bluuebunny/crossref_metadata_2025 huggingface dataset:
1650 Is There a Place for Medical Students at Organ Retrieval? 4 Years’ Experience at a Single Centre
Authors: Duck E , Schofield E
Published: October 2021

Aim

Medical students at a hospital with a national organ retrieval service (NORS) had the unique opportunity to attend organ retrieval. This retrospective survey investigated how attendance affected students’ desire to pursue a career in surgery, and what they learnt from the experience.

Method

Clinical medical students were invited to sign-up to shifts with the regional NORS team. If notified of a potential organ donation event the NORS co-ordinator would inform the medical student, who would then join the retrieval team and travel with them to the donation site. An electronic survey was later distributed to students, whether or not the donation proceeded. This survey collected both quantitative and qualitative information about the students’ experiences.

Results

51 responses were collected from students who attended proceeding organ donations between January 2015 and October 2019. 100% of students found it a useful learning experience and would recommend it to their peers. 98% were able to scrub in for the retrieval procedure. Common learning points were improved understanding of the process of organ retrieval (n = 34), and anatomy (n = 15). Following experience of organ retrieval 59% reported being more likely to pursue a career in transplant surgery and 69% reported being more likely to pursue any surgical career.

Conclusions

Medical students should be included in organ retrieval, as it not only benefits their learning, but also increases interest in surgical careers. Given that only two out of the sixteen UK NORS teams involve medical students currently, there is scope for much greater adoption of student retrieval rotas.
1653 How Do Trainees Prepare for Operating and Improve Theatre Learning Experiences?
Authors: Dunstan M , Fawns T
Published: October 2021

Introduction

Reforms to surgical training in the last three decades have threatened to reduce trainees’ operative experience. In 2012 ASiT recommended that trainees “take a proactive role in utilising all training opportunities” and that they “should be well prepared”. Published quantitative studies into surgical preparation involve mental practice and simulation and make assumptions that these are the most appropriate preparatory techniques. No qualitative studies have been published that explore how trainees prepare, to put this evidence base in context. This study aimed to investigate what trainees do to prepare for operating, their opinions on preparation for surgery, and how preparation may improve training experiences.

Method

Twelve General Surgical trainees consented to semi-structured interviews at a London District General Hospital. Interviews were recorded, transcribed and thematic analysis was undertaken.

Results

Interviewees described how preparation involves complex interactions between learning resources, their mental processes, emotions, the actions, and attitudes of other members of the theatre team, and situational and organisational barriers. These affected the quality of preparation and training experiences. Significant barriers to preparation were identified as a lack of learning resources and time to prepare. Techniques for preparation were mainly learnt informally through the ‘hidden curriculum’ and were lacking from the formal curriculum. Trainees felt that raising awareness of preparatory processes may enhance learning experiences.

Conclusions

An awareness of the factors that affect preparation and actions to mitigate barriers to preparation may help trainees to gain more from training opportunities, in the context of threats to training and the Covid-19 pandemic.
1668 Buying Your Way into A Run-Through Surgical Training Post: The Way Forward?
Authors: Raja H , Ebrahim S
Published: October 2021

Introduction

Competition for core surgical training (CST) applications has increased significantly over the last few years. This has been largely attributable to the introduction of limited run-through surgical posts which avoids the bottleneck at ST3 applications. We sought to assess how financial factors may affect current or potential future surgical trainees in their pursuit for run-through posts.

Method

A 10-point questionnaire was designed to assess various financial considerations for surgical trainees applying to the 2021 CST cycle who had the sole goal of securing a run-through post. Results were analysed using Chi-squared test.

Results

Of the 40 respondents, 95% were foundation doctors and 5% were core trainees. There was a significant association between willingness to achieve full marks in the CST interview and attending an interview course and obtaining 1-1 coaching sessions (p < 0.05). Familial income was not found to be a significant barrier to spending money on interview courses and coaching sessions (p < 0.05).

Conclusions

Applicants are willing to pay a significant premium to secure a run-through surgical post. Further research is required to fully understand the reasons behind this phenomenon and the impact on those from widening participation backgrounds.
1691 Survey of Patient Attitudes Towards Face-To-Face and Telemedicine Teaching in the COVID-19 Era
Authors: Coady L , Charturvedi A , Fearon N , Heneghan H , Carrington E
Published: October 2021

Background

COVID-19 has profoundly impacted the healthcare education environment and telemedicine has been used to augment face-to-face learning and support social-distancing. There is little evidence which examines how patients feel about participating in teaching with this technology.

Method

A prospective survey of 229 surgical inpatients/outpatients was conducted at a university hospital between August–September 2020. The survey consisted of 31 questions (7-point Likert scales, quantitative items, and free-text answers) to explore: general attitudes towards teaching, attitudes towards COVID-19, perceptions of face-to-face teaching and perceptions of telemedicine teaching. Relationships between demographics and areas of interest were analysed qualitatively and quantitatively.

Results

Patients reported a positive attitude towards both face-to-face (mean 5.5 [1.1SD]) and telemedicine teaching (5.4 [1.2]) however there was a preference for the face-to-face approach (mean difference [MD]=.16, p = 0.14). Face-to-face teaching was found to be less bothersome (MD=.32, p=.002) and more rewarding (MD.33, p<.001). Older patients were more likely to report both teaching techniques as embarrassing (face-to-face r=.16, p=.048; telemedicine r=.15, p=.036) or as an infringement on their privacy (face-to-face r=.13, p=.048; telemedicine r=.17, p=.017). Qualitative analyses revealed four themes of the patient experience: apprentice role of students, communication skills, transient need for telemedicine during COVID-19 and privacy concerns.

Conclusions

Despite reporting a favourable impression of telemedicine teaching, patients prefer traditional face-to-face styles as they find telemedicine more bothersome and less rewarding. Educators should take this into consideration during planning of teaching during the pandemic.
1695 Undergraduate Cardiothoracic Surgery: Pumping Up Knowledge and Inspiration with High-Fidelity Simulation
Authors: Hirniak J , Hussein F , Seyedzenouzi G , Adil S , Vaghela M , Liu G , Asif A , Churchill T , Zargaran A
Published: October 2021

Introduction

Alongside declining ST3 applications, cardiothoracic surgery (CTS) is underrepresented in the medical curriculum with 90% of medical students reporting no exposure to the specialty in medical school placements. This may result in clinicians having difficulties recognising emergency presentations, with subsequent referrals made inappropriately.

Method

A simulation course involving teaching around common CTS conditions and procedures was delivered by CTS trainees to undergraduate medical students (n = 50). This involved both theory and high-fidelity simulations of coronary anastomoses using cardiac surgical equipment on porcine hearts and ureters. Delegates were given pre and post-test questionnaires, and another at six-weeks to test knowledge retention. Results were statistically analysed using paired and independent sample t-tests.

Results

Delegates demonstrated significant improvements in post-test knowledge of 56% (p<0.01), and sustained improvement of 51% (p<0.01) six-weeks later compared to baseline. 64% of delegates reported an increased interest in pursuing CTS as a career; 40% reported improved confidence performing a coronary anastomosis.

Conclusions

Immediate and long-term knowledge retention of key CTS concepts and ability to assess common CTS pathological scenarios were demonstrated in this study. CTS simulation therefore represents an effective mechanism by which key concepts can be taught to undergraduate medical students, whilst enhancing interest in pursuing CTS as a career. As an educational adjunct, simulation can help bridge the gap between taught theory and applied practice, with the potential to empower future doctors to make more informed referrals and management decisions.
1697 Undergraduate Otolaryngology: Enhancing Interest and Education with Hands-on Simulation
Authors: Hirniak J , Jain A , Van M , Kokotkin I , Vaghela M , Churchill T , Zargaran A
Published: October 2021

Introduction

With cancelled student placements due to the COVID-19 pandemic, there is a shift towards non-patient-facing methods to deliver medical education. The aim was to design, deliver and evaluate an ENT course for undergraduate medical students.

Method

A three-part simulation course on common and emergency ENT conditions was delivered by ENT trainees to undergraduate medical students (n = 50). It involved theoretical and hands-on experience with otoscopy on head models; nasoendoscopy and epistaxis management with upper airway head models and nasal packing kits; and management of compromised airways using critical airway models, airway adjuncts, intubation and cricothyroidotomy kits. Delegates were given pre- and post-course questionnaires, with another at six-weeks to test knowledge retention. Results were statistically analysed using paired and independent sample t-tests.

Results

A statistically significant improvement in post-test knowledge of 55% (p<0.01) was observed. Delegates also demonstrated a sustained improvement of 51% (p<0.01) six-weeks later compared to baseline knowledge. 76% and 80% reported improved confidence managing epistaxis and performing intubation respectively; 46% reported increased interest in pursuing ENT as a potential career.

Conclusions

This study demonstrated statistically significant and sustained improvements in knowledge about common and emergency ENT concepts. ENT simulation therefore represents an efficacious mechanism for teaching key ENT concepts and improving confidence in undergraduate medical students, whilst improving interest in pursuing ENT as a career. Additionally, simulation is an invaluable educational adjunct that may foster more realistic, impactful, and safer educational experiences for medical students whilst exposure to patients is minimised due to the current pandemic.
175 Sternal Closure with Single Compared to Double or Figure-Of-8 Wires in Obese Patients Post Cardiac Surgery: A Systematic Review and Meta-Analysis
Authors: Shafi Ahmed Mohamed Abdel , Abuelgasim Eyad , Abuelgasim Biyaser , Iddawela Sashini , Harky Amer
Published: October 2021

Aim

Sternal instability and wound infections are a major cause of morbidity following cardiac surgery, which is further amplified in high-risk patients that include diabetics and patients with high BMI. We compare the different outcomes of different sternal wire closure techniques following median sternotomy for cardiac surgery in obese patients

Method

A comprehensive electronic literature search was undertaken according to PRISMA guidelines from inception to July 2020 to identify all published data comparing single wire sternal closure to either double wire or figure-of-8 techniques following median sternotomy for cardiac surgery in obese patients, defined as a BMI ≥ 30.

Results

Eight studies met the final inclusion criteria; single wire versus double wire sternal closure (n = 2) and single wire versus figure-of-8 wire closure (n = 6). Higher rate of sternal instability was noted in single wire vs double wire closure (22/150 (14.7%) patients vs 6/150 (4%) patients, p = 0.003, OR 0.25 [95% CI 0.10-0.63]). Similarly, sternal instability was higher in single wire vs figure-of-8 wire closure technique (33/2422 (1.3%) vs 11/8035 (0.1%), p = 0.04 OR 0.30 [95% CI, 0.09-0.96]) respectively.

Conclusions

There is benefit in the use of either double or figure-of-8 sternal wire closure techniques over single wire closure in terms of sternal instability. However, as the studies were limited, larger scale comparative studies are required to provide a solid evidence base for choosing the optimal sternal closure technique in this high-risk group of patients.
593 Colonic Perforation Following Major Burns: A Systematic Review
Authors: Fadel M , Iskandarani M , Cuddihy J , Jones I , Collins D , Kontovounisios C
Published: October 2021

Introduction

Major burns complicated by stress ulceration and perforation of the stomach or duodenum is a recognised clinical phenomenon. Colonic perforation in burns patients is seemingly uncommon, and the overall incidence, clinical signs/diagnosis of perforation, intervention required, and mortality is incompletely described in the literature.

Method

We performed a systematic review of the literature on severe burns resulting in colonic perforation during admission. Relevant studies from January 1975 to June 2020 were retrieved from MEDLINE and EMBASE databases. Patient demographics, total body surface area (TBSA), site of colonic perforation, management and overall outcome were extracted. We present a case series of five major burns patients who had colonic perforations in our Specialist Burns Centre.

Results

We identified 54 studies, of which nine (two case series and seven case reports) met the inclusion criteria. In most cases, the TBSA associated with a colonic perforation was ≥ 30% (10/16 patients, 63%) and the abdomen was involved in 9/16 patients (56%). Perforations mainly affected the right colon (12/16 patients, 75%), usually occurring after the second week of admission (13/16 patients, 81%). Right-sided colonic perforations were associated with an increased mortality rate compared to left-sided perforations (42% vs 25%).

Conclusions

The current literature, mainly limited to case series and case reports, confirms that colonic perforations in burns patients are rare. The resulting perforation is related to the systemic effect of burn injuries including sepsis and gastrointestinal stasis. We have identified patients who are at higher risk of developing colonic perforations in order to prompt early diagnosis and intervention.
628 Management of Chyle Leaks Following Oesophagectomy: A Systematic Review
Authors: Power R , Smyth P , Donlon N E , Nugent T , Donohoe C L , Reynolds J V
Published: October 2021

Aim

Chyle leakage is a rare but potentially life-threatening complication following oesophageal resection. The optimal management strategy is not clear.

Method

Searches were conducted up to 31/12/2020 on MEDLINE, Embase and Web of Science for randomised trials or retrospective studies that evaluated the management of chyle leakage following oesophageal resection. Two authors independently screened studies extracted data and assessed for bias. The protocol was prospectively registered on PROSPERO (CRD: 42021224895) and reported in accordance with PRISMA guidelines.

Results

A total of 530 citations were reviewed. Twenty-five studies, totaling 1016 patients met the inclusion criteria, including 2 low-quality clinical trials and 23 retrospective case series. Heterogeneity of study design and outcomes prevented meta-analysis. The overall incidence of chyle leaks was 3.2% but no consistent risk factors were found across studies. Eighteen studies describe management of chyle leaks conservatively, 17 by surgical ligation of the thoracic duct, and 6 described percutaneous lymphangiography with thoracic duct embolisation (TDE) or disruption (TDD). There is a paucity of high-quality prospective studies directly comparing treatment modalities, but there is some low-certainty evidence that percutaneous approaches have reduced morbidity, but lower efficacy compared to surgery.

Conclusions

The evidence-base for optimal management of chyle leakage post-oesophagectomy is lacking, which may be related to its low incidence. Further high quality, prospective studies that compare interventions at different levels of severity are needed to determine the optimal approach to treatment.
697 The Use of Augmented and Mixed Reality Technology to Improve Surgical Outcomes: A Systematic Review
Authors: Bollen E , Solomon J , Stubbs M , Langridge B , Butler P E M
Published: October 2021

Aim

The use of augmented and mixed reality technology is a novel and rapidly developing field. This technology has generated significant interest in surgery, however the evidence supporting its proposed benefits is limited. This systematic review aims to critically appraise the intraoperative use of augmented and mixed reality technology to improve surgical outcomes in order to provide directions for future research.

Method

This systematic review is registered with PROSPERO (CRD42020205892) and was performed in adherence to PRISMA guidelines. Studies reporting primary data on surgical outcomes of the intraoperative use of augmented and mixed reality technology were included. A structured search of major literature databases was performed. Risk of bias was assessed following the guidance of the Cochrane Handbook.

Results

68 studies met the inclusion criteria, with 63 reporting the intraoperative use of augmented reality technology and 5 reporting the use of mixed reality. The number and methodological quality of these studies is increasing. The intraoperative use of this technology has been demonstrated to reduce operative times, intraoperative blood loss and lengths of hospital admissions in specific settings. The widespread adoption of this technology faces the challenges of its cost, technical precision and integration into the surgical workflow.

Conclusions

The intraoperative use of augmented and mixed reality technology is an area of research still in its early stages, with an increasing number of methodologically robust studies on the subject. Current results suggest that the use of this technology is safe and, in certain applications, has the potential to significantly improve surgical and health-economic outcomes.
720 Pringle Versus Selective Hepatic Vascular Exclusion in Major Hepatectomy: A Systematic Review and Meta-Analysis
Authors: Mobarak S , Stott M , Tarazi M , Varley R , Davé M , Baltatzis M , Satyadas T
Published: October 2021

Aim

Mortality and morbidity following hepatic resection is significantly affected by major intra-operative blood loss. Multiple techniques have been developed in an attempt to minimise blood loss by occluding hepatic inflow and outflow. This systematic review and meta-analysis evaluates whether selective hepatic vascular exclusion compared to a Pringle manoeuvre in hepatic resection reduces rates of morbidity and mortality.

Method

A systematic review and meta-analysis were conducted according to the PRISMA guidelines by screening EMBASE, MEDLINE/PubMed, CENTRAL, SCOPUS and bibliographic reference lists for comparative studies meeting the predetermined inclusion criteria. Intra- and post-operative outcome measures were investigated. Pooled odds ratios or mean differences with 95% confidence intervals were calculated using either fixed- or random-effects models.

Results

Five studies were identified including two randomized controlled trials and three observational studies reporting a total of 2,198 patients. Data synthesis showed significantly decreased rates of mortality, overall complications, patients requiring blood transfusion, air embolism, warm ischaemia time, liver failure and multi-organ failure when performing SHVE compared to a Pringle manoeuvre. Rates of hepatic vein rupture and post-operative haemorrhage remained the same. Performing SHVE resulted in a significantly longer operation time.

Conclusions

Performing SHVE in major hepatectomy may result in reduced rates of morbidity and mortality when compared to a Pringle manoeuvre, although may prolong operating time. The results of this meta-analysis are based on a few high-quality studies where tumours were adjacent to major vessels. Further RCTs are required to validate these results and determine the best technique for hepatic vascular control in this patient cohort.
724 Quadriceps Tendon Autograft Versus Hamstring Tendon Autograft in Anterior Cruciate Ligament Repair: A Systematic Review and Meta-Analysis
Authors: Tan T K , Subramaniam A G , Radic R
Published: October 2021

Aim

Quadriceps tendon (QT) autograft has recently become the popular choice of autograft in anterior cruciate ligament reconstruction (ACLR) and slowly replacing hamstring tendon (HT) autograft. QT autograft has traditionally served as the alternative of HT autograft, but recent studies revealed that QT autografts are not inferior to HT autografts. The purpose of this study was to provide an in-depth review the clinical and functional outcomes between QT and HT autografts in ACLR.

Method

Databases of Pubmed, EMBASE, MEDLINE and CENTRAL were systematically searched from its inception until November 2020. All observational studies comparing QT and HT autografts in the ACRL surgery were included.

Results

Twenty-two observational studies (3 randomized controlled trials and 19 comparative studies) comprising of 16952 patients (QT = 1407, HT = 15545) were included in quantitative meta-analysis. In comparison to HT autograft, patients who received QT autograft had similar postoperative Lysholm Score (MD:1.05, p = 0.44), Tegner Score (MD:0.11, p = 0.06), IKDC score (MD:0.48, p = 0.48), side to side laxity(MD:-0.08, p = 0.77), limb symmetry index (MD:1.87, p = 0.61), Pivot shift test grade 0 (OR:1.13, p = 0.74), Lachman test grade 0 (OR:2.38, p = 0.32), hamstring to quadriceps ratio (MD:-1.10, p = 0.82), incidence of graft failure (OR:0.68, p = 0.43), contralateral knee injury (OR:1.22, p = 0.61), peak torque muscle strength flexion (MD:-0.20, ρ = 0.10) and Cincinnati score (MD:-0.85, p = 0.66).

Conclusions

In this meta-analysis, the usage of QT autograft is not inferior to HT autograft in ACLR. Our study demonstrated comparable morbidity, clinical and functional outcome in QT and HT autografts, indicating that QT autograft is equally safe as HT autograft.
728 A Systematic Review of The Efficacy and Safety of Outpatient Bladder Tumour Ablation
Authors: Malde S , Grover S , Raj S , Yuan C , Nair R , Thurairaja R , Khan M S
Published: October 2021

Introduction

The management of recurrent non-muscle-invasive bladder cancer (NMIBC) typically requires repeated transurethral resections under general anaesthesia. This is costly and results in poor health-related quality-of-life for patients. Outpatient-based laser ablation and diathermy to recurrent tumours could reduce morbidity and cost of managing NMIBC. This systematic review evaluates the safety and efficacy of outpatient-based diathermy or laser ablation for recurrent NMIBC.

Method

The EMBASE, MEDLINE and Cochrane Library were searched until June 2020. All studies evaluating the use of outpatient diathermy or laser ablation for NMIBC were included. The quality of evidence and risk of bias were assessed using the GRADE and ROBINS-I tools, respectively.

Results

From 1328 studies identified, 17 studies (1584 patients) were included. Overall, the majority of tumours (80%) were low-grade (G1 and G2). Laser ablation and diathermy resulted in a mean recurrence rate of 47% and 40% at 20-31 months follow-up, respectively, with a mean progression rate of 3-11%. Both procedures were well-tolerated with low pain scores (mean score of 1) and low periprocedural complication rates. However, the overall quality of evidence of low.

Conclusions

This review demonstrates that both procedures have good short-term efficacy in patients with low-grade NMIBC. The procedures are well-tolerated with low complication rates and importantly, reduce the need for intervention under general anaesthesia. These findings can aid patient counselling regarding less invasive treatment options, avoiding the morbidity of transurethral resection. Future randomised studies with standardised risk stratification and outcome measures are required to add to the quality of evidence.
810 Intravenous Iron Versus Oral Iron in Anemia Management for Perioperative Patients: A Systemic Review and Meta-Analysis
Authors: Alshantti A
Published: October 2021

Introduction

Perioperative anemia commonly occurs in patients undoing major surgery. We aimed to assess the efficacy and safety of intravenous iron therapy (IVIT) given compared to standard practice of oral iron in the perioperative period.

Design

The search strategy was conducted in Medline, Embase, and Cochrane for only eligible clinical trials (randomized controlled trials) comparing IV over oral iron therapy up to July 2019. The primary outcome was the effect of IVIT on the change of hemoglobin level. The secondary outcomes were the effects of IVIT compared to oral iron on ferritin level, mean corpuscular volume, and adverse side effects. Data were collected from each trial and where applicable meta-analyzed using RevMan.

Results

Six randomized clinical trials that fit our inclusion criteria were included in the study.We found that IVIT increases the level of hemoglobin compared to oral iron (MD: Mean difference 0.90, 95% confidence interval [CI]: 0.44–1.36, P = 0.000). Serum ferritin levels increased significantly in favor of the IV iron group compared to the oral iron group at posttreatment (MD: 106.95, 95% CI: 73.29, 140.62 ng/mL). In addition, marked increases in the pooled mean corpuscular volume (MCV) level were observed in favor of the IVIT (MD: 6.07, 95% CI: −0.88–13.02). There was no significant difference in the rate of adverse effects in both the groups.

Conclusions

IV iron therapy is more effective than oral iron on increasing hemoglobin, ferritin, and MCV in the perioperative period and is also as safe with no diffidence in the risk of developing adverse side effects.
863 Online Patient Resources to Support Shared Decision Making for Fundoplication Surgery: A Systematic Review
Authors: Virupaksha S
Published: October 2021

Aim

The royal college of Surgeons’ Supported Decision-Making guidance details how patients should access information necessary to make clinical decisions alongside their medical team. As patients become more reliant on information found via the internet, it is important to ensure that there are suitable, validated, and appropriate resources. This study aims to assess the quality of online patient information related to anti reflux (Fundoplication) surgery and we believe this review is first of its kind with regards to surgery for gastroesophageal reflux disease.

Method

A comprehensive, targeted search was made of online healthcare information relating to Fundoplication surgery. Search terms ‘fundoplication’ and ‘anti-reflux surgery’ were entered into three main search engines using a pre-defined search strategy. Websites were assessed according to their readability (Klesch-Kincaid Reading Ease Score), quality and content (International Patient Decision Aids Standards (IPDAS) and DISCERN scores) as well as the presence of accreditation. The PRISM and AMSTAR guidelines have been followed in this article.

Results

Overall, 74 sources from three search engines were found. Duplicates were removed and pre-defined eligibility criteria applied, giving 40 sources for analysis. The mean readability score was higher than the recommended score for patient education materials, while the IPDAS and DISCERN scores were low. There were only 22.5% of the websites accredited by the HANcode. No statistical significance was found on the overall quality of websites between the accredited and non-accredited websites

Conclusions

Patient information available online for fundoplication is difficult to read and of poor quality impacting negatively on shared decision-making.
866 The Use of Deep Learning for The Detection, Characterisation and Prediction of Metastatic Disease From CT: A Systematic Review
Authors: Shivakumar N , Chandrashekar A , Handa A , Lee R
Published: October 2021

Introduction

Computed tomography (CT) is widely used in the clinical setting for the diagnosis, staging and management of cancer. The presence of metastatic disease in cancer has significant implications on most effective treatment options as well as prognosis. With advances in computing technology, deep learning - a form of machine learning - where layers of programmed algorithms are able interpret and recognise patterns may have a potential role in CT image analysis. This review aims to provide an overview on the use of deep learning in CT image analysis in the diagnostic evaluation of metastatic disease.

Method

A systematic search on databases Medline, Embase and Central was performed. Retrieved studies were screened as per the inclusion and exclusion criteria. A total of 29 studies were included for which a narrative synthesis was provided

Results

With regards to metastatic disease, the studies could be grouped together into three areas of research. Firstly, the use of deep learning on the detection of metastatic disease from CT imaging. Secondly, its use on the characterisation of lesions on CT into metastatic disease. Finally, the use of deep learning to predict the presence or development of metastatic disease based on the primary tumour.

Conclusions

Deep learning in CT image analysis could have a potential role in evaluating metastatic disease, however, prospective clinical trials investigating its clinical value is required.
1020 Delay to Surgery in Acute Perforated and Ischaemic Gastrointestinal Pathology
Authors: Murray V , Burke J , Hughes M , Schofield C , Young A
Published: October 2021

Introduction

Patients with acute abdominal pathology requiring emergency laparotomy who experience a delay to theatre have an increased risk of morbidity, mortality, and complications. The timeline between symptom onset and operation is ill-defined with international variance in assessment and management. This systematic review aims to define where delays to surgery occur and assess the evidence for previous interventions.

Method

A systematic review was performed searching MEDLINE and EMBASE databases (January 1st 2005 to May 6th 2020). All studies assessing the impact of time to theatre in patients with acute abdominal pathology requiring emergency laparotomy were considered.

Results

Eighty-five results were assessed to include 19 papers in the analysis. Fifteen unique timepoints were identified in the patient pathway between symptom onset and operation which could be classified into four distinct phases. Time from admission to theatre (1 to 72 hours), and mortality rate (10.6-74.5%) varied greatly between studies. Mean time to surgery was significantly higher in deceased patients compared to survivors. Delays were related to imaging, diagnosis, decision-making, theatre availability and staffing. Four of five interventional studies showed a reduced mortality following introduction of an acute laparotomy pathway.

Conclusions

There is wide variation in the definition and measurement of time delays prior to emergency surgery with few studies exploring interventions. Given the heterogenous nature of the patient population and pathologies, an assessment and management framework from onset of symptoms to operation is proposed. This could be incorporated into national mortality prediction and audit tools and assist in the assessment of interventions.
1070 A Systematic Review of Seymour Fracture Management
Authors: Khanal P , Srivastava A , Zargaran D , Zargaran A , Nikkhah D , Mosahebi A
Published: October 2021

Aim

Seymour fractures are distal phalanx fractures of the finger in children with a juxta-epiphyseal or Salter-Harris Type I/II pattern associated with a nail-bed injury. There remains a paucity in literature regarding the development of complications between Seymour fracture management options, with early studies encouraging non-operative management due to the increased rates of post-operative infection. This systematic review aims to identify present-day, optimal management strategies for Seymour fractures, with further analysis of infection rates and secondary outcomes during post-operative recovery.

Method

Free-text search, MeSH terms and expanded keywords/phrases were employed to search the PubMed, Embase (via Ovid), Web of Science and CINAHL databases. Studies that described the management of Seymour fractures in paediatric patients were included, subject to inclusion/exclusion criteria. The data extracted included the sample size, intervention, infection rates and secondary outcomes.

Results

An initial search identified 305 articles, following the PRISMA guidance, 8 studies were eligible for full-text analysis. Across all studies, 307 Seymour fractures were identified (mean age, 10±1.2 years). A cross-study analysis showed a lower rate of adverse outcomes (including malunion/non-union and unplanned operative intervention) for K-wire fixation when compared to external splinting, 8.3% and 20.7% (P ≤ 0.001), respectively.

Conclusions

There was no statistically significant difference between non-operative and operative management in rates of infection and adverse outcomes. However, further analysis revealed a significantly lower risk of complications in patients who received K-wire fixation when compared to external splinting. Nonetheless, further studies with greater levels of evidence need to be carried out to consolidate this.
1136 Cochlear Implant Outcomes in Patients with Otosclerosis: A Systematic Review
Authors: Lam C M , Cornwall H L , Chaudhry A , Muzaffar J , Bance M , Monksfield P
Published: October 2021

Introduction

In otosclerosis, spongiotic bone replaces normal bone in the ossicular chain. Focal deposits may also be found within the cochlea leading to sensorineural hearing loss refractory to conventional treatment. Cochlear implantation can play an important role in the management of otosclerosis in these patients. Our study objective is to establish hearing outcomes following cochlear implantation in patients with otosclerosis.

Method

Systematic review and narrative synthesis. Databases searched: Medline, PubMed, Embase, Web of Science, Cochrane Collection and ClinicalTrials.gov. No limits placed on language or year of publication. Review conducted in accordance with the PRISMA statement.

Results

Searches identified 68 studies meeting the inclusion criteria and reporting outcomes in a minimum of 481 patients with at least 516 implants. The methodological quality of included studies was modest, predominantly consisting of case reports and non-controlled case series with small numbers of patients. Significant heterogeneity existed in terms of outcomes and methods of reporting, which precluded a meta-analysis. Access to good rehabilitation support is essential to achieving the good hearing outcomes and Patient Reported Outcome Measures that can be expected by 12 months post-implantation in most cases. There was significant association between the radiological severity of otosclerosis and an increase in surgical and post-operative complications. Post-operative facial nerve stimulation can occur and may require deactivation of electrodes and subsequent hearing detriment.

Conclusions

Hearing outcomes are typically good, but patients should be counselled on associated surgical complications which may compromise hearing. Modern diagnostic techniques may help to identify potentially difficult cases to aid operative planning and patient counselling.
1273 Appendicitis and Patient Information: A Systematic Analysis of Websites Using the EQIP Tool
Authors: Fan K S , Ghani S , Fan K H , Lenti L , Raptis D
Published: October 2021

Background

Appendicitis is a common surgical problem amongst the young adult population, who are likely to use the Internet to obtain medical information. This information may determine the health-seeking behaviour of an individual and may delay medical attention. This study aims to study the quality of patient information on appendicitis on the Internet as it has not been previously studied.

Method

A systematic review of health information on appendicitis available online is conducted using 4 search terms via Google: ‘appendicitis’ ‘appendix’, ‘appendectomy’ and ‘appendicectomy’. The top 100 websites of each search term were assessed using the validated ’Ensuring Quality Information for Patients’ (EQIP) tool (score 0-36). Only websites containing health information intended for the general public were included.

Results

A total of 119 websites met the eligibility criteria for evaluation. The overall median EQIP score for all websites was 20 (interquartile range 18-22). More than half the websites originated from the USA (53%). 45% of all websites originated from hospitals but 43% of these did not mention qualitative risks from surgery. Incidence rates were only provided for complications and mortality in 13% and 3% of all websites, respectively.

Conclusions

The assessment of the quality and readability of websites concerning appendicitis by the EQIP tool indicates that most sites online were of poor credibility, with minimal information regarding complication rates and mortality. To improve education and awareness of appendicitis, there is an immediate need for more informative and patient-centred websites that are more compatible with international quality standards.
1303 Obesity: A Growing Concern in Gynaecological Surgery
Authors: Raja P
Published: October 2021

Introduction

Obesity is becoming a major concern in healthcare. The rise in obesity has now reached alarming levels. Obesity is driven by the economic growth, unbalanced diet, and a sedentary lifestyle. Obesity has played a disastrous role in the health of many but significantly has had a detrimental health effect among girls and women. This review focuses on the effect of obesity on various aspects of women’s health including prognosis after gynaecological surgery.

Method

The search engine used for this literature review was Ovid MEDLINE. Only studies reported in English have been included in this review. The snowball and citation searching method was used to find further relevant articles.

Results

Various genetic components have been identified to increase the risk of obesity which is further exacerbated with the current obesogenic environment. Women with a BMI≥35 had longer surgeries and an increased rate of severe postoperative adverse events. Additionally, women with a higher BMI had an increased risk of cervical cancer due to under-diagnosis of cervical precancerous lesions, though obesity did not directly alter the association between preoperative biopsy and final tumour grade.

Conclusions

Despite increased awareness, obesity is still a major contributor of mortality and morbidity. Women in particular are facing severe consequences of the obesogenic environment. In women obesity not only increases their risk of developing gynaecological conditions but also adversely affects prognosis after surgical treatment. In the face of an obesogenic environment, it is important to sought out potential ways to reduce the risk of surgical complications in obese patients.
Phenotyping hypertrophic cardiomyopathy using cardiac diffusion magnetic resonance imaging: the relationship between microvascular dysfunction and microstructural changes
Authors: Das Arka , Kelly Christopher , Teh Irvin , Nguyen Christopher , Brown Louise A E , Chowdhary Amrit , Jex Nicholas , Thirunavukarasu Sharmaine , Sharrack Noor , Gorecka Miroslawa , Swoboda Peter P , Greenwood John P , Kellman Peter , Moon James C , Davies Rhodri H , Lopes Luis R , Joy George , Plein Sven , Schneider Jürgen E , Dall’Armellina Erica
Published: October 2021

Aims

Microvascular dysfunction in hypertrophic cardiomyopathy (HCM) is predictive of clinical decline, however underlying mechanisms remain unclear. Cardiac diffusion tensor imaging (cDTI) allows in vivo characterization of myocardial microstructure by quantifying mean diffusivity (MD), fractional anisotropy (FA) of diffusion, and secondary eigenvector angle (E2A). In this cardiac magnetic resonance (CMR) study, we examine associations between perfusion and cDTI parameters to understand the sequence of pathophysiology and the interrelation between vascular function and underlying microstructure.

Methods and results

Twenty HCM patients underwent 3.0T CMR which included: spin-echo cDTI, adenosine stress and rest perfusion mapping, cine-imaging, and late gadolinium enhancement (LGE). Ten controls underwent cDTI. Myocardial perfusion reserve (MPR), MD, FA, E2A, and wall thickness were calculated per segment and further divided into subendocardial (inner 50%) and subepicardial (outer 50%) regions. Segments with wall thickness ≤11 mm, MPR ≥2.2, and no visual LGE were classified as ‘normal’. Compared to controls, ‘normal’ HCM segments had increased MD (1.61 ± 0.09 vs. 1.46 ± 0.07 × 10−3 mm2/s, P = 0.02), increased E2A (60 ± 9° vs. 38 ± 12°, P < 0.001), and decreased FA (0.29 ± 0.04 vs. 0.35 ± 0.02, P = 0.002). Across all HCM segments, subendocardial regions had higher MD and lower MPR than subepicardial (MDendo 1.61 ± 0.08 × 10−3 mm2/s vs. MDepi 1.56 ± 0.18 × 10−3 mm2/s, P = 0.003, MPRendo 1.85 ± 0.83, MPRepi 2.28 ± 0.87, P < 0.0001).

Conclusion

In HCM patients, even in segments with normal wall thickness, normal perfusion, and no scar, diffusion is more isotropic than in controls, suggesting the presence of underlying cardiomyocyte disarray. Increased E2A suggests the myocardial sheetlets adopt hypercontracted angulation in systole. Increased MD, most notably in the subendocardium, is suggestive of regional remodelling which may explain the reduced subendocardial blood flow.
Genome silencer therapy leading to ‘regression’ of cardiac amyloid load on cardiovascular magnetic resonance: a case report
Authors: Florian Anca , Bietenbeck Michael , Hüsing-Kabar Anna , Schilling Matthias , Schmidt Hartmut H , Yilmaz Ali
Published: October 2021

Background

Hereditary or variant transthyretin amyloidosis (ATTRv) is a progressive disease manifesting with neuropathy and/or cardiomyopathy. An early and accurate diagnosis of cardiac amyloidosis is a pre-requisite for timely and appropriate patient management, including anti-amyloid therapies, as it is associated with heart failure, conduction disease, and arrhythmias, leading to reduced quality of life and early death.

Case Summary

We present the case of an ATTRv male patient presenting with a mixed amyloidosis phenotype (neuropathy and cardiomyopathy). Cardiac disease manifestation comprised tachyarrhythmias (atrial fibrillation) and conduction abnormalities (atrio-ventricular block) in addition to segmental left ventricular (LV) hypertrophy (septal wall) due to regionally pronounced amyloid deposits in the basal LV myocardium. Interestingly, by means of serial cardiovascular magnetic resonance (CMR) studies, we were able to demonstrate an impressive and unexpected improvement of cardiomyopathy findings within a relatively short period-of-time after the implementation of genome-silencer therapies.

Discussion

This is our second case report that showed ATTRv cardiomyopathy reversal under anti-amyloid therapy—documented by multi-parametric CMR. Our findings support the hypothesis that amyloid infiltration leading to cardiomyopathy is not an irreversible pathological process—but rather a dynamic one, that cannot only be stopped but even reversed (to a certain degree) by currently emerging anti-amyloid therapies. Moreover, the role of serial multi-parametric CMR imaging for surveillance of cardiomyopathy dynamics under these therapies is nicely illustrated.
How exercise can deteriorate the clinical course of an ARVC patient: a case report
Authors: Lüsebrink Enzo , Binzenhöfer Leonhard , Brunner Stefan , Hausleiter Jörg , Massberg Steffen , Orban Martin , Kääb Stefan
Published: October 2021

Background 

Arrhythmogenic right ventricular cardiomyopathy (ARVC)/dysplasia is a genetic disease characterized by fibro-adipose degeneration of ventricular myocardium. Initial clinical presentation is variable and ranges from asymptomatic cases to chronic heart failure and sudden cardiac death due to malignant arrhythmias.

Case summary 

Here, a 67-year-old male patient who started extensive physical training upon retirement and presented with ventricular tachycardia and progressive heart failure as a first sign of his disease. Arrhythmogenic right ventricular cardiomyopathy diagnosis was established according to the 2010 modified Task Force Criteria and supported by HRS/EHRA consensus-based genotyping. After initial discharge on optimal medical therapy and prophylactic implantable cardioverter-defibrillator implantation according to his individual ARVC risk score, the patient reported rapid decline in physical capacity on a regular follow-up 4 months later. To better understand the aetiology of his clinical deterioration, we performed stress echocardiography, coronary angiogram, and exercise right heart catheterization, which conclusively suggest impaired left ventricular filling secondary to right ventricular failure as a main cause of global circulatory failure.

Discussion 

The present case report focuses on relation of physical activity to disease onset and the concomitant advent of symptoms during exercise as well as a structured and guideline-aided diagnostic workup in ARVC and staged treatment options. Continuous ARVC centre-oriented re-assessment and treatment planning including lifestyle intervention, psychological support, medical, surgical, and interventional options are key elements of sustained long-term care for ARVC patients.