bluuebunny/crossref_metadata_2025 huggingface dataset:
Towards more sustainable and inclusive development corridors in Africa
Authors: Bignoli Diego Juffe , Burgess Neil , Wijesinghe Amayaa , Thorn Jessica P R , Brown Molly , Gannon Kate E , Sang Catherine C , Lesutis Gediminas , Lyimo Paulo , Chilagane Nyemo , Tam Christine , Munishi Pantaleo , Kashaigili Japhet J , Sandbrook Chris , Olago Daniel , Marchant Robert , Waruingi Lucy , Meng Han , Conway Declan , Payne Tanya , van Soesbergen Arnout , Xu Yinlong , Wentworth Julia , Niazi Aisha , Hargey Ayesha , Butt Hamza , Foglietti Camilla Blasi , Palmer Rowan , Bull Joseph W , Runsten Lisen
Published: September 2024

Abstract

Development corridors are linear programmes of infrastructure and agriculture aiming to facilitate rapid socio-economic development. In Africa, they are a major development activity, with 88 underway or planned corridors. Drawing from extensive literature and insights gleaned from a 4 year research programme, this review scrutinizes the impacts of development corridors on people, wildlife and ecosystems in Kenya and Tanzania, proposing solutions to achieve better outcomes. The overarching goal was to discern the principle challenges emerging from the practical execution of the prevailing corridor model. The holistic approach taken, assessing the development corridors paradigm through an integrated ecological, social, and economic lens, provides novel insights that have not been possible using more traditional—siloed—research approaches. Eight key challenge areas are identified: impact assessments processes; coherence across international, national and local planning; governance; inclusivity; equality; impacts on biodiversity and ecosystem services; incorporation of future climate risks; and integrated water resource management. Poorly planned and implemented corridors detrimentally impact livelihoods and ecosystems. They lack a sustainable development vision, detailed social, environmental or climate risk assessments, and develop incrementally in policy and corporate spaces. There is also often a disconnect between investors and recipient governments, with some investors funding what governments request without applying internationally-recognised safeguards, and governments lacking capacity and resources to enforce regulations. We make recommendations for addressing these challenge areas. These aim to enhance impact assessment efficacy; integrate local perspectives into effective and inclusive corridor planning; overcome siloed project development and implementation; anticipate future development projections; and prioritise landscape preservation for enhanced ecosystem services and climate resilience.
India Institute of the Deutsche Akademie
Authors: Roy Baijayanti
Published: September 2024

The India Institute was a part of the Deutsche Akademie (DA), a private cultural organization established in 1925 in Munich. As part of the DA, the India Institute claimed to be a non-political entity which had the sole aim of promoting cultural ties with India. In reality, as this chapter shows, both the DA and the India Institute identified with various political concerns of successive German governments. After 1933, the Nazi regime started to utilize the India Institute’s apolitical façade to conduct pro-Nazi propaganda as well as espionage in India, using different Indian religious sects, particularly certain Hindu revivalist groups and individuals, as conduits. This chapter traces the interface of National Socialist politics, Indian nationalist aspirations, and Hindu revivalism, with particular focus on certain German Indologists, Indian nationalists, and Nazi agents who were the main mediators in this process. One of the concerns of the chapter is to analyse the knowledge discourses on India that were called on or generated by these German and Indian individuals. Among them are Jakob Wilhelm Hauer and Walther Wüst, the two German Indologists involved in the Institute’s administration, Koodavuru Anantrama Bhatta or Pandit Bhatta, a beneficiary of the Institute who turned into a prominent Nazi propagandist, as well as Horst Pohle and Alfred Würfel, the German lectors sent by the DA to India, who evolved into propagandists and informers for the Nazi regime.
Conclusion
Authors: Roy Baijayanti
Published: September 2024

The Conclusion sums up the answers to the research questions posited by this monograph. Such quests include those that are commonly raised by historians probing the connections between scholars of humanities and Nazi politics, as well as some additional ones generated by the particular context of this study. The former category includes the persecution of the Jewish Indologists, the self-mobilization of certain knowledge providers, and the fortunes of politically compromised scholars after the war. The conclusion discusses the fates of these individuals in the context of West Germany’s Vergangenheitsbewältigung or efforts to cope with the Nazi past. The second category comprises knowledge discourses on India which were turned into political resources, as well as the exchange of such resources and capital between individual knowledge providers and different representatives of the Nazi regime. Other distinctive aspects of the study included the role of the Indians involved in this nexus of knowledge and power and an analysis of the scholars’ projections of the ‘usefulness’ of Indology (and Indologists) to the Nazi authorities. The Conclusion outlines the key findings on these issues and ends with an examination of the possible impact of the knowledge generated by the ‘experts’, from both German and Indian perspectives.
Qualitative Interviewing
Authors: Brent John J. , Kraska Peter B. , Hutchens Justin
Published: September 2024

Given the multifaceted and interdisciplinary nature of studying crime and criminal justice, the pursuit of credible, reliable, and rigorous knowledge requires a well-developed methodological infrastructure. To explore and examine these areas, there are times when research needs to document probabilities, examine rates, identify correlations, and test theoretical propositions. There are also times when research needs to explore the more qualitative elements, namely the perspectives, interpretations, lived experiences, and constructed realities. Among the more prominent qualitative methods within the field’s methodological toolbox are interviews. Aiding other approaches, qualitative interviews contribute to the field’s methodological means by first offering a more inductive and interpretive framework to study crime-related phenomena. From these foundations, they are replete with avenues through which to conceptualize, construct, and administer research efforts. They also provide a host of unique and beneficial methodological means to collect, code, and analyze collected data. When their overall impact is examined, the continued use and development of qualitative methods—more specifically, interviews—can progress the field’s body of knowledge while contributing to more informed practices and policies. Given their use and utility, interviews have become some of the most used methodological approaches within the social sciences.
Social Justice and Equitable Systems in Education
Authors: Madrid Miranda Romina , Chapman Christopher
Published: September 2024

Social Justice is a term that encapsulates many of the problematic issues concerning modern societies. As a reflection of society, the concept has evolved to emphasize different aspects of fairness such as distribution or recognition. One often tacit but central element in this discussion is the articulation of social justice with the development of equitable education systems. In other words, what it means to pursue social justice in educational change and improvement.

To address this question, contemporary ideas of social justice can be brought into the field of educational change and improvement in a more intentional and explicit way to respond to the societal imperatives for justice in education. By tracing the evolution of the key conceptualizations of social justice rooted in political philosophy, it is possible to examine its implications for educational and systemic transformation. Furthermore, from a systems perspective, understanding the ecology of equity can offer important insights into the interplay between schools, education systems, and wider society. The exploration of experiences and approaches in education that aim to disrupt inequities can be used to propose a number of key principles to guide educational change efforts from a social justice perspective, aiming to foster more equitable educational systems.

These principles serve to unpack issues of social justice and move to a more complex and action-oriented perspective that places distribution, recognition, and representation as key to developing more equitable education systems. The six principles are: a focus on learning and teaching; a commitment to collaboration and networking; the use of inquiry, research, and evidence; understanding the contextual nature of justice; investing in support and agency; and

building leadership capacity. The notion of a networked learning system and how this perspective can advance the discourse toward a more explicit agenda for developing socially just approaches in educational research, policymaking, and practice is also helpful. The overarching goal is to stimulate dialogue and action aimed at creating more equitable educational systems that prioritize social justice principles in all facets of education.
The American Housing Finance System: Structure, Evolution, and Implications
Authors: Deng Yongheng , Wachter Susan M. , Yoon Heejin
Published: September 2024

The U.S. housing finance system has been characterized by fixed-rate, long-term, and high maximum loan-to-value ratio mortgage loans, with unique support from secondary market entities Ginnie Mae and the government-sponsored enterprises, Fannie Mae and Freddie Mac. The authors provide a comprehensive review of the U.S. housing finance system, from its structure and evolution to the current continuing policy debate. The “American Mortgage” provides many more options to borrowers than are commonly provided elsewhere: U.S. homebuyers can choose whether to pay a fixed or floating rate of interest; they can lock in their interest rate in between the time they apply for the mortgage and the time they purchase their house; they can choose the time at which the mortgage rate resets; they can choose the term and the amortization period; they can generally prepay without penalty; and they can generally borrow against home equity. They can also obtain insured home mortgages at attractive terms with very low down payments. Perhaps most importantly, in the typical mortgage, payments remain constant throughout the potentially 30-year term of the loan. The unique characteristics of the U.S. mortgage provide substantial benefits for American homeowners and the overall stability of the economy. This article describes the evolution of the housing finance system which has led to the predominant role of this mortgage instrument in the United States.
Improving the validity of noninterventional comparative effectiveness research by basing study design on a specified existing randomized controlled trial
Authors: Wing Kevin , Leyrat Clémence
Published: September 2024

This issue of the American Journal of Epidemiology includes 3 articles (2 reporting original analyses and 1 systematic review) in which noninterventional studies used an existing randomized controlled trial (RCT) as a reference standard to inform noninterventional study design and against which to benchmark results. This commentary provides a brief background on the challenges of noninterventional comparative effectiveness research, before elaborating on (1) the potential benefits and challenges of basing noninterventional study design on a specified existing RCT and (2) the distinction between designing analysis based upon a specified existing RCT and studies based solely upon a hypothetical target trial. Finally, several recommendations for the conduct and reporting of noninterventional studies based on existing RCTs are provided.

This article is part of a Special Collection on Pharmacoepidemiology.
Mating system, morphological and genetic evidence endorse clonality as an essential reproductive mode in Daphnopsis filipedunculata (Thymelaeaceae), a dioecious and endemic species from the Amazon
Authors: Carvalho Carolina da Silva , da Costa Lucas Erickson Nascimento , Leal Bárbara Simões Santos , Silva Kleber Resende , Valentin-Silva Adriano , Costa Ana Carolina Galindo , Tyski Lourival , dos Santos Fernando Marino Gomes , Watanabe Mauricio Takashi Coutinho
Published: September 2024

Background and Aims: Clonality is characterized by the formation of independent individuals of the same genotype that are capable of reproducing and propagating vegetatively. Although clonality is an important mechanism that facilitates the persistence of a population, its extensive use can lead to negative impacts on sexual reproduction due to trade-offs in the investment of resources. Therefore, studies on the sexual reproduction of species that exhibit clonality can provide information about resilience to environmental changes, information about fecundity, the risk of the absence of pollinators and the ability to persist in unfavourable conditions and to successfully occupy new areas. Here, we investigated the role of clonal propagation and sexual reproduction in Daphnopsis filipedunculata (Thymelaeaceae), a dioecious species distributed only in Serra dos Carajás. Methods: We evaluated the extent of clonality in this species using molecular tools and anatomical analyses of the underground system responsible for developing new ramets. Furthermore, we analysed the sexual system and its contribution to reproductive success through morphometric analyses of floral types and pollination experiments in the field. Key Results: Overall, we found that clonal propagation plays an important role in maintaining the population of D. filipedunculata. Specifically, we demonstrated that this species presents functional male and female plants, indicating that D. filipedunculata is an obligate xenogamous species but has low reproductive success. We also showed that clonal vegetative propagation is the main form of asexual reproduction in this species, with roots responsible for clonal growth. Finally, our results indicated that this species presents an intermediate phalanx–guerrilla clonal architecture. Conclusions: Our study provides the first insights into sexual reproduction and clonal propagation in D. filipedunculata and can inform management practices, conservation and the restoration of endemic species.
Polarization of circulating follicular helper T cells correlates with bullous pemphigoid severity
Authors: Pérals Corine , le Jan Sébastien , Muller Céline , Le Naour Richard , Bernard Philippe , Viguier Manuelle , Fazilleau Nicolas
Published: September 2024

Background

Follicular helper T (Tfh) cells form a distinct population of T-helper cells with different polarizations (type 1, type 2 and type 17) that regulates humoral responses and may participate in the pathophysiology of B-cell-mediated autoimmune diseases such as bullous pemphigoid (BP), a dermatosis mediated by autoantibodies specific for hemi-desmosomal proteins.

Objectives

To evaluate the impact on circulating Tfh cells of super potent topical corticosteroid (TCS) treatment, which is more effective and safer than high doses of oral corticosteroids, and is the recommended first-line treatment of BP.

Methods

Using flow cytometry, we compared the frequency, polarization and activation of Tfh cells in the blood of patients with BP with age- and sex-matched control participants without BP at baseline and longitudinally, after the initiation of TCS treatment.

Results

We found that, at baseline, circulating Tfh cells were more frequent in patients with BP than in participants without BP and exhibited an activated phenotype. We further showed a decrease in type 1 and an increase in type 17 Tfh cells in the blood of patients with BP, which resulted in a higher type 2 + type 17 to type 1 Tfh cell ratio. This ratio correlated positively with disease severity, as measured by the Bullous Pemphigoid Disease Area Index. Remarkably, with TCS treatment, although the frequency of Tfh cells in patients with BP returned to a level similar to that of control participants, the activated phenotype persisted. Interestingly, serum interleukin-21 levels and the Tfh cell subset ratio, similarly to disease activity and serum anti-BP180 and anti-BP230 autoantibodies, decreased with TCS treatment.

Conclusions

Overall, our findings suggest the involvement Tfh cell polarization in the pathophysiology of BP and open the door to modulation of Tfh cell activity for treatment purposes.
BJS 3 - The ScotCap registry: an evaluation of over 1000 colon capsule endoscopy procedures carried out in Scotland
Authors: Macleod Campbell , Rajapaksha Nipuni , Brown Caroll , Watson Angus , Asif Zarin , Hudson Jemma
Published: September 2024

Aims

To report on the outcomes of patients undergoing colon capsule endoscopy (CCE) in Scotland (ScotCap) using a national CCE registry.

Methods

Patients undergoing CCE in NHS Scotland between August 1st, 2021 and August 1st, 2022 were included in this study. Patients were vetted to undergo CCE by clinicians in 5 NHS Scotland health boards. Patient data were collected prospectively by an eHealth system managing CCE referral and report sign off. CCE procedure data were collected by the ScotCap managed service carrying out CCE procedures. Data from both sources were compiled in the national CCE registry managed by Public Health Scotland.

Results

1290 patients were included in this study. The median age of patients was 59 years and 58.5% of patients were female. A haemoglobin count was available for 1062 (82.3%) patients and the mean value was 139g/L. Faecal immunochemical test results were available for 1105 (85.7%) patients and of those with a test result, 903 (81.7%) had a result ≥10 µgHb/g. The rate of complete test, adequate bowel preparation and successful test (complete test with adequate bowel preparation) was 66.4%, 63.8% and 62.1%, respectively. Following CCE, 41.2%, 36.7%, 20.9% and 1.1% of patients required no further test, colonoscopy, flexible sigmoidoscopy and gastroscopy, respectively. One patient was reported to have experienced capsule retention with obstruction.

Conclusions

These are the first reported outcomes from the Scottish national CCE registry, and the largest reported series of CCE to date, which demonstrate a significant proportion of patients avoid colonoscopy when CCE is deployed nationally.
SP1.7 - Cholecystectomy in Children: Tertiary Institutional Review of 10-years
Authors: Omran Kareem , Faruqi Duaa , Ladipo-Ajayi Oluwaseun , Holbrook Charlotte , Upadhyaya Manasvi
Published: September 2024

Aim

This study evaluates cholecystectomy necessity in pediatric patients with gallstones, correlating clinical symptoms, diagnostic imaging, histological findings, and postoperative outcomes.

Method

A decade-long (2013-2023) retrospective analysis at our tertiary Pediatric institution focused on patients aged 0-16 years undergoing cholecystectomy. Data from electronic patient records included demographics, preoperative symptoms, ultrasound findings, liver function tests, associated health conditions, surgical techniques, and postoperative developments.

Results

Our review encompassed 52 patients (35/52 females). Their ages ranged from 3 to 16 years (median = 13). Recurrent abdominal pain was the predominant symptom, reported in 49 patients. A minority (3 patients) were asymptomatic. 18 patients exhibited jaundice, while 5 cases each were associated with pancreatitis and cholecystitis, both clinically and biochemically.

Comorbid conditions were identified in 24 patients, including sickle cell disease (15 cases), hereditary spherocytosis (6 cases), and metachromatic leukodystrophy (3 cases).

Ultrasound findings revealed gallstones in 48 out of 52 patients, with the remaining 4 (3 metachromatic leukodystrophy) showing no stones. Histologically, cholecystitis was confirmed in 32 patients, but gallstones were only verified in 34 cases.

Laparoscopic cholecystectomy was performed in 49 cases, and 13 of these also involved splenectomy. In 3 cases, laparoscopy was converted to open surgery due to splenectomy-related factors.

During follow-up, 2 patients reported recurrent symptoms. One of these, initially diagnosed with chronic cholecystitis, was later found to have irritable bowel syndrome. Another patient required subsequent splenectomy.

Conclusion

Our study reveals a notable disparity between preoperative ultrasound findings and histological results. Nevertheless, cholecystectomy remains a safe and effective intervention in judiciously selected symptomatic paediatric patients, with most experiencing symptom resolution post-surgery.
SP1.10 - Patient Perceptions of Shared Decision-Making in Emergency Surgery
Authors: Spence Rachel , Bisset Carly , Moug Susan
Published: September 2024

Background

Shared decision-making (SDM), a concept becoming increasingly more prevalent in medical practice, is now considered the ‘gold standard’ approach. Research into patient perceptions of SDM is lacking and barriers to its implementation remain, specifically in emergency general surgery. Considering procedures with high mortality risks makes research into patients understanding of SDM here a critical step for its implementation.

Aim

Explore what emergency surgery patients understand about SDM and their experience of it.

Methods

A literature review and scoping review determined the quantity and quality of research in this area enabling long-listing of known SDM concepts. This developed questions and structured discussions for the patient and public involvement (PPI) exercise.

This exercise was developed following research, patient representative input and discussions with experienced researchers. Twenty-five participants, identified from the local ELLSA database, were invited with their support-person. Small-group discussions considered how surgeons make decisions, what SDM means to patients, and improving this process. Responses were transcribed, then analysed.

Results

Nine patients and four supporters attended the exercise. Thematic analysis identified two key themes: patient perceptions of how surgeons make decisions, and patient experiences of emergency surgical decision-making. Subtheme analysis showed participants weren’t aware of surgeons’ use of “30-day mortality” and couldn’t quantify surgical risk, feeling time pressures and out-of-control. They relied on surgeons to make their decision.

Conclusions

Patients who’ve undergone emergency surgery don’t understand how surgeons make emergency surgical decisions. Many reported not experiencing SDM at all. This work provides the first patient-insights into an area requiring more research – on a larger scale.
SP2.1 - Endoscopic retrograde appendicitis therapy for peri-appendiceal abscess
Authors: Yang Baohong , Li Deliang , Podda Mauro , Liu Bingrong
Published: September 2024

Aims

ERAT is a novel technique primarily for uncomplicated appendicitis, but it is starting to be used also for peri-appendiceal abscesses. The aim of this study was to evaluate the efficacy and clinical outcomes of ERAT in treating patients with peri-appendiceal abscess.

Methods

Between January 2018 and April 2023, twenty-eight patients with peri-appendiceal abscess were treated with ERAT. We retrospectively analyzed the location and size of the peri-appendiceal abscess, success rate of ERAT, median operative time, postoperative hospital stay and complications. We defined success of ERAT as finding the appendiceal orifice and successful performance of ERAT without conversion to appendectomy or percutaneous drainage of the appendiceal abscess within one month. All patients were followed up at least 6 months, with a median follow-up of 31.5 months.

Results

The success rate of ERAT was 75.0% (95% CI, 54.8%-88.6%; n = 21/28). 35.7% (95% CI, 19.3%-55.9%; n = 10/28) of peri-appendiceal abscesses were located in the lower ileum, and the median size of appendiceal abscesses was 43.5 mm (95% CI: 33-53). 80.8% (95% CI, 60.0%-92.7%; n = 21/26) of patients had a visual analogue scale pain score of ≤3 at 24 hours after treatment. The median procedure time was 69.5 minutes (95% CI: 51-76), and the median hospital stay was 6.5 days (95% CI: 5-9). During the follow-up period, a total of four (17.1%; 95% CI, 0.9%-13.1%; 4/21) patients presented with abdominal pain associated with peri-appendiceal abscesses.

Conclusions

ERAT is a technically feasible treatment for peri-appendiceal abscesses.
SP2.4 - Appendicetomy in pregnancy: a retrospective analysis of 39 cases between 2012-2022
Authors: Fourie Amy , Manson Cameron , Johnston Magnus , Le Saint-Grant Alexander , Damaskos Dimitrios
Published: September 2024

Background

Acute appendicitis is the commonest surgical emergency in pregnant women. Physiological changes during pregnancy can obscure symptoms. Prompt diagnosis and surgical intervention is essential to minimise risks such as sepsis and preterm labour.

Objective

This study aims to evaluate how gestational age, type of imaging, surgeons' expertise, and antibiotics management affect the surgical outcomes in pregnant patients with acute appendicitis.

Methods

A retrospective analysis of 39 obstetric cases between 2012 and 2022 in the Royal infirmary of Edinburgh. Statistical methods for analysis including ANOVA were used to compare different surgical techniques, and correlation assessments to investigate links between gestational age and aspects of post-operative care.

Results

The study found that the surgical method significantly impacted post-operative recovery, with laparoscopic procedures leading to shorter hospital stays and decreased antibiotic use compared to open surgeries (p=0.001169 for hospitalisation length and p=0.01049 for antibiotic course, respectively). Surgeon grade did not significantly alter these outcomes. There was a moderate correlation between gestational age and both post-operative antibiotic duration (r = 0.3293) and length of hospital stay (r = 0.3640. The varied use of imaging techniques across different stages of pregnancy suggests there is no consensus of best practice.

Conclusion

The study identifies a need for consistent guidelines on treating pregnant women with appendicitis, particularly regarding antibiotic use. The results support the preferential use of minimally invasive surgery and value MRI as a non-invasive diagnostic tool, both contributing to a comprehensive, multidisciplinary approach required for these complex clinical scenarios.
SP3.6 - Do non-colorectal surgeons produce an inferior lymph node yield in emergency colorectal cancer resections?
Authors: Bisheet George , Mandal Piya , Campbell Timothy , Fernandes Roland
Published: September 2024

Introduction

Lymph node yield is a surrogate indicator of adequate resection and yields of 20 or more have been shown to be associated with better survival outcomes. There is controversy as to whether colorectal cancers should be operated on by non-colorectal surgeons in the emergency setting. This study explores whether there are differences in lymph node yield between colorectal and non-colorectal surgeons in the context of emergency Hartmann's procedures performed for malignancy.

Methods

A retrospective study was conducted at a 3-site Trust in South East England between 2012 and 2022. Theatre and Info flex Cancer records were used to obtain patients who had undergone a Hartmann's procedure for malignancy and their operating surgeon. The histology reports were then reviewed and statistical analysis was undertaken.

Results

346 patients were included in the study, in a 197:149 male-to-female ratio. The mean age was 73 (28-92 IQR). Histology confirmed malignancy in all the study participants. 11% (38/346) of the operations were conducted by non-colorectal surgeons (UGI, Breast, and Endocrine). The mean lymph node yield for the non-colorectal surgeons was 28 (24-33 IQR). The mean lymph node yield for colorectal surgeons was 29 (26-34 IQR). There was no statistical difference between the lymph node yield between colorectal and non-colorectal surgeons (p=0.671)

Conclusion

The study concluded that adequate oncological colonic resections could be conducted safely by non-colorectal surgeons in emergency settings.
SP3.11 - Beyond the microscope – Unravelling the Significance of Colorectal Cancer Histopathology Request Forms
Authors: Yi Ng Zoe Zhen , Pal Shreya , Pangeni Anang , Bagla Nipin , Shrestha Ashish
Published: September 2024

Accurate histopathology reporting of colorectal cancer resected specimens (CCRS) is crucial for optimal patient care. The adequacy of clinical information provided by surgeons influences the quality of documentation. This audit aims to identify if histopathology request forms for CCRS in our trust meets national standards, as published by The Royal College of Pathologists.

A retrospective study encompassing 40 consecutive histopathology request forms following colorectal cancer resections was conducted over 4 months (June to September 2023), where we assessed local adherence to national guidelines. The guidelines address a range of information from the surgical details to the patient’s medical background.

Among the 40 request forms, 87.5% (35) were completed by consultants and 12.5% (5) by registrars. The information predominantly included were details on tumour site (98%) and nature of the resection (98%). Details on surgical procedure through a diagram and method of approach, were provided in 45% (18) and 48% (19) of the forms. Conversely, details on the pre-operative stage of tumour and types of therapy given was discerned in less than 25% of the forms. Only 3% (1) included information regarding presence of iatrogenic specimen defect and if specimen included other tissues or organ. Alarmingly, none addressed patient hereditary conditions or presence inflammatory bowel disease.

The current histopathology request forms for CCRS lack information to facilitate comprehensive histopathological analysis. Addressing this necessitates raising awareness on national guidelines available. Additionally, a new structured form has been implemented in our trust, with the aim of encouraging surgeons to provide more comprehensive information.
SP5.9 - A cost-benefit analysis of a digital post-operative integrated care plan app for surgical patients
Authors: Chacko Anil , Moore Melanie , Vlazaki Myrto , Kelkar Ashish
Published: September 2024

Aims

To study the cost-benefit analysis of a digital post-operative integrated care plan app for surgical patients.

Methods

1. Preliminary data from patient survey - we designed a questionnaire to assess patients’ views of the Post Op app.

2. Estimates for NHS services cost - derived from the King’s Fund latest report (2023) and the NHS Digital National schedule of reference costs (2017, 2021-22).

3.Estimates for travel-associated costs - We assumed a total cost per mile of 16p, and also assumed the patients would need to pay an average cost of £1.6/h for hospital parking for an average of 3h per visit. We assumed a carbon emission of 221.4 grams per mile (Department for Transport data).

4.Modelling approach - We used a conservative modelling approach simulating different patient groups with varying levels of postoperative anxiety/complications.

Results

Taking into account avoidable presentations to ED, costs borne by the patients, lost productivity, environmental costs, avoidable re-operations and the costs related to antibiotic tolerance/resistance, the lower boundary of total savings from a digital post-operative follow-up tool equates to £58,739 per 100 patients and the upper boundary is £79,949 per 100 patients.

Conclusion

Post Op application provides excellent support for most patients in the immediate postoperative period and is likely to result in a significant reduction in the number of contacts patients make with the GP or hospital, and with the Emergency Department resulting in significant cost saving for both the service and the patients. Furthermore, earlier recognition, monitoring and appropriate treatment of SSIs provides further savings whose magnitude is likely underestimated.
SP6.3 - Comparison of three new wireless non-radiation techniques for localization of non-palpable breast cancer - an updated systematic review and pooled meta-analysis
Authors: Subramanian Kumaresh Timma , Elnour Abdolazeem , Kurup Vijay
Published: September 2024

The method for finding non-palpable breast cancers has evolved due to technological advancements. New wire-free techniques have made implantation and retrieval easier with improved oncological outcomes. Although some evidences are available as to reduced requirement for re-operation with wireless techniques when compared to wire, in current clinical practice, the choice of selection amongst wireless technique depends on clinician preference and there is a lack of consensus. The objective of current systematic review and meta-analysis is to assess the clinical effectiveness between three new wireless non radiation localisation techniques, such as Magseed (Magnetic seed), Radiofrequency identification tag (RFID) and Savi-scout reflector localization from published literature over the last 3 years. Literature search as per PRISMA guidelines revealed twenty-six studies from 2020 to 2022 involving 6275 innovative agents analysing the 3 groups were identified. Statistical analysis using Medcalc software showed a pooled positive margin rate of 12.28% (95% CI, 10 -15%) and a re-excision rate of 11.29% (95%CI, 9 -14%) for all 3 innovative technique combined whereas studies that compare innovative techniques with wire, showed higher positive margin rate of 14.87% (95% CI, 12-18%) and re-excision rate of 16.23% (95% CI, 14-18%) for wire localization, along with considerable heterogeneity. In sub group analysis with Kruskal-Wallis test, there were no statistical significance for margin (p 0.797) and re-operation (p 0.464) rates between each group. Consolidated insertion and retrieval success for innovative group were 98.13% and 99.13% respectively. To establish the best localization approach, future RCT's will be required to assess quantitative cost-effective analyses.
SP9.8 - Assessing the quality of guidelines for the management of Gastro-Intestinal Stromal Tumour
Authors: Askari Alan , Ebrahim Saarah , Al Habsha Osama , Zuberi Sharukh , Raja Haseem , Jambulingam Periyathambi , Rashid Farhan
Published: September 2024

Introduction

Gastro Intestinal Stromal Tumours (GISTs) are tumours of the gastro-intestinal tract that arise from connective tissue and they have potential for malignancy. A number of guidelines exist in their management. The aim of this study is to assess the quality of these guidelines.

Methods

A search of the literature was undertaken for appropriate guidelines pertaining to the diagnosis and management of GISTs. The AGREE II checklist was used to assess the current GIST guidelines.

Results

A total of nine guidelines were included in this study. The overall median score across all guidelines was 68% (lowest; 50%, highest 89%). Guidelines tended to score highly in Domain IV (Clarity of Presentation, median score 76%) as well as Domain VI (Editorial Independence, 67%) and Domain I (Scope and Purpose, 61%). However, lower scores were noted in the Domain V (Applicability, 39%), Domain III (Rigor of Development, 52%) and Domain II (Stakeholder Involvement, 56%). None of the guidelines scored a unanimous ‘Yes’ vote for clinical usage, and all needed some level of modifying.

Conclusion

Whilst some of the current guidelines for the management of GISTs is of a high quality, there is a need for improvement with regards to the quality of the methodology used to formulate the guidelines and how they can be implemented in daily clinical use.
WP1.5 - Outcomes of inguinal hernia repair in adolescents by both paediatric and adult surgeons- a retrospective observational study
Authors: Kuronen-Stewart Cameron , Fitt Beth , Clyde Danielle , Faulkner Elizabeth , Damaskos Dimitrios , Cullis Paul
Published: September 2024

Aims

Adolescent inguinal herniae are repaired by both paediatric and adult surgeons, but there is significant variation in operative technique. We aim to report both adult and paediatric practice, and to compare outcomes amongst different repair techniques.

Methods

Data were collected from records of patients aged 12-18 who underwent inguinal hernia repair in adult or paediatric services within our region between 2000 and 2023.

Results

116 inguinal herniae in 106 adolescents were identified. 66% were repaired by paediatric surgeons. 85% were male. Median age was 14.1 years. Median length of follow-up was 15.0 years. 71% herniae were right-sided and 9% bilateral. 98% were indirect. 3% were incarcerated.

72% underwent open repair. Herniotomy with high ligation of the sac was the most common open operation in adult and paediatric practice.

28% herniae were repaired laparoscopically (64% by adult surgeons). Adult surgeons most commonly utilised total extraperitoneal repair, and paediatric surgeons most utilised closure of the deep ring.

4% recurred (all operated on by paediatric surgeons). 4% of patients developed chronic pain (80% from adult services). Only 1 of 5 patients with chronic pain had mesh repair. Logistic regression showed no independent variables predictive for recurrence or chronic pain.

Conclusions

There is significant variation in practice between adult and paediatric surgeons in adolescents with inguinal herniae. Recurrence was more common after repair by paediatric surgeons whilst post-operative chronic pain was less common. Paediatric and adult surgeons could learn from each other to optimise outcomes. This study also raises the question of who should be doing these procedures.
WP1.6 - Intraoperative fascial traction for the treatment of large hernias - results of a multicentre study
Authors: Woeste Guido , Meier Hansjörg , Sardoschau Nihad , Kiehle Adrien , Niebuhr Henning
Published: September 2024

Background

The incidence of incisional hernias after median laparotomy is about 20%. Intraoperative fascial traction (IFT) is a new technique for treatment of large hernias.

Materials and methods

In this study data from five hospitals using IFT between 12/2020 and 9/2023 was analysed. In all cases the Fasciotens®Hernia System was applied. When fascia closure was not possible, transversus abdominis release (TAR) was performed. All patients underwent a standardized clinical and ultrasound examination during follow-up. Quality of life was assessed using the HerQLes questionnaire.

Results

A total of 96 patients were included in the study (HH-62, DA-11, SB-10, D-9, L-4). The age was 59.9±14.1 years, 41% were female, BMI was 31.0±7.3kg/m², hernia width was 15.7±5.1cm. 88.5% underwent pretreatment with botulinum toxin (BTX). A TAR was performed in 28.1% cases. Bridging was necessary in 5.2%. Length of stay was 8.3 days.

In the postoperative course, 39/96 (40.6%) patients experienced a complication: 20.8% seroma, 9.4% wound infection, 4.2% haematoma, 2.1% intestinal injury, 1.0% wound dehiscence, 3.1% pneumonia and 2.1% urinary tract infection. No patient died. The incidence of wound infections was higher in patients with additional TAR (11.1% vs. 8.7%).

During the mean follow-up of 15.7±12.6 months 2 hernias at the border of the mesh were recognized. The HerQLes summary score was 64.5.

Conclusion

This multicentre study shows a low incidence of wound infection and recurrences using IFT. The fascia closure rate is high when combining IFT with BTX pretreatment.

Further randomised studies of IFT should follow to support these data.
WP1.14 - Evaluation of mesh closure of laparotomy and extraction incisions in open and laparoscopic colorectal surgery: A systematic review and meta-analysis
Authors: Albendary Mohamed , Issa Mohamed , Mohamedahmed Ali Yasin
Published: September 2024

Background

In colorectal surgery, postoperative evisceration and incisional hernia (IH) were not only noted after open procedures, but also at extraction incision (EI) sites used in laparoscopic resections. Few techniques, including using different sutures, closure techniques, and surgical meshes, have been evaluated in the literature to prevent the occurrence of IH and postoperative wound failure. This systematic review investigates the efficacy and safety of using prophylactic mesh on closure of midline laparotomy or extraction incision (EI) in colorectal oncological and non-oncological resections.

Method

Literature databases, including PubMed, Cochrane, Science Direct and Google Scholar, were searched for studies comparing the use of prophylactic mesh to conventional suture closure in colorectal operations, either in laparotomy closure in open surgery or EI closure in laparoscopic procedures, regardless of the indication; oncological and non-oncological. Primary endpoints were identified as incisional hernia (IH), and postoperative evisceration. Other outcomes included surgical site infection (SSI), seroma formation and length of hospital stay (LOS).

Results

Six studies fulfilled the inclusion criteria and studied 1,398 patients. Occurrence of IH was significantly reduced on using mesh closure compared to suture closure (OR 0.23, P=0.00001), while there was no statistically significant difference in evisceration rate (OR 0.51, P=0.25). Additionally, no notable difference was identified between both groups in terms of SSI (OR 1.20, P=0.54), postoperative seroma (OR 1.80, P=0.13), and LOS (MD -0.54, P=0.63).

Conclusion

The use of prophylactic mesh on closing laparotomy incision or EI for open and laparoscopic colorectal resections reduces the risk of developing IH. There were no significant safety concerns; however, further randomised trials may provide more creditable results.
WP3.3 - Surgical Management of multiple mega large stones of a congenitally low inserted Cystic Duct – A Case Report
Authors: Elfeky Mohamed , Al-Maliki Doaa , Elkhalifa Ahmed , Abdulla Samir
Published: September 2024

Introduction

Low cystic duct insertion is uncommon, and the presence of multiple large stones in the cystic duct with normal laboratory investigation is rare. The infrequency with which it is encountered and the management done makes this an interesting presentation.

Case presentation

A 61-year-old female with incidental gall stones and possible CBD/cystic duct stones on a CTAP during a workup for management of an incisional hernia of the abdomen. The patient initially presented with abdominal pain that was thought to be due to the incisional hernia. On examination, the patient had a soft abdomen with no jaundice and normal laboratory investigations. MRCP scan demonstrated multiple gall stones and cystic duct stones suggestive of Mirizzi syndrome. The patient underwent laparoscopic repair of the incisional hernia and cholecystectomy with an on-table cholangiogram. Cholangiogram showed a low inserting cystic duct joining the common hepatic duct at the sphincter of Oddi with an almost nonexistent common bile duct and a cystic duct containing multiple mega-large stones. The cystic duct was explored and stones were milked out except the most inferior stone which was impacted at the sphincter of Oddi. This was dislodged with a Fogarty catheter and all stones were retrieved. Completion cholangiogram demonstrated complete clearance of the biliary tree with dye entering the duodenum. The patient recovered well postoperatively with no complications at 1 month post-operative.

Conclusion

This case illustrates a rare presentation of large cystic duct stones in the presence of abnormal anatomy and provides an option for surgical management.
WP3.5 - Laparoscopic cholecystectomy: analysis of indications, time to surgery (TTS) and complications
Authors: Li Aleksandra , Gurung Ishani , Yiu Jonathan , Halme Helmi
Published: September 2024

Aims

Our aims are to establish whether current waiting times for cholecystectomy in our local trust between 01/2021 and 01/2022 are in line with NICE guidelines and compare with average national waiting times. We aim to establish the indications for cholecystectomy (CBD stones, cholecystitis, biliary colic, pancreatitis) and compare waiting times and readmission rates during the waiting period; estimate the rate of conversion to open/subtotal cholecystectomy and any subsequent complications.

Methods

Data collection and analysis for the period of 01/2021 – 01/2022: average waiting times, rate of conversion, indications, complications.

Results

269 patients were analysed after exclusions. Of these, mean waiting time from booking to TTS for uncomplicated biliary colic was 63.26 days. The median TTS from booking was 14 days for hot gallbladders.

Of patients diagnosed as biliary colic, the TTS following an acute hospital admission was 63.26 days. Similarly, the patients referred via GP to the outpatient surgical clinic for the same diagnosis was 78.88 days.

5 patients who were referred routinely via GP to the outpatient surgical clinic had complications requiring an acute surgical admission during the waiting period. The rate of conversion to open was 0% during the 1-year period. 2 patients had subtotal cholecystectomies, one of which had persistent bile leak managed with drains and subsequent ERCP.

Conclusion

The median TTS for hot gallbladder is in line with national standard.

There is a tendency to opt for subtotal cholecystectomy as bail out as compared to the previous years.
WP4.2 - Covid positivity: the pandemic surgical referral telephone triage legacy lives on
Authors: Court Emma , Alexander Rod , Henwood Gemma , Spearman John
Published: September 2024

Introduction

Covid restrictions provided opportunities for novel approaches to patient assessment. Innovative telephone triage of surgical referrals at Great Western Hospital, a UK District General Hospital, resulted in reduction in those patients reviewed and discharged the same day from 56% to 23.6%. Furthermore, 28.4% of admissions were avoided by triage.

This novel work was adapted for the Ambulatory Emergency Care (AEC) department of Yeovil District Hospital, in response to exponential increases in Primary Care and Emergency Department referrals.

Aims

To develop a telephone triage system to get the right patient to the right place at the right time, reviewed by the right team.

Methods

Over the two-week study period (18/9–29/9/2023) a dedicated triage telephone line enabled a discussion between referring clinician and an experienced surgeon. Four outcomes were offered:AdviceOutpatient review within 1 weekHot clinic review within 24-48 hoursSame-day review by the on-call team

Prospective referral data (18/9–29/9/2023) and retrospective non-triage data (1/9–14/9/2023) were gathered. Triage effects were measured by outcome comparison with non-triage data.

Results

A total of 193 patients were discussed. 48% were Emergency Department referrals, 25% from General Practitioners. Same-day reviews reduced by 35%. Overall, the on-call workload decreased by 68%. Return to AEC for review reduced by 99%. Reduction in average time spent by patients in AEC from 6.9 to 1.29 hours, saved up to 6 bed-days per day and facilitated significant cost savings.

Conclusions

Novel approaches can be cost effective and positively impact patient care.