bluuebunny/crossref_metadata_2025 huggingface dataset:
P31 Cauda equina syndrome – the importance of an early, accurate diagnosis and treatment in preventing bladder dysfunction
Authors: Porter Victoria Amy
Published: April 2021

Introduction

Cauda Equina Syndrome (CES), is a neurological emergency with many urological features. Delayed decompressive surgery can cause urinary retention, overflow incontinence, long term catherization and loss of sexual function. This article focusses on the accuracy of the initial diagnosis and the time taken before treatment is commenced.

Methods

In this systematic literature review, OneSearch and PubMed have been searched for articles which identify the main symptoms of CES, evaluate the effectiveness of several diagnostic methods and compare the postoperative results of bladder function following timely and delayed treatment.

Results

A total of 20 articles have been referenced, of which 9 studies have been reviewed. While no individual symptom is 100% indicative of CES, urinary retention (diagnostic accuracy 0.9), is the most consistent clinical finding. Therefore, MRI is necessary for an accurate diagnosis. Further 4 out of 5 studies state that treatment within 24-hours improves patient outcomes compared to 48-hours, one study showed no significant difference between 24 and 48 hours. All articles indicate beyond 48-hours, surgical intervention has little impact on the relief of symptoms.

Conclusion

The studies concluded that any patient presenting in the emergency department with lower back pain should be screened for CES. A thorough history and neurological examination should be performed; however, the evidence base for rectal examination to assess anal tone is poor. Decompressive surgery carried out within the first 24-hour period from the onset of symptoms is favourable. Overall, early accurate diagnosis and treatment is invaluable to preventing urological complications and improving prognosis.
P37 COVID-19 and non-emergency cancer operating: Implementing a successful testing system
Authors: Tomlinson Ashley , Kelliher Leigh , Jones Chris
Published: April 2021

Introduction

Early evidence has demonstrated poor peri-operative outcomes for patients undergoing cancer surgery with COVID-19 (C-19) . As a tertiary cancer centre, offering major oesophageal and hepatobiliary surgery we were concerned on how the C-19 pandemic would affect our patients. Elective operating was split between our trust and a local private provider as a “clean” site; and an official trust C-19 screening programme started on 24th April.

Methods

Retrospectively the electronic theatre record was searched for patients undergoing a non-emergency cancer operation between March & May 2020. The data was cross-referenced with investigations and mortality to ascertain swab results (pre-operatively and 30 days postoperatively) and mortality.

Results

During the 3 months at the height of the pandemic 596 non-emergency cancer operations took place, (compared with 986 in the same time-frame from 2019). In March 6 of 281, April 98 of 141 and May 166 of 175 patients undergoing an operation had a pre-operative swab, with only 6 screening swabs positive (5 in April, 1 in May).

In total 4 patients died, only 1 had a positive C-19 test (patient had not been screened pre-operatively).

Conclusion

Non-emergency cancer surgery was impacted but Screening was successfully implemented in April and by May 95% of patients underwent testing. Six patients were tested positive post-operatively with only one deceased which appears to show a lower mortality rate than currently quoted within the literature. This adds further evidence that with comprehensive screening, cancer surgery can safely take place during a pandemic.
P50 Exploring the Merits and Availability of Smartphone Applications Related to Melanoma
Authors: Kabbani Jade , Kabbani Jamil
Published: April 2021

Background

The increased use of smartphone applications across healthcare specialties has been particularly relevant in dermatology, with dermatology related applications widely available on mainstream application stores. We reviewed published literature regarding melanoma-related applications, and the number and types of such applications available for download.

Methods

A literature search of “dermatology”, “smartphone” and “melanoma” was conducted to identify publications assessing applications of interest. “Melanoma” was searched in Apple’s (iOS) “App Store” and Google’s “Google Play”, and application purposes and ratings were analysed.

Results

54 of the 63 literature search results explored smartphone use in relation to melanoma, describing benefits including quicker patient access to care, reduced referrals and hence unnecessary consultations, and improved accessibility to information. However, concerns include insufficient image quality, privacy issues related to encryption, and diagnostic inaccuracy. Searches on the Google Play and iOS stores identified 249 and 51 apps respectively. 25% of Google Play results were categorised as clinical tools, 17% as educational, and 58% as recreational. The corresponding results for the App store were 92%, 6% and 2%. 81% of the educational apps and 92% of the clinical management apps related to dermatology and melanoma on Google Play, whereas all of the clinical management apps and 67% of the education apps on the App store were of relevance.

Conclusion

The results illustrate the widespread availability of applications related to melanoma, particularly for educational and clinical purposes. Standardising photographing techniques, improving diagnostic accuracy, and privacy issues are important aspects to consider and warrant further investigation.
P52 Feasibility of “The Defect Study”: Neonatal diaphragmatic defect measurement and repair techniques in Congenital Diaphragmatic Hernia
Authors:   Paediatric Surgery Trainee Research Network, Eastwood M P , Bethell G , Rooney A , Arthur F , Harwood R
Published: April 2021

Introduction

Defect size and closure technique in neonates with congenital diaphragmatic hernia (CDH) has long term consequences for morbidity in survivors. Although subjective operative reporting of defect size has been standardised, objective evaluation is lacking. There is no reported optimum closure technique related to size and position of diaphragmatic defect. We aimed to objectively describe diaphragmatic defects and repair methods at the time of neonatal CDH repair.

Methods

A national, three centre cohort feasibility study was undertaken over a 4-month period. Data collection was registered as service evaluation at participating centres. All surviving neonates with CDH undergoing defect closure were eligible. Anonymised data were collected using a RedCAP database. Data collection variables (n = 47) included both antenatal and postnatal measures. Data were checked for normality and reported as mean±SD or median (IQR).

Results

12 neonates were eligible for inclusion, 10 (83%) were included. Observed/Expected Lung Head Ratio (%) was reported in 5 cases (45±8), neonates were term, male (60%), birth weight (3.3±0.5kg). 80% of patients had a laparotomy, 80% had a left-sided defect, 60% a patch repair with PTFE and 60% graded defect size C. Poorly reported variables included pre-operative oxygenation and defect size was measured in 30%.

Discussion

Data collection through RedCAP was feasible and most variables were documented. Simplifying the intraoperative data collection form and providing clear instructions for taking measurements may improve reporting. A further pilot study with these modifications and improving engagement through advertisement, emails and online presence is intended to optimize the study before roll-out.
P57 Global recruitment for the RESECT study (transurethral REsection and Single-instillation intravesical chemotherapy Evaluation in bladder Cancer Treatment) - an international observational cohort study aiming to improve the quality of surgery for non-muscle invasive bladder cancer
Authors: Lam C M , Gallagher K , Bhatt N , Clement K , Zimmermann E , Shah T , Khadhouri S , Kulkarni M , Gao C , Light A , Jayaraajan K , Asif A , Anbarasan T , Chan V , Kasivisvanathan V
Published: April 2021

Introduction

Non-muscle invasive bladder cancer (NMIBC) is one of the most expensive cancers to treat, driven by high recurrence rates and disease progression. Mortality rates in the UK for all bladder cancers have remained relatively stable over the past decade. NMIBC can be curatively treated with transurethral resection of the bladder tumour (TURBT). Despite international evidence-based guidelines on the TURBT procedure and postoperative single instillation of mitomycin-C, TURBT quality continues to vary widely. RESECT will be the first ever international study of TURBT surgery evaluating the achievement of TURBT quality indicators globally and assessing if audit and performance feedback can improve surgical outcomes.

Methods

RESECT is a prospective, multicentre international observational cohort study. Collaborators at each site will collect data using REDCap about local TURBT practice, early recurrence rates and the experience of local TURBT surgeons. The primary outcome is the rate of achievement of key TURBT quality indicators. Advertisement for the study launched in 2020.

Results

As of October 1st, 2020, 524 collaborators have registered to participate. Collaborators represent 334 centres from 54 countries, with the highest number of centres from the United Kingdom (133), Spain (17), and India (16). 50.8% are trainees, 30.3% consultants, and 17.2% medical students. Based on current registrations, patient recruitment will far exceed initial projections and considerably improve statistical power.

Conclusion

RESECT has attracted many collaborators internationally from consultants and trainees at all stages. RESECT has significant potential to positively impact TURBT practice, health economics and ultimately improve outcomes for patients with NMIBC globally.
P58 Head Injury CT scan: measuring up to NICE guidelines
Authors: Ghalab Ahmed , Tariq Munim , Akram Rahim , Ikwuagwu Allen
Published: April 2021

Introduction

Head injury is the most common cause of death and disability in individuals between 1-40 years in the UK, with roughly 200,000 annual admissions. The aim is to evaluate how effectively CT scans following a head injury are being performed with reference to NICE guidelines 1-hour criteria1 as patient’s prognosis could potentially be improved with early detection.

Standards

Methods

Results First cycle

Second cycle

Conclusion

About only half of the patients presenting with the risk factors got their scan done in line with NICE guidelines. Following change of ICE to include criteria patients were better categorized, eliminating any unnecessary scans, reducing waiting times and cost, improving patient flow in ED and all scans are now justifiable according to criteria.

References

1-National Institute for Health and Clinical Excellence. CG176. Head Injury: assessment and early management. London. January 2014. https://www.nice.org.uk/guidance/cg176: 2-irefer. The Royal College of Radiologists. Making the best use of clinical radiology services 8th edition. 2017 https://www.rcr.ac.uk/sso/irefer/v8: 3-https://www.rcr.ac.uk/audit/compliance-nice-guidelines-2014-traumatic-head-injury-regard-ct
P59 How COVID-19 influenced UK Burns Services: a national multicentred audit
Authors: Yoshimura Ryo , Phillips Georgina , Wormald Justin , Collins Declan
Published: April 2021

Introduction

COVID-19 has affected national guidelines and availability of resources, resulting in different approaches to treating burns. This project aimed to identify changes to burns management in the UK during the “first wave” of COVID-19, and how the lessons learned can be applied to the current “second wave”.

Methods

Between 11th July-15th September, 18 burns services across the UK completed a MDT survey and contributed data on service evaluation. The MDT survey captured perspectives of multiple stakeholders and included changes to burns services, disruptions to supply chain, and service improvements resulting from COVID-19. Service evaluation data was collected retrospectively and prospectively on patients who received inpatient/outpatient treatment during COVID-19. Patients in the retrospective cohort were first seen by burns services between 6th-30th April (coinciding with the UK’s COVID-19 peak), and the prospective cohort were first seen between 30th April-15th September. Each cohort consisted of 10-20 patients per burns service. Service evaluation covered key areas of burns aetiology, referral pathway changes, patient presentation delays to tertiary services, patient management decisions, and outpatient dressing clinic management. Data from the MDT survey and the service evaluation were analysed by descriptive statistics and thematic analysis.

Results

The changes to burns services include delays in burn referrals, increase in conservative management, and increased use of telemedicine.

Conclusion

Across the UK, safe and effective burns care continued to be delivered despite difficulties from the pandemic. We hope the learning points identified in this study will be of use during the “second wave” of the pandemic.
P63 Improving cervical smear uptake through an Automated Voice Messages Reminder
Authors: Bladt Francesca , Wong Felyx
Published: April 2021

National cervical screening programs have played a pivotal role in the prevention of cervical cancer. However, practices across the UK have reached an all-time low in cervical screening uptake. This study aimed to assess the efficacy of implementing an automated voice message reminder within the local general practice (GP) telephone triage system and explore the reasons which deter eligible patients away from cervical screening.

A 20-second voice-message reminder in the telephone queue was played, addressing key risk factors along with a message from a child who lost his mother to cervical cancer. From the anonymised GP database, weekly new smear test bookings were monitored from 4 weeks prior until 2 weeks after the intervention was implemented. To qualitatively assess factors which deter patients away from screening, female patients were randomly sampled to fill in an anonymous questionnaire.

The use of a low-cost 20 second voice message in the telephone queue across UK GP practices could be an effective method to increase cervical smear test coverage towards the national target of 80%.

35 questionnaire responses were received, main themes reported for not attending screening include embarrassment(37%), busy schedule(32%) and cultural differences(24%). In the week following the intervention, cervical smear tests increased more than 2-fold, from an average of 12 to 26 smears per week. This could be partly due to the convenient timing of voice recording, reminding them to book both appointments simultaneously and the child’s emotive message.
P70 Investigating the current state of practice for reporting on surgeon's learning and the learning curve in IDEAL studies of surgical innovation: A systematic review
Authors: Shah Max , Alford Natasha , Mutanga Ian , Hudson Elizabeth
Published: April 2021

Introduction

Community learning is a key component for the progression of surgical innovation, which is itself crucial to advancing surgical practice. Assessment of learning curve’s (LCs) allow rigorous evaluation of new surgical procedures/devices and their introduction into clinical practice. The Idea–Development–Exploration–Assessment–Long-term (IDEAL) framework provides recommendations for the evaluation of new surgical procedures and devices throughout the stages of innovation. This study aimed to identify the current reporting practice of LCs in IDEAL studies.

Methods

A systematic review was conducted to identify author-reported IDEAL/IDEAL-D studies of any IDEAL stage and surgical specialty. Included were primary studies citing any of 10 key IDEAL papers. Data were extracted including information relating to surgeons’ experience and training, support and performance monitoring, and methods for measuring and assessing the LC.

Results

Searches yielded 1411 publications, of which 59 studies met the eligibility criteria. Some 31/59 (53%) studies reported information on the LC, however, only 3 (5%) studies measured or reported on LC in detail. These 3 papers included statistical methods (cumulative sum control charts, Shewhart control charts and multivariate analysis). Some 21/59 (36%) studies reported training for surgeons and 16 (27%) reported support or performance monitoring.

Conclusion

Reporting of the LC or factors influencing LC such as training, was found to be poor in the included studies. Development of more detailed guidance for measuring and reporting the LC in future studies is recommended to facilitate robust evaluation of new surgical procedures and devices.
P75 Long-Term Survival After Minimally Invasive Resection versus Open Resection for Hepatocellular Carcinoma: A Systematic Review, Meta-Analysis and Meta-Regression
Authors: Gujjuri Rohan R , Kamarajah Sivesh K , Hilal Moh’d Abu , Manas Derek M , White Steven A
Published: April 2021

Introduction

Minimally invasive liver surgery (MILS) for hepatocellular carcinoma (HCC) has gained widespread interest as an alternative to conventional open liver surgery (OLS). However, long-term survival benefits of this approach seem unclear. This meta- analysis was conducted to investigate long-term survival following MILS.

Methods

A systematic review was performed to identify studies comparing long-term survival after MILS and OLS until January 2020. The I2 test was used to test for statistical heterogeneity and publication bias was assessed using Egger test. Random-effects meta-analysis was performed for all-cause 5-year (main outcome) and 3-year mortality, and disease-specific 5-year and 3-year mortality. Meta-regression was performed for the 5-year and 3-year survival outcomes with adjustment for study factors (region, design), annual center volume, patient factors (ASA grade, gender, age, BMI, cirrhosis, tumor size and number), and resection extent. Sensitivity analyses were performed on studies by study year, region, annual centre volume, resection type.

Results

The review identified 50 relevant studies including 13,731 patients undergoing liver resection for HCC of which 4,071 (25.8%) underwent MILS. Pooled analysis revealed similar all-cause (OR: 0.83, 95% CI: 0.70 - 1.11, p = 0.3) and disease-specific (OR: 0.93, 95% CI: 0.80 - 1.09, p = 0.4) 5-year mortality after MILS compared with OLS. Sensitivity analysis of published studies from 2010 to 2019 demonstrated a significantly lower disease-specific 3-year mortality (OR 0.75, 95% CI: 0.59 - 0.96, p = 0.022) and all cause 5-year mortality (OR 0.63, 95% CI: 0.50 - 0.81, p = 0.002). Meta- regression identified no confounding factors in all analyses.

Conclusions

Improvement in MILS techniques over the past decade appears to demonstrate superior disease-specific mortality with MILS compared to OLS. Therefore, MILS can be recommended as a standard surgical approach for HCC.
P87 Paradigms about the COVID-19 pandemic: knowledge, attitudes and practices from medical students
Authors: Lincango-Naranjo Eddy , Solis-Pazmino Paola
Published: April 2021

Introduction

As new coronavirus has spread globally, economic instability in healthcare systems has been significant. This reality is especially accentuated in Ecuador where, the shortage of healthcare workers combined with cultural and macroeconomic factors have led it to face the most aggressive outbreak in Latin America. In this context, the participation of medical students on the front line is indispensable. Appropriate training on COVID-19 is an urgent need that universities and health systems must guarantee. We aimed to describe the knowledge, attitudes and practices in Ecuadorian final year medical students in order to identify the knowledge gaps, perceptions and behavior patterns which could guide the desig3n of better medical education curricula regarding COVID-19.

Methods

This descriptive 33-item online survey conducted between April 6 to April 20 sent by email and by Facebook and WhatsApp.

Results

309 students responded to the survey. 88% scored high (≥ 70% correct) for knowledge of the disease. The majority of students were pessimistic about possible government actions, which is reflected in the negative attitude towards the control of COVID19 in Ecuador and volunteering during the outbreak (77%, and 58% of the students, respectively). Moreover, 91% of students said they did not have adequate protective equipment or training in their health facilities.

Conclusions

Ecuador has a capable upcoming workforce that could benefit from an opportunity to strengthen, improve and advance their training in preparation for COVID-19. Creating a national curriculum may be one of the most effective ways for all students to be trained, while simultaneously focusing on the students’ most pressing concerns.
P91 Phyllodes Tumours: Looking for Predictive Features from Multidisciplinary Assessments
Authors: Kandiyil Aneeshya , Guan Yue
Published: April 2021

Introduction

The breast triple assessment enables rapid evaluation of breast abnormalities. Lesions are assessed via the assessments based on clinical examination, imaging and histological sampling. Fibroepithelial lesions (FELs) are amongst the most common breast lesions of uncertain malignant potential. They encompass a spectrum of entities ranging from benign fibroadenomas (FA) to malignant phyllodes tumours (PT), with contrasting clinical management approaches. Unfortunately, the distinction between various FELs is often difficult, despite recent diagnostic advances. This is especially so between FAs and PTs. Nevertheless, understanding how to prioritise key characteristics of PTs, both radiologically and histologically may ease this challenge. In our opinion, a multidisciplinary approach including radiological input is probably the most helpful in reaching an accurate diagnosis.

Methods

We, retrospectively studied data from breast lesions which were initially diagnosed pre-operatively as R3/B3 FELs, and those with a final diagnosis of PT on excision. 71 suitable cases were identified from 2009 to 2019. Information was extracted from reports made by specialists at the pre-operative and post-excision stages. Statistical analysis will be applied to quantify the significance of features evaluated.

Results

Preliminary results suggest diagnoses made by pathologists on pre-operative samples correlated well with the eventual final diagnosis made on post-operative specimens. Adequate sampling appears to be a significant factor in influencing the pre-operative core biopsy diagnosis.

Conclusion

We anticipate to acquire a comprehensive knowledge of various predictive features of PTs, and the correlation between the key radiological features, thereby allowing accurate pre-operative diagnosis of these interesting and challenging lesions.
P98 Quality Improvement Project: Improving documentation and junior doctor confidence on COVID-19 ward rounds using a ward round pro forma
Authors: Brown Niall , Horne Joseph , Low Andrew
Published: April 2021

Introduction.

Templates and checklists have improved patient outcomes in multiple settings.1,2 There are barriers in junior doctors scribing complete entries using blank sheets; patient care might suffer due to incomplete records. This project implemented a ward round pro-forma across three wards of a tertiary hospital containing high risk COVID-19 patients, aiming to improve both documentation rates and subsequent ease in finding pertinent information.

Methods.

Respiratory consultants determined 11 key parameters that should be documented daily for COVID-19 patients.

Baseline objective data collection analysed all high-care ward round entries (n = 15), recording parameters as present or absent. Multidisciplinary team (MDT) opinions were collected via questionnaire. The pro-forma was trialled for two-weeks; repeated subjective and objective analysis was performed. All (n = 12) inpatient notes on the COVID-19 high-care ward were analysed.

Results/Discussion.

Pro-forma compliance was 100%. The mean number of key parameters documented per ward round entry increased by 80%, from 5 to 9. Eleven (100%) of the key parameters showed increased completion rates (fig.1). Junior doctor confidence increased 1-Likert point: ‘average’ to ‘confident’ (fig.2). 97% of respondents (n = 31) reported the pro forma saved time. Information finding and swab tracking both increased by 1-Likert point: ‘average’ to ‘easy’ (fig.2). From a medico-legal perspective, documentation of basic information (date, time) improved by 13%. This project shows not only a 60% increase in ceiling of care documentation, but also improved ease in accessing such information.

Conclusion.

This pro-forma is a simple and acceptable intervention to improve documentation rates and information accessibility, giving junior doctors more confidence.
P101 Remote risk stratification of dyspnoea in acute respiratory disorders and applications for COVID-19 and future pandemics: a systematic review of the literature
Authors: Dominic Catherine , Khare Yuti , Ponnapalli Anuradha , Ganesh Shivani , Bhalla Gaurav , Gokani Shyam
Published: April 2021

Background

Due to the highly infectious nature of the disease, a large amount of community-based triage of COVID-19 is performed by video/telephone consultation, especially in primary care. This presented clinicians with a new challenge in risk stratification of patients with dyspnoea due to suspected COVID19.

This review searched existing literature to identify existing modalities to remotely assess patients with acute respiratory distress, which can be adapted for the COVID-19 pandemic and in future similar situations.

Methods

We conducted a systematic search of Medline, Embase and Medrxiv for studies of the remote assessment of dyspnoea in acute respiratory disorders in adults/children. The study was registered on PROSPERO (ID: CRD42020202292): 3014 abstracts were screened independently by two reviewers and 32 studies were progressed to full text screening.

Results

Five studies were selected for review, including 1317 patients. Two studies assessed video consultation, two assessed telephone related triage tools, and one study assessed an online triage tool for dyspnoea. In one study, video consultation was found to have 83% sensitivity for diagnosing ‘severe’ respiratory distress in comparison to face-to-face assessment. The online triage tool was found to have 87.5% sensitivity for detecting dyspnoea requiring emergency level care.

Conclusion

A range of successful remote risk stratification tools and clinical features were identified for assessing dyspnoea severity which can be adapted to COVID-19 and future pandemics to assess respiratory distress via telemedicine. These findings will influence development of comprehensive evidence-based tools to assess dyspnoea which will reduce resource strain during current/future pandemics.

References

Loinaz C, Marcacuzco A, Fernández-Ruiz M, Caso O, Cambra F, San Juan R, et al. Varied clinical presentation and outcome of SARS-CoV-2 infection in liver transplant recipients: Initial experience at a single center in Madrid, Spain. Transpl Infect Dis Off J Transplant Soc. 2020 Jun 20;e13372.
P120 The burden of the management of cerebral aneurysms in Africa: a scoping review
Authors: Tetinou Francklin , Kanmounye Ulrick Sidney , Nitcheu Igor , Ndajiwo Aliyu Baba , Bankole Nourou Dine A
Published: April 2021

Introduction

In Africa, the epidemiology, management, and prognosis of cerebral aneurysms remain poorly understood. Cerebral aneurysms are still highly underdiagnosed and inadequately treated in Africa due to a lack of vascular neurosurgeons and infrastructure. In this review we mapped the burden and management of intracerebral aneurysm in Africa.

Methods

A full systematic search on articles published in Africa on brain aneurysms was performed in PubMed, African Journals Online, Google Scholar, WHO Global Health Library and LILACS with no language restrictions. The search results were merged, uploaded into Rayyan software, (FDT, USK, IN, NDAB) independently based on the pre-defined inclusion and exclusion criteria. The full text of the remaining articles were then retrieved and screened by three reviewers independently (FDT, USK, NDAB). Conflicts were resolved by mutual agreement. From all included documents, we extracted information regarding study design, socio-demographic characteristics, clinical findings, type of treatment and outcome results.

Results

We included 28 articles in our full text retrieval. These studies totaled 1181 patients managed for cerebral aneurysm in Africa. Half (50.0%; n = 14) of all studies had been published in the past 5 years and nearly half (46.4%; n = 13) of these studies were conducted in two countries: eight in Morocco and five in South Africa, we didn’t found any publication on cerebral aneurysm for nearly 80% of African countries. Also, there was a female predominance among cerebral aneurysm study participants (62.5%), and the mean time from diagnosis to surgery was 12.1 days. Cerebral aneurysms were most often located in the internal carotid artery (29.6%) and anterior cerebral artery (23.2%). Microneurosurgery (67%) was the most widely used option in these studies ahead of coiling (7.9%). Patient outcomes were judged favorable in 64.2% of cases, and the mortality rate following surgical (open vascular and endovascular) intervention was 19.4%.

Conclusion

The management of intracerebral aneurysms remains suboptimal in Africa. There are few peer-reviewed reports of aneurysm practice.
P124 The effect of next day discharge protocol on the length of stay in hospital, after bariatric surgery
Authors: Sam Miraheal
Published: April 2021

Introduction

Bariatric surgery has been proven to be a safe surgical procedure with very low perioperative mortality for the average patient, although the patients group tend to be high risk patients.

In present day medical practice there is an increase drive and paradigm shift toward enhanced recovery after surgery (ERAS). This drive is founded on the several evidence suggesting reduced post-operative complications and improved post-operative outcomes following ERAS.

Method

Data collection was via our prospectively maintained bariatric dataset. We evaluated the length of stay prior the implementation of the POD 1 discharge in the first cycle, and the LOS after the implementation of POD1 discharge in the second cycle. A total of 32 patients were included in the study, with 16 patients in each cycle.

Results

In the first cycle the length of stay ranged between 1- 4 days with a median LOS of 2 days and an average LOS of 2.25 days.

17% of patients were discharged on POD 1 day, 67% on POD 2 and 8% for POD 3 and 4 each. There were no 30- day re admissions.

In the second cycle, the LOS ranged between 1- 4 days with a median LOS of 1 day and an average LOS of 1.4 days. 69% of patients were discharged on POD1, 25% on POD 2 and 6% on POD 4. There were no 30-day re admissions.

Conclusion

The next day discharge protocol reduces the length of hospital stay after BS with no difference in 30-day readmission rate.
P127 The global impact of the first Coronavirus Disease 2019 (COVID-19) pandemic wave on vascular services
Authors:   The VERN COVER study collaborative
Published: April 2021

Background

The Coronavirus Disease 2019 (COVID-19) pandemic is having an unprecedented impact on healthcare delivery. This international qualitative study captured the global impact on vascular patient care during the first pandemic ‘wave’.

Methods

An online structured survey was used to collect regular unit-level data regarding the modification to a wide range of vascular services and treatment pathways on a global scale.

Results

The survey commenced on 23rd March 2020 worldwide. Over six weeks, 249 vascular units took part in 53 countries (465 individual responses). Overall, 65% of units stopped carotid surgery for anyone except patients with crescendo symptoms or offered surgery on a case-by-case basis, 25% only intervened for symptomatic aortic aneurysms cancelling all ‘elective’ repairs. For patients with symptomatic peripheral arterial disease 60% of units moved to an endovascular-first strategy. For patients who had previously undergone endovascular aortic aneurysm repair, 31.8% of units stopped all postoperative surveillance. Of those units regularly engaging in multidisciplinary team meetings, 59.5% of units stopped regular meetings and 39.1% had not replaced them. Further, 20% of units did not have formal personal protective equipment (PPE) guidelines in place and 25% reported insufficient PPE availability.

Conclusions

The COVID-19 pandemic has had a major impact on vascular services worldwide. There will be a significant vascular disease burden awaiting screening and intervention after the pandemic.
P131 Transferring critically ill Covid-19 patients in ITU - A multidisciplinary training exercise
Authors: Tebbett Alex , Purcell Ian , Watton Shereen , Shanmugham Rathinavel
Published: April 2021

Introduction

During Covid-19 many staff members were redeployed to the Intensive Care Unit (ICU) with little opportunity to train in the new skills they would require. One such skill was the transfer of a critically ill, and contagious, patient from ICU; a risky and complicated procedure which requires planning, preparation, risk assessment, situational awareness and, ideally, experience. To assist our colleagues in this skill an existing ICU transfer course has been adapted to cover the Covid-19 situation, or any similar contagious pandemic, in patient transfer.

Methods

An in-situ simulation method was chosen as the most realistic method of immersing our participants into the environment of ICU and to highlight real-life complexities and issues they may face. A multidisciplinary training session was devised so that novice anaesthetists, ACCPs and nurses could learn together, reflective of the usual team. Human factors such as communication, team leadership, task management and situational awareness are the focus of the post-simulation debrief, and human factors sheets have been created to guide the participants in analysing these skills. Pre- and post-simulation confidence, knowledge and attitudes will be assessed using validated appraisal tools and questionnaires to gather both quantitative and qualitative data about the experience.

Discussion

Multidisciplinary training is often difficult to arrange, due to the different requirements, processes, and procedures each department demands. A hidden blessing of Covid-19 is the realisation that this barrier can be broken, for the benefit of our patients and colleagues alike, and training sessions like this implemented.
P134 Under the weather: The Meteorological correlation in Orthopaedic Trauma and within Hertfordshire
Authors: Vella-Baldacchino M , Hanrahan J , Islam S , Sofat R
Published: April 2021

Background

The paper aims to understand the effect of meteorological factors on the number of referrals and volume of trauma operating cases within our local area.

Method

Trauma data was analysed in our database: (eTrauma), a digital clinical platform that co-ordinates all admissions and: trauma theatre activity. Data consisted of number of referrals per day, patient: age, mechanism of injury and type of orthopaedic injury. Weather data was: gathered from a local weather station which: records daily weather observations.

Results

1160 consultations wereanalysed, 779 required an operative intervention. Neck of femur fractures: and ankle trauma were the two most common cause of trauma, accounting for 27% and 15% respectively. Neck of femur fracture pathology were not significantly correlated with any meteorological factor studied. On the contrary, ankle trauma were the only injuries significantly correlating with temperature (p < 0.03) and due point (p < 0.04).

Conclusion

Weather has no effect on neck of femur fractures, the most common trauma pathology treated in our department. In all seasons allocated specific trauma lists for the latter should be arranged irrelevant of the weather conditions. We identified the days receiving highest referral rate, using this data to shape the future on call trauma service.
P136 Vegan orthopaedics
Authors: Silk Gwithyen , Vetherajan Niraj , Blohm Alice , Keen Katie , Teeling Fiona , Sullivan Niall
Published: April 2021

Introduction

Bristol is the vegan capital of the UK. The UK vegan index reveals that Bristol has 360,000 Google searches each month for Vegan content. However, do we think about the possible animal source of the medications we prescribe. Although all medications in the UK need to be tested on animals prior to being licensed and therefore cannot be truly “vegan”, there are alternatives available for some commonly used medications that do not contain animal products. Several world religions prohibit their followers from consuming certain foods, ranging from those not prepared in a specific manner to those derived from certain animals.

Kosher and halal diet adherents share concerns with those on vegan diets. Vegan options are a solution when only non-conforming or uncertain products are available.

Methods

We conducted a review of commonly used medications in Orthopaedics and reviewed their source. The BNF, local pharmacy and online Summary of Product Characteristics (SPCs) for the medications were reviewed.

Results

Where possible we have compiled a list of those that contain animal derived components and suggest alternatives. Sometimes, pharmaceutical companies cannot guarantee or differentiate the specific sources of animal-derived ingredients, as various suppliers are used in the manufacturing process and the sources can change.

All unfractionated or standard heparin is porcine in origin; Rivaroxaban and Fondaparinux are simple alternatives for example. Cholecalciferol (vitamin D3) – Manufacture also involves the use of lanolin from sheep’s wool. Vitamin D2 (ergocalciferol) is vegan.

Conclusion

Disclosure of animal content and excipients would help patients make an informed choice. With an increasingly informed population and ethnic diversity, we should all be aware of the drugs that may contain animal products so that we can offer alternatives. Patients are more likely to adhere to prescribed medicines if they have been actively involved in prescribing decisions.
O5 Outcomes of vascular and endovascular interventions performed during the COVID-19 pandemic: The Vascular and Endovascular Research Network (VERN) COvid-19 Vascular sERvice (COVER) Tier 2 study
Authors:   VERN COVER Study Collaborative, Preece Ryan
Published: April 2021

Introduction

The COVID-19 pandemic forced rapid adaptations to healthcare provision. The COvid-19 Vascular sERvice (COVER) Study aimed to contemporaneously report outcomes for patients undergoing vascular interventions worldwide during the pandemic.

Methods

COVER is an international multi-centre observational cohort study of outcomes following vascular interventions during the pandemic. The primary outcome was to capture procedural information on all open and endovascular interventions undertaken. Secondary outcomes included in-hospital mortality and changes in management resulting from the pandemic.

Results

1103 patients from 57 institutions in 19 countries were enrolled. Mean age was 66.9±13.9 (75·6% male). The rate of suspected/confirmed COVID-19 infection was 4·0%. Overall, in-hospital mortality was 11.0%. Aortic interventions had a mortality of 15·2% (23/151), amputations 12·1% (28/232), carotid interventions 10·7% (11/103) and lower limb revascularisation 9·8% (51/521). Increased risk of in-hospital mortality was noted for patients with chronic obstructive pulmonary disease, lower respiratory tract infection, Caucasian ethnicity and those undergoing urgent/immediate surgery. Choice of procedure deviated from standard management in 7·1% cases. Adjusting for confounders, antiplatelet (OR 0·503 (0·273-0·928) and oral anticoagulant (OR 0·411 (0·205-0·824) reduced risk of in-hospital mortality.

Conclusions

Patients undergoing vascular intervention during the pandemic had substantially higher overall and condition-specific mortality compared to pre-pandemic cohort reports, despite low COVID-19 infection rates.
O8 The COMPOSE Study: Characteristics, Outcomes and Management of PeriprOsthetic fractures: a Service Evaluation
Authors: Scrimshire A B , Farrier A , Kottam L , Walker R , Jameson S , Baker P
Published: April 2021

Introduction

The number of peri-prosthetic fractures (PPF) is increasing, yet there still lacks a clear evidence-based strategy to best manage these injuries. There is a growing interest to collect a substantial body of information about PPFs in order to aid understanding of this population, current treatments and clinical outcomes. COMPOSE is a national multi-centre, retrospective service evaluation examining the incidence, management, outcomes and patient characteristics of those presenting to secondary care hospitals in the UK with a PPF.

Methods

Data will be collected via REDCap for all PPFs which presented to the orthopaedic departments between 1st January 2018 to 31st December 2018 from the participating hospitals. The evaluation will aim to collect pre-operative data (baseline demographics, fracture characteristics, surgical characteristics) and post-operative outcome data (length of stay, discharge, post-operative complications, re-admissions, re-operations, mortality).

Results

Currently, 24 hospital sites have registered with a total of 388 cases recorded. We continue to seek further interested sites to join. COMPOSE will generate a unique and robust dataset of PPFs and current practices. All data and outcomes will be reported descriptively. The outcome measures will be analysed using regression modelling with adjustment for baseline variables. Between group comparisons will be reported using confidence intervals and p-values.

Conclusion

Following analysis, the aim is to make supported recommendations regarding management, to help plan clinical services for this patient population and to assist with identification of potential risk factors for PPFs and the subsequent outcomes. The dataset will also aid development of testable hypotheses for future research.
FAK in the nucleus prevents VSMC proliferation by promoting p27 and p21 expression via Skp2 degradation
Authors: Jeong Kyuho , Murphy James M , Ahn Eun-Young Erin , Lim Ssang-Taek Steve
Published: April 2021

Aims

Vascular smooth muscle cells (VSMCs) normally exhibit a very low proliferative rate. Vessel injury triggers VSMC proliferation, in part, through focal adhesion kinase (FAK) activation, which increases transcription of cyclin D1, a key activator for cell cycle-dependent kinases (CDKs). At the same time, we also observe that FAK regulates the expression of the CDK inhibitors (CDKIs) p27 and p21. However, the mechanism of how FAK controls CDKIs in cell cycle progression is not fully understood.

Methods and results

We found that pharmacological and genetic FAK inhibition increased p27 and p21 by reducing stability of S-phase kinase-associated protein 2 (Skp2), which targets theCDKIs for degradation. FAK N-terminal domain interacts with Skp2 and an APC/C E3 ligase activator fizzy-related 1 (Fzr1) in the nucleus, which promote ubiquitination and degradation of both Skp2 and Fzr1. Notably, overexpression of cyclin D1 alone failed to promote proliferation of genetic FAK kinase-dead (KD) VSMCs, suggesting that the FAK-Skp2-CDKI signalling axis is distinct from the FAK-cyclin D1 pathway. However, overexpression of both cyclin D1 and Skp2 enabled proliferation of FAK-KD VSMCs, implicating that FAK ought to control both activating and inhibitory switches for CDKs. In vivo, wire injury activated FAK in the cytosol, which increased Skp2 and decreased p27 and p21 levels.

Conclusion

Both pharmacological FAK and genetic FAK inhibition reduced Skp2 expression in VSMCs upon injury, which significantly reduced intimal hyperplasia through elevated expression of p27 and p21. This study revealed that nuclear FAK-Skp2-CDKI signalling negatively regulates CDK activity in VSMC proliferation.
Contemporary Ross procedure outcomes: medium- to long-term results in 214 patients
Authors: Generali T , Jansen K , Steedman R , De Rita F , Viganò G , McParlin D , Hermuzi A , Crossland D , O’Sullivan J , Coats L , Hasan A , Nassar M S
Published: April 2021

OBJECTIVE

Our goal was to present 2 decades of our experience with the Ross procedure and its sequential modifications, adopted since 2010, to improve the reoperation rate.

METHODS

We performed a single-centre, retrospective review of database information and medical notes about the implantation technique: the freestanding root. We compared era 1 (1997–2009) and era 2 (2010–2019).

RESULTS

Between 1997 and 2019, a total of 214 Ross procedures were performed (71% men, median age 24 years) [interquartile range (IQR) 15–38]. Of these, 87% had various forms of congenital-dysplastic aortic valves. The median cross-clamping and bypass times were 173 (IQR 148–202) and 202 (IQR 182–244) min. The median postoperative stay was 6 days (2–77). Thirty-day mortality was 0.5%. The median follow-up time was 8.2 years (IQR 3.9–13.2). Survival at 10 and 20 years was 97% and 95%; freedom from greater than moderate aortic regurgitation or aortic valve intervention was 91% and 80%; and 93% of the patients were in New York Heart Association functional class I. Twenty (21%) patients operated on during era 1 and 6 (9%) during era 2 underwent autograft reoperations. The median follow-up time was 14.3 (IQR 11.5–17.4) and 4.8 (IQR 2.5–7) years. Freedom from autograft reoperation was 87% and 69% at 10 and 20 years, with no significant difference between eras. Freedom from homograft reoperation was 96% and 76% at 10 and 20 years. The presence of aortic regurgitation, infective endocarditis and era 1 were predictors of autograft reoperation. Male gender and era 1 were predictors of neoaortic root dilatation.

CONCLUSIONS

The contemporary modified Ross procedure continues to deliver excellent results and should remain part of the strategy to treat children and young adults requiring aortic valve replacement.
The presence of an additional ventricular chamber does not change the outcome of Fontan circulation: a comparative study
Authors: Rossi Elena , Frigo Anna Chiara , Reffo Elena , Cabrelle Giulio , Castaldi Biagio , Di Salvo Giovanni , Vida Vladimiro L , Padalino Massimo A
Published: April 2021

OBJECTIVES

The role of an additional ventricle in patients with a functional single ventricle undergoing the Fontan operation has been debated due to conflicting data. Our goal was to report our experience with Fontan circulation for complex congenital heart disease, with a focus on the influence that an additional ventricular chamber may have on early and long-term clinical outcomes.

METHODS

We performed a retrospective clinical study including all patients undergoing the Fontan procedure between 1978 and 2019. Clinical data were retrieved from our institutional database. A ‘biventricular’ Fontan (BVF) was defined as that performed in a patient with single ventricle anomaly where an additional diminutive ventricular cavity was present at echocardiographic evaluation.

RESULTS

A total of 210 consecutive patients with functional single ventricle were included. Among these, 46 had BVF (21.9%). Early complications occurred in 42 patients (20.0%; 11 in BVF vs 31 in univentricular Fontan; P = 0.53) There were 18 early deaths (8.6%) with no difference between the groups. At a median follow-up of 12.7 years (interquartile range 5.4–20.7), there were no significant differences in late mortality, whereas cardiac rhythm disturbances resulted more frequently in univentricular Fontan (P = 0.018). Statistical analysis showed an equal distribution of BVF across time (P = 0.620), and there were no significant differences in terms of early and late survival (P = 0.53 and P = 0.72, respectively) or morbidity (P = 0.45 and P = 0.80, respectively).

CONCLUSIONS

A secondary ventricle in Fontan circulation is not significantly related to any clinical disadvantage in terms of survival or onset of complications. However, the immediate postoperative course may be influenced negatively by the presence of an additional secondary ventricle.