bluuebunny/crossref_metadata_2025 huggingface dataset:
470 Survival Stratification After Proximal Femoral Fracture Surgery Using the Modified Glasgow Prognostic Score
Authors: Kamande I , McGuire C , Meek D , Glen P
Published: July 2024

Aim

Proximal femoral fracture (PFF) after blunt trauma is common and significantly associated with mortality. A simple scoring system based on systemic inflammation, the modified Glasgow Prognostic Score (mGPS), has been shown to stratify survival in patients with malignant disease and we wished to assess its usefulness in the trauma cohort.

Method

Patient demographics, albumin, C-reactive protein (CRP), and survival data were retrospectively obtained from a previous local hip fracture audit of 278 adult (>18 years) patients whose PFFs were repaired between October 2012 and April 2014 at the Queen Elizabeth University Hospital, Glasgow. Follow-up was for 18 months allowing the generation of survival curves and univariate analysis using Kaplan-Meier and Log Rank analyses. Multivariate survival analysis and hazard ratios were calculated using Cox Regression.

Results

The median survival was 26.5 months with a 41.4% 1-year mortality. On univariate analysis, one year mortality was associated with advanced age (>80 years, p<0.0001), American Society of Anaesthesiology (ASA) score(p<0.0001), CRP (>10mg/L, p=0.027), Albumin (<35g/L, p=0.007), type of surgery (p=0.005) and mGPS (p=0.016). On multivariate analysis advanced age (p<0.001), male gender (p=0.016), ASA score (p<0.001) and mGPS (p=0.027) retained significance as predictive factors for 1-year mortality. A higher mGPS was associated with a shorter median survival (37.4, 27.6 and 24.0 months for mGPS 0, 1 and 2 respectively (p=0.048)).

Conclusions

This study demonstrated a statistically significant survival association with advanced age, ASA score, male gender and mGPS. This is the first study looking at mGPS as a predictive factor for one year mortality following PFF.
142 Understanding the Burden of Emergency Bariatric Surgery Admissions
Authors: Temple J , Manoharan G , Marsden M , Ramar S
Published: July 2024

Aim

To quantify the incidence and resource use of bariatric surgical emergencies (BSE) in a tertiary hospital setting.

Method

Patients were identified prospectively for 17 weeks from the 1st March 2023. Inclusion criteria were a bariatric emergency with an admission duration exceeding 24 hours.

Results

Of the 471 emergency general surgery admissions, 21 (4.5%) were identified as BSE. From 63 elective bariatric procedures, 4 (6.3%) necessitated prolonged stays owing to post-operative complications. Most patients were female (23/25), with an average age of 48 years (IQR 34-55) and a pre-operative BMI averaging 39 (IQR 37-44). The typical hospital stay was 5 days (IQR 1-15), with no reported fatalities. In total 23 patients had CT scans, 7 required surgical or procedural interventions, and 5 were admitted to the ICU. Interestingly, 12 emergency admissions had no prior NHS history, and 10 had undergone their procedures in Turkey. The post-surgery admission time was notably shorter for the Turkey group [2 (1-7) weeks] compared to those treated under the NHS [86 (5-750) weeks, p=0.003].

Conclusions

More than one patient per week is admitted for a BSE. These patients have substantial resource requirements and highlight the need for adequate training and preparedness to manage these emergencies.
960 Quality of Life Outcomes of Metabolic and Bariatric Surgery Tourism: A Single-Centre Survey-Based Study
Authors: Khan H J , Yunus T E , Nimeri A , Abbas H , Ghumman A K , Rana F A
Published: July 2024

Global obesity affects one in three adults, prompting increased demand for metabolic and bariatric surgery (MBS). Despite its effectiveness, limited access to MBS has led to more people seeking it through medical tourism for lower costs and shorter wait times. However, ethical concerns arise due to limited follow-up care and potential complications. This study compares the quality of life (QOL) of native MBS patients (n = 69) to those engaged in MBS tourism (n = 36) from 11 different countries, utilizing the Bariatric Quality of Life Index (BQLI). Conducted in Lahore, Pakistan, with 105 participants who had MBS in the last 3 years, the survey-based study aims to assess the impact of MBS tourism on QOL and the efficacy of bariatric surgery for weight loss. The study revealed no significant difference in the quality of life between MBS tourism participants and native patients (p > 0.05). Both cohorts experienced considerable weight reduction post-MBS (p = 0.00001). A higher total weight loss percentage (TWL%) correlated positively with increased BQLI scores (p = 0.01). Younger patients experienced significantly improved quality of life after MBS compared to their older counterparts (r = -0.3, p = 0.005). The TWL% exhibited a progressive increase as the months advanced post-MBS (r =0.3, p = 0.004). The type of bariatric surgery (SG, RYGB, OAGB, SADI) didn't significantly affect post-MBS quality of life (p > 0.05).
1080 Evaluating the Impact of Bariatric Surgery Tourism on an Emergency Upper GI Service: A Case Series
Authors: Patel E A , Gourgiotis S
Published: July 2024

Aim

The number of individuals seeking weight loss surgery has been increasing globally. It is not uncommon for patients to travel abroad for these procedures due to various reasons, such as cost savings or availability. This audit identifies patients who underwent bariatric surgery abroad and subsequently presented to our hospital, observes trends in presentation, types and frequencies of complications, and management strategies employed.

Method

A retrospective case study of medical records of patients who presented acutely following gastric bypass, sleeve, or gastric band operations abroad between January 2018 to July 2023 was performed.

Results

A total of 21 patients were identified. 17 (81%) were female, with mean age 42.2 years. 15 (71.4%) patients presented between 2022-2023, and 5 (33.3%) of these were diagnosed with leak. 11 (52.4%) had undergone sleeve gastrectomy, 6 (28.5%) Roux-en-Y gastric bypass and 4 (19%) gastric band. Operations were performed in 11 different countries, with 10 (47.6%) performed in Turkey. The commonest presenting complaint was abdominal pain (71%). Average Length of stay was 9.1 days (range 1-45). 9 patients (42.9%) had multiple attendances (range 2-6). 7 (33.3%) underwent surgery; 3 laparoscopic removal of gastric band, and 4 emergency procedures for leak, involving either laparotomy and/or endoscopic therapy.

Conclusions

The number of patients presenting with complications of bariatric surgery tourism has increased year-on-year. This is leading to a growing burden on NHS resources. Healthcare professionals, policymakers, and patients themselves must be aware about the importance of follow-up when deciding to undergo weight loss surgery abroad. A national audit is also warranted.
1225 Endoluminal Stenting for Sleeve Gastrectomy Leak: Case Report, Literature Review and Atlas of Endoscopic Management
Authors: Attia A , Vasas P
Published: July 2024

Introduction

One of the most serious complications of bariatric surgery is post-operative leak and it can result in significant risk on the patient. Early detection and management of postoperative leak is essential to reduce the morbidities and mortality of such complication. Endoluminal Stent placement is a less invasive alternative to surgical intervention for management of bariatric surgical leak. We are reporting a case of post sleeve gastrectomy leak that has been managed by inserting self-expandable metal stents (SEMS) via endoscopy.

Case presentation

A 55-year-old woman presented with gradual onset of epigastric pain and high temperature with reduced oral intake. She had had a Laparoscopic sleeve gastrectomy done in another country as a form of “medical tourism” 10 days ago. She had a CT scan revealed an irregular 4.5 cm paraoesophageal collection suggesting post-operative leakage.

Discussion

Endoscopic management of GI leaks provides a minimally invasive, safe, and efficient alternative for surgery in selected cases. Endoscopic management is then proven to be the least invasive method to control and repair post LSG leak.

Conclusions

The clinical presentation of post LSG leak can vary from mild abdominal pain to severe sepsis. Endoscopic management, with its different types, has been widely used because its less invasive yet very effective way of managing such feared complication.
990 A Rare Case of Adenomyoma in Gastric Pylorus of a Young Adult Female: A Case Report
Authors: Wickramasinghe V C , Saranga K G V , Piyarathne S A , Madhawa J K G , Prashantha A H A
Published: July 2024

Introduction

Gastric adenomyoma is a rare benign tumour which occurs 85% in antrum and 15% in pylorus. Although adenomyomas are benign, diagnosis is difficult as they are commonly found alongside with adenocarcinomas.

Case report

A 20-year-old previously healthy female presented with epigastric pain, gastric outflow obstruction features and weight loss for 3 months. Initial USS was followed by a CECT which, showed intramural mass lesion with necrotic centre arising from the inferior wall of the pre pyloric area of the stomach with acute inflammatory changes of the adjacent omental fat, giving differential diagnosis of GIST or gastrinoma at pyloric region. Subsequent upper GI endoscopy revealed a protruding pyloric mass without mucosal lesions. Unfortunately, the unavailability of EUS and biopsy posed a diagnostic hurdle. Intraoperatively, a mass intricately adhered to the transverse colon and omentum was discovered, leading to a surgical intervention involving distal gastrectomy, gastrojejunostomy, and jejunojejunostomy. Unexpectedly, histological analysis unveiled adenomyoma at the prepyloric area, characterized by Brunner’s glands, dilated glands, and heterotrophic small intestinal tissue.

Discussion

This rare manifestation of adenomyoma in the gastric pylorus, particularly in a young adult, highlights the challenges in accurate preoperative diagnosis. The favourable postoperative outcome prompts reflection on the potential role of advanced diagnostic tools, emphasizing the significance of EUS and biopsy in steering clear of extensive surgeries.

Conclusions

This case report underscores the crucial role of personalized diagnostic methods, especially in cases like ours where a rare adenomyoma mimicking other tumours.
456 Comparison of Postoperative Outcomes Between Robotic and Laparoscopic Surgery for Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis
Authors: Wuheb A
Published: July 2024

Aim

To evaluate comparative outcomes of robotic versus laparoscopic bowel resection in patients with inflammatory bowel disease (IBD).

Method

A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library, Clinical trials.gov and Science Direct. Comparative studies comparing robotic versus laparoscopic resection for IBD were included. Primary outcomes were post-operative complications rate. Operative time, conversion to open, length of hospital stays, and mortality were the evaluated outcome parameters.

Results

Eleven studies with total number of 5,566 patients divided between those undergoing robotic (n=365) and conventional laparoscopic (n=5,201) surgery. Moreover, subgroup analysis for sub-total colectomy group showed shorter LOS [MD: -1.62, P=0.03]. Overall complications rate was significantly higher in the laparoscopy group compared to robotic group [OR: 0.48, P=0.03], however the operative time was longer in the robotic group [MD: 40.61, P=0.00001]. Pooled analysis showed comparable results regarding conversion to open [OR: 0.46, P=0.15], anastomosis leak [OR: 0.92, P=0.84], abdominal abscess / collection [OR: 0.34, P=0.21], and mortality [RD: 0.00, P=1.00].

Conclusions

Compared to laparoscopic approach, Robotic surgery provides a significantly lower rate of post-operative complications and shorter LOS at the expense of operative time with similar 30-day Mortality.
566 Serum Thyroid Stimulating Hormone (S-TSH) Levels as a Predictor of Malignancy in Thyroid Nodules
Authors: Kottegoda G , Dadigamuwage S , Bhagya J , Kannangara D , Suganthini S , Gunawardena S
Published: July 2024

Introduction

The evaluation of thyroid nodules include: a clinical history and examination followed by ultrasonography and fine needle aspiration cytology of ultrasonically suspicious nodules. Even after a full evaluation, some thyroid nodules are found to be indeterminate in respect of malignancy. It has been suggested that high levels of sTSH can be used as a predictor of malignancy in thyroid nodules.

Method

A retrospective analysis of patients who underwent surgery for thyroid nodules between 01st January 2019 and 31st December 2022. Patients who had been on Thyroxine or Carbimazole/ Propylthiouracil were excluded. Data was collected using previous medical records and patient interviews. Statistical analysis was performed using SPSS version 24.

Results

Data collection was completed on 102 patients. 86 patients (84.3%, mean age 43.6 years) were female, and 16 patients (15.6%, mean age 45.2 years) were male. Histologically confirmed thyroid malignancy was present in 18 patients (17.6%), out of which 15 (83.3%) were female and 3 (16.6%) were male. There was no statistically significant (P<0.05) difference in the sTSH noted in patients with thyroid carcinoma (mean sTSH 1.378 μIU/ml) compared to histologically benign nodules (mean sTSH 1.350 μIU/ml).

Conclusions

Multiple studies done in different settings have shown an association between a high sTSH and a higher possibility of thyroid carcinoma. However, in our cohort of patients no such association was observed.
1217 BiZact Tonsillectomies: An Update on Novel Technique for Efficiency Improvement
Authors: Hatfield T , Nwodo C , Sahota B
Published: July 2024

Aim

Tonsillectomies represent one of the most commonly performed ENT procedures worldwide. Waiting lists throughout the NHS remain large with associated delays in treatment and increased morbidity, so we must strive to maximise our operative efficiency. In the past 2 years in our trust, we have introduced the use of the BiZact tonsillectomy device in order to increase theatre efficiency and reduce operative and wait times. We have previously presented this work and here present updated figures.

Method

The BiZact device has been used by a range of consultants and registrars having been proven in multiple previous studies to offer a safe alternative to conventional technique tonsillectomies. Analysis of the theatre time, “time-on-tonsil” and post-operative bleed and admission rates has been continuous.

Results

Previously analysed conventional tonsillectomy data showed average recorded theatre time of 36m:00s (n=72). With 103 comparable BiZact tonsillectomies performed, the average theatre time for BiZact is 13m:11s, with an average time-on-tonsil of just 4m:22s (for bilateral tonsillectomy). A post-tonsillectomy haemorrhage rate of 17.5% was recorded including those attending separate trusts. There have been 0 primary post-tonsillectomy bleeds requiring return to theatre. 24% of BiZact tonsillectomies were performed by SHOs or Registrars.

Conclusions

The efficiency gains offered by BiZact tonsillectomy continue to be evident as numbers increase with more being performed by junior trainees. Bleed rates remain within the range of expected adult haemorrhage rates more recently observed nationally and internationally. This has facilitated further efficiency gains in our theatre usage for tonsillectomy lists with additional cases per session.
877 Demand-Side Barriers to Surgical Care in Low- and Middle-Income Countries - a Scoping Review
Authors: Rauf S , Faheem M , O’Flynn E
Published: July 2024

Aim

Thirty per cent of diseases worldwide can be treated by surgery or require the direct care of a surgeon. The Lancet Commission (2015) found that five billion people lack access to safe surgery, predominately those living in low- and middle-income countries, where nine out of ten people cannot access basic surgical care. Numerous studies have examined supply-side barriers, but few have examined the demand-side. We report a scoping review to identify and explore the barriers that prevent patients from seeking surgical care.

Method

A systematic search of multiple databases using the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines was conducted, looking for papers published between January 2015 and November 2023. Two independent reviewers charted qualitative variables and significant demographic data.

Results

Out of 2,899 studies examined, 228 met the inclusion criteria. The studies spanned six continents and fifty-seven countries. 14% were multi-country. Forty-seven barriers were identified and organised under ten headings. The five most frequently cited barriers were distance, fear/lack of trust, transport costs, reliance on religious/traditional healers and indirect costs (food/accommodation/companion).

Conclusions

Our review demonstrates the breadth of barriers contributing to the unmet need for surgery amongst all surgical specialities. While countries pursue their 2030 target to increase the provision of safe surgical care, there also needs to be a clear focus on understanding the factors that prevent patients from accessing established surgical care and how to mitigate them.
20 An Evaluation of the Quality and Readability of Online Information Regarding TMJ Dysfunction
Authors: Tan D J Y , Ko T K , Fan K S
Published: July 2024

Aim

The accessibility and availability of the internet has allowed people to increasingly seek health information online, and therefore it plays an essential role in the decision-making process of the patient. The study aimed to assess the quality and readability of online health information on TMJ dysfunction.

Method

The search was conducted on Google using keywords: jaw pain, jaw locking, jaw discomfort, jaw clicking, jaw popping, temporomandibular joint, TMJ dysfunction, TMD and temporomandibular disorder. Ensuring Quality Information for Patient (EQIP) tool was used to assess quality of information and the application of readability score reflected through Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level(FKGL), Gunning-Fog Index(GFI) and Simple Measure of Gobbledygook(SMOG).

Results

134 websites were eligible for assessment. The overall median EQIP score was 23, with an IQR of 7 and maximum score of 30. The most common source of information was healthcare industry (n=60; 45%), followed by news services (n=19; 14%), with a median EQIP score of 20 and 25 respectively. Statistically significant differences in overall EQIP scores were found between different sources of information (p=0.004). Only 31(23%) websites achieved the recommended 6th grade or below readability level, and only 14 (10%) discussed complication rates with none mentioning mortality rates at all.

Conclusions

Most online information on TMJ dysfunction is of suboptimal quality and readability. This study identified areas for improvements when producing patient material regarding TMJ dysfunction. To improve patient education and awareness, content creators should strive to be informative, accurate, and patient-centric.
173 Pressure Sores in Spinal Patients Admitted to Intensive Care - a Retrospective Observational Study
Authors: Glossop S , Upadhyay A , Abdallah M , McCarthy M
Published: July 2024

Aim

Spinal patients in the intensive care unit (ICU) have a high risk of developing pressure sores due to factors such as immobilisation and collar use. In a collaboration between the spinal surgery department and the ICU at a tertiary care hospital, this study aimed to assess the prevalence of pressure sores in spinal patients in the ICU as well as potential risk factors, to establish any required changes to patient care.

Method

NHS-mandated DATIX reports for all pressure sores in ICU were cross-referenced with a list of all spinal patients admitted to ICU between January 2018 and August 2022 (4-and-a-half years). We included pressure sores such as occipital, sacral, clavicular, hips. Exclusions were sores categorised below Grade 2 and those caused by intubation such as lips or mouth.

Results

97 patients were included and fifteen (15.5%) developed grade 2 or above pressure sores in ICU. Admission age, days spent in hospital and days in ICU were significantly greater in those who developed pressure sores compared to those who did not (all P < 0.05). Advanced respiratory support time was also greater in those who developed pressure sores (P < 0.05).

Conclusions

Just over 1 in 7 spinal patients in the ICU developed pressure sores and clinicians should be aware of the potential risks for mutual benefits of patient comfort and the NHS cost burden. However, in comparison to other studies reporting percentages of 19.1% and 37.5%, the department appears to be doing comparatively well in preventing pressure sores.
624 A Retrospective Review of Blood Pressure Variability (BPV) and Abdominal Aortic Aneurysm (AAA)
Authors: Ramirez Piriz C , Charles E , Martin G , Bicknell C
Published: July 2024

Background

Abdominal aortic aneurysms (AAA) rupture risk increases with expansion. Understanding of factors influencing AAA growth are crucial to reduce the risk of rupture. Blood pressure (BP) is considered a contributor to AAA formation, but the association with AAA growth remains unclear. Blood pressure variability (BPV) has emerged as an important cardiovascular risk factor, yet its relationship with AAA growth has not been investigated.

Method

A retrospective review of 90 patients participating in a multi-centre AAA growth study (NCT05376514) was conducted. Mean growth (mm/yr) was calculated from first and most recent duplex ultrasound scans. Outpatient BP readings between scans were used to calculate BPV defined as the standard deviation (SD) of systolic and diastolic values. Patients were stratified into high and low BPV groups and again into tertiles. Mann-whitney U and unpaired T-tests were used for group comparisons, Kruskall-Wallis to assess for a dose-response relationship between tertiles of BPV. Multiple regression analysis examined variable impact on growth.

Results

High diastolic BPV was associated with a faster growth rate (2.05 mm/yr [IQR= 1.00 – 3.00]) vs low diastolic BPV (1.44 mm/ yr ([IQR= 0.475-2.00]p=0.036) with a significant dose-response relationship between the lowest and highest BPV tertiles (p= 0.019). DBPV was a significant predictor of AAA growth in the multiple regression model for tertile classification (p=0.016). There was no association between systolic BPV and faster AAA growth rates.

Conclusions

There was a significant association between higher diastolic blood pressure variability and AAA growth. DBPV may be an important risk stratification tool.
946 Soft Tissue Sarcoma Survival Analysis and Evaluation of Management Options in Wales: A 3-Year Retrospective Single-Centre Analysis
Authors: Li C Y , Young H , Vass J , Bragg T
Published: July 2024

Aim

Soft tissue sarcomas (STS) are a rare group of mesenchymal neoplasm with great heterogeneity in their histologic subtype, anatomy, natural biological behaviour, and prognosis. The aim of this project is to evaluate the need of early detection and review the prognostic factors contributing to the overall STS survival outcome among patients who were under the care of the Welsh Sarcoma Service over a three-year period.

Method

Patients are selected from the Morriston Hospital sarcoma database from March 2019 to March 2022. Demographic data, tumour grade, histological subtype, performance status, treatment type, operative details and outcomes were recorded.

Results

159 patients with a diagnosis of STS were selected from the database. The median overall survival was 2.19 years; with a 23.9% of mortality rate in the first-year post diagnosis and 10.8% in the third-year post diagnosis. Of all factors evaluated, grading (p = 0.008), performance status (p <0.001), treatment types (p= <0.001) and site of cancer recurrence (p = 0.024) resulted statistically significant. Metastatic development has a significant increased risk of death by 2.5-fold compared to those without recurrence.

Conclusions

This study evaluates the management of STS at a single centre over three years and summarises the significant prognostic factors contributing to the overall survival rate. Analysis further highlights development of metastasis carry a poorer prognosis. Hence, the importance of early detection and treatment within the first year of diagnosis should not be overlooked.
589 Survivorship After Radical Gastrectomy with Adjuvant Chemoradiotherapy for Locally Advanced Gastric and Junctional Adenocarcinoma
Authors: Moran P , Elliott J A , Ravi N , Donohoe C L , Cunningham M , Reynolds J V
Published: July 2024

Introduction

In the US Intergroup-0116 trial adjuvant chemoradiotherapy (aCRT) significantly improved overall survival (OS) compared with surgery alone for locally advanced gastric adenocarcinoma. Subsequently, the CRITICS and ARTIST-2 trials demonstrated no additional benefit to aCRT compared with chemotherapy alone. The aim of this study was to evaluate long-term outcomes in survivorship among patients previously treated with radical D2 gastrectomy and aCRT (MacDonald Regimen).

Method

Consecutive patients who underwent aCRT following radical D2 gastrectomy between 2002-2018 were identified from a prospectively maintained database. Among patients without evidence of recurrence at 1 year postoperatively, long-term radiotherapy complications were coded using the framework of the Common Toxicity Criteria for Adverse Events (CTCAE) V5, and use of nutritional adjuncts and micronutrient supplementation recorded.

Results

Some 49 patients were included (pT3-4, 88%; pN2-3, 61%; diffuse type, 45%). Median, 1-, 3- and 5-year OS were 29.8 months, 90%, 45% and 41%. Late effects data were available for 18 patients. Gastrointestinal late effects were evident in 81% (most commonly dysphagia, subacute obstructive symptoms, food intolerance and diarrhoea). Small bowel obstruction occurred in 2 patients, small intestinal bacterial overgrowth in 2 patients and pancreatic exocrine insufficiency in 2 patients. 3 patients required long-term oral nutritional supplementation, and 2 required home enteral nutrition.

Conclusions

Despite adverse pathological features, long-term survival was achieved in a significant proportion of patients. However, these data highlight that adjuvant chemoradiotherapy following radical gastrectomy with D2 lymphadenectomy may be associated with considerable late effects in survivorship, and management within specialist multidisciplinary teams is advocated.
969 Assessment of Diagnostic Criteria and Treatment Approaches for Biliary Dyskinesia: A Retrospective Analysis in NHS Grampian
Authors: Luangboriboon J , Yousif M , Ghazanfar M
Published: July 2024

Aim

Biliary dyskinesia is a motility disorder of the gallbladder and sphincter of Oddi which presents with biliary-type pain without a structural pathology. Diagnosis relies on the ROME IV criteria for Functional Gallbladder Disorder, but its clinical utilisation remains limited. This retrospective study evaluates the diagnostic criteria, investigations, treatment, and surgical outcomes in patients with suspected biliary dyskinesia.

Method

Data from 185 patients who underwent cholecystokinin cholescintigraphy between 2017 and 2022 in NHS Grampian were analysed. Information on patient demographics, Rome IV criteria, supportive investigations, treatments, complications, hospital admissions, and medication use was collected from Trakcare.

Results

The average patient age was 46 years, with 21.1% male and 78.9% female participants. The Rome IV Criteria was used in only 12.4% of cases. Cholecystectomy was performed in 40.5% of cases, with complications occurring in 10.6% of these surgeries. On average, patients were admitted to the hospital 1.07 times, staying for approximately 3.92 days before surgery. Notably, 30.6% of cholecystectomy patients needed readmission for unresolved symptoms, and 40.5% relied on analgesics.

Conclusions

Rome IV criteria was underutilised in diagnosing biliary dyskinesia. Cholecystectomy did not reliably relieve symptoms in all patients, resulting in repeat admissions. Better adherence to diagnostic criteria and clear treatment guidelines are needed.
68 The Emerging Role of Stem Cell Enriched Fat Grafts for Breast Reconstruction: A Systematic Review and Meta-Analysis
Authors: Hayre A
Published: July 2024

Aim

Recent trials involving adipose derived stem cell (ADSC) enriched fat grafts have shown promising results when compared to routine autologous fat transfer (AFT) in breast reconstruction surgeries. The current systematic review and meta-analysis aimed to compare outcomes of ADSC-enriched fat grafts versus routine AFT for breast reconstruction purposes.

Method

A search of electronic information was conducted identifying all case control and cohort studies comparing the outcomes of ADSC-enriched fat grafts versus routine AFT for breast reconstruction. Primary outcomes included volume retention, fat necrosis and cancer recurrence. Secondary outcome measures were patient satisfaction post-surgery, cyst development, redness and swelling, infection and operation time. Fixed and random effects modelling were used for the analysis. Six studies enrolling 381 subjects were selected.

Results

There was a significant difference between the ADSC-enriched fat grafts and routine AFT groups in terms of mean volume retention (standardised mean difference [MD]= 2.52, P= 0.05). There were no significant differences between the two groups in terms of fat necrosis (Odds Ratio [OR]= 3.81, P =0.13) and cancer recurrence (OR= 1.39, P= 0.58). For secondary outcomes, the intervention group had similar results compared with the control group in terms of patient satisfaction, redness and swelling as well as infection and cyst development. Operation time was shorter for the latter group.

Conclusions

ADSC-enriched fat grafting is a superior option compared to the routine AFT for breast reconstruction surgery as it improves the mean volume retention and does not worsen patient satisfaction and surgical complications.
804 Exploring the Characteristics of ENT Senior House Officers: Insights for Workforce Planning
Authors: D’Souza F , Springford L , Seymour K , Ahmed J , Nogueira C
Published: July 2024

Aim

The current healthcare climate has adversely impacted the recruitment and retention of healthcare professionals, particularly Senior House Officers (SHOs), who play an important role in the provision of ENT services. Consequently, there has been a shift in the characteristics of applicants for SHO positions. We examined applicant characteristics for a Trust Grade ENT SHO position at The Royal London Hospital.

Method

Data was collected from all applications made for the position, evaluating qualifications, experience, academic achievements, skills, and fitness to practice. Essential characteristics included a medical degree, surgical experience, <2 years' ENT experience, foundation program completion, and English proficiency. Desirable features encompassed MRCS exam success, NHS experience, peer-reviewed publications, teaching and research qualifications, and participation in audits and quality improvement projects.

Results

There were 110 applicants; 94% qualified outside the UK. Whilst 74% met all essential criteria, significantly fewer satisfied desirable criteria such as passing surgical membership examinations (0-5%) and prior NHS experience (7%). 2% to 4% reported experience of performing basic ENT procedures under supervision, and only 4% reported previously assisting in theatre. 1 applicant satisfied all desirable characteristics.

Conclusions

The current healthcare climate has significantly impacted the characteristics of the ENT SHO workforce. A lack of NHS experience and limited ENT exposure necessitates intensive support for new SHOs. Departments must consider how to balance the provision of support, for example with the implementation of registrar hot weeks or funding for additional staffing, with key economic and educational interests.
814 If You Want to Go Far, Go Together: Student Perception of Joint Medical and Surgical Education Programmes
Authors: Kerdegari N , Sunder Bala Sundaram D , Kirby R , Leng G
Published: July 2024

Aim

Medical students have varied specialty interests which acts as a barrier to undergraduate engagement at specialty-specific conferences. The Tomorrow's Doctors 2023 conference, hosted at The Royal Society of Medicine, aimed to improve students’ understanding of current innovations across multiple medical and surgical specialties. The aim of this study is to determine student perception of a combined medical and surgical conference.

Method

The two-day conference consisted of 8 talks and 8 workshops. Feedback was collected following each day using online questionnaires. Each questionnaire was specific to the agenda of that day. Quantitative and qualitative feedback was collected on students’ perception of combined medical and surgical conferences for undergraduate students. Free-text responses underwent thematic analysis.

Results

There were 90 delegates on day one and 85 delegates on day two from 16 medical schools. Post-conference feedback was completed by 45 (50.0%) and 42 (49.4%) attendees for days one and two respectively. 82.2% of day one and 88.1% of day two respondents agreed that joint medical and surgical conferences were beneficial for medical students. Thematic analysis of post-conference free-text responses revealed the commonest themes for favouring joint medical and surgical conferences were ability to explore both medical and surgical interests (52.5%), supports career progression (27.5%) and practical application of knowledge gained (17.5%).

Conclusions

Our feedback demonstrates that joint medical and surgical conferences are perceived as beneficial by current medical students. Future undergraduate conferences should adopt a combined approach to allow students to explore their varied interests and subsequently facilitate informed specialty selection.
416 The Impact of Pancreas Transplantation on Secondary Diabetic Complications: A Systematic Review
Authors: Giri G , Doherty D , Azmi S , Khambalia H , Van Dellen D
Published: July 2024

Aim

Pancreas transplantation (PT) provides diabetic cure for patients with complicated Type 1 Diabetes Mellitus (T1DM). We aimed to examine the impact of PT on secondary diabetic complications, including retinopathy, neuropathy, and cardiovascular disease.

Method

A database search using MedLINE for publications up to April 2023 was conducted employing MeSH terms ‘Pancreas Transplantation’ AND ‘Diabetes Mellitus, Type 1’ AND ‘Diabetic Retinopathy’ OR ‘Heart Disease’ OR ‘Cardiovascular Diseases’ OR ‘Peripheral Vascular Disease’ OR “Amputation’ OR ‘Neuropathy.”

Results

223 articles were screened, with 172 excluded as per study design (total included 51). 64.7% (n=33) of studies were retrospective case control studies, 35.3% (n=18) of studies were retrospective cohort studies. A total of 5616 patients with a mean of 99.1 (SD± 262.4) simultaneous kidney transplant (SPK) patients and 48.2 (SD± 262.4) pancreas transplant alone (PTA) patients per article were studied. All articles examining diabetic retinopathy concluded that retinopathy improved or stabilized. 69% (n=11) of papers demonstrated no significant change to visual acuity. An equal number of articles (n=4) demonstrated increased peripheral nerve conduction velocity after SPK and PTA. 40% (n=2) of articles examining vibration perception studies demonstrated an increase post-transplantation. Improvements in cardiac events incidence, metabolic factors, and heart structure were seen in 79% (n=15) of cardiovascular articles.

Conclusions

Despite significant heterogeneity in outcome measures observed, PT provides benefits in mitigating the complication profile of T1DM. Standardised outcome measurement should be adopted to allow assessment of the impact of beta-cell replacement with the potential for objective evidence reversibility of secondary complications.
632 Hepatitis C Positive Organ Donation and Direct Acting Antivirals in Pancreas Transplantation: A Systematic Review
Authors: Siran L S , Doherty D , Moinuddin Z , Khambalia H , van Dellen D
Published: July 2024

Background

Pancreas transplantation (PT) provides diabetic cure for patients with complicated diabetes mellitus. However, there is a paucity of suitable donor organs to fulfil requirements resulting in deaths on the waiting list. Organs from otherwise suitable hepatitis C virus positive (HCV+) donors alongside direct-acting antiviral agents (DAAs) have been used in kidney and liver transplants in small trials. We aimed to review this strategy in PT.

Method

A literature search was conducted on OVID MedLINE, PubMed and EMBASE to evaluate evidence on the use of HCV+ organ donors for PT in HCV- recipients alongside DAA therapy.

Results

Database analysis produced 5 articles (4 single centre retrospective, 1 case report). This included a total of 65 patients, 15 of which received PT. Two studies examined multiple organ transplants whilst 3 evaluated PT alone. Three studies employed prophylactic perioperative therapy, while 2 examined treatment post-transplantation. 100% of patients achieved a sustained virological response (SVR) at 12 weeks across all 5 studies. There were no episodes of acute rejection or complications directly associated with DAA therapy or HCV infection. HCV transmission occurred in only 1 of 15 patients, which was successfully treated. Pancreatic graft function and outcome after 7-12 months was good.

Conclusions

The use of DAA therapy is safe and effective for HCV+ donors to HCV- transplant in early reported studies. This approach could facilitate the successful utilisation of HCV+ organs for transplantation thereby minimising impact on supply and demand disparities. Pancreas transplantation specific studies are required to further analyse outcomes.
292 Predictive Factors for Post-Operative Hypotension Following Carotid Endarterectomy
Authors: Musa A M , Gaba K , Nash T , Patterson B , Pemberton M
Published: July 2024

Background

Post-operative hypotension is a recognised complication following carotid endarterectomy (CEA). This study aimed to examine the incidence of post-operative hypotension requiring vasopressors and to identify variables associated with this phenomenon following CEA.

Method

A retrospective cohort study of 73 consecutive patients undergoing CEA between June 2022 and June 2023 was conducted. Patient data, including degree of carotid stenosis, and comorbidities such as myocardial infarction, diabetes, hypertension, and chronic kidney disease (CKD), were extracted from medical records. Fisher’s exact test was used to evaluate the difference in prevalence of co-morbidities between groups, and Mann-Whitney U test to assess for difference in degree of carotid stenosis.

Results

71 symptomatic and 2 asymptomatic CEAs were performed, with 12.3% (n=9) experiencing post-operative hypotension requiring vasopressors. In the post-CEA hypotension group, 33.3% (n=3) had a history of myocardial infarction, 77.8% (n=7) had hypertension, and none had diabetes or CKD. In comparison, the non-hypotensive group had a prevalence of 17.2% (n=11) for myocardial infarction, 18.8% (n=12) for diabetes, 71.9% (n=46) for hypertension, and 6.3% (n=4) for CKD. There was no significant difference in prevalence of these co-morbidities between the two groups. The degree of carotid stenosis was similar in the post-CEA hypotension and the non-hypotension group, 75% (IQR 60% – 90%), and 70% (IQR 65% - 90%), respectively.

Conclusions

Approximately 1 in 8 CEA patients require vasopressor support for post-operative hypotension. However, no specific variable emerged as a significant predictor for vasopressor requirement. Consequently, emphasis should be placed on post-operative monitoring to facilitate timely and appropriate intervention.
360 Driving Technology for Endovascular Aortic Arch Repair: An International Analysis of Relay Branched Outcomes
Authors: Jubouri M , Surkhi A O , Tan S , Williams I M , Bashir M
Published: July 2024

Aim

The introduction of endovascular aortic arch repair (EAR) represents a paradigm shift in the management of complex arch pathologies. In this multicentre study, a comparative analysis of international outcomes data on the single-, double- and triple-branch RELAY™ endografts is presented.

Method

Multicentre data was collected prospectively (2019-2022) and stored in an international registry. This was later retrieved and analysed retrospectively. All patients were followed-up for 24 months. Outcomes measured included target vessel patency (TVP), reintervention, stroke, and mortality.

Results

Of the total 148 patients, 17 (11.5%) received the single-branch RELAY™, 108 (73%) double-branch, and 23 (15.5%) triple-branch. The group characteristics were similar at baseline. Target vessel cannulation and technical success were achieved in 99.3% of patients. TVP at 30 days post-EAR was 100% in all groups, however, this became 93.8%, 74.0% and 100% at 24 months in the single-, double- and triple-branch endograft groups, respectively. As for reinterventions, these were only required with the double-branch RELAY™ (n=50, 34%). Similarly, disabling strokes were only observed in the double-branch group (n=35, 32.4%), and the overall study incidence was 23.8%. Non-disabling strokes had an overall incidence of 12.8% (n=19). The overall mortality rate was 2.7%, with all 4 deaths recorded occurring in the double-branch group. Logistic regression analysis showed a significant association between urgency (acute) and reintervention.

Conclusions

Our results clearly demonstrate that EAR using RELAY™ Branched is a highly efficacious strategy. Nevertheless, it seems that clinical outcomes with the single- and triple-branch RELAY™ are more favourable than with the double-branch configuration.
Responsibility fixes: patching up circular economy value chains
Authors: Barford Anna , Ahmad Saffy Rose
Published: July 2024

Recycled plastics value chains are being collaboratively constructed amid calls for greater responsibility of the corporates driving today’s plastic waste crisis. The resulting ‘responsibility fix’ bolts new arrangements onto linear production processes, offering a mechanism to push linear processes towards circularity, while starting to patch up some of the social and economic injustices associated with waste-picking work within contemporary systems of capitalist production and consumption. This research draws upon semi-structured interviews to trace international collaborations within recycled plastics value chains to identify how new, low-disruption, circular business models are being built.
Clinical Application of ISO and CEN/TS Standards for Liquid Biopsies—Information Everybody Wants but Nobody Wants to Pay For
Authors: Bonstingl Lilli , Skofler Christina , Ulz Christine , Zinnegger Margret , Sallinger Katja , Schönberger Julia , Schuch Katharina , Pankratz Karin , Borrás-Cherrier Anatol , Somodi Visnja , Abuja Peter M , Oberauner-Wappis Lisa , Moser Tina , Heitzer Ellen , Bauernhofer Thomas , Kroneis Thomas , El-Heliebi Amin
Published: July 2024

Background

Liquid biopsies are emerging as valuable clinical biomarkers for cancer monitoring. Although International Organization for Standards (ISO) and Technical Specifications from the European Committee for Standardization (CEN/TS) standardized workflows exist, their implementation in clinical practice is underdeveloped. We aimed to assess the applicability of ISO and CEN/TS standards in a real-world clinical setting, with a particular focus on evaluating the impact of preanalytical parameters and hemolysis on liquid biopsy analysis.

Methods

We evaluated 659 peripheral blood samples from advanced prostate cancer patients against ISO and CEN/TS standards and documented all essential criteria, including tube draw order, filling level, temperature, and time tracking from blood draw to storage. We assessed hemolysis and its effect on circulating tumor DNA (ctDNA) and circulating tumor cell (CTC) analysis.

Results

Our results demonstrated a high compliance rate, with 96.2% (634/659) of samples meeting essential ISO and CEN/TS criteria. We did not observe a significant impact on ctDNA or CTC detection rates between hemolytic and nonhemolytic samples. Hemolysis was identified in 12.9% (40/311) of plasma samples from our advanced prostate cancer cohort, and within the draw order of 5 blood collection tubes, hemolysis did not significantly increase from tube 1 to 5. In total, 83.8% (552/659) of blood collection tubes had high fill levels above 80% of nominal filling level.

Conclusions

Our study demonstrates the feasibility and benefits of adhering to ISO and CEN/TS standards in a clinical liquid biopsy study. The standards revealed that hemolysis occurred frequently but did not impair downstream ctDNA and CTC analysis in our cohort of advanced prostate cancer patients.
Assessment of stress levels and reproductive condition in giant pandas: insights from hair, faecal and saliva samples
Authors: Yan Zheng , Liu Xiaoyan , Liu Haoqiu , Xu Haihong , Liu Yanhui , Li Changqing , Wang Bo , Cui Shengnan , Jia Ting , Yang Di , Zhang Chenglin , Liu Xuefeng , Buesching Christina D , Liu Dingzhen
Published: July 2024

Concerted conservation efforts have brought the giant panda (Ailuropoda melanoleuca) back from the brink of extinction, but pandas continue to face anthropogenic threats in the wild and breeding success in captivity remains low. Because stress can have detrimental impacts on reproduction, monitoring stress- and sex-steroid levels would help assess the effectiveness of conservation mitigation measures in panda populations as well as monitor the welfare and reproductive health of captive animals. In this proof-of-concept study, we used faecal sex steroid and cortisol concentrations (n = 867 samples collected from five males and five females at Beijing Zoo every 4 days over the course of 12 months) as a reference to investigate if testosterone, estradiol, progesterone and cortisol can be meaningfully measured in panda hair (n = 10) using radio-immuno-assays. Additionally, we calculated the ratio of testosterone to cortisol (T:C ratio) for each male, which can provide a biomarker of stress and physical performance. Our findings revealed distinct monthly variations in faecal sex-steroid and cortisol concentrations, reflecting reproductive seasonality and visitor-related stress among individual pandas. Notably, the oldest male had a significantly lower T:C ratio than other males. Our results confirm that the level of sex steroids and cortisol can be assayed by panda hair, and the hair cortisol concentrations correlate significantly with that in faeces with one month lag behind (r = 0.68, P = 0.03). However, the concentrations of hormones detected in saliva are lower than those in faeces by two orders of magnitude, making it difficult to ensure accuracy. By assessing the applicability of hair, faecal and salivary sampling, we can infer their utility in monitoring the reproductive status and acute and chronic stress levels of giant pandas, thereby providing a means to gauge the success of ongoing habitat restoration efforts and to discuss the feasibility of sample collection from wild populations.