use and increased market competition. Interviewees stressed that responsibility for errors lies with the surgeon, but with the manufacturer for instrument malfunctions.

Conclusions
This study highlights stakeholders’ views on the opportunities and challenges of RS. The identified themes should form the basis of the proposed recommendations to facilitate a more widespread adoption of RS.
231 Diagnostic Outcomes in Suspected Appendicitis Before and During the COVID-19 Pandemic
Authors: Vera V. , Ashcroft J. , Bennett J. , Davies R.J. 
Published: February 2022

Abstract

Introduction
Routine operative treatment of appendicitis was temporarily interrupted during the COVID-19 pandemic. Non-operative management in suspected appendicitis makes a definitive diagnosis difficult. This study investigated diagnostic outcomes of suspected appendicitis patients before and during COVID-19.

Method
A retrospective review of patients aged 16–45 undergoing treatment for suspected appendicitis pre-COVID-19 (1st January 2019–1st January 2020) and during the COVID-19 pandemic (1st March 2020 to 31st June 2020) was performed. Patients were followed up for one year (31st June 2021) to explore diagnostic outcomes.

Results
At one year follow up, 206 patients were identified in the pre-COVID-19 cohort with 100% (n = 206) undergoing an appendicectomy. On histopathological examination 77.2% (n = 159) had appendicitis; 10.7% (n = 22) another pathology; 2.9% (n = 6) neuroendocrine tumour. There were 62 patients in the COVID-19 cohort in which 79% (n = 49) underwent appendicectomy (56% (n = 35) immediate appendicectomy; 23% (n = 13) interval appendicectomy). On histopathological examination 61% (n = 38) had appendicitis; 13% (n = 8) another pathology; 5% (n = 3) neuroendocrine tumour.
Of the remaining 13/62 patients, one had undergone a CT scan and colonoscopy for gastrointestinal symptoms demonstrating signs of chronic caecal inflammation treated conservatively. One underwent a CT scan alone for gastrointestinal symptoms finding no pathology. The remaining 11/62 patients had no further reported symptoms or diagnostics.

Conclusions
This study demonstrates that the risk of appendiceal malignancy and chronic inflammation is important in non-operative management of suspected appendicitis and establishing consistent follow up pathways is essential.
232 “SuturesApp”: A Digital Application to Improve Cancer Patients” Understanding of Surgical Procedures
Authors: Essangri H. , Bensbih S. , Majbar M.A. , Benkabbou A. , Souadka A. 
Published: February 2022

Abstract

Aim
Patient participation in decision making is of utmost importance, particularly in oncological surgery where body image altering procedures may be required. “SuturesApp” is a digital application developed by oncological surgeons in a low-middle income setting and where users can replicate any resection and/or reconstruction technique on the screen. The study is an interpretation of surgical residents’ opinion of the use of a digital application in comparison to traditional modalities (pen and paper) used to explain surgical procedures to patients.

Method
This is a qualitative study using semi-structured interviews conducted with surgical trainees following the use of “SuturesApp” for a 1-week period from July 13th to July 20th, 2020, in order to depict possible outcomes of “SuturesApp” use in comparison to pen and paper in explaining surgical procedures and body image changes in oncological surgery. Participants number was determined according to data saturation when no more new themes emerged from the individual interviews.

Results
Fifteen surgical residents were interviewed after using “SuturesApp'' for a 1-week period in preoperative consultations. Successful patient-surgeon communication faces the challenges of workload and illiteracy, which surgical residents try to overcome with verbal communication and drawing. The use of SuturesApp can provide a frame for the progressive explanation and visualization of procedures, despite the need for improvements.

Conclusions
The use of SuturesApp alongside verbal communication and drawing can benefit patient understanding and adherence to treatment, as well as future surgeons’ communication skills. A next step would be to further develop “SuturesApp” and engage patients in the process.
237 Antibiotic Prophylaxis of Precision Point Prostate Biopsy Under LA: Changed Practice in a District General Hospital
Authors: Islam F. , Saiyara N. , Fazili Z. , Shahid J. 
Published: February 2022

Abstract

Aim
More than 4 million prostate biopsies are performed worldwide each year (1). Out of three different techniques (Template, transperineal, TRUS), Transperineal precision point biopsy under local anaesthesia is the latest and reported to have fewer infectious complications (2). UTI, Urosepsis, septicaemia are some well-known infectious complications following prostate biopsies. Therefore, the Canadian Urological Association recommended the use of broad-based Gram-negative antibiotic prophylaxis 30 to 60 minutes before the procedure and continued for 2 to 3 days in their guideline (3). Our aim was to compare the outcome of two different antibiotic prophylaxis regimens.

Method
In our study to assess the outcome of single-dose prophylaxis compared to regular dose, we collected retrospective data of 119 patients who had undergone precision point biopsy in our hospital.

Results
Among 119 patients, 52 (43.69%) were given 3 days of oral antibiotic followed by preprocedural dose and 67 (56.31%) were given just a single dose before the procedure. None of these patients from both groups were readmitted with any infectious complication post-procedure. 1 patient from the second group (single dose) was admitted with urinary retention but no increased inflammatory markers were found.

Conclusions
TRUS biopsy breeches the rectal mucosa and carries higher chances of post-biopsy infection so requires antibiotic prophylaxis. Single-dose antibiotic prophylaxis is recommended option for transperineal biopsies as the infection rate is lower. Our study shows the same outcome for single-dose and 3-day regimens for transperineal precision point prostate biopsy. Moreover, the use of single dose will significantly reduce medicine costs and antibiotic resistance to improve patient compliance.
239 Surgical Techniques Relating to First Carpometacarpal Joint Osteoarthritis - a Hand Therapy Perspective
Authors: Menon D. , Stavropoulos S. 
Published: February 2022

Abstract

Introduction
First carpometacarpal joint (CMCJ) osteoarthritis contributes a significant burden of disease. Patients with unremitting disease, despite conservative measures, may be considered for surgical intervention. Evidence has not identified superior outcomes relating to any one particular surgical technique. This study aims to identify whether a predisposition and preference towards an intervention exists in UK practice from the hand physiotherapist perspective.

Method
An online questionnaire was distributed to UK-based hand therapists by electronic mail. Seven commonly utilised techniques in the management of first CMCJ osteoarthritis were listed as treatment options. Questions included demographic information, procedural experience, and ranking of these treatment options based on perceived post-operative functional outcomes.

Results
32 responses were recorded. All listed techniques were performed in UK practice. Trapeziectomy alone was the most widely used option, with 94% (n = 31) of respondents stating this intervention was performed in their centre of practice. Trapeziectomy with ligament reconstruction and interposition (LRTI) was associated with the highest rating relating to post-operative functional outcome as perceived by hand therapists. Partial arthroscopic trapezium resection with spacer was not favoured, with the lowest rating reported.

Conclusions
This study has identified that trapeziectomy alone remains a widely used operative technique in first CMCJ osteoarthritis in UK practice with good post-operative outcomes relative to other options as perceived by hand therapists. The most favourable intervention was trapeziectomy with LRTI. However, no significant relationship was identified between the pre-defined interventional options and rating, which may suggest no superiority in any one particular technique.
244 The Lessons Learned from Managing Malignant Melanoma During COVID-19 Pandemic in a Plastic Surgery Unit in Ireland
Authors: Dhannoon A. , Hurley C.M. , Regan P.J. 
Published: February 2022

Abstract

Aim
The COVID-19 pandemic continues to present unprecedented challenges for healthcare systems. This has resulted in the pragmatic shift in practice of plastic surgery units worldwide. Many units reported a significant fall in urgent melanoma referrals, leading to patients presenting with advanced disease. Our objective was to evaluate our unit's experience with both non-invasive and invasive melanoma during the COVID-19 pandemic and compare it to the UK, mainland Europe and North America.

Method
A Retrospective chart review was performed on all patients diagnosed with invasive and non-invasive cutaneous melanoma between March to December of 2019 (control) compared to 2020 (COVID-19 pandemic) in a single plastic surgery unit in Ireland.

Results
A total of 589 patients were included in the study. Of these, 314 (53%) with invasive melanoma, compared to 275 (47%) with non-invasive disease. Overall, more patients were diagnosed with both invasive and non-invasive melanoma in 2020 than 2019 (p&lt;0.05). However, significantly longer waiting times in 2020 (64 days) compared to 2019 (28 days) (p&lt;0.05) with the majority of referral being from GP in 2019 (83%) compared to 61% in 2020. Positive sentinel lymph node was higher in 2019 at 56% (n = 28) compared to 24% (n = 22) in 2020. There was no statistically significant difference in the tutor characteristics or metastasis status.

Conclusions
Our study highlights that with prompt efficient restructuring of services, including governmental agreement to utilise private sector to continue urgent elective surgery, virtual triaging and follow-up and most importantly virtual complex skin multidisciplinary team meeting, we could reserve successful management of skin cancer even in the most devastating times.
253 Innovative Teaching Early in Medical Career to Expose Medical Students to Surgery
Authors: Hennessy M. , Johnson J. , Spence T. , Justusson D. , Paladugu M. , Shetty V. 
Published: February 2022

Abstract

Aim
At Lancashire Teaching Hospitals medical students begin their clinical career in Year 3 and are posted in General Surgery for 4 weeks, a relatively short period to experience the wide variety of surgical specialities and operative techniques. A surgical skills course - Lancashire Teaching Hospitals Surgical Skills for Medical Students (LTHSSMS) was designed and piloted. The aim was to assess the student experience of the LTHSSMS course conducted for Year 3 students at Lancashire Teaching Hospitals in 2019.

Method
This all-day course was optional, taught in groups of 15 students per course with a minimum of 2 experienced tutors. The LTHSSMS course included practical skills such as scrubbing, gloving, surgical knotting, suturing, excision of skin lesions and local anaesthetic techniques. It also included lectures on suture materials, abdominal incisions, laparoscopic and robotic surgery. There were interactive discussions to include non-technical skills, theatre in brief and WHO checklist.

Results
95% (n- 86) of students posted in surgery attended the course. 86.3% (n-75) felt the course was very relevant for their training. 90.7% (n-78) stated they enjoyed the course and 98.8% (n-85) stated they would recommend the course to fellow third-year students. 97.7% (n-84) stated the tutors delivered the course in an enthusiastic and positive manner. 79.1% (n-68) rated the audio video as excellent.

Conclusions
This course has provided a high impact surgical experience for the medical students at the beginning of their clinical careers. Similar opportunities if made available to students in all medical schools could improve and renew the interest in a surgical career.
255 An Audit on the Knowledge of Junior Doctors About DKA at a Local Hospital, Khartoum, Sudan
Authors: Elhassan A.B.E. , Ibrahim A. , Salman M.S.T. , Ali Al. , Mohammed O.A.A. , Bashir S.A.T. , Mohamed N.E.M. , Ali M. , Abdalla N. 
Published: February 2022

Abstract

Aim
DKA is the most common cause of death in pediatric patients with insulin-dependent diabetes mellitus (IDDM). Junior doctors have a significant role in the management of those patients. We conducted this audit to assess and improve the knowledge of house officers about the characteristic features and management of DKA.

Method
The audit was conducted in Alshuhada hospital, Khartoum. It consisted of two cycles (2019–2021). A 14 items questionnaire based on Sudan Diabetes Mellitus guidelines 2011 was used for the assessment. All house officers in the department of pediatrics were involved in this study. Teaching sessions were used as an intervention in the first cycle, while poster presentations and teaching sessions were used in the second cycle.

Results
Nine house officers participated in the first cycle, while seven house officers were involved during the second cycle. The correct choice of initial fluid correction was selected by 55.5%, 88.8%, and 100% of the house officers before the first cycle, after the first cycle, and after the second cycle, respectively. The figures for the initial management of cerebral edema also rose from 33.3% to 66.7% after the first cycle and reached 100% after the second cycle. The percentage of house officers who identified Investigations needed in suspected cases of DKA improved with each cycle, from 66% to 77% in the first cycle and increased to 100% after the second cycle.

Conclusions
Teaching sessions and posters helped to improve the knowledge of the House officers about the diagnosis and management of DKA.
295 Ear Conditions in Adult Patients with Learning Disabilities and Autism: A New Approach to Outpatient Management
Authors: Hundle A. , Atkins S. , McAnenny S. , Lindley K. , Whittaker H. , Dalton C.L. 
Published: February 2022

Abstract

Introduction
Patients with learning disability and autism (PwLDA) are a priority group for care quality and outcomes improvement in the NHS Long Term Plan. The aim of this project was to establish a new standard of care for PwLDA in our otology department.

Method
We first conducted a retrospective analysis of PwLDA who accessed routine adult otology clinics (RCs) between August-October 2020. We assessed achievement in four broad outcome domains: i) documentation of patient-specific special needs; ii) examination of ears; iii) assessment of hearing; iv) completion of hospital passport. We then formed a multidisciplinary team (MDT), which introduced specialised MDT-clinics (SCs) for PwLDA with otology conditions. These SCs were continuously improved by incorporating reasonable adjustments. We subsequently performed a retrospective analysis of PwLDA reviewed in the initial four months of SCs. This enabled a comparison between the type of clinic, RCs or SCs, and the achievement of specific outcomes. This interaction was statistically analysed using Chi-squared test.

Results
A mean of 7.7 and 5.0 PwLDA per month were booked into RCs and SCs respectively. Type of clinic had a significant effect on achievement of outcomes in domains i. and iv. (χ2 (1)&gt;10.3; p&lt;0.005) favouring attendance at SCs. There was no significant interaction for these variables in domains ii. and iii.

Conclusions
This is the first dedicated otology MDT service for PwLDA in the UK. Overall, these results demonstrate an improvement following implementation of the SCs. This innovative work establishes a new MDT-clinic outpatient model for PwLDA who suffer with ear- and hearing-related conditions.
323 Carcinoma of Prostate Masquerading as Retroperitoneal Lymphoma
Authors: Kale S. , Rashid T. 
Published: February 2022

Abstract
Prostate cancer is the fifth most common malignancy worldwide and the second most common in men. It usually metastasizes to the bony skeleton, followed by lung, liver, pleura, and adrenals. We report a 71-year-old male patient who initially presented only with retroperitoneal lymphadenopathy and constitutional symptoms, misleading the diagnosis of retroperitoneal lymphoma. Who later on was discovered to have carcinoma prostate.
325 Improving the Documentation in the Consent Form for Patients Lacking Capacity: A Completed Audit Cycle
Authors: Al-Kharouf K. , George A. , Elbayyar O. 
Published: February 2022

Abstract

Aim
According to GMC guidance, we are bound to discuss with close members of the patients to consider their views and reach the consensus of clinical management when patients lack capacity to make decisions. Our audit aimed to compare the practice of our institution against this guidance and instigate changes as necessary.

Method
We collected data of 30 randomly selected patients with dementia, undergoing emergency orthopaedic operations, from February to April 2021 in the first cycle. The data were collected from medical notes prospectively. The findings were presented in the local meeting. The implementations involved raising awareness of the GMC guidance among the members of the Trauma & Orthopaedics team by organizing a teaching session, creating posters, and sending an email from the clinical lead to the staff members to highlight the audit result. It was followed by the second audit cycle, which included 40 patients from June to August 2021.

Results
The first cycle revealed that there was only 36% compliance to the GMC guidance in our department, since only 9 out of the 30 cases had documentation about the discussion with the appropriate family member. The compliance rate of the second cycle (40 patients) saw a huge improvement up to 83%.

Conclusions
Significant improvement in documentation of the socially and medicolegally important discussion with the close contact of the patient was achieved. This was done by identifying the area which needed improvement and instigating changes in our department. Further audit loops will be conducted in due course to sustain this achievement.
329 Virtual Orthopaedic Trauma Meetings, Is This the Future?
Authors: Toma O. , Karagiannidis G. 
Published: February 2022

Abstract

Aim
The Covid -19 pandemic has drastically altered how we conduct handover meetings. To adapt to the new restrictions, the daily ‘’Trauma Meeting’’ for the Trauma & Orthopaedic department was conducted utilising Microsoft ‘’Teams’’. We present our experience of the ‘’Teams Trauma meeting’’ at Colchester hospital, Essex, UK.

Method
All T&O department members (both clinical and non-clinical) were provided with a secure Teams link and could participate from any location.

Results
Both clinical and management members joined the meeting allowing for real coordination, especially in allocating extra theatre space. Due to shift work patterns, the virtual trauma meeting allowed personnel who were off shift to participate while being off site, eliminating the need to commute to work. We noted improved case discussions with specialist teams. Teaching was provided to junior clinicians who were off shift. Previous trauma meetings were reliant on a single screen to view radiology investigations, this made viewing details difficult from members seated at a distance. The virtual meeting resolved this issue. T&O members can now participate in the meeting from a location of their convenience rather than being limited by office space. Members have expressed satisfaction with the current set up and desire to continue utilising ‘’virtual meetings’’ in addition to in-person attendance post pandemic.

Conclusions
The ‘’Teams Trauma Meeting’’ is a safe, convenient, and reliable method of handover and case discussion in T&O. We hope to expand to include medical students attending their T&O rotation, providing teaching while observing Covid-19 restrictions.
344 Interval Ultrasound Scanning in Idiopathic Pancreatitis - Are We Following Up Patients Appropriately?
Authors: Pringle H. , Ghandour O. , Okocha M. 
Published: February 2022

Abstract

Aim
Acute pancreatitis of unknown cause requires investigation to identify reversible causes of the disease before classifying it as truly idiopathic. This study reports on the follow-up of patients in a district general hospital (DGH) who were diagnosed with acute pancreatitis of unknown cause compared to the gold standard evaluation of the disease by interval abdominal ultrasound scan (US) or outpatient endoscopic US.

Method
Inclusion criteria was all patients discharged from the DGH with a diagnosis of acute pancreatitis and no cause described on the discharge summary from 1st January 2021 to 30th June 2021. The primary outcome was outpatient abdominal US follow-up. Secondary outcomes included an endoscopic US booked as an outpatient. Patients with gallstones identified on imaging or with another identified cause of the acute pancreatitis were excluded.

Results
50% (12 out of 24) patients did not receive follow-up US or any other imaging. Of the patients who did receive follow-up imaging 50% (6 out of 12) had a magnetic resonance imaging (MRI) abdomen or magnetic resonance cholangiopancreatography (MRCP) and the remainder 50% had an abdominal US. 12.5% of patients (3 out of 24) had an outpatient endoscopic US requested.

Conclusions
Management of patients with acute pancreatitis is costly at an estimated £303 per night. To reduce likelihood of future unnecessary admissions, patients require appropriate investigation to have any reversible causes identified and managed. In a system which has suffered bed shortages and significant financial restraints we need to ensure these patients are not lost to US follow-up.