bluuebunny/crossref_metadata_2025 huggingface dataset:
1337 A Regional Review of The Epidemiology and Pathological Characteristics of Malignant Melanoma in Northern Ireland (NI), And Correlation with Socio-Economic Status
Authors: Currie R , Martin S , McAllister S
Published: October 2021

Introduction

The incidence of cutaneous malignant melanoma is increasing. Internationally, there is evidence of an association between melanoma incidence and higher socioeconomic status (SES). This study aims to assess the characteristics of patients with melanoma in NI, and correlate to SES.

Method

Retrospective review of electronic records for patients undergoing surgery for melanoma at the Northern Ireland Plastic Surgery Unit from August 2015 to March 2020. Patients were identified from theatre records and a prospectively collected sentinel lymph node database. The NI Multiple Deprivation Measure 2017 was used to measure SES.

Results

440 patients were included (F = 54%, M = 46%). Mean age=63 (M = 67, F = 59). Mean Breslow Depth (BD) = 2.61mm (Range 0.17 – 27mm). Females had significantly thinner tumours at presentation (mean BD 2.16mm. vs 3.1mm in males, p = 0.001). In males the commonest sites were head and neck (36%) and back (23%). In females, the commonest sites were lower limb (42%) and upper limb (23%). There was a positive correlation between higher SES and increased incidence of melanoma (correlation coefficient (CC) 0.922), but this did not correlate with an increase in Breslow depth (CC -0.020).

Conclusions

This study provides important information on melanoma in NI, including gender and site variances. Females were more commonly affected and were a mean of 8 years younger than males at diagnosis but presented with significantly thinner tumours. Unlike the rest of the UK, the commonest site in males was the head and neck. Higher SES was related to higher incidence of melanoma but with presentation at an earlier stage of disease.
1289 Gender Representation in The Authorship of Surgical Journals
Authors: Arshad S , Gallivan E , Skinner H , Burke J , Young A
Published: October 2021

Introduction

Despite the increase in female doctors graduating from medical schools internationally, gender disparity in surgery remains. This disparity is also evident in academic surgery. This study aims to quantify the extent of gender disparity in the authorship of articles in major surgical journals.

Method

The Top 10 Surgical Journals were identified using SCImago Journal Rank indicator. Authorship details for papers published in 2019 were collected. Authors were assigned as female, male or unknown using Gender API software (Gender API, Germany). For each journal, the percentage of first author, last author, corresponding author and all authors split by gender was interrogated. Gender differences by publication type were also identified.

Results

9 of the 10 journals had full names publicly available. Overall, 2414 manuscripts were interrogated which included 16,277 number of authors. Respectively, females and males accounted for 29.8% [22.9-34.9%] (N = 655) and 62.4% [56.3-70.2%] (N = 1419) of first authors, 20.6% [11.8-27.1%] (N = 453) and 74.2% [65.6-84.1%] (N = 1706) of last authors, 23.9% [14.9-29.6%] (N = 510) and 69.9% [60.5-79.3%] (N = 2341) of corresponding authors and in total 27% [19.4-31.6%] (N = 4298) and 65.5% [58.6-73.4%] (N = 9982) of all authors. The wide range in these results could be a result of various factors.

Conclusions

This study has identified a gender imbalance in authorship positions, with the greatest difference observed in the most senior author position. Whether this is reflective of the current disparity observed in senior academic surgery positions or due to gender discrimination is unclear.
1612 Unconscious Gender Bias from Patients: Are Female and Male Doctors Perceived Differently?
Authors: Toi T , Lewis S , Lounis S , Najdawi A
Published: October 2021

Introduction

While the need for gender equality has been well recognised within the medical profession, attitudes of patients towards doctors of different genders has not been addressed. We aim to identify whether gender biases exist within the minds of patients we treat and how we can address this.

Method

A survey was disseminated through social media platforms and work communication groups. Data was collected on gender, ethnicity, frequency of being mistaken for different members of the healthcare team and frequency of being asked to perform non-medical tasks. A free text option was available for respondents to elaborate on the context and how this made them feel.

Results

88 doctors (26 male, 62 female) responded. 65% (40) of females have had their roles misidentified at least once a week, compared to 0%(0) of males. 75% (46) of women reported negative emotions associated with being mistaken in their role, 25% (15) were neutral, none were positive. 62% (38) of female doctor’s report being asked to perform non-medical tasks at least once a week compared to 31% (8) of male doctors.

Conclusions

There is a clear disparity in how patients perceive male and female roles in medicine, with females being less likely to be identified as a doctor and twice as likely to be asked to perform non-medical tasks. As well as being potentially disruptive to their role, responses suggest that this impacts negatively on the confidence of these respondents. Further exploration of this subject, the impacts and remedies will be required in future.
951 More Than A Checkbox: Importance of Role-Modelling and Visibility Initiatives in Improving Perceptions of Diversity in Surgical Leadership
Authors: Shah V , Khan H , Komor J , Vig S
Published: October 2021

Introduction

The Royal College of Surgeons of England have committed themselves to championing diversity in surgery in light of recent socio-political events. Although there are now more trainees from underrepresented backgrounds entering the profession, this is not reflected in leadership roles which are key in establishing attitudes and cultures. This study evaluated whether an event showcasing surgeons from underrepresented groups holding leadership positions could improve student perceptions of diversity in surgical leadership.

Method

Participants attended an online event hosted by a student surgical society, where speakers with surgical leadership experience from a range of marginalised backgrounds highlighted topics of diversity and discrimination in surgery. Pre- and post-event questionnaires comprising Likert scales were completed to evaluate student perceptions of surgeons holding a leadership role from the following underrepresented groups: women (or gender non-conforming), BAME, LGBTQ+ and individuals with disabilities. Statistical significance was assessed using a Mann-Whitney U test with p < 0.05 denoting significance throughout.

Results

The event significantly increased attendee confidence in the idea of a surgeon being seen in a leadership role from all underrepresented groups evaluated: 9.3% for female/gender non-conforming individuals (p < 0.01), 12.3% for BAME individuals (p < 0.01), 7.5% for non-heterosexual individuals (p = 0.04) and 16.0% for individuals with a disability (p < 0.01).

Conclusions

Attendees felt significantly more confident in the belief that surgeons from underrepresented backgrounds could hold leadership positions following the event, indicating the benefit of such role-modelling initiatives. More investment is necessary in exploring factors dissuading specific underrepresented groups from pursuing surgical careers and for novel strategies to support these communities accordingly.
749 Unexpected benefits of pandemic guidelines for the management of epistaxis
Authors: Empey J A , Gogo E , Zuccarelli A , Diver C
Published: October 2021

Aim

The Royal Victoria Hospital adopted ENT UK’s pandemic guidelines for the management of epistaxis. We aimed to reduce ENT referrals, in-patient admissions and staff exposure to COVID-19 whilst maintaining patient safety. This involved collaboration with ED to promote the use of absorbable packs and pharmacological alternatives over rhinoscopy & rigid endoscopy with cautery +/- non-absorbable packs.

Method

Data was collected on patients presenting with epistaxis over a six-week period beginning March 2020 and the same period in 2019. Key factors recorded were number of presentations, ENT referrals, admissions, and their durations, along with management and outcomes. ENT provided training to ED staff and produced video resources for the "My ED" app. Feedback from ED and patient data was gathered to improve training and assess effectiveness.

Results

Pre-pandemic, 48% of ED epistaxis presentations were referred to ENT vs. 28% following the guidelines introduction. In 2019 49% of referrals were admitted vs. 42% in 2020. The average in-patient stay was reduced from four nights to one. Re-admission rate remained similar from 22% in 2019 to 20% in 2020. These results were achieved following repeated improvements to the training sessions.

Conclusions

The ENT UK guidelines, when supplemented with ED collaboration, are effective at reducing ENT referrals and admissions. In addition to reducing COVID-19 exposure, the guidelines offered an improved patient experience (less invasive intervention, reduced/removed in-patient stay) with no loss of efficacy. This, combined with a reduced treatment cost of ∼£2,000 per in-patient, suggests the guidelines have long-term value out-with a pandemic setting.
1201 The Impact of a Spinal Best Practice Tariff on Compliance with The British Spine Registry
Authors: Rajgor H , Habbebulah A , Gardner A , Jones M
Published: October 2021

Aim

The British Spine Registry (BSR) was introduced in May 2012 to be used as a web-based database for spinal surgeries carried out across the UK. In 2019 NHS England and NHS Improvement introduced a new Best Practice Tariff (BPT) to encourage input of spinal surgical data on the BSR. The aim of our study was to assess the impact of the spinal BPT on compliance with the recording of surgical data on the BSR.

Method

A retrospective review of data was performed at a tertiary spinal centre, Royal Orthopaedic Hospital Birmingham, between 2018-2020. 3587 patients were included in our study. Data was collated from electronic patient records, theatre operating lists and trust specific BSR data.

Results

1684 patients were eligible for BPT. In 2018-19 269/974 (28%) records were complete on the BSR for those that would be eligible for BPT. Following introduction of BPT in 2019, 671/710 (95%) records were complete having filled in the mandatory data (P < 0.01). Patient consent to data collection also improved from 62% to 93%. Email details were present in 43% of patients compared with 68% following BPT introduction.

Conclusions

Our study found that following the introduction of a BPT, there was a statistically significant improvement in BSR record completion compliance in our unit. The BPT offers a financial incentive which can help generate further income for trusts. National data input into the BSR is vitally important to assess patient outcome following spinal surgery. The BSR can also aid future research in spinal surgery.
601 The Effect of the COVID-19 Pandemic on Hip Fracture Mortality in The South West of England
Authors: Spolton-Dean C , Kent B , Ball T , Middleton R , Marusza C , Hinsley H , King A , Ayeko S
Published: October 2021

Aim

High perioperative mortality rates in surgical patients suffering concomitant COVID-19 infection have contributed to a fall in elective and urgent surgery. However, data and debate have centred around post hoc infected cases, without the context of the rest of the surgical cohort, and without comparable historical control groups. We aimed to address this by studying patients with a neck of femur fracture. This common condition has a stable incidence with good prospective data collected routinely for the National Hip Fracture Database (NHFD).

Method

We analysed NHFD data for all hospitals within our region over a 3-month period, covering the height of the first outbreak and compared this with the same months in 2019.

Results

The incidence of hip fracture was stable (463 in 2019, 448 in 2020). 30-day mortality was 6.26% in 2019 and 7.14% in 2020 (p = 0.595). In the second cohort, 14 patients tested positive for COVID-19 perioperatively. Of these, 3 died (21%) compared to 29 who tested negative (p < 0.001). Mean time to operation reduced by 1.90 hours, with a significant drop in patients waiting over 36 hours (190 to 85, p < 0.001). There were no significant differences between gender, ASA grade or pre-operative AMTS.

Conclusions

We have confirmed high perioperative mortality for those with COVID-19 infection but have not shown a statistically significant difference in overall mortality from hip fracture during the initial phase of the pandemic. We argue from this data set that the hypothetical risk of surgery during this pandemic may have been overestimated.
92 Increased Proportion of Alcohol-Related Trauma in A South London Major Trauma Centre During Lockdown, A Cohort Study
Authors: Brown O , Smith T , Gaukroger A , Tsinaslanidis P , Hing C
Published: October 2021

Background

Alcohol has been associated with 10-35% trauma admissions and 40% trauma-related deaths globally. In response to the Covid-19 pandemic, the United Kingdom (UK) entered a state of ‘lockdown’ on 23rd March 2020. Restrictions were most significantly eased on 1st June 2020, when shops and schools re-opened. The purpose of this study was to quantify the effect of lockdown on alcohol-related trauma admissions.

Method

All adult patients admitted as ‘trauma calls’ to a London Major Trauma Centre (MTC) during April 2018 and April 2019 (pre-lockdown; N = 316), and 1st April – 31st May 2020 (lockdown; N = 191) had electronic patient records analysed. Patients’ blood alcohol level and records of intoxication were used to identify alcohol-related trauma. Trauma admissions from pre- and post-lockdown cohorts were compared using multiple regression analyses.

Results

Alcohol-related trauma was present in a significantly higher proportion of adult trauma calls during lockdown (lockdown 60/191 (31.4%), versus pre-lockdown 62/316 (19.6%); (Odds Ratio (OR) 0.83, 95% CI 0.38 to 1.28, p < 0.001). Lockdown was also associated with increased weekend admissions of trauma (lockdown 125/191 weekend (65.5%) vs pre-lockdown 179/316 (56.7%); OR -0.40, 95% CI -0.79 to -0.02, p = 0.041). No significant difference existed in the age, gender, or mechanism between pre-lockdown and lockdown cohorts (p > 0.05).

Conclusions

UK lockdown was independently associated with an increased proportion of alcohol-related trauma. Trauma admissions were increased during the weekend when staffing levels are reduced. With the possibility of subsequent global ‘waves’ of Covid-19, the risk of long-term repercussions of dangerous alcohol-related behaviour to public health must be addressed.
37 Accuracy of Venous Thromboembolism Risk Assessments in The Trauma and Orthopaedics Wards of The Gloucestershire Royal Hospital
Authors: Njim T , Hafez A , Omar I
Published: October 2021

Introduction

Venous thromboembolism (VTE) risk assessment is crucial for patients undergoing orthopaedic surgery. An accurate risk assessment leads to patient stratification into risk groups for appropriate VTE prophylaxis.

Aim

To evaluate the accuracy of VTE risk assessment in the orthopaedic wards of the Gloucestershire Royal Hospital (GRH).

Method

We used the drug charts available on the wards of GRH which follow the NICE Clinical guideline [CG92]. We identified four variables out of the 19 questions that assess thrombosis risk: age, BMI, presence of infection/inflammatory conditions and surgery to the lower limb. Drug charts from the 10th of November to the 15th of November 2020 were assessed for completeness and accuracy. The number and accuracy of drug charts with VTE risk assessments on admission and 24 hours after admission were assessed.

Results

Fifty-seven drug charts with VTE risk assessments were identified over this period. Only 66.7% of VTE risk assessments were complete on admission and 21.1% were complete 24 hours after admission. Accuracy of assessment on admission was 92.1%, 86.1%, 81.6% and 79.0% for age, BMI, categories of surgery to the lower limbs and presence of inflammation, respectively. Accuracy of assessment at 24 hours was 91.7%, 83.3%, 50.0% and 91.7% for age, BMI, surgery to the lower limbs and presence of infection/inflammation, respectively.

Conclusions

VTE risk assessment upon admission and at 24 hours is relatively low and needs improvement. A further enquiry is necessary to evaluate the reasons for defective VTE assessment.
94 Audit of Management of Shoulder Dislocations Against BOA Traumatic Anterior Shoulder Instability Guidelines
Authors: Varasteh A , Hakim Z
Published: October 2021

Background

Traumatic anterior shoulder dislocation is associated with a high risk of shoulder instability, reduced functional outcome, and recurrence. We conducted an audit to assess the direct management, review in fracture clinic, and definitive imaging of patients with anterior shoulder instability in Southport and Formby Hospital.

Aim

To identify compliance with the 2015 BOA Traumatic anterior shoulder instability guidelines.

Method

Identified all patients from 01/01/2019 to 31/12/2019 who had shoulder dislocation coded for their diagnosis. We used imaging, scanned notes, and clinic letters where available to identify the clinical information. We excluded patients with a false diagnosis code, and those with non-local post codes from the analysis.

Results

We identified 67 patients who had an anterior dislocation. 88% of patients had x-rays in both AP and Lateral. We identified that 8.9% of patients had pre-reduction x-rays in AP only, 11.9% had no pre-reduction x-rays, and 1.5 % had no post reduction imaging. 79% of patients were seen in clinic within 6 weeks but only 40.3% were seen by a shoulder specialist and only 43.3% had appropriate imaging. 16.4% of patients were not given fracture clinic follow up.

Conclusions

Although most patients were managed acutely according to the guidelines, the follow up and subsequent investigations of these patients can be improved. One method we suggest is renaming fracture clinic days from consultant names to sub-specialty clinic names. In addition, a dedicated session to review the guideline with senior orthopedic surgeons cold improve the compliance as well.
988 A Quality Improvement Project; Improving the Quality and Safety of Handover During COVID-19
Authors: Chawla M , Said Noor M
Published: October 2021

Aim

The World Health Organisation (WHO) positions effective handover, in its top five patient safety solutions. During our District Hospital Trust’s COVID-19 response, an unprecedented reorganisation of all teams occurred. All surgical and medical speciality junior doctors were re-deployed and split into 4 zones to cover the hospital. In this quality improvement project (QIP), we sought to understand our trainees’ thoughts on this new multi-zonal handover process and aimed to identify risk-reduction measures to aid better patient care.

Method

The opinions of trainees on the new handover system were obtained using an online Likert scale survey. Following the responses, a new morning and night handover proforma was developed. This was used trust-wide and a post-intervention repeat survey was conducted to assess the new changes.

Results

The primary survey received 31 responses with feedback illustrating mixed effectiveness of the existing handover process. Free text comments highlighted issues surrounding “safety”, “poor organisation”, “poor continuity of care” with one serious incident reported. Post-intervention of a new handover proforma, a repeat online survey received 25 responses. Results were significantly more positive with >84% of responses being in the “strongly agree to agree” category, including for “continuity of care”, “organisation”, and “safety”.

Conclusions

This QIP illustrates a good example of a low-cost intervention to create a better handover system and aid hospitals during time of crises. For us, it managed to reform the handover process and ultimately improved our patient care. Forthcoming, we would like to create a national best practice guide for effective handover.
1144 How Much Does Colorectal Enhanced Recovery Program Education Affect Knowledge of Newly Joined Junior Doctors? A General District Hospital Re-Audit
Authors: Dorra A , Alhammali T , Arnob A , Murtaza M , Essa N , Fahmy W
Published: October 2021

Aim

Aim of the study is closing the audit loop on knowledge of colorectal Enhanced Recovery Program (ERP) among newly joined junior doctors in a general district hospital. Original audit showed shortage of awareness and knowledge among newly joined junior doctors. The recommendation was educating them regarding ERP and re-auditing.

Method

Education through a 30-minute power point presentation, on colorectal ERP, was done among newly joined junior doctors. This was followed by a 12-point questionnaire for testing the knowledge of colorectal ERP protocol among 5 newly joined junior doctors (Senior House Officers, Foundation year 2 and Foundation year 1) in our surgical department in August 2020.

Results

The responses showed an increase in doctors’ knowledge to 90 % (re-audit) from 52.9% (original audit). An increase of about 40% in their knowledge. The average score of their knowledge was 10.8/12 (90 %). One doctor (20 %) scored 12 out of 12 (12/12), two (40 %) scored 11/12 and two (40 %) scored 10/12.

Conclusions

The study showed that education of newly joined junior doctors resulted in a substantial improvement in their level of knowledge of colorectal ERP, almost up to the local hospital guidelines target (100 %). The study recommends this education to be an integral part of their induction program not only locally but also nationwide. It highlights the impact of education on colorectal ERP implementation.
1232 Trust-Wide Assessment of Delirium in Post-Operative Elective Surgery
Authors: Sundar S , Biggs S , Abraham M , Cook J , Watts N , Price R , Brack M , Brown N , Dixon L , Crowther O , Trenaman R , Quinn D , Hall W , Younie S
Published: October 2021

Aim

Delirium is an acute change in cognition and associated with adverse patient outcomes. The incidence of post-operative delirium after elective non-cardiac surgery is unknown. We aimed to assess the incidence of post-operative delirium in this group and the effect on patient outcomes.

Method

Patients aged 65 and over who underwent elective non-cardiac surgery were identified on post-operative day three. Delirium screening was performed in real time using the validated 4-AT assessment tool. A retrospective review of the patients’ preoperative and perioperative record was conducted to collect demographics and identify risk factors for delirium. Outcome data was collected at 30 days. Patients with a positive delirium score (>4) underwent a more in-depth assessment and managing teams given a delirium management pack.

Results

75 (39 male) consecutive patients were screened over a period of 4 months. Median age 77 years and 18% had frailty assessed as “vulnerable”. The majority of patients (37.3%) underwent thoracic surgery, followed by hepatobiliary (17.3%), gynaecological (17.3%), colorectal (12%), maxillofacial (9.3%) and ENT (4%). 5.3% (4) of patients had a positive 4-AT screen. No patients had a formal delirium screen or diagnosis in the initial 48 hours. The median length of stay for patients with a positive screen was 8.5 days (IQR 7.5-12) compared to 8 days (IQR 5-13) for patients with a negative screen.

Conclusions

Reassuringly, rate of post-operative delirium following elective operations in our Trust are low (5%). Larger numbers of patients are required to assess the impact this has on patient outcomes and identify correlation with risk factors.
1302 Ratio of Adenoma Detection Rate to Polyp Detection Rate
Authors: Rajain S , Adam A , Amarnath T
Published: October 2021

Introduction

Colorectal cancer is the 3rd most common cancer in the UK. The higher Adenoma Detection Rate during colonoscopy is associated with reduction in the mortality incidence of colorectal cancer. Endoscopists with less than 20% ADR is directly proportional to higher risk of the development of an interval Colorectal cancer. The aim of this study was to calculate the Adenoma Detection Rate and Polyp Detection Rate for each endoscopist to assess the performance of the unit as well as individuals.

Method

A retrospective analysis was conducted for patients who had colonoscopy in a period of 3 consecutive months at a primary care hospital in England. This study included collecting the data through patient’s histology reports and medical records. The primary outcome was total Adenoma Detection Rate and Polyp Detection Rate and its ratio for each endoscopist.

Results

913 colonoscopies were done by 16 different endoscopists out of which 279 patients with polyps were considered for the study. It was observed that half of the total endoscopists were found to have ADR more than 20%. 4 endoscopists had ADR between 15-20% whereas below minimal rate (less than 15%) ADR was recorded by the other 4 endoscopists.

Conclusions

Lower ADRs are associated with higher rates of interval cancers. An improvement of the ADR of 1% prevents 3% people from colon cancer which can be achieved by maintaining the aspirational adenoma detection rate more than 20%.
1405 Improving Documentation of Per Rectal (PR) Exams in An Acute Surgical Unit
Authors: Deeny D
Published: October 2021

Aim

A PR exam is routinely performed as part of the complete examination of surgical patients. The General Medical Council (GMC) has provided guidance on the use of chaperone during intimate exams stating that consent should be obtained, and a chaperone offered to all patients and documented accordingly. We aimed to assess and improve our documentation of PR exams.

Method

Data was collected prospectively from surgical admission documentation. The number of patients with consent and presence of chaperone documented during PR exam was recorded. Following a period of data collection, a proforma was implemented with education on correct documentation as per guidelines. A second audit cycle was performed where formal inclusion of the sticker in the admission booklet was implemented.

Results

20 patients were included in the initial data collection, 95% of which had incomplete documentation of PR exam on admission. A sticker was designed to prompt accurate documentation and inserted into the acute admissions booklet. Following this, 50% of PR exams were correctly documented. The remaining 50% without documentation had no sticker in the admission booklet. The second intervention included changing the hardcopy of the admission booklet. Following this, 80% of patients had consent documented and 90% had documented chaperone.

Conclusions

GMC guidelines state that documentation of consent and the presence of chaperones during intimate medical examinations are crucial. The implementation of a prompt in our admissions booklet has greatly improved our documentation in PR examination.
319 Systematic Review of Safety and Oncological Outcomes of Irreversible Electroporation in Renal Tumours
Authors: Hilton A , Kourounis G , Georgiades F
Published: October 2021

Introduction

Thermal tumour ablation techniques are effective alternatives to nephrectomy for small renal masses (SRM). Thermal effects limit their use in tumours adjacent to vital structures. We review safety and oncological outcomes of irreversible electroporation (IRE), a novel non-thermal ablation technique, in SRMs.

Method

MEDLINE, EMBASE, and SCOPUS databases were interrogated up to 29/11/2020 for studies reporting safety and oncological outcomes for SRMs in humans treated by IRE.

Results

Of 224 results screened, 10 met the inclusion criteria. In total, 83 patients were identified. Except for one cohort study (n = 41), remaining studies were case series of n < 10. Follow up was <12 months in 7/10 articles (Range 3-34 months). 10/10 articles reported safety outcomes. There were no 30-day mortalities. The most reported adverse events were transient haematuria (11/83) and asymptomatic perirenal haematomas (7/83). 62/63 patients with reported length of stay were discharged within 24 hours. No significant long-term changes in renal function were reported. 7/10 articles reported oncological outcomes. Only 1 article assessed histopathology outcomes. Remaining studies used CT, PET, or MRI for assessment. 4/7 (57%) patients with histopathology outcomes, showed complete response (CR). 43/55 (78%) patients with imaging base outcomes, showed CR. No mortalities were reported due to SRMs.

Conclusions

Initial findings support IRE as safe and feasible in managing SRMs. Results from larger studies with longer follow-up are needed to evaluate oncological outcomes and compare these with other ablation methods. Discrepancy between CR rates in histopathology vs imaging assessment could indicate higher sensitivity of histopathology for assessing outcomes.
474 Effectiveness of Platelet Rich Plasma in the Treatment of Recalcitrant Shoulder Pathology
Authors: Hadi H , Asaad O , Kucera M , Arealis G
Published: October 2021

Aim

To assess the outcome of platelet rich plasma injections (PRP) in patients with recalcitrant shoulder pathology using steroid injections as a control.

Method

This was a pragmatic retrospective analysis of patients treated for recalcitrant shoulder pathology between October 2018 to March 2019 with either PRP or steroid injection.

Results

In the PRP group 10 patients (n = 15) had previous steroid injections and 7 had previous surgery. 2 progressed to shoulder replacement. 5 have progressed to arthropathy. 4 patients were discharged due to improving symptoms. In the steroid group 2 patients (n = 15) were lost to follow up, 0 had previous surgery and 1 had a previous steroid injection. 6 were discharged due to improving symptoms. The average time to discharge post procedure was 241 days for PRP and 173 days for the steroid group. No complications were noted in either group.

Conclusions

Our findings show that PRP injections are a safe and effective treatment for cases of recalcitrant shoulder pathology leading to a 27% success rate for patients who have required steroid injections or arthroscopy in the past. In patients with arthropathy, PRP only has a short effect and should only be offered to patients that are unable to have surgery either due to high risk or patient choice. PRP requires a centrifuge machine and an operating theatre, thus incurring higher costs compared to steroid injections which may be given in clinic. Steroid injections should therefore remain the first line of treatment for recalcitrant shoulder pathology.
514 F1-taught Orthopaedic Teaching for Students (FOTS)
Authors: Hashmi Y , Kumar P R , Beedham W
Published: October 2021

Introduction

F1 doctors, despite being expected to teach, have had reduced opportunity to do so during COVID-19. Medical students have also become increasingly concerned for upcoming exams due to time away from placements. A national orthopaedic teaching programme was designed to provide F1 doctors with opportunities to develop their teaching skills and synergistically improve students’ confidence in performing clinical orthopaedic examinations.

Method

A University Trauma & Orthopaedics society coordinated the teaching programme consisting of 6-weekly online sessions on each joint examination (shoulder, hip, knee, hand, ankle and lumbar spine). Each session was delivered by two F1 tutors. Pre- and post-session MCQs were provided to students to assess improvement in knowledge. Anonymous feedback forms were also disseminated.

Results

From the 341 students that attended, 87.1% provided feedback. 86.2% felt that they had de-skilled due to time off, with a mean 15 weeks off from placement. Based on a 5-point Likert scale, students displayed a mean improvement in confidence (1.9±1.1, p < 0.001) and MCQ scores (1.4±1.3, p < 0.001) before and after the sessions. 91.6% of students agreed that the use of online teaching increased attendance. Of the 10 tutors, all reported improvement in confidence to teach and teaching skills.

Conclusions

We demonstrate that online delivery of clinical orthopaedic examinations is effective and present our findings to encourage similar teaching programmes to be adopted at other locations and specialities.
613 The Floating Hip: A Distinct Injury Pattern? A Descriptive Study and Case-Control Analysis
Authors: Wong M , Ghobrial M , Han W M , Alsousou J , Chou D , Carrothers A , Hull P , Rawal J
Published: October 2021

Aim

A “Floating Hip” injury describes a simultaneous ipsilateral fracture of the femur and pelvis. We performed a descriptive study of the injury patterns, management, and outcomes of floating hip patients, and compared these patients to those with similar pelvic fractures without femoral involvement.

Method

This was a retrospective case-series review with secondary case-control analysis. Medical records of patients presenting with a floating hip injury to our tertiary orthopaedics department between 2015 and 2020 were reviewed. The control group comprised of patients with pelvic fractures but without associated femoral fractures, matched by age, sex, pelvic fracture classification, and mechanism of injury.

Results

46 Floating Hip cases were identified (34 males), of average age 39 (15-86) years. 20 had acetabular fractures, 21 had pelvic ring fractures and 5 had both fractures, concomitant with ipsilateral femoral fractures. The most common site of femoral fracture was mid-shaft (21.7%), followed by distal (19.6%). 69.6% of P/A fractures were managed surgically, with ORIF (43%) the most common option. 4 (12.50%) patients suffered complications, including 2 infections and 1 DVT. Compared to controls, Floating Hip patients were more likely to require surgical management (67.6% vs 47.8%, p = 0.03), and had higher rates of surgical complications (12.5% vs 4.6%), though not statistically significant (p = 0.3).

Conclusions

Our study describes the patterns, management, and outcomes of Floating Hip injuries, and observes differences in the management and complications compared to similar pelvic fractures without femoral involvement. These findings suggest Floating Hip cases may warrant consideration as a distinct injury pattern.
Values, Ethics and Theoretical Perspectives of the Hartford Social Competency Scale-II: Factorial Structure and Reliability of a Portuguese Version
Authors: Daniel Fernanda , Espirito-Santo Helena
Published: October 2021

Social work practice with the older population demands assessing gerontological competencies, for which values and ethics are central. This study aimed to test the adjustment of the Portuguese version of the Hartford Geriatric Social Work Competency Scale II subscale—values, ethics and theoretical perspectives (GSWCS-II-VEPT) to a bifactor structure and to analyse its reliability in a sample of social workers. The study enrolled 534 social workers employed in older adults’ care organisations. The confirmatory factorial analysis showed that the items presented factorial loads more than 0.60, and the bifactorial component model fitted well with the data. The two components consisted of ‘nuclear competencies’ and ‘specialised skills’. The GSWCS-II-VEPT presented excellent reliability (Cronbach’s α = 0.90). However, high interfactor correlations demanded the test of a single-factor solution. The single-factor model did not fit the data as well as the two-factor solution, and the Akaike information criterion value was smaller in the two-factor model, indicating a superior fit. The results support adequate psychometric properties of GSWCS-II-VEPT in evaluating ethical skills, values and theoretical perspectives in Portuguese social workers and can be used as a tool for self-evaluation of these professionals’ ethical behaviour.
Metamorphosis of flora and vegetation during ontogeny of the Juan Fernández (Robinson Crusoe) Islands
Authors: Stuessy Tod F , Crawford Daniel J , Greimler Josef , López-Sepúlveda Patricio , Ruiz Eduardo A , Baeza Carlos M , Takayama Koji
Published: October 2021

Colonization, levels of speciation and vegetational metamorphosis during ontogeny of oceanic islands over geological time are central evolutionary and biogeographic concerns. A suitable archipelago in which to examine such events is the Juan Fernández (Robinson Crusoe) Archipelago, located at 33° S latitude off the coast of continental Chile and consisting of three major islands: Robinson Crusoe Island, 667 km west of the coastline; Santa Clara Island, 1.6 km off the south-western end of the former island and Alejandro Selkirk Island, 181 km directly further west into the Pacific Ocean. The two largest islands are c. 50 km2, with Santa Clara Island being only 2.1 km2. Radiometric dating for the three islands reveals the ages of Robinson Crusoe Island and Santa Clara Island to be c. 4 My, whereas that of Alejandro Selkirk Island is c. 1 My. Molecular clock estimates of crown-group divergences of endemic taxa fall mostly in these geological ages. Recent investigations have brought together a detailed inventory of the vascular flora of the archipelago with biological, evolutionary and biogeographic information that now supports examining metamorphosis of the vegetation and flora during the 4 My of island ontogeny. Geological dating and geomorphological models are used to infer changes in the landscape on both major islands. It is suggested that the original Robinson Crusoe Island may have been substantially larger and higher than at present (3000 vs. 915 m). Subsidence and erosion of the island led to loss of vegetation zones, especially impacting plants between 1000 and 3000 m. Some species may have adapted to this restructuring, but many would have gone extinct. Alejandro Selkirk Island, now 1 My, is only slightly smaller and lower than the original island (1319 vs. 2000 m), but it has probably lost some higher elevation habitats. The present vegetation of the two islands correlates with these suggestions, with Alejandro Selkirk Island retaining broad zones, but Robinson Crusoe Island having a flora that has been compacted and substantially intermixed with invasive species in recent centuries. Floristic inventory reveals 11 endemic genera, but most of these occur only on Robinson Crusoe Island, which has been the centre of cladogenesis in contrast to greater levels of anagenesis on Alejandro Selkirk Island. The ferns, due to their high dispersability, show almost no cladogenesis. Total endemic species diversity is higher on Robinson Crusoe Island (87) than on Alejandro Selkirk Island (62), and this difference is probably due to the greater age of the island and initial environmental heterogeneity. It is also probable that during this ontogeny, numbers of endemic species on Robinson Crusoe Island have been lost through island subsidence and erosion, loss of habitat and human impact.
Trefoil factor family 2 inhibits cholangiocarcinogenesis by regulating the PTEN pathway in mice
Authors: Hasebe Keiji , Yamaguchi Junpei , Kokuryo Toshio , Yokoyama Yukihiro , Ochiai Yosuke , Nagino Masato , Ebata Tomoki
Published: October 2021

Trefoil factor family 2 (TFF2) is one of three trefoil factor family proteins and is expressed abundantly in the gastrointestinal epithelium. Recent studies have shown that TFF2 acts as a tumor suppressor in gastric and pancreatic carcinogenesis; however, little is known about its function in cholangiocarcinogenesis. To investigate the function of TFF2 in cholangiocellular carcinoma (CCC), immunohistochemistry of surgically resected human CCC samples was performed. TFF2 expression was upregulated in the early stage and lost in the late stage of cholangiocarcinogenesis, suggesting the association of TFF2 and CCC. A TFF2 expression vector was then transfected into a CCC cell line (HuCCT1) in vitro, revealing that TFF2 functions as a tumor suppressor not only by inhibiting proliferation and invasion but also by promoting the apoptosis of cancer cells. In addition, PTEN signaling activity was downregulated by TFF2, suggesting an association between TFF2 and PTEN. Next, hepatic carcinogenesis model mice (KC; albumin-Cre/Lox-Stop-Lox KRASG12D) were bred with TFF2-knockout mice to generate a TFF2-deficient mouse model (KC/TFF2−/−). Although the incidence of hepatocellular carcinoma was not different between KC/TFF2−/− mice and control mice, biliary intraepithelial neoplasm (BilIN), the precursor of CCC, was frequently found in the biliary epithelium of KC/TFF2−/− mice. Immunohistochemistry revealed that BilIN samples from these mice did not express PTEN. In addition, two KC/TFF2−/− mice developed CCC adjacent to BilIN, suggesting that TFF2 functions to inhibit the development of CCC in vivo. These results indicate that TFF2 acts as a tumor suppressor to inhibit the development of CCC by regulating PTEN activity.
Fault-Tolerant Strongly Hamiltonian Laceability and Hyper-Hamiltonian Laceability of Cayley Graphs Generated by Transposition Trees
Authors: Xue Shudan , Deng Qingying , Li Pingshan
Published: October 2021

A bipartite graph is Hamiltonian laceable if any two of its vertices in different partite sets are connected by a Hamiltonian path. A Hamiltonian laceable graph $G$ is called strongly Hamiltonian laceable if any two of its vertices in the same partite set are connected by a path of length $|V(G)|-2$. A Hamiltonian laceable graph $G$ (with two partite sets $V_0, V_1$) is called hyper-Hamiltonian laceable, if for any vertex $v \in V_{i}$ for $i \in \{0,1\}$, there is a Hamiltonian path of $G-\{v\}$ between any two vertices in $V_{1-i}$. In this paper, we focus on the edge-fault-tolerant strongly Hamiltonian laceability and hyper-Hamiltonian laceability on the class of Cayley graphs generated by transposition trees, which are a generalization of star graph and bubble-sort graph. For every $n$-dimensional Cayley graph generated by a transposition tree $\Gamma _n$, we show that $\Gamma _{n}-F$ is strongly Hamiltonian laceable for any $F \subseteq E(\Gamma _{n})$ with $|F|\leq n-3$, which generalizes results in [ 1, 11], and show that $\Gamma _{n}-F$ is hyper-Hamiltonian laceable for any $F \subseteq E(\Gamma _{n})$ with $|F|\leq n-4$.
Acute pericarditis, Graves’ disease, and thymic hyperplasia: a case report
Authors: Acquaro Mauro , Breviario Federico , Greco Alessandra , Ghio Stefano
Published: October 2021

Background

Acute pericarditis as a sign of mediastinal mass is rare and aetiological diagnosis can be challenging without adequate imaging.

Case summary

An 18-year-old woman came to our attention describing acute sharp chest pain radiated to the left arm, exacerbated with supine positioning and attenuated while sitting or leaning forward. The electrocardiogram showed diffuse ST elevation and PR depression, with sinus tachycardia. Cardiac biomarkers and D-dimer were negative; echocardiography showed no abnormalities and the absence of pericardial effusion. Her blood work revealed no sign of inflammation or bacterial infection (PCR and procalcitonin were normal); thyroid-stimulating hormone plasma levels were suppressed, showing decompensated thyrotoxicosis. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Epstein–Barr virus, human immunodeficiency virus, hepatitis C virus, Enterovirus, Parvovirus B19, and Adenovirus tests were normal. Her past medical history was silent, apart from Grave’s disease on treatment with methimazole. Chest computed tomography (CT) was performed and showed the presence of slightly increased density pericardial effusion, with a maximum thickness of 15 mm in the upper mediastinum. Finally, cardiac magnetic resonance (MR) identified a mass of 73 × 51 mm located in the upper mediastinum. The mass was subsequently biopsed with video-assisted thoracoscopic surgery and the histological analysis showed thymic hyperplasia.

Discussion

This case shows the importance of an adequate clinical suspicion of thymic hyperplasia in the context of acute pericarditis symptoms and known Graves’ disease. In this case, a negative chest CT finding may not be sufficient to rule out the diagnosis and cardiac MR imaging is necessary.
Treatment stability with bonded versus vacuum-formed retainers: a systematic review of randomized clinical trials
Authors: Bellini-Pereira Silvio Augusto , Aliaga-Del Castillo Aron , dos Santos Cibelle Cristina Oliveira , Henriques José Fernando Castanha , Janson Guilherme , Normando David
Published: October 2021

Background

In orthodontics, the retention phase can be considered challenging and unpredictable. Therefore, evidence obtained from different retention protocols is important to facilitate clinical decision-making.

Objectives

This systematic review aimed to compare the clinical effectiveness of bonded versus vacuum-formed retainers (VFRs) regarding their capacity to maintain treatment stability, periodontal effects, and failure rates.

Search methods and eligibility criteria

Ten databases comprising published and unpublished literature were systematically searched up to August 2021. Randomized clinical trials (RCTs) comparing both retainers were included.

Data collection and analysis

The risk of bias (RoB) evaluation was performed with the Cochrane Collaboration RoB Tool 2.0. All steps of the screening phase and RoB assessment were performed independently by two reviewers. The Grade of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to evaluate the certainty of the evidence.

Results

Initial database search yielded 923 studies. After duplicates removal and full-text assessment, five RCTs remained. Overall, the studies presented Low RoB, except one study judged with ‘Some concerns’. Based on the included studies, on a short-term (3–6 months) and long-term (4 years) basis, bonded retainers (BRs) were more effective to maintain treatment stability than VFRs in the lower arch. However, from 12 to 24 months both retainers presented the same efficacy. In the upper arch, the retainers were equally effective. BRs were associated with greater plaque and calculus accumulation than VFRs after 12 months. The retainers’ failure rates were similar in the upper arch on the first year of retention; however, after 2 years VFRs showed significantly greater failure rates. Contrarily, BRs presented greater failure rates in the lower arch than VFRs.

Limitations

The findings of the included studies may be influenced by different factors related to the unpredictability of relapse.

Conclusions

Most of the evidence generated in this systematic review derived from a moderate level of certainty. In the lower arch, BRs are more effective than VFRs to maintain treatment stability in the initial 6 months of retention and in the long term. In the upper arch, both retention protocols are equally effective.

Registration

Regist0ration number: PROSPERO CRD42020199392.

Funding

Coordination for the Improvement of Higher Educational Personnel (CAPES, Process code-001).
An alternative valve for mitral valve replacement in young children: using an NO-REACT® INJECTABLE BIOPULMONIC™ prosthesis as a mitral valve replacement in a 14-month-old child
Authors: Carro Cristina , Marianeschi Stefano , Ghiselli Simone , Uricchio Nicola
Published: October 2021

Mitral valve replacement in infants is challenging and there are limited alternative valves available. Since the Boston group published their first report on alternative valves for mitral valve replacement in infants, there has been a growth in the literature on the topic, mostly based on the use of a stented bovine jugular vein graft (Melody® valve). The challenges of the Melody valve are firstly in its length of 28 mm unexpanded, which has the potential to cause left ventricular outflow tract obstruction, and secondly, the valve needs mechanical dilatation, which is laborious. A modified No-React® Injectable Biopulmonic™ Prosthesis (Bio Integral Surgical, Inc., Mississauga, ON, Canada) which is shorter (19 mm) and simpler in that it is self-expanding was implanted in a 14-month-old child to replace her mitral valve. The operation was successful and the short-term function of the prosthesis is good.