Royal College Of Surgeons Research Articles

Exosomes derived from IFNγ-stimulated mesenchymal stem cells protect photoreceptors in RCS rats by restoring immune homeostasis through tsRNAs.

Retinitis pigmentosa is a neurodegenerative disease with major pathologies of photoreceptor apoptosis and immune imbalance. Mesenchymal stem cells (MSCs) have been approved for clinical application for treating various immune-related or neurodegenerative diseases. The objective of this research was to investigate the mechanisms underlying the safeguarding effects of MSC-derived exosomes in a retinal degenerative disease model. Interferon gamma-stimulated exosomes (IFNγ-Exos) secreted from MSCs were isolated, purified, and injected into the vitreous body of RCS rats on postnatal day (P) 21. Morphological and functional changes in the retina were examined at P28, P35, P42, and P49 in Royal College of Surgeons (RCS) rats. The mechanism was explored using high-throughput sequencing technology and confirmed in vitro. Treatment with IFNγ-Exo produced better protective effects on photoreceptors and improved visual function in RCS rats. IFNγ-Exo significantly suppressed the activated microglia and inhibited the inflammatory responses in the retina of RCS rats, which was also confirmed in the lipopolysaccharide-activated microglia cell line BV2. Furthermore, through tRNA-derived small RNA (tsRNA) sequencing, we found that IFNγ-Exos from MSCs contained higher levels of Other-1_17-tRNA-Phe-GAA-1-M3, Other-6_23-tRNA-Lys-TTT-3, and TRF-57:75-GLN-CGG-2-m2 than native exosomes, which mainly regulated inflammatory and immune-related pathways, including the mTOR signaling pathway and EGFR tyrosine kinase inhibitor resistance. IFNγ stimulation enhanced the neuroprotective effects of MSC-derived exosomes on photoreceptors of the degenerative retina, which may be mediated by immune regulatory tsRNAs acting on microglia. In conclusion, IFNγ-Exo is a promising nanotherapeutic agent for the treatment of retinitis pigmentosa.

EGS SO02 - The undifferentiated general surgical take over 10 years: Admissions

Abstract Background Hospital admissions in England and Wales have been increasing over time. This increase has occurred across many specialties, including across the surgical specialties. The aim of this study is to review the undifferentiated emergency general surgical take, with regards to admissions in July 2013 and July 2023, at a District General Hospital to understand the specific pressures on the department and to identify areas in which we could adapt to facilitate these demands. Method Retrospective data regarding admission and re-admission on all patients treated by the emergency general surgical team in July 2013 and July 2023 was collected from electronic notes. If insufficient information was available, patients were excluded from analysis. Results Patient numbers increased by 50% from 2013 to 2023, from 395 to 594. Average length of stay in 2013 was 3.26 days (+/-0.2, p = 0.03), reducing to 2.58 days (+/-0.2, p = 0.03) in 2023. Number of patients admitted overnight has decreased from 74% (n=291/395) in 2013, to 54% (n=324/594) in 2023. Proportion of referrals from ED increased from 48% in 2013, to 69% in 2023. Planned reviews and patients ambulated for surgery the following day has increased from 4% of all patients seen in 2013, to 16% in 2023. Conclusion Volume of patients has increased significantly over this 10-year period. Simultaneously, duration and number of overnight admissions have decreased, alongside increasing use of ambulatory services. This reflects the aims of the Government, and the Royal College of Surgeons, with increasing investment in day-case and ambulatory services. However, without an increase in hospital bed numbers, the rising volume of patients may become difficult to manage.

Surgical Training Pathways in the United Kingdom and the United States: Lessons for Resource-Limited Settings From High-Income Countries.

Background Surgical training is a critical component of healthcare, especially in high-income countries such as the United Kingdom (UK) and the United States (US), which have established distinct, well-organised training frameworks. Comparing these systems provides valuable insights that may enhance global surgical education, particularly in low- and middle-income countries, where training and retaining proficient surgeons are considerable challenges. Methodology This comparative study examines the surgical training systems in the UK and the US, focusing on key aspects, including training structure, competency-based assessments, and work-hour regulations. Data were sourced from regulatory organisations such as the General Medical Council, the Royal College of Surgeons, the Accreditation Council for Graduate Medical Education, and the American Board of Surgery. The analysis explores how elements of these models might be adapted to support sustainable surgical education frameworks in resource-limited environments. Ethical approval was not required due to the use of publicly accessible data and no patient involvement. Results The UK and US surgical training systems differ substantially in their structure, training duration, and specialisation timing. The UK employs a tiered approach, offering generalist experience before specialisation, while the US favours early specialisation directly after medical school. Both systems implement competency-based evaluations, though the US system places a greater emphasis on case volume and procedural exposure. Work-hour regulations also vary, with the UK capping weekly hours at 48 under the European Working Time Directive, compared to an 80-hour maximum in the US, which results in differing levels of trainee satisfaction and burnout rates. Conclusions The competency-based assessments in both the UK and the US offer adaptable frameworks for resource-limited settings. The phased training approach in the UK is well-suited for environments requiring versatile surgeons capable of handling a wide range of cases. By implementing these adaptable elements, along with cost-effective training innovations such as simulation tools, e-learning platforms, and international partnerships, resource-constrained regions can foster a sustainable, skilled surgical workforce. These insights offer pathways to improve healthcare outcomes and equity globally by enhancing surgical capacity in regions with limited resources.

Enhanced auditory responses in visual cortex of blind rats using intrinsic optical signal imaging

Functional maturation of the visual cortex is induced by visual experiences during critical periods. Blind animals and humans exhibit improved auditory abilities after losing their vision. Here we investigated the response of the visual cortex to white noise stimuli during the progression of photoreceptor degeneration in a rat model of blindness (Royal College of Surgeons [RCS] (rdy/rdy) rats). Optical coherence tomography of RCS (+/+) rats with normal visual function revealed normal photoreceptor cells, whereas 3-month-old RCS (rdy/rdy) rats demonstrated photoreceptor cell degeneration. Visual cortex responses (VCRs) to a single flash stimulus were negligible in 3-month-old photoreceptor-degenerated rats. However, VCRs with white noise stimuli were significantly increased in blind versus RCS rats (+/+). Slight changes in the intrinsic optical signals of the control rats were observed on the ventral side of the visual cortex. In contrast, responses were markedly increased throughout the visual cortex of RCS (rdy/rdy) rats. These results indicate that the visual cortex rapidly acquires auditory system function over the first 3 months of life and that the entire visual cortex, rather than just the portion close to the auditory cortex, responds to white noise.

The higher education’s role in the multisectoral evolution of the diabetes mobile unit programme

Abstract Background The global prevalence of obesity and diabetes is increasing. Overweight and obesity during early childhood increase the risk of developing type 2 diabetes. The diabetes mobile unit (DMU) programme is a collaborative initiative between the Bahrain Diabetes Society, the Royal College of Surgeons in Ireland (RCSI) Medical University of Bahrain, the Ministry of Education, and other stakeholders. Objectives To develop a sustainable educational programme to empower nursing and medical students to educate schoolchildren on healthy lifestyle choices and potentially reduce the risk of obesity and type 2 diabetes. Results The DMU programme is incorporated into the undergraduate nursing and medical curricula. It fosters experiential learning in public health education and promotion, encourages trainee-trainer mentorship, and cultivates essential graduate skills, thus enhancing their career prospects. Since 2012, the programme inducted 300 staff and students and educated 7,000 children. In 2023, the programme was re-launched in alignment with RCSI’s three strategic pillars: learning and teaching, research, and community engagement. The programme expanded its stakeholders’ network and incorporated strategies to promote interprofessional learning among staff, students, and alumni. The outcome of these endeavours included publishing an interactive storybook, creating innovative educational tools, and ongoing research. Conclusions This novel programme highlights the role of higher education in promoting multisectoral collaboration for public health awareness initiatives. The key to the programme’s success is synchronizing education, research and community engagement in higher education curricula and various contexts. Key messages • Multisectoral collaboration is essential in developing evidence-based and culturally congruent programmes. • Linking education, research, and community is vital to achieving sustainable development goals.

Extracellular Vesicles Derived from Adipose-Derived Mesenchymal Stem Cells Alleviate Apoptosis and Oxidative Stress of Retinal Pigment Epithelial Cells Through Activation of Nrf2 Signaling Pathway.

Purpose: To examine the potential protective effects of adipose-derived mesenchymal stem cell-derived extracellular vesicles (ASC-EVs) on ARPE-19 cells exposed to hydrogen peroxide (H2O2) stress and to evaluate their ability to delay retinal degeneration in Royal College of Surgeons (RCS) rats. Methods: ARPE-19 cells were pre-treated with ASC-EVs for 24 h, followed by exposure to 200 μM H2O2 for an additional 24 h. RCS rats received an intravitreal injection of phosphate-buffered saline in one eye and ASC-EVs in the other eye. Results: ASC-EV pretreatment significantly protected against H2O2 in the Cell Counting Kit-8 assay and was also effective in the lactate dehydrogenase-release assay. It notably reduced early apoptosis (Annexin V-fluorescein isothiocyanate/propidium iodide assay) and late apoptosis (Terminal Deoxynucleotidyl Transferase dUTP Nick End Labeling assay), while significantly decreasing intracellular reactive oxygen species, glutathione levels, and superoxide dismutase activity. NFE2L2, HMOX1, and NQO1 mRNA levels, along with Nrf2, HO-1, and NQO1 protein levels, were significantly elevated with ASC-EV pretreatment. Compared with ARPE-19-derived EVs, 11 miRNAs were upregulated and 34 were downregulated in ASC-EVs. In RCS rats, intravitreal injections of ASC-EVs led to significant preservation of the outer nuclear layer and photoreceptor segments, along with increased nuclear Nrf2 expression and elevated HO-1 and NQO1 levels in the inner retina. Eyes that received intravitreal injections of ASC-EVs demonstrated significantly preserved electroretinography a- and b-wave amplitudes at 1 week post-injection, though this effect faded by 2 weeks. Conclusions: ASC-EVs mitigated apoptosis and oxidative stress in ARPE-19 cells subjected to H2O2 exposure and temporarily slowed retinal degeneration in RCS rats via Nrf2 pathway activation by miRNAs.

The Life and Contributions of Dr. Abraham Colles: A Pioneer in Orthopaedics.

Abraham Colles (1773-1843) was a pioneering Irish surgeon whose contributions significantly advanced the fields of anatomy and surgery. Best known for describing the "Colles' fracture" of the distal radius, Colles' meticulous clinical observations and innovative treatment methods remain influential in modern orthopaedic practice. Born in Kilkenny, Ireland, Colles pursued medical education at Trinity College Dublin and the University of Edinburgh before training in London under the renowned surgeon Astley Cooper. Upon his return to Dublin, Colles was appointed resident surgeon at Steevens' Hospital, where he spent the majority of his career. Beyond his work on fractures, Colles made notable contributions to the understanding and treatment of syphilis, leading to the formulation of "Colles' law," and he introduced new surgical techniques for treating vascular conditions, including aneurysms. A dedicated educator, Colles played a central role in shaping Irish surgical practice through his teaching and leadership at the Royal College of Surgeons in Ireland. His legacy endures not only through his clinical innovations but also through his impact on medical education and public health in Ireland and beyond.

Effectiveness of hybrid simulation training on medical student performance in whole-task consultation of cardiac patients: The ASSIMILATE EXCELLENCE randomized waitlist-controlled trial

BackgroundAssessment of comprehensive consultations in medicine, i.e. a complete history, physical examination, and differential diagnosis, is regarded as authentic tests of clinical competence; however, they have been shown to have low reliability and validity due to variability in the real patients used and subjective examiner grading. In the ASSIMILATE EXCELLENCE study, our aim was to assess the effect(s) of expert tuition with hybrid simulation using a simulated patient wearing a novel auscultation vest, i.e. a hybrid simulated patient, and repeated peer grading using scoring checklists on student learning, performance, and acumen in comprehensive consultations of patients with valvular heart disease.MethodsASSIMILATE EXCELLENCE was a randomized waitlist-controlled trial with blinded outcome assessment undertaken between February 2021 and November 2021. Students at the Royal College of Surgeons in Ireland in either the second or third year of the four-year graduate-entry medical degree programme were randomized to a hybrid simulation training or waitlist control group and undertook three consultation assessments of three different clinical presentations of valvular heart disease (cases: C1–C3) using hybrid simulation. Our primary outcome was the difference in total score between and within groups across time; a secondary outcome was any change in inter-rater reliability across time. Students self-reported their proficiency and confidence in comprehensive consultations using a pre- and post-study survey.ResultsIncluded were 68 students (age 27.6 ± 0.1 years; 74% women). Overall, total score was 39.6% (35.6, 44.9) in C1 and increased to 63.6% (56.7, 66.7) in C3 (P < .001). On intergroup analysis, a significant difference was observed between groups in C2 only (54.2 ± 7.1% vs. 45.6 ± 9.2%; P < .001), a finding that was mainly driven by a difference in physical examination score. On intragroup analysis, significant improvement in total score across time between cases was also observed. Intraclass correlation coefficients for each pair of assessors were excellent (0.885–0.996 [0.806, 0.998]) in all cases. Following participation, students’ confidence in comprehensive consultation assessments improved, and they felt more prepared for their future careers.ConclusionsHybrid simulation-based training improves competence and confidence in medical students undertaking comprehensive consultation assessment of cardiac patients. In addition, weighted scoring checklists improve grading consistency, learning through peer assessment, and feedback.Trial registrationClinicalTrials.gov Identifier: NCT05895799

Exploring Allied Health Professionals’ Perceptions and Practice Regarding Recommendations for Intensity of Multidisciplinary Therapy for Stroke Patients: A Qualitative Study

Abstract Background Stroke is a leading cause of death and disability in Ireland; approximately 7,500 Irish people have a stroke every year. Rehabilitation is a key aspect of stroke care; greater amounts of therapy are associated with better recovery. Data from the Irish National Office of Clinical Audit shows that stroke survivors often do not receive recommended amounts of therapy. The recently updated UK and Ireland stroke clinical guidelines now recommend larger amounts of therapy time. This qualitative study explored how allied health professionals (AHPs) feel about the recommendation, and what methods they employ in working to achieve recommended amounts of therapy. Methods This study used a qualitative research design employing semi-structured interviews to collect data. Participants were AHPs working in stroke care in Dublin, Ireland, and were recruited using a combination of purposive and snowball sampling. Interviews were audio-recorded, transcribed, and analysed using the Braun and Clarke six-step thematic analysis method. An external validator was utilised for code and theme validation. This research was approved by the Royal College of Surgeons in Ireland Research Ethics committee. Results Two main themes emerged: ‘Barriers and enablers to achieving guideline recommended therapy time’ and ‘methods of increasing therapeutic time’. Patient factors and clinical resources impact on the provision of therapy post-stroke. Overall, participants felt positive about the recent guideline recommendation for increased therapeutic time. Various methods are employed to augment patient therapeutic time, including technology and semi-supervised practice. Therapy assistants play an important role in achieving greater amounts of therapy. Conclusion AHPs see the new recommendation as challenging but are generally keen to try and achieve it, citing benefits of increased therapy time for patient outcomes. AHPs utilise a wide range of methods to optimise therapeutic time for stroke patients. The role of therapy assistants in supporting delivery of larger amounts of therapy time warrants further evaluation.

Lizard with a Double-Ended Tail—Is That All?

Specimen GLAHM:120240 (Fig. 1) has been on display in The Hunterian Anatomy Museum at the University of Glasgow for more than a century labelled as “Lizard with Double-ended Tail.” An interesting enough reason for display and being under the spotlight perhaps? Maybe not: examples of lizards being found with two, or even more, tips to their tails are not that uncommon and is possible due to their caudal autotomy behaviour, where a lizard can shed its tail when attacked by a predator to provide a distraction and a possible means of escape. However, if a tail is only partially shed during an incident then sometimes another tip may start to grow at the break point, eventually resulting in two tips to the tail. There are many examples of this phenomenon viewable from a quick online search, and specimens showing this can often be seen in museums, collected and displayed as curiosities. Is having a lizard on display in an anatomy museum reason enough for being in the spotlight? Possibly, but it's not that original, in fact the other Hunterian museum in London at the Royal College of Surgeons also has specimens of lizards with two tails in their collections and the inclusion of animal specimens alongside human remains is fairly common due to the teaching of comparative anatomy in the last century. However, the real reason I have brought this specimen to the spotlight talks is that I only recently identified it in a very serendipitous and timely way. I had seen the lizard before, when getting to know the Anatomy Museum but as it was displayed alongside other specimens with malformations I did not pay it much attention as a zoological specimen. Months later when I was conducting a tour of the Anatomy Museum, a visitor pointed out an error on a label on one of the human specimens on the same shelf, so I looked more closely at all the objects to work out what had been mislabelled. It was then that I realized that the double-tailed specimen was the same genus or possibly even species as another lizard in our zoology collection, which I had been photographing earlier in the week for another project. This is where it gets interesting, the lizard I had been photographing was not just any lizard, but an endemic species, only found in Jamaica. The Jamaican Giant Galliwasp (Celestus occiduus), which is presumed to have gone extinct in the 1800s due to loss of habitat, and invasive rats and introduced mongoose preying on them. There are only a handful of specimens, maybe fewer than 30, in collections in Europe and the USA, so to find a Celestus sp. sitting openly on a shelf was a fantastic moment. Further investigation of an old register (Reference Code: GB 247 MR 49/4 in the University of Glasgow Archives and Special Collections), written by Prof Allen Thomson, who was head of Anatomy in the mid-1800s, provided a very tantalising clue as to its provenance: "Large lizard (?) The Galawasp from Jamaica given me by Dr Douglas Maclagan 19th Nov. 1853, found in the swamps on the S.W. part of the island, piebald colour much brighter during life as stated by Dr M's correspondent Dr Macfarlane of Montego Bay." However, I must say I am slightly wary of connecting this record with the specimen, as there is no mention of it having a double-tipped tail. Having said that, there are no other galliwasp specimens in Anatomy, so the odds are high that this entry is talking about the same specimen. Its discovery was very timely as it was made when the other Jamaican giant galliwasp in The Hunterian was in the process of being repatriated to Jamaica. This lizard had been in our zoology collections since 1888, but as part of the decolonization process and as a way of building relationships, I suggested offering the specimen back to a museum in its country of origin. The reasons being that it was endemic, more than likely extinct (so no new specimens could be collected), but mainly because at that time, there were no known specimens of this species in Jamaica. The repatriation went ahead in April 2024, when curators from Jamaica came for a knowledge exchange visit to Scotland and took the galliwasp back home with them. As we still have the "double-ended tail" galliwasp in the collection, we can continue to tell the tragic story of this species. Interesting and significant specimens can be hidden in plain sight in many collections, so keep your eyes open and who knows what you may find.

Housing RCS rats under specific pathogen-free conditions mildly ameliorates retinal degeneration and alters intestine microbiota

Retinitis pigmentosa (RP) is a genetic blinding disease with over 80 causative genes. Disease progression varies between patients with similar genetic backgrounds. We assessed the association between environment, gut microbiota, and retinal degeneration in the RP rat model Royal College of Surgeons (RCS). The rats were born and raised for two generations under specific pathogen-free (SPF, n = 69) or non-SPF conditions (n = 48). At the age of four weeks, SPF rats had significantly shorter dark-adapted a-wave and dark and light-adapted b-wave implicit times by electroretinogram (p = 0.014, p = 9.5*10−6, p = 0.009, respectively). The SPF rats had significantly less photoreceptor apoptosis at ages four, eight, and twelve weeks (all p < 0.022), significantly thicker debris zone at age 14 weeks, and smaller hypofluorescent lesions in SPF rats at ages 10–16 weeks, especially in the inferior retina. The non-SPF rats had significantly higher microbiota alpha diversity (p = 0.037) and failed to present the age-related maturation of Proteobacteria, Spirochaetes, Actinobacteria, and Bacteroidetes seen in SPF conditions. Specific microbial amplicon sequence variants were reduced in rats with more severe retinal degeneration. Our data suggest an environmental effect on retinal deterioration in RCS rats. These findings may lead to the development of novel microbiome-related interventions for retinal degeneration.

EP529 - The Impact of Royal College of Surgeon (RCS) Guidelines on the Quality of Operation Notes Documentation: A Closed Loop Audit

Abstract Introduction Operation notes are an important component of a patient’s medical record. Accurate documentation of surgical procedures is essential to understand the details of the operation and the post-operative management plan. The aim of this audit was to assess the current practices of documentation of operation notes, identify shortcomings, and compare the outcomes after introduction of recommendations made by the Royal College of Surgeons (RCS) of England in 2014. Methods This retrospective and prospective closed-loop audit was conducted in August-September 2021 at Basharat Hospital, Rawalpindi, Pakistan. 125 operation notes were evaluated to analyze the current documentation practices. The findings of the initial audit were compared with the Royal College of Surgeons (RCS) guidelines of Operation notes documentation. A re-audit was carried out after implementation of the improved version of operation notes. A panel reviewed 125 operation notes for adherence to international guidelines. Results The documentation rate was increased from 37.5% to 83.3% after the completion of this closed loop audit. Documentation of timing of surgery, operative findings, complications, additional procedure performed, anticipated blood loss, closure technique and deep vein thrombosis (DVT) prophylaxis were noted to be lacking in the initial audit. Implementation of the RCS guidelines revealed an improvement in the documentation of all parameters, with documentation rates exceeding 83% and an overall improvement of 45.8%. Conclusion This audit signifies the positive impact of RCS guidelines on the quality of operation notes documentation. Such audits should be regularly conducted for refined documentation practices, and enhanced patient care and safety.

ThP6.17 - ‘If it’s not documented, it didn’t happen’: an audit into surgical ward documentation and clinicians expectations in a district general hospital

Abstract Introduction &amp; Aims There are guidelines published by the Royal College of Surgeons (RCS) on adult surgical ward round documentation. Locally, documentation is done on pre populated sheets containing blood results, antibiotics and VTE prophylaxis. We aimed to assess documentation in our unit against the RCS guidelines. Methodology We audited documentation for surgical inpatients over 1 week, looking at daily ward rounds (DWR), and initial consultant post take ward round (PTWR). Through an online survey, we established the minimum standards of documentation expected by doctors of varying seniority on a ward round within our unit. Results 21 DWR and 21 PTWR entries were reviewed; 90% (n=19) contained the date and 95% (n=20) the name of the reviewing consultant. Time of review was documented in 29% (n=6) and 35% (n=7) respectively. 33% (n=4) DWR entries documented examination findings, compared to 8 40% (n=8) PTWR entries. 45% (n=10) PTWR contained the presenting complaint. 26 doctors completed the online survey; 100% thought date, time and examination findings were important. More senior doctors highlighted that drain status was a key part of ward round documentation. Conclusions Within our unit, there is poor adherence with the RCS ward round documentation guidelines. Juniors suggested this is because ward rounds are too fast paced, often on complex and comorbid patients. We plan to address our findings with an improved surgical admission proforma and an electronic handover to ensure all team members are up to date with patients’ admission details.

Unfolding the empathic insights and tendencies among medical students of two gulf institutions using interpersonal reactivity index

BackgroundEmpathy is an essential core competency for future doctors. Unfortunately, the medical curriculum is infamously known to burn out aspiring doctors, which may potentially lead to a decline in empathy among medical students. This research was planned to understand the evolution of empathic approaches among students across the curriculum using the Interpersonal reactivity index (IRI) as a benchmark at the Royal College of Surgeons in Ireland - Medical University of Bahrain (RCSI-MUB) and University of Sharjah (UoS).MethodsWe adopted a cross-sectional design and administered an online survey to the medical students of RCSI-MUB and UoS using a modified version of the IRI along with its three subscales of empathic concern (EC), perspective taking (PT), and personal distress (PD). To identify intra- and inter-institutional variations in empathy scores, the Analysis of Variance (ANOVA) was performed separately for each institution and with both institutions combined. A two-way ANOVA was conducted for the comparison between years and institutions. For the subscale analysis of EC, PT, and PD, we used one-way ANOVA for significant differences between years at both institutions. For the gender-effect analysis, t-test was performed to examine the differences in total IRI scores at both institutions combined and at each institution separately. Additionally, an Analysis of Covariance (ANCOVA) was done to identify the influence of gender on empathy scores.ResultsA total of 140 students from both institutions participated in this study. We found a fluctuating pattern of empathy scores without a clear trend across the years. The sub-scales of EC, PD, and PT across academic years at both institutions showed significant differences within the EC at RCSI-MUB (p = 0.003). No significant differences were identified across other years from both institutions. There were significant differences between empathy scores from RCSI-MUB and UoS for EC (p = 0.011). Additionally, a pronounced interaction effect between year and institution was observed for PT (p = 0.032). The gender-wise analysis showed that female students had higher empathy scores than males (p = 0.004). The ANCOVA for IRI score results revealed a p-value of 0.023, indicating that gender plays a crucial role in empathy levels among medical students. The ANCOVA results revealed a p-value of 0.022 in the EC subscale.ConclusionOur study unveiled intricate patterns in empathy development among medical students across years and genders at RCSI-MUB and UoS. These congruences and dissimilarities in empathy scores signal a subjective understanding of empathy by medical students. The disparities in understanding may encourage medical educators to embed empathy in standard medical curricula for better healthcare outcomes.

WP5.19 - The undifferentiated general surgical take over 10 years: admissions

Abstract Aims The aim of this study is to review the undifferentiated emergency general surgical take, with regards to admissions in July 2013 and July 2023, at a District General Hospital in order to understand the specific pressures on the department and to identify areas in which we could adapt to facilitate these demands. Methods Retrospective data regarding admission and re-admission on all patients treated by the emergency general surgical team in July 2013 and July 2023 was collected from electronic notes. If insufficient information was available, patients were excluded from analysis. Results Patient numbers increased by 50% from 2013 to 2023, from 395 to 594. Average length of stay in 2013 was 3.26 days (+/-0.2, p = 0.03), reducing to 2.58 days (+/-0.2, p = 0.03) in 2023. Number of patients admitted overnight has decreased from 74% (n=291/395) in 2013, to 54% (n=324/594) in 2023. Proportion of referrals from ED increased from 48% in 2013, to 69% in 2023. Planned reviews and patients ambulated for surgery the following day has increased from 4% of all patients seen in 2013, to 16% in 2023. Conclusions Volume of patients has increased significantly over this 10-year period. Simultaneously, duration and number of overnight admissions have decreased, alongside increasing use of ambulatory services. This reflects the aims of the Government, and the Royal College of Surgeons, with increasing investment in day-case and ambulatory services. However, without an increase in hospital bed numbers, the rising volume of patients may become difficult to manage.

Practices of Informed Written Consent for Elective Urological Procedures at a Tertiary Care Hospital in Sudan.

Objective This study aimed to assess informed consent practices in elective urological surgeries at a tertiary care facility. Materials and methods A retrospective cross-sectional survey was carried out between March 1, 2023and April 1, 2023, at the Department of Urology, Omdurman Military Hospital, Sudan. We included all patients who had undergone elective urological procedures under local, spinal, or general anesthesia. The medical records were accessed to analyze the consent forms' standards. A total of 42 consent forms were included and analyzed. We use the General Medical Council's (GMC) Guidance on Professional Standards and Ethics for Doctors: Decision Making and Consent, and the Royal College of Surgeons (RCS) of England's Consent: Supported Decision-Makingas the standard for our study. The GMC and the RCS of England have provided comprehensive and standardized guidelines for obtaining informed written consent, including indications, benefits, risks involved, and alternatives in addition to demographics, patient details, responsible consultant, diagnosis, and title of the surgery, intended benefits, probable risks, type of anesthesia, consenting doctor's name, designation, and signature, and the patient's signature and name. Results A total of 42 consent forms were included. The diagnosis and the intended surgical procedure were mentioned in all consents. The potential benefits and risks were discussed in 36 (85.7%) and 18 (42.9%) cases, respectively. The type of anesthesia was discussed in 39 (92.9%) of cases. The likely result of not having the procedure and the alternative treatment: Recorded completion rates of 10 (23.8%) and 12 (28.6%), respectively. Patient demographics were completely documented in 41 (97.6%) forms. Senior doctors were only involved in 14 (33.3%) of the consents. Details of the consenting doctor, including name, title, and signature, were present in 30 cases (71.4%), and the date of signing the consent was documented in 38 cases (90.5%). The completeness of the consent form correlated with the level of the doctor obtaining it, with consultants achieving the highest completion rates (100%), followed by registrars (66.7%) and medical officers (35.7%). Conclusion The current practices of informed consent were found to be substandard. Handwritten consent forms do not adhere to the recommended guidelines for informed consent in elective urological procedures. It is preferable to utilize a pre-designed consent form, allowing for personalized additions based on the patient's specifics. Our recommendation is to organize an educational session for junior doctors to emphasize proper consent procedures, and deepen their knowledge of common urological elective procedures, and associated risks. This approach promotes adherence to best clinical practices and minimizes the risk of legal challenges.

Effects of ECM protein-coated surfaces on the generation of retinal pigment epithelium cells differentiated from human pluripotent stem cells.

Retinal degeneration diseases, such as age-related macular degeneration (AMD) and retinitis pigmentosa (RP), initially manifest as dysfunction or death of the retinal pigment epithelium (RPE). Subretinal transplantation of human pluripotent stem cell (hPSC)-derived RPE cells has emerged as a potential therapy for retinal degeneration. However, RPE cells differentiated from hPSCs using current protocols are xeno-containing and are rarely applied in clinical trials. The development of hPSC-derived RPE cell differentiation protocols using xeno-free biomaterials is urgently needed for clinical applications. In this study, two protocols (the activin A and NIC84 protocols) were selected for modification and use in the differentiation of hiPSCs into RPE cells; the chetomin concentration was gradually increased to achieve high differentiation efficiency of RPE cells. The xeno-free extracellular matrix (ECM) proteins, laminin-511, laminin-521 and recombinant vitronectin, were selected as plate-coating substrates, and a Matrigel (xeno-containing ECM)-coated surface was used as a positive control. Healthy, mature hPSC-derived RPE cells were transplanted into 21-day-old Royal College of Surgeons (RCS) rats, a model of retinal degeneration disease. The visual function of RCS rats was evaluated by optomotor response (qOMR) and electroretinography after transplantation of hPSC-derived RPE cells. Our study demonstrated that hPSCs can be efficiently differentiated into RPE cells on LN521-coated dishes using the NIC84 protocol, and that subretinal transplantation of the cell suspensions can delay the progression of vision loss in RCS rats.

Patient’s Perception of the Role of Gym Activity in Abdominal Wall Herniation in Adults: A Prospective Study

BackgroundDespite significant changes in healthcare, work practices, and leisure activity, the proposed precipitating factors for abdominal wall hernias have remained largely unchanged for almost two centuries. We aimed to investigate if there have been shifts in these factors over time by examining patients’ perception of precipitating factors for abdominal wall hernia development. This study was conducted in the Royal College of Surgeons In Ireland Department of Surgery, Connolly Hospital, Blanchardstown, Dublin, where patients with abdominal wall hernias completed a questionnaire .ResultsA total of 277 patients (mean age 55.7; 85.6% male) with abdominal wall hernia completed the questionnaire (66.1% inguinal; 10.8% umbilical; 6.9% paraumbilical; 10.5% epigastric; 3.2% incisional; 1.4% femoral, and 1.1% port-site). One hundred and twenty patients (43.3%) believed their hernia was due to lifting, 71 (25.6%) cited gym activity and 17 (6.1%) cited other sporting activities as the precipitating factor. Traditional factors – chronic cough and constipation - were cumulatively cited only by 11 patients (4.0%), while prostatic obstruction was not cited by any.ConclusionThis study suggests that fitness pursuits may be an increasing contributor to the development of abdominal wall hernia. Greater attention should be paid to the proper use of gym equipment to minimise the risk of hernia development.

A Study in Wad Madani, Sudan: Are We Documenting Operation Notes Effectively?

Operative notes represent the critical record of a surgical procedure, encompassing comprehensive details encountered throughout the operation. Recognizing the importance of comprehensive documentation, the Royal College of Surgeons (RCS) developed the Good Surgical Practice guidelines, which emphasize accurately recording every procedure and specifying the necessary parameters for each operative note. These guidelines help maintain high standards of surgical care and patient safety. A retrospective review of 88 orthopaedic surgery operative notes for fracture neck of femurs was conducted at Gezira Centre for Orthopedic Surgery and Traumatology (GCOST) from March 12 to May 28, 2022. The review assessed 18 parameters against RCS guidelines.Statistical analysis was performed using Statistical Product and Service Solutions (SPSS,version 25.0; IBM SPSS Statistics for Windows, Armonk, NY), which facilitated comprehensive data examination. In 37 cases (42.05%), the operation notes were written by a medical officer. In 29 cases (32.95%), an orthopaedic resident authored the notes. A specialist documented the notes in 21 cases (23.86%), and a consultant wrote the notes in one case (1.14%). Over 90% of the notes included surgeon and assistant names, procedure names, operative diagnoses, operative procedures, prosthesis details, deep vein thrombosis (DVT) and antibiotic prophylaxis, and signatures. The name of the theatre anaesthetist, elective/emergency details, and additional procedures with reasons were absent in all notes. Less than 50% of the notes documented the time of the procedure, type of incision, operative findings, anticipated blood loss, closure technique specifics, and complications. The study emphasizes the shortcomings in the operating notes, underscoring the necessity for training initiatives to enhance the recording by medical officers and orthopaedic trainees. Implementing structured templates that adhere to RCS standards can improve the comprehensiveness and consistency of operating notes, effectively resolving existing discrepancies. Regular audits and feedback sessions are essential for identifying and rectifying persistent issues. It is recommended to arrange workshops and seminars to educate medical officials and trainees on the skills of efficient note-taking and thorough documentation procedures.

Graduate and Undergraduate Medical Curricula That Address the Needs of People Who Experience Homelessness: A Scoping Review Protocol

Background The impact that increased homelessness has on the healthcare system should be of great concern to medical providers and the institutions that train them. While the demand for medical providers who understand the healthcare needs of homeless individuals is high, traditional medical curricula do not adequately address this. Objectives This scoping review aims to examine published undergraduate and graduate medical curricula that address the healthcare needs of homeless individuals to support the development and evaluation of homeless healthcare curricula globally. Methods This paper will utilise Arksey &amp; O’Malley’s framework for scoping reviews to ensure a systematic scoping review. Research will be conducted in accordance with the Joanna Briggs Institute's (JBI) Updated Methodological Guidance for the Conduct of Scoping Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Review (PRISMA-ScR). Due to financial and time constraints, only articles published after 2000 and written in English will be reviewed. A comprehensive search strategy will be developed that includes searches in PubMed, Scopus, Embase and CINAHL with additional hand-searching of key articles. Each article will be screened independently by two reviewers. A third reviewer will resolve any disagreements. Data extraction will begin with a pre-defined extraction form (Extended Data File 3) and will be subsequently analysed with JBI’s current guidelines on inductive approaches to qualitative content analysis. Conclusion Research findings will be distributed to individuals who oversee the university’s medical curricula at the Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences. Discussions will be held to assess opportunities for the implementation/integration of homeless healthcare curricula. Furthermore, these findings will be disseminated globally to healthcare providers and administrators at conferences, hospitals and clinics.