N. Kerdegari, D. Sunder Bala Sundaram, R. Kirby, G. Leng
Medical students have varied specialty interests which acts as a barrier to undergraduate engagement at specialty-specific conferences. The Tomorrow's Doctors 2023 conference, hosted at The Royal Society of Medicine, aimed to improve students’ understanding of current innovations across multiple medical and surgical specialties. The aim of this study is to determine student perception of a combined medical and surgical conference. The two-day conference consisted of 8 talks and 8 workshops. Feedback was collected following each day using online questionnaires. Each questionnaire was specific to the agenda of that day. Quantitative and qualitative feedback was collected on students’ perception of combined medical and surgical conferences for undergraduate students. Free-text responses underwent thematic analysis. There were 90 delegates on day one and 85 delegates on day two from 16 medical schools. Post-conference feedback was completed by 45 (50.0%) and 42 (49.4%) attendees for days one and two respectively. 82.2% of day one and 88.1% of day two respondents agreed that joint medical and surgical conferences were beneficial for medical students. Thematic analysis of post-conference free-text responses revealed the commonest themes for favouring joint medical and surgical conferences were ability to explore both medical and surgical interests (52.5%), supports career progression (27.5%) and practical application of knowledge gained (17.5%). Our feedback demonstrates that joint medical and surgical conferences are perceived as beneficial by current medical students. Future undergraduate conferences should adopt a combined approach to allow students to explore their varied interests and subsequently facilitate informed specialty selection.
{"title":"814 If You Want to Go Far, Go Together: Student Perception of Joint Medical and Surgical Education Programmes","authors":"N. Kerdegari, D. Sunder Bala Sundaram, R. Kirby, G. Leng","doi":"10.1093/bjs/znae163.173","DOIUrl":"https://doi.org/10.1093/bjs/znae163.173","url":null,"abstract":"\u0000 \u0000 \u0000 Medical students have varied specialty interests which acts as a barrier to undergraduate engagement at specialty-specific conferences. The Tomorrow's Doctors 2023 conference, hosted at The Royal Society of Medicine, aimed to improve students’ understanding of current innovations across multiple medical and surgical specialties. The aim of this study is to determine student perception of a combined medical and surgical conference.\u0000 \u0000 \u0000 \u0000 The two-day conference consisted of 8 talks and 8 workshops. Feedback was collected following each day using online questionnaires. Each questionnaire was specific to the agenda of that day. Quantitative and qualitative feedback was collected on students’ perception of combined medical and surgical conferences for undergraduate students. Free-text responses underwent thematic analysis.\u0000 \u0000 \u0000 \u0000 There were 90 delegates on day one and 85 delegates on day two from 16 medical schools. Post-conference feedback was completed by 45 (50.0%) and 42 (49.4%) attendees for days one and two respectively. 82.2% of day one and 88.1% of day two respondents agreed that joint medical and surgical conferences were beneficial for medical students. Thematic analysis of post-conference free-text responses revealed the commonest themes for favouring joint medical and surgical conferences were ability to explore both medical and surgical interests (52.5%), supports career progression (27.5%) and practical application of knowledge gained (17.5%).\u0000 \u0000 \u0000 \u0000 Our feedback demonstrates that joint medical and surgical conferences are perceived as beneficial by current medical students. Future undergraduate conferences should adopt a combined approach to allow students to explore their varied interests and subsequently facilitate informed specialty selection.\u0000","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141696948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This quality improvement project aimed to improve the completeness of referrals to vascular surgery from in-patient wards and the Sameday Emergency Care unit at a UK district general hospital. We implemented a comprehensive vascular surgery proforma to enhance the quality of referrals to the department. Referrals made between 01/01/23 and 01/03/23 were assessed according to Professional Record Standards Body (PRSB) guidelines, which outlines the necessary information to be included in clinical referrals. The new proforma was introduced to all hospital clinicians, enabling them to email completed referrals to a dedicated vascular surgery inbox. To evaluate the impact of the new system, referrals were re-audited between 12/05/23 and 13/07/2023 using the same PRSB criteria. Significant improvements were observed in the completeness of referrals, as indicated by the percentage of fulfilled PRSB criteria: patient demographics (60% vs. 100%), referrer details (51% vs. 100%), reason for referral (93% vs. 100%), relevant clinical risk factors (60% vs. 95%), medication history (60% vs. 100%), family history (40% vs. 84%), social history (47% vs. 93%), patient ideas concerns and expectations (40% vs. 81%), examination findings (60% vs. 93%), and investigation findings (63% vs. 91%). The median number of fulfilled criteria per referral increased from 2.5 to 9 (out of 10), demonstrating a substantial improvement (p < 0.0001). Our dedicated vascular surgery referrals proforma had a significant positive impact on the completeness of referrals to the department. This change has the potential to enhance continuity of care, improve clinical prioritisation, promote patient safety, and enhance the overall efficiency of our service.
该质量改进项目旨在提高英国一家地区综合医院住院病房和 "三日急诊 "科室血管外科转诊病例的完整性。我们采用了血管外科综合表格，以提高该科室的转诊质量。我们根据专业记录标准机构（PRSB）的指导方针对2013年1月1日至3月1日期间的转诊进行了评估，该指导方针概述了临床转诊中应包含的必要信息。所有医院的临床医生都使用了新的表格，他们可以将填写好的转诊申请通过电子邮件发送到专门的血管外科收件箱。为评估新系统的影响，在 2012 年 5 月 12 日至 2023 年 7 月 13 日期间，使用相同的 PRSB 标准对转诊病例进行了重新审核。从符合 PRSB 标准的百分比来看，转诊的完整性有了显著提高：患者人口统计学（60% 对 100%）、转诊人详细信息（51% 对 100%）、转诊原因（93% 对 100%）、相关临床风险因素（60% 对 95%）、用药史（93% 对 100%）、相关临床风险因素（60% 对 100%）、相关临床风险因素（95% 对 100%）、相关临床风险因素（60% 对 100%）。95%）、用药史（60% vs. 100%）、家族史（40% vs. 84%）、社会史（47% vs. 93%）、患者的顾虑和期望（40% vs. 81%）、检查结果（60% vs. 93%）和检查结果（63% vs. 91%）。每次转诊符合标准的中位数从 2.5 个增加到 9 个（满分 10 分），显示出显著改善（P < 0.0001）。我们的专用血管外科转诊表对该科室转诊的完整性产生了显著的积极影响。这一改变有可能加强护理的连续性，改善临床优先次序，促进患者安全，并提高我们服务的整体效率。
{"title":"765 Enhancing the Quality of Referrals to Vascular Surgery at a District General Hospital: A Closed-Loop Quality Improvement Project","authors":"L. Boyce","doi":"10.1093/bjs/znae163.031","DOIUrl":"https://doi.org/10.1093/bjs/znae163.031","url":null,"abstract":"\u0000 This quality improvement project aimed to improve the completeness of referrals to vascular surgery from in-patient wards and the Sameday Emergency Care unit at a UK district general hospital. We implemented a comprehensive vascular surgery proforma to enhance the quality of referrals to the department.\u0000 Referrals made between 01/01/23 and 01/03/23 were assessed according to Professional Record Standards Body (PRSB) guidelines, which outlines the necessary information to be included in clinical referrals. The new proforma was introduced to all hospital clinicians, enabling them to email completed referrals to a dedicated vascular surgery inbox. To evaluate the impact of the new system, referrals were re-audited between 12/05/23 and 13/07/2023 using the same PRSB criteria.\u0000 Significant improvements were observed in the completeness of referrals, as indicated by the percentage of fulfilled PRSB criteria: patient demographics (60% vs. 100%), referrer details (51% vs. 100%), reason for referral (93% vs. 100%), relevant clinical risk factors (60% vs. 95%), medication history (60% vs. 100%), family history (40% vs. 84%), social history (47% vs. 93%), patient ideas concerns and expectations (40% vs. 81%), examination findings (60% vs. 93%), and investigation findings (63% vs. 91%). The median number of fulfilled criteria per referral increased from 2.5 to 9 (out of 10), demonstrating a substantial improvement (p < 0.0001).\u0000 Our dedicated vascular surgery referrals proforma had a significant positive impact on the completeness of referrals to the department. This change has the potential to enhance continuity of care, improve clinical prioritisation, promote patient safety, and enhance the overall efficiency of our service.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141702426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Recent advances in artificial intelligence (AI) driven natural language processing have made it possible to use tools such as ChatGPT to generate pieces of text which are realistic, eloquent, and challenging to distinguish from human-generated content. This work aims to answer the question: could the use of these tools for medical portfolios represent a positive opportunity to enhance learning, or would it detract from the purpose of reflective practice? In total, 98 post-graduate doctors from across the UK were surveyed to gather data on their awareness of, previous use of, disclosure of use and experience with these tools for their professional portfolios. Their opinions on the need for future guidance in this area were also explored. From 90 respondents who currently maintain a professional portfolio, 18 (20%) had used AI-driven tools in some form to generate content for it and none disclosed this use. Regarding disclosing the use of AI-driven tools, 67.3% advocate for this whereas 32.7% believe disclosure is unnecessary. There was slightly stronger consensus regarding how useful guidance from regulatory bodies on this practice would be, with 73.5% in support of guidance and 26.5% in opposition. Clearly, there is an urgent need for larger studies, discussion, and consensus from regulatory bodies so that guidance can be put in place. Without this, maintaining the integrity of CPD will become challenging for both trainee doctors and assessors of medical portfolios.
{"title":"1179 Navigating the AI Landscape: Surveying the Use of AI Language Tools for Medical Portfolios","authors":"M. Harris, J. Majchrzak, F. Baig","doi":"10.1093/bjs/znae163.124","DOIUrl":"https://doi.org/10.1093/bjs/znae163.124","url":null,"abstract":"\u0000 \u0000 \u0000 Recent advances in artificial intelligence (AI) driven natural language processing have made it possible to use tools such as ChatGPT to generate pieces of text which are realistic, eloquent, and challenging to distinguish from human-generated content. This work aims to answer the question: could the use of these tools for medical portfolios represent a positive opportunity to enhance learning, or would it detract from the purpose of reflective practice?\u0000 \u0000 \u0000 \u0000 In total, 98 post-graduate doctors from across the UK were surveyed to gather data on their awareness of, previous use of, disclosure of use and experience with these tools for their professional portfolios. Their opinions on the need for future guidance in this area were also explored.\u0000 \u0000 \u0000 \u0000 From 90 respondents who currently maintain a professional portfolio, 18 (20%) had used AI-driven tools in some form to generate content for it and none disclosed this use. Regarding disclosing the use of AI-driven tools, 67.3% advocate for this whereas 32.7% believe disclosure is unnecessary. There was slightly stronger consensus regarding how useful guidance from regulatory bodies on this practice would be, with 73.5% in support of guidance and 26.5% in opposition.\u0000 \u0000 \u0000 \u0000 Clearly, there is an urgent need for larger studies, discussion, and consensus from regulatory bodies so that guidance can be put in place. Without this, maintaining the integrity of CPD will become challenging for both trainee doctors and assessors of medical portfolios.\u0000","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141708420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Chaudhry, J. Konakanchi, R. Ratnayaka, S. Momin
Operation notes are critically important documents which serve as record for significant events in the lives of patients. They serve multiple functions, but chiefly to help guide peri-operative management. Surgeons must keep records that are accurate, thorough, and readable. This is fundamental part of the GMC’s Good Medical Practice as well as the Royal College of Surgeons of England Good Surgical Practice guidelines which lays out 18 various parameters for what should be included in an operation note. This retrospective audit aimed to evaluate the compliance of neurosurgical operation notes with the Royal College of Surgeons guidelines, identifying areas for improvement. All neurosurgical procedures between October 1 and October 31, 2023, at a Major Trauma Centre in the West Midlands were retrospectively audited. Two independent reviewers used a standardized proforma in Microsoft Excel for data extraction, comparing compliance. 91 operation records were examined and found high compliance (100%) in key fields: date, surgeon's name, assistant's name, operative procedure, operative diagnosis, and signature. Negligible compliance was found in identification of prosthesis (0%), estimated blood loss (1%), extra procedures (1%), elective/emergency classification (1%), time (4%), and problems/complications (19.8%). Notably, detailed post-op instructions were lacking in over 1 in 3 operation notes, with 19.7% omitting DVT prophylaxis, and 20% neglecting clip/suture removal instructions. While certain aspects showed exemplary compliance, critical deficiencies were identified, particularly in post-operative instructions. A template proforma for post op instructions is required in addition to more targeted guidelines for operation notes within neurosurgery.
{"title":"1088 The Quality of Information Recorded in Neurosurgical Operation Notes: A Closed Loop Audit","authors":"D. Chaudhry, J. Konakanchi, R. Ratnayaka, S. Momin","doi":"10.1093/bjs/znae163.152","DOIUrl":"https://doi.org/10.1093/bjs/znae163.152","url":null,"abstract":"\u0000 \u0000 \u0000 Operation notes are critically important documents which serve as record for significant events in the lives of patients. They serve multiple functions, but chiefly to help guide peri-operative management. Surgeons must keep records that are accurate, thorough, and readable. This is fundamental part of the GMC’s Good Medical Practice as well as the Royal College of Surgeons of England Good Surgical Practice guidelines which lays out 18 various parameters for what should be included in an operation note.\u0000 \u0000 \u0000 \u0000 This retrospective audit aimed to evaluate the compliance of neurosurgical operation notes with the Royal College of Surgeons guidelines, identifying areas for improvement.\u0000 \u0000 \u0000 \u0000 All neurosurgical procedures between October 1 and October 31, 2023, at a Major Trauma Centre in the West Midlands were retrospectively audited. Two independent reviewers used a standardized proforma in Microsoft Excel for data extraction, comparing compliance.\u0000 \u0000 \u0000 \u0000 91 operation records were examined and found high compliance (100%) in key fields: date, surgeon's name, assistant's name, operative procedure, operative diagnosis, and signature. Negligible compliance was found in identification of prosthesis (0%), estimated blood loss (1%), extra procedures (1%), elective/emergency classification (1%), time (4%), and problems/complications (19.8%). Notably, detailed post-op instructions were lacking in over 1 in 3 operation notes, with 19.7% omitting DVT prophylaxis, and 20% neglecting clip/suture removal instructions.\u0000 \u0000 \u0000 \u0000 While certain aspects showed exemplary compliance, critical deficiencies were identified, particularly in post-operative instructions. A template proforma for post op instructions is required in addition to more targeted guidelines for operation notes within neurosurgery.\u0000","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141695933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The study aimed to investigate the causes of temporary postoperative hypocalcemia and strategies for correction. Objectives included assessing the impact of preoperative trust guidelines on detecting and managing Vitamin D deficiency in thyroidectomy patients and analyzing its correlation with postoperative hypocalcemia at Northampton General Hospital. A three-cycle audit analyzed 16, 12, and 8 cases, respectively, encompassing total and completion thyroidectomies at NGH. Collaborative development of standardized trust guidelines involved the ENT Team, Endocrinology, and Pharmacists. Data collection covered various parameters, and departmental teachings were conducted to educate the team on the new guidelines. Thyroidectomy indications included Graves's disease, large Multinodular Goitre, and malignancy. In the third cycle, all patients underwent preoperative Vitamin D checks, aligning postoperative hypocalcemia with the national range. Our interventions increased preoperative Vitamin D checks from 56% to 100%, reducing deficiency from 25% to 0%. Postoperative hypocalcemia decreased from 56% in Cycle 1 to 8.3% in Cycle 2 and 12.5% in Cycle 3. Long-term hypoparathyroidism dropped to 0% in Cycle 3, with no correlation between surgeon technique or indication and postoperative hypocalcemia. The introduction of preoperative guidelines significantly enhanced Vitamin D deficiency detection, substantially reducing postoperative hypocalcemia. This underscores the positive impact of standardized protocols on patient care. Future efforts involve re-auditing with the involvement of junior doctors to ensure continuous enhancement in clinical practice.
{"title":"1234 Optimising Vitamin D and Calcium Management in Thyroidectomy Patients","authors":"B. Yussuf, N. Tharakaran, M. Roderick, L. Thomas","doi":"10.1093/bjs/znae163.120","DOIUrl":"https://doi.org/10.1093/bjs/znae163.120","url":null,"abstract":"\u0000 \u0000 \u0000 The study aimed to investigate the causes of temporary postoperative hypocalcemia and strategies for correction. Objectives included assessing the impact of preoperative trust guidelines on detecting and managing Vitamin D deficiency in thyroidectomy patients and analyzing its correlation with postoperative hypocalcemia at Northampton General Hospital.\u0000 \u0000 \u0000 \u0000 A three-cycle audit analyzed 16, 12, and 8 cases, respectively, encompassing total and completion thyroidectomies at NGH. Collaborative development of standardized trust guidelines involved the ENT Team, Endocrinology, and Pharmacists. Data collection covered various parameters, and departmental teachings were conducted to educate the team on the new guidelines.\u0000 \u0000 \u0000 \u0000 Thyroidectomy indications included Graves's disease, large Multinodular Goitre, and malignancy. In the third cycle, all patients underwent preoperative Vitamin D checks, aligning postoperative hypocalcemia with the national range. Our interventions increased preoperative Vitamin D checks from 56% to 100%, reducing deficiency from 25% to 0%. Postoperative hypocalcemia decreased from 56% in Cycle 1 to 8.3% in Cycle 2 and 12.5% in Cycle 3. Long-term hypoparathyroidism dropped to 0% in Cycle 3, with no correlation between surgeon technique or indication and postoperative hypocalcemia.\u0000 \u0000 \u0000 \u0000 The introduction of preoperative guidelines significantly enhanced Vitamin D deficiency detection, substantially reducing postoperative hypocalcemia. This underscores the positive impact of standardized protocols on patient care. Future efforts involve re-auditing with the involvement of junior doctors to ensure continuous enhancement in clinical practice.\u0000","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141706005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To evaluate comparative outcomes of robotic versus laparoscopic bowel resection in patients with inflammatory bowel disease (IBD). A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library, Clinical trials.gov and Science Direct. Comparative studies comparing robotic versus laparoscopic resection for IBD were included. Primary outcomes were post-operative complications rate. Operative time, conversion to open, length of hospital stays, and mortality were the evaluated outcome parameters. Eleven studies with total number of 5,566 patients divided between those undergoing robotic (n=365) and conventional laparoscopic (n=5,201) surgery. Moreover, subgroup analysis for sub-total colectomy group showed shorter LOS [MD: -1.62, P=0.03]. Overall complications rate was significantly higher in the laparoscopy group compared to robotic group [OR: 0.48, P=0.03], however the operative time was longer in the robotic group [MD: 40.61, P=0.00001]. Pooled analysis showed comparable results regarding conversion to open [OR: 0.46, P=0.15], anastomosis leak [OR: 0.92, P=0.84], abdominal abscess / collection [OR: 0.34, P=0.21], and mortality [RD: 0.00, P=1.00]. Compared to laparoscopic approach, Robotic surgery provides a significantly lower rate of post-operative complications and shorter LOS at the expense of operative time with similar 30-day Mortality.
{"title":"456 Comparison of Postoperative Outcomes Between Robotic and Laparoscopic Surgery for Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis","authors":"A. Wuheb","doi":"10.1093/bjs/znae163.110","DOIUrl":"https://doi.org/10.1093/bjs/znae163.110","url":null,"abstract":"\u0000 \u0000 \u0000 To evaluate comparative outcomes of robotic versus laparoscopic bowel resection in patients with inflammatory bowel disease (IBD).\u0000 \u0000 \u0000 \u0000 A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library, Clinical trials.gov and Science Direct. Comparative studies comparing robotic versus laparoscopic resection for IBD were included. Primary outcomes were post-operative complications rate. Operative time, conversion to open, length of hospital stays, and mortality were the evaluated outcome parameters.\u0000 \u0000 \u0000 \u0000 Eleven studies with total number of 5,566 patients divided between those undergoing robotic (n=365) and conventional laparoscopic (n=5,201) surgery. Moreover, subgroup analysis for sub-total colectomy group showed shorter LOS [MD: -1.62, P=0.03]. Overall complications rate was significantly higher in the laparoscopy group compared to robotic group [OR: 0.48, P=0.03], however the operative time was longer in the robotic group [MD: 40.61, P=0.00001]. Pooled analysis showed comparable results regarding conversion to open [OR: 0.46, P=0.15], anastomosis leak [OR: 0.92, P=0.84], abdominal abscess / collection [OR: 0.34, P=0.21], and mortality [RD: 0.00, P=1.00].\u0000 \u0000 \u0000 \u0000 Compared to laparoscopic approach, Robotic surgery provides a significantly lower rate of post-operative complications and shorter LOS at the expense of operative time with similar 30-day Mortality.\u0000","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141691764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Jubouri, A. O. Surkhi, S. Tan, I. Williams, M. Bashir
Endovascular aortic repair (EVAR) has become the mainstay treatment for abdominal aortic aneurysms and is associated with optimal outcomes. However, there remains a risk of complications requiring reintervention. Several EVAR devices exist commercially, yet, the Fenestrated Anaconda™ (FA) has demonstrated outstanding results. This study aims to presents a 9-year cross-sectional international analysis of custom-made FA outcomes. Patient data was collected prospectively in 27 countries over 9 years and stored in an international registry. This was later retrieved and analysed retrospectively. A total of 5058 patients received the FA endograft. This was indicated either due to complex anatomy for competitor devices (n = 3891, 76.9%) or based on surgeon preference (n = 1167, 23.1%). Overall, the FA was utilised to rescue 2987 (59%) failed previous EVARs. The predominant device category and proximal ring stent configuration were bifurcate (83.6%) and standard (64.5%). Most devices were delivered within 6-8 weeks (55.4%) of diagnosis and 95% came with a prototype. As for clinical outcomes, both survival and TVP were 100% during the first 6 postoperative years but dropped to 77.1% and 81% thereafter. A sac regression of 0-30% was observed in 4772 (94.3%) patients over the first 4 years, whilst all patients had 20-45% sac regression in years 5-9 of follow-up. No cases of endograft migration or reintervention were recorded. All clinical outcomes were further stratified by indication group. The custom-made FA endograft features a highly unique and innovative design which enables it to treat highly complex aortic anatomy while achieving favourable results.
{"title":"358 Driving Endovascular Solutions for Abdominal Aortic Aneurysms: A 9-Year International Experience with the Fenestrated Anaconda Endograft","authors":"M. Jubouri, A. O. Surkhi, S. Tan, I. Williams, M. Bashir","doi":"10.1093/bjs/znae163.194","DOIUrl":"https://doi.org/10.1093/bjs/znae163.194","url":null,"abstract":"\u0000 \u0000 \u0000 Endovascular aortic repair (EVAR) has become the mainstay treatment for abdominal aortic aneurysms and is associated with optimal outcomes. However, there remains a risk of complications requiring reintervention. Several EVAR devices exist commercially, yet, the Fenestrated Anaconda™ (FA) has demonstrated outstanding results. This study aims to presents a 9-year cross-sectional international analysis of custom-made FA outcomes.\u0000 \u0000 \u0000 \u0000 Patient data was collected prospectively in 27 countries over 9 years and stored in an international registry. This was later retrieved and analysed retrospectively.\u0000 \u0000 \u0000 \u0000 A total of 5058 patients received the FA endograft. This was indicated either due to complex anatomy for competitor devices (n = 3891, 76.9%) or based on surgeon preference (n = 1167, 23.1%). Overall, the FA was utilised to rescue 2987 (59%) failed previous EVARs. The predominant device category and proximal ring stent configuration were bifurcate (83.6%) and standard (64.5%). Most devices were delivered within 6-8 weeks (55.4%) of diagnosis and 95% came with a prototype. As for clinical outcomes, both survival and TVP were 100% during the first 6 postoperative years but dropped to 77.1% and 81% thereafter. A sac regression of 0-30% was observed in 4772 (94.3%) patients over the first 4 years, whilst all patients had 20-45% sac regression in years 5-9 of follow-up. No cases of endograft migration or reintervention were recorded. All clinical outcomes were further stratified by indication group.\u0000 \u0000 \u0000 \u0000 The custom-made FA endograft features a highly unique and innovative design which enables it to treat highly complex aortic anatomy while achieving favourable results.\u0000","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141713711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Deceased donor kidney utilisation confronts challenges leading to prolonged cold ischemia time (CIT), affecting graft survival. Despite these challenges, an understanding of the obstacles remains unclear. This audit aims to identify the factors that prolong CIT. A multicentre, prospective audit of adult deceased donor kidney-only transplants spanned 14 UK transplant centres from February to September 2022. Data, encompassing time intervals between important checkpoints pre-transplantation and perceived reasons for delays, were collected through RedCap. Descriptive statistics was used for analysis. Data from 476 kidney-only transplants were gathered (29 excluded for incomplete/incorrect data). Of these, 230 were donations after brainstem death (DBD) organs, and 202 were donations after circulatory death (DCD) organs. Median CIT was 10:55 (IQR:08:11-15:13) for DBD organs and 11:19 (IQR:08:31-15:10) for DCD organs, with 42% of DCD and 15% of DBD organs surpassing national CIT recommendations. Median time from organ arrival to knife to skin was 04:02 (IQR:02:35-07:35). Full and virtual crossmatches constituted 35% and 65%, respectively, with 16% of results arriving after the organ arrives at centre. Anaesthetic time had a median duration of 00:55 (IQR:00:39-01:10) and Knife to skin to organ perfusion was 01:25 (01:10-01:51). Delays reported in 34% of transplant cases, most common causes were the availability of surgical and anaesthetic teams, porters, and the operating theatre. This audit allowed us to uncover the factors that prolong CIT at each stage of the transplantation post-arrival. These findings will guide the establishment of realistic targets for optimizing processes in the future.
{"title":"1087 Factors That Impact Cold Ischaemia Time for Deceased Donor Kidney Transplants: Results of a National Transplant Access to Theatre Audit (NTACT)","authors":"M. Mujeeb, B. Borbas, A. Tanase, S. Aroori","doi":"10.1093/bjs/znae163.183","DOIUrl":"https://doi.org/10.1093/bjs/znae163.183","url":null,"abstract":"\u0000 \u0000 \u0000 Deceased donor kidney utilisation confronts challenges leading to prolonged cold ischemia time (CIT), affecting graft survival. Despite these challenges, an understanding of the obstacles remains unclear. This audit aims to identify the factors that prolong CIT.\u0000 \u0000 \u0000 \u0000 A multicentre, prospective audit of adult deceased donor kidney-only transplants spanned 14 UK transplant centres from February to September 2022. Data, encompassing time intervals between important checkpoints pre-transplantation and perceived reasons for delays, were collected through RedCap. Descriptive statistics was used for analysis.\u0000 \u0000 \u0000 \u0000 Data from 476 kidney-only transplants were gathered (29 excluded for incomplete/incorrect data). Of these, 230 were donations after brainstem death (DBD) organs, and 202 were donations after circulatory death (DCD) organs. Median CIT was 10:55 (IQR:08:11-15:13) for DBD organs and 11:19 (IQR:08:31-15:10) for DCD organs, with 42% of DCD and 15% of DBD organs surpassing national CIT recommendations. Median time from organ arrival to knife to skin was 04:02 (IQR:02:35-07:35). Full and virtual crossmatches constituted 35% and 65%, respectively, with 16% of results arriving after the organ arrives at centre. Anaesthetic time had a median duration of 00:55 (IQR:00:39-01:10) and Knife to skin to organ perfusion was 01:25 (01:10-01:51). Delays reported in 34% of transplant cases, most common causes were the availability of surgical and anaesthetic teams, porters, and the operating theatre.\u0000 \u0000 \u0000 \u0000 This audit allowed us to uncover the factors that prolong CIT at each stage of the transplantation post-arrival. These findings will guide the establishment of realistic targets for optimizing processes in the future.\u0000","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141709866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acute Kidney Injury (AKI) is an important complication following cardiac surgery that has been associated with adverse outcomes. The aim of this work was to investigate the incidence and risk factors for AKI in patients undergoing cardiac surgery at our centre. This is a retrospective analysis of 1441 patients who underwent elective or urgent (but not emergency) cardiovascular surgery with use of cardiopulmonary bypass over a 1-year period. Our exclusion criteria were heart transplant, single CABG, congenital repairs or patients on dialysis or renal transplant pre-operatively. Data analysis was performed in R studio. The mean age of the patients was 67.7 years. Mean creatinine from a 7-day period before surgery was 90µmol/L compared with the mean peak post operative creatinine of 127 µmol/L (95% CI 33-42, p-value <0.05). As defined by the KDIGO AKI stages, 27% developed an AKI stage 1, 11% developed AKI stage 2 and 1% AKI stage 3. The following variables correlated strongly (P-value <0.001) with post-operative risk of AKI: The comorbidities of diabetes, smoking, and peripheral vascular disease; pre-operative medications: diuretics, calcium channel blockers and SGLT-2 inhibitors and receiving FFP or RBC transfusion postoperatively. AKI is a common complication following cardiac surgery. Having an insight into the risk factors for AKI allows an opportunity for intervention preoperatively and can also highlight patients that may require extra vigilance in the perioperative period to reduce its incidence, which may lead to an improvement in outcomes following surgery.
急性肾损伤（AKI）是心脏手术后的一种重要并发症，与不良预后有关。这项工作的目的是调查在我们中心接受心脏手术的患者中急性肾损伤的发生率和风险因素。 这是一项回顾性分析，研究对象是在一年时间内接受了使用心肺旁路的择期或紧急（但非急诊）心血管手术的 1441 名患者。我们的排除标准是心脏移植、单次 CABG、先天性修复或术前接受透析或肾移植的患者。数据分析在 R studio 中进行。 患者的平均年龄为 67.7 岁。术前 7 天的平均肌酐为 90 微摩尔/升，而术后的平均峰值肌酐为 127 微摩尔/升（95% CI 33-42，P 值<0.05）。根据 KDIGO AKI 分期的定义，27% 的患者出现 AKI 1 期，11% 的患者出现 AKI 2 期，1% 的患者出现 AKI 3 期。以下变量与术后发生 AKI 的风险密切相关（P 值<0.001）：糖尿病、吸烟和外周血管疾病等合并症；术前用药：利尿剂、钙通道阻滞剂和 SGLT-2 抑制剂；术后接受全血细胞或红细胞输注。 AKI 是心脏手术后常见的并发症。了解 AKI 的风险因素可以为术前干预提供机会，还可以突出围手术期可能需要格外警惕的患者，以减少其发生率，从而改善术后效果。
{"title":"297 Exploring Risk Factors for Acute Kidney Injury in Patients Undergoing Cardiac Surgery","authors":"E. Abelian, M. Bhandari, R. Purmessur, J. Ali","doi":"10.1093/bjs/znae163.096","DOIUrl":"https://doi.org/10.1093/bjs/znae163.096","url":null,"abstract":"\u0000 \u0000 \u0000 Acute Kidney Injury (AKI) is an important complication following cardiac surgery that has been associated with adverse outcomes. The aim of this work was to investigate the incidence and risk factors for AKI in patients undergoing cardiac surgery at our centre.\u0000 \u0000 \u0000 \u0000 This is a retrospective analysis of 1441 patients who underwent elective or urgent (but not emergency) cardiovascular surgery with use of cardiopulmonary bypass over a 1-year period. Our exclusion criteria were heart transplant, single CABG, congenital repairs or patients on dialysis or renal transplant pre-operatively. Data analysis was performed in R studio.\u0000 \u0000 \u0000 \u0000 The mean age of the patients was 67.7 years. Mean creatinine from a 7-day period before surgery was 90µmol/L compared with the mean peak post operative creatinine of 127 µmol/L (95% CI 33-42, p-value <0.05). As defined by the KDIGO AKI stages, 27% developed an AKI stage 1, 11% developed AKI stage 2 and 1% AKI stage 3. The following variables correlated strongly (P-value <0.001) with post-operative risk of AKI: The comorbidities of diabetes, smoking, and peripheral vascular disease; pre-operative medications: diuretics, calcium channel blockers and SGLT-2 inhibitors and receiving FFP or RBC transfusion postoperatively.\u0000 \u0000 \u0000 \u0000 AKI is a common complication following cardiac surgery. Having an insight into the risk factors for AKI allows an opportunity for intervention preoperatively and can also highlight patients that may require extra vigilance in the perioperative period to reduce its incidence, which may lead to an improvement in outcomes following surgery.\u0000","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141712074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Jamalludin, G. Elegio, H. Abu Shamat, E. Haxhiaj
Patient handover is vital in ensuring patient safety and quality of patient care, in line with Royal College of Surgeons Guidance of Safe Handover (2007). ‘RAAAIDDSSS’ method stands for resection (surgery), airway, anticoagulant, antibiotics, intake, drain, Doppler, serology, scans, structure (plans). It shows comprehensive clinical updates for planning best management, ensuring smooth flow of activity and reducing morbidity. This method is ideal as our surgical patients often have altered airway anatomy and airway plans and consequently variable feeding routes. To audit the compliance of RAAAIDDSSS method. This is a prospective audit in Head and Neck Surgery Department of University College London Hospital (UCLH), done within 4 weeks across June-July 2023, with sample (n=100) for first cycle and (n=81) for second cycle. The format was implemented in handover sheet and case presentation was run according to this method. First cycle showed good compliance to RAAAIDDSSS handover method. The least compliant component is ‘structure’ which showed only 62%. Results were presented in grand ward round. Second cycle showed significant improvement. Almost all components showed 100% compliance, except for the ‘intake’, which was 90%. Overall shows positive compliance to this handover method. UCLH Head and Neck Surgery has strict compliance with the RAAIDDSSS method. This audit brings significant positive impacts and changes to clinical practice in terms of patient safety, service efficiency and quality of patient care. This audit also holds valuable clinical value and opens doors for further audits as well as project expansion regionally and nationally.
{"title":"208 Head and Neck Surgical Oncology Handover Audit Using ‘RAAAIDDSS’ Method","authors":"A. Jamalludin, G. Elegio, H. Abu Shamat, E. Haxhiaj","doi":"10.1093/bjs/znae163.146","DOIUrl":"https://doi.org/10.1093/bjs/znae163.146","url":null,"abstract":"\u0000 \u0000 \u0000 Patient handover is vital in ensuring patient safety and quality of patient care, in line with Royal College of Surgeons Guidance of Safe Handover (2007). ‘RAAAIDDSSS’ method stands for resection (surgery), airway, anticoagulant, antibiotics, intake, drain, Doppler, serology, scans, structure (plans). It shows comprehensive clinical updates for planning best management, ensuring smooth flow of activity and reducing morbidity. This method is ideal as our surgical patients often have altered airway anatomy and airway plans and consequently variable feeding routes.\u0000 \u0000 \u0000 \u0000 To audit the compliance of RAAAIDDSSS method.\u0000 \u0000 \u0000 \u0000 This is a prospective audit in Head and Neck Surgery Department of University College London Hospital (UCLH), done within 4 weeks across June-July 2023, with sample (n=100) for first cycle and (n=81) for second cycle. The format was implemented in handover sheet and case presentation was run according to this method.\u0000 \u0000 \u0000 \u0000 First cycle showed good compliance to RAAAIDDSSS handover method. The least compliant component is ‘structure’ which showed only 62%. Results were presented in grand ward round. Second cycle showed significant improvement. Almost all components showed 100% compliance, except for the ‘intake’, which was 90%. Overall shows positive compliance to this handover method.\u0000 \u0000 \u0000 \u0000 UCLH Head and Neck Surgery has strict compliance with the RAAIDDSSS method. This audit brings significant positive impacts and changes to clinical practice in terms of patient safety, service efficiency and quality of patient care. This audit also holds valuable clinical value and opens doors for further audits as well as project expansion regionally and nationally.\u0000","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141702896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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