Reshma Bharamgoudar and Aniket Sonsale are final year medical students at the University of Birmingham, with a keen interest in improving healthcare deliveryrnand optimising organisational performance. James Hodson is an experienced statistician at University Hospitals Birmingham (UHB) with previous experience inrnthe CholeS dataset as well as expertise in producing various scoring tools. Mr Griffiths is a Consultant Upper GI Surgeon at UHB with a passion for research andrnimproving care quality. He has published extensively in this field and is a widely respected surgeon.

Background: The ability to consistently predict operative duration can revolutionise patient care and staff satisfaction whilstrnoptimising theatre efficiency and utilisation, thus reducing costs. With laparoscopic cholecystectomies being one of the mostrncommonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcarernorganisations.rnMethods: Data collected on patients undergoing cholecystectomy in acute UK and Irish hospitals between 03/2014 andrn05/2014 formed the CholeS dataset, which was used as the basis for duration prediction. Data were evaluated to assess the effectrnof age, gender, BMI, ASA and results of any pre-operative imaging on operative duration. A binary logistic regression modelrnwas produced, with a forwards stepwise approach used to select variables for inclusion. The resulting model was converted torna risk score and its predictive accuracy was assessed using ROC curves. The model also applied to a second cohort of patientsrnfor external validation.rnResults: After exclusions, data were available for 7,227 surgeries in the derivation (CholeS) cohort. The risk score was thenrnapplied to a cohort of N=2,405 patients from a tertiary centre for external validation. This cohort had a similar operativernduration to the derivations cohort, with a median of 66 minutes (IQR: 52-85), and 20% (N=481) of operations taking >90rnminutes. The score as a whole had a similar degree of predictive accuracy to that observed in the derivation cohort. ASA wasrna significant predictor of duration and all other factors but gender (p=0.480) and planned intra-op cholangiogram (p=0.306)rnwere found to be significantly predictive of operative duration.rnConclusion: Through validating the score using a large and comparable cohort, this tool has shown to have the potential tornenable organisations to better organise theatre lists and deliver greater efficiencies in care.

Sujen Jayakody is a current surgical registrar at Westmead Hospital. He was the Mary Jo Reeve Endocrine Surgery Fellow at Royal North Shore Hospital, Australiarnin 2016 where he has developed his research interests in Endocrine Surgery.

The incidence of thyroid cancer has been increasing globally over the last few decades. A significant part of this rise is duernto the increase in detection of papillary thyroid carcinoma. Whilst improved diagnostic techniques are thought to bernthe main reason for this rise, the overall picture however is more complex. Concurrent to rising incidence, survival rates arernimproving and mortality rates have remained the same. Research reports geographical variation and multi-factorial causes forrnthe epidemiological trends. However there is minimal data on incidence rates in Australia and the effect of tumour size onrnincident trends. This study presents unique data on thyroid cancer over a 20-year period at a NSW tertiary institution - thernUniversity of Sydney Endocrine Surgical Unit. Our aim is to add to current research knowledge by reviewing our data andrnexamining thyroid cancer incidence and survival outcomes in relation to tumour size. Univariate analyses were performed tornexplore the effects of age, sex, tumour size, vascular invasion and lymph node metastasis. Kaplan-Meir survival curves werernproduced to examine survival rates and multivariate Cox regression was performed to identify independent prognostic factors.rnWe found that 49% of new papillary thyroid cancers were due to papillary micro carcinomas, however there was a significantrnincrease in papillary carcinomas greater than 20mm. Overall survival rates were lower than anticipated however mortalityrnrates were presumed to have fallen. We also found that genetic status in medullary thyroid carcinoma directly affected overallrnsurvival. Further research in thyroid cancer incidence should focus on mortality rates and TNM staging. The reasons for therntrue rise in incidence rates should also be studied. Advances in genetic testing are important in identifying at risk individualsrnfor medullary thyroid cancer.

Francesca Cuzzocrea has her expertise in evaluation and improving the health and wellbeing. More specifically she has involved in the educational field with\r\nparticular reference behavioural analysis. She has, therefore, designed and built some parent training of parents of disabled people and families at risk. In\r\ncooperation with the Pediatric Surgery Unit of University Hospital of Messina directed by Prof. Carmelo Romeo, Prof. Larcan and Prof. Cuzzocrea verify the efficacy\r\nof this psychological support to ensure continuous improvement in hospital practices, always with the main aim of reducing the emotional distress and promoting\r\nthe welfare of children and parents. For these reasons, they have also developed a specific interest in “Paediatric interventions” to guarantee well-being in typically\r\nand untypically child development and to prevent behavioural problems through the parent education.

A Psychological program for surgery preparation, in which young patients were informed and prepared to surgical\r\nprocedures in a manner appropriate to their age, was very efficacy on enhancement of coping strategies (1). Children’s\r\nAnxiety is related to the presence of parents in the hospitalization period (2). This is particularly evident when parents are\r\nthemselves anxious (3-4). The purpose of this study is to evaluate the effectiveness of a psychological preparation to reduce\r\nanxiety of patients and their mothers and to support children’s compliance to anesthetic induction. Methodology & Theoretical\r\nOrientation: Fifty children and their mothers were selected. Half of them followed psychological program during all surgical\r\nphases, with the other half did not receive any psychological support. Child anxiety was assessed using mYPAS; compliant\r\nbehaviors with Induction Compliance Checklist; mothers’ anxiety with Amsterdam Pre-Operative Anxiety and Information\r\nScale. Children and mothers watched a puppet show representing interactive story (created ad hoc) of teddy bear Benny: this\r\nstory not only traces in a playful way the most important moments of the surgical iter, but also gives to children and their\r\nmothers some suggestions to address them properly and improve their own coping strategies (5). Findings: Children of the\r\nfirst group were less anxious and more cooperative in hospitalization period and during anesthesia induction than others. The\r\nprogram was also more efficient in reducing mothers’ anxiety. Finally, mothers of the group 1 have highly evaluated the program.\r\nConclusion & Significance: Preparing children through playful dramatization of the operative procedure, manipulation of\r\nmedical instruments and psychologist’s support may be useful in pediatric surgery structures. Starting from this experience a\r\ncartoon was realized and at the moment an experimentation study is carrying out. We want verify if giving information about\r\nthe main phases of hospitalization can reduce anxiety even in absence of psychologists.

Nahla K Gaballa Assistant Lecturer of Anesthesia has her expertise by working in National Liver Institute Hospital for 10 years, attending 200 cases of living donor\r\ntransplant, interested in pain in cirrhotic patients, has the desire to add a smile and quality of life of chronic patients; to observe the drug effect on metabolic monitor\r\nin stages of transplant as a tool for protection of reperfusion injury.

Statement of the Problem: Dexmedetomidine a novel selective α2 anesthetic agent currently used in hepatic patients may\r\nprovide more hemodynamic stability. It decreases oxygen consumption(VO2), carbon dioxide production(VCO2) and energy\r\nexpenditure(EE). As the increase in whole body oxygen consumption occurs after reperfusion may reflect oxygen uptake by\r\nthe graft. We suggest that we may benefit from suppressing effect of DEX on whole metabolism which may be reflected in graft\r\nmetabolism specially in critical phases (anhepatic, reperfusion).\r\nPurpose: The purpose is to study the Effect of continuous infusion of Dexamedetomedine on preoperative indirect gas\r\ncalorimetry monitoring on recipients of liver transplantation.\r\nMethodology & Theoretical Orientation: After ethical committee approval, Pan African Clinical Trial Registry (PACTR\r\n201402000776978) and consent approval 40 patients were categorized to: Dex (n=20) beginning at 0.5 micg/kg/h (0.2-0.7μg/\r\nkg/h) and placebo C(n=20) after induction till extubation. Anesthesia was guided by entropy (40-60) with desflurane. Indirect\r\ncalorimetry parameters (VO2, VCO2, EE, RQ), arterial blood gasses, hemodynamics were taken at base line, dissection,\r\nanhepatic, reperfusion and 3 hours after end of operation. Trans esophageal Doppler (TED) was used for fluid optimization.\r\nFindings: Dexmedetomidine decreases indirect calorimetry readings in general in comparison to control group specially at\r\nreperfusion and extending for hours after that, avoiding bolus and infusion at 0.5 may not affect hemodynamic stability, nonsignificant\r\ndifference between groups regarding fluids, inotropic support and I.C.U stay.\r\nConclusion & Significance: Dexmedetomidine has a depressing effect on indirect calorimetry with no major adverse effects\r\non hemodynamics. This may be used as a tool for protection from reperfusion injury.