bluuebunny/crossref_metadata_2025 huggingface dataset:
Resilience and Cascading Disasters
Authors: Pescaroli Gianluca , Trump Benjamin D. , Linkov Igor , Alexander David E.
Published: September 2024

In the 1st decades of the 21st century, society became highly interconnected and increasingly dependent on the delivery of essential services assured by critical infrastructure and tightly coupled systems. Its vulnerability to disruptions has become more concerning. Events like the 2010 Eyjafjallajökull eruption disrupting air transportation and the 2011 earthquake, tsunami, and nuclear meltdown in Japan underscore the importance of adopting the concept of cascading disasters for advancing the field of emergency planning and management. The potential of this approach, based on understanding the possible escalation of secondary crises, became more evident when considering the impacts of the COVID-19 pandemic and the compounded weather extremes from climate change.

The premise for understanding the new operational reality of the 21st century is accepting that there are conditions of higher uncertainty, whereby disruptions are becoming the new “business as usual” and are bound to happen across highly reliable systems. The recombination of crisis extremes, failures, and vulnerabilities takes new forms that are harder to predict and model, reducing the effectiveness of existing methods of risk assessment and disaster risk reduction approaches.

There is an urgent need to develop flexible procedures that could shift toward a comprehensive understanding of system-wide resilience management. An option worth considering is a focus on understanding the common points of failure in the operational context, considering both society and organizations. Addressing resources on the weaknesses between known and unknown events will support leveraging existing capacity, aligning short-term responses with long-term planning, and fostering collaboration between social and physical sciences, as well as academics and practitioners. The adoption of new tools, such as stress testing, could facilitate a “threat-agnostic approach” in emergency and continuity management, enhancing response flexibility.
PHF1::TFE3-positive fibromyxoid sarcoma? Report of 2 cases and review of 13 cases of PHF1::TFE3-positive ossifying fibromyxoid tumor in the literature
Authors: Wei Shuanzeng , Patchefsky Arthur S , Pei Jianming , Brown Scot A , Basu Mallick Atrayee , Wang Zixuan , Jiang Wei
Published: September 2024

Objectives

Ossifying fibromyxoid tumor (OFMT) is a rare soft tissue neoplasm of uncertain histogenesis. Most OFMTs have benign behavior, and many harbor gene fusions involving the PHD finger protein 1 (PHF1), such as EP400::PHF1, MEAF6::PHF1, EPC1::PHF1, and PHF1::TFE3. The PHF1::TFE3 fusion is unique because PHF1 is at 5ʹ instead of residing at 3ʹ in the other fusions. In this study, we describe 2 cases of OFMT harboring PHF1::TFE3 fusions and review 13 published cases.

Methods

Two cases of PHF1::TFE3-positive OFMT were investigated using RNA Next-Generation Sequencing and immunohistochemistry.

Results

Most (12/15) of the PHF1::TFE3 OFMTs we studied were located at proximal and distal extremities, with a multinodular growth pattern. Only 1 case (1/10) had a shell of bone at the periphery. Areas morphologically similar to sclerosing epithelioid fibrosarcoma or low-grade fibromyxoid sarcoma were found in 8 of 12 (66.7%) cases. Eleven cases (11/15 [73.3%]) were regarded as malignant based on more than 2/50 high-power field mitotic figures, increased cellularity, or the presence of necrosis. Among the 9 cases with follow-up data, 2 patients died of disease (with metastases), 1 patient is alive with metastases, and 1 patient had multiple local recurrences.

Conclusions

Because PHF1 is located at 3ʹ in all the PHF1 fusions in OFMTs except PHF1::TFE3, the different driver molecular alterations suggest that OFMTs with 3ʹ-PHF1 fusions and OFMTs with PHF1::TFE3 are different tumors. Immunohistochemistry confirmed TFE3 expression in all PHF1::TFE3 OFMTs. Because PHF1::TFE3-positive OFMTs have increased mitotic figures and tumor cellularity, with a high rate of metastasis, using the name PHF1::TFE3 positive fibromyxoid sarcoma may be appropriate.
The Healthy User Effect in Pharmacoepidemiology
Authors: Olawore Oluwasolape , Stϋrmer Til , Glynn Robert J , Lund Jennifer L
Published: September 2024

The healthy user effect is a well-recognized bias in the field of pharmacoepidemiology and can be expected to overstate the effect of a preventive intervention when comparing long term users or “adherers” to non-users. Similar to the healthy worker effect observed in occupational epidemiology, the healthy user effect can be separated into a healthy initiator effect (baseline confounding) and a healthy adherer effect (selection bias). Restriction approaches and new user designs that implicitly condition on the indication and, similar healthy behaviors or health status can often mitigate the healthy initiator effect (confounding) or healthy adherer effect (selection bias) at the start of a study. Addressing the healthy adherer effect due to continued conditioning on adherence over the duration of a study is more challenging as methods to mitigate it require the ability to predict adherence, which is often difficult using databases common in pharmacoepidemiologic research. Here, we describe the healthy user effect, with supporting examples, and describe study design approaches available to pharmacoepidemiologists to mitigate the potential for bias.
The Clinical Implication of Nocturia in Predicting Hypertension Among Working-Aged Koreans
Authors: Park Sung Keun , Oh Chang-Mo , Ryoo Jae-Hong , Jo Hyun chul , Kim Eugene , Jung Ju Young
Published: September 2024

BACKGROUND

Evidence has indicated that nocturia is a clinical manifestation of adverse health conditions, including cardiovascular diseases and metabolic disorders. However, previous studies are less available for the clinical implication of nocturia on the development of hypertension.

METHODS

Study participants were 32,420 working-aged Koreans (21,355 men and 11,065 women) who periodically received health checkups. They were categorized into 4 groups by the frequency of nocturia (never, <1, 1–2, and ≥3/week). We used Cox proportional hazards models to analyze the multivariable-adjusted hazard ratio (HR) and 95% confidence intervals (CIs) for incident hypertension (multivariable-adjusted HR [95% CI]) in relation to the frequency of nocturia. Subgroup analysis was conducted by gender and sleep quality (good and poor sleep quality).

RESULTS

In women, nocturia was associated with an increased risk of hypertension, compared with never nocturia (HR [95% CI]; never: reference, <1/week: 1.33 [1.10–1.60], 1–2/week: 1.26 [1.00–1.58], and ≥3/week: 1.34 [1.05–1.72]). This association was not observed in men (HR [95% CI]; never: reference, <1/week: 1.00 [0.93–1.08], 1–2/week: 1.00 [0.88–1.12], and ≥3/week: 1.06 [0.94–1.23]). In subgroup analysis by sleep quality, only women with good sleep quality showed an association between nocturia and the risk of hypertension. However, women with poor sleep quality and men did not show an association between the frequency of nocturia and the risk of hypertension.

CONCLUSIONS

Nocturia is a potential risk factor for incident hypertension in working-aged women with good sleep quality.
XII—The Ethical Problem of Evil
Authors: Watts Daniel
Published: September 2024

I introduce a distinct challenge to religious belief: the Ethical Argument from evil. By this argument, paradigmatic forms of religious practice constitutively involve failures of ethical acknowledgement with respect to the reality of evil. I show how standard discussions of the problem of evil, as a purely logical or epistemic issue, abstract away from its fundamentally ethical dimensions. Drawing on an analogy with Moore’s paradox, I argue that the Ethical Argument presents a genuine theoretical problem, not merely a practical or pastoral one: the problem of how religious devotion can be compossible with properly acknowledging the reality of evil. I further argue that, in order properly to address this problem, the philosophy of religion needs to take a phenomenological turn. To illustrate this approach, I focus on the case of thankful prayer and draw out from Kierkegaard’s writings a religious ideal of unconditional gratitude. Developing the relevant notion of a failure of ethical acknowledgement in terms of two vices—wishful self-deception and spiritualized self-absorption—I show how Kierkegaard’s account can help us to assess whether expressions of religious devotion are objectionable on these grounds.
The Use of Tranexamic Acid in Breast Reduction and Abdominoplasty: A Review of a Multicenter Federated Electronic Health Record Database
Authors: Habarth-Morales Theodore E , Isch Emily , Zavitsanos Alexander P , Wride Wesley M , Davis Harrison D , Rios-Diaz Arturo J , Broach Robyn B , Fischer John P , Serletti Joseph M , Azoury Said C , Jenkins Matthew
Published: September 2024

Background

Tranexamic acid (TXA), a fibrinolysis inhibitor, is widely used in various surgical fields to minimize blood loss. However, its efficacy and safety in plastic surgery, especially in reduction mammaplasty and abdominoplasty, remain underexplored. This study investigates the utility of intravenous (IV) TXA in these procedures, focusing on reducing postoperative complications and evaluating its safety in the context of venous thromboembolism (VTE).

Objectives

To evaluate the efficacy and safety of TXA in reduction mammaplasty and abdominoplasty.

Methods

Using data from the TriNetX LLC (Cambridge, MA) National Health Research Network database, this retrospective study compared adult patients undergoing reduction mammaplasty or abdominoplasty who received intraoperative IV TXA against those who did not. Primary outcomes included postoperative seroma and hematoma incidences, whereas secondary outcomes assessed the necessity for procedural drainage and the occurrence of VTE within 1-year postsurgery.

Results

No significant differences in the rates or risks of hematoma, seroma, or the need for procedural drainage between patients administered IV TXA and those who were not, for both reduction mammaplasty and abdominoplasty. Additionally, IV TXA did not increase the risk of VTE in either patient group.

Conclusions

IV TXA application in reduction mammaplasty and abdominoplasty does not provide added benefits in reducing postoperative complications such as seroma, hematoma, or the necessity for procedural drainage. Furthermore, it does not alter the risk of thromboembolic events. These findings highlight the need for further research, particularly through randomized control trials, to understand TXA's efficacy in plastic surgery.

Level of Evidence: 3 (Therapeutic)
SP2.10 - Early outcomes with the Insides Chyme Reinfusor (ICR) device in the management of parenteral nutrition dependent high output stomas (PN-HOS)
Authors: Mohammed Rifat , Travers Angela , Slater Colette , Cotgrave Amy , Wilson Jeremy , Magee Conor
Published: September 2024

Aims

PN-HOS represent a complex challenge, requiring input from surgical, gastroenterology and nutritional teams. Length of stay (LOS) is prolonged with difficulties in achieving output control and adequate nutrition with other associated risks.

ICR is a modified stoma bag/mechanical pump and catheter device, reinfusing chyme into the distal limb, maintaining gut continuity, preserving enteral nutrient absorption and preventing distal limb atrophy. ICR may accelerate establishment of nutritional autonomy and reduce costs associated with PN/LOS.

We report the largest study of ICR outcomes

Methods

Prospective study of ICR outcomes in patients with PN-HOS. Analysis included LOS, duration of PN, establishment of nutritional autonomy, nutritional markers, adverse ICR effects.

Results

Sixteen patients were trained to use the ICR (6M:10F). Median age 60yr.

75% achieved independent use (median 5.6 days). Overall usage was 395 days (median 32 days). Nutritional autonomy achieved in nine patients (pre-reversal). ICR increased median albumin 10.5 g/l.

Adverse events included changing difficulties, spillage, noise, and discomfort.

Two patients discontinued ICR because of pain/reflux. One patient died from unrelated post-operative complications.

One patient with multiple loop stomas was successfully established on dual ICR.

Nursing experience with ICR demonstrated ease of use and straightforward patient education.

Cost analysis PN £5000/mth v ICR 1800/mth.

Anecdotally at the time of reversal, surgical opinion was of much favourable bowel for anastomosis and return to function.

Conclusions

The ICR device is safe and contributes to restoration of nutritional autonomy. It reduces PN dependence with cost-benefits and acceptable adverse effects. At time of initial surgery distal limb should be fashioned to allow potential use of ICR.
SP3.12 - Effect of Anticoagulants on Faecal Immunochemical Tests (FITs) in Bowel Cancer Screening
Authors: Maleki Aryan , Iacob George , Chandran Palanichamy
Published: September 2024

Background

Bowel cancer screening in the United Kingdom is based on the faecal immunochemical test (FIT). Eligible participants sometimes use anticoagulants which may stimulate bleeding from benign lesions affecting the screening performance of FITs for colorectal cancer. We aimed to evaluate the effectiveness of FITs in screening for colorectal cancer for patients taking anticoagulants.

Methods

This was a retrospective study of FIT positive patients on anticoagulation who underwent colonoscopy or CT colonoscopy between October 2022 and June 2023. The threshold for a FIT positive result was 150µg Hb/g of faeces for asymptomatic patients and 10µg Hb/g of faeces for symptomatic patients. Histology reports were reviewed for the presence of colorectal neoplasms and advanced adenomas (defined as adenomas with high-grade dysplasia, villous histology, or ≥10mm in size).

Results

A total of 57 patients were included- 38 used a direct oral anticoagulant (DOAC), 3 used warfarin, 15 used clopidogrel or ticagrelor, and 1 used dabigatran. Colorectal cancer was identified in 8.8% of individuals (5 out of 57) and advanced adenoma in 17.5% of individuals (10 out of 57). Use of anticoagulants was associated with a positive predictive value for advanced neoplasia (PPVAN) of 26.3%.

Conclusion

FIT accuracy as a surrogate marker for advanced neoplasia was not affected by the use of anticoagulants when compared with the current literature. Suspension of anticoagulation prior to FIT screening is not recommended. Further studies investigating the dosage and class of anticoagulation on FIT accuracy for bowel cancer screening may be warranted.
SP4.12 - A single centre experience of managing patients admitted for elective Nissen’s Fundoplication as a day case procedure
Authors: Carey Charles , James Stuart , Richardson Gemma , Jaunoo Shameen
Published: September 2024

Aims

Laparoscopic Nissen’s fundoplication (LNF) is an elective procedure used to treat gastro-oesophgeal reflux which cannot be managed effectively with medical and conservative methods. LNF is the most common surgical procedure used to treat reflux in the UK and optimising the discharge process for these patients can therefore prevent excessive admission times for many patients. This study aimed to analyse the success of LNF as a day case procedure in a tertiary centre.

Methods

The notes from patients who underwent LNF between January 2020 and December 2023 were retrospectively reviewed. The demographics, co-morbidities and the rates of readmission and complications of the patients included were noted. All patients were managed following local and national surgical, anaesthetic and nursing guidelines.

Results

67 patients underwent LNF within the time frame studied, each of which were initially planned to be kept in hospital overnight. 41 (61.2%) cases however, were considered to be medically safe for discharge as a day case operation. None of the patients studied required readmission or suffered any complications despite this change in their care plan.

Conclusions

This single centre experience showed that patient safety was not compromised by encouraging LNF as a day case procedure in selected patients. Day-case protocols should therefore be considered for patients undergoing LNF who have no/few major co-morbidities and can be looked after at home post-operatively in order to reduce healthcare costs and maximise bed space availability.
SP6.5 - The NHS's value-based funding model for organ transplantation achieves superior equity and outcomes vs global peers
Authors: Sharma Hemant , Millward Alex , Mehra Sanjay , Sharma Abhishek
Published: September 2024

Introduction

Value-based practice is gaining traction as a way to control costs, improve patient satisfaction, and increase provider accountability. The rising prevalence of end-stage organ disease contrasts with limited donor organs, necessitating maximising equitable access, clinical outcomes, and appropriate cost control. We compare key kidney transplant metrics across the UK, US, and Canada.

Methods

Parameters analysed from the 2010–2022 national registries include: (1) Policy-components, (2) Transplant rates per million population; (3) 1-5 year survival, (4) Median waiting times, (5) Average cost per patient. Inequality was assessed using the Gini-index and concentration-curves.

Results

The UK NHS funded >1000 kidney-transplants in 2021 under standardised pricing and coordinated care. This enabled 98% one-year patient survival, 7 percentage points higher than in the US and Canada. The median kidney waiting time is 54% lower than in Canada. The UK transplantation rate per million increased by 25% over the decade, versus a 3% rise in the US and Canada. The Gini index is 0.03 in the UK, indicating highly equitable access, versus 0.11 in the US. Average transplant costs per patient are nearly 85% lower in the UK ($130,000) than in the US ($830,000).

Conclusions

The integrated funding and oversight model has facilitated access, survival, and sustainability gains on kidney transplantation for the UK NHS system versus lagging peer countries. Continued value optimisation remains necessary to tackle trade-offs.

High-Level Structural Comparison ParameterUnited-KingdomUnited-StatesCanadaKey Payer(s)Single: NHSMedicare, Medicaid, PrivateSingle: Provincial-plansUse of Quality-MetricsYesPartialIn ProgressPricing ModelNational-TariffFragmentedProvincialRegulatory-OversightCentralizedVariableProvincial
SP6.8 - Predicting Determinants of Successful Transplantation Using Supra-Marginal (DRI-Donor Risk Index >1.5) Deceased Donor Kidneys
Authors: Sharma Hemant , Sharma Abshishek , Al-Amiedy Zaid , Devkaran Bhavesh , Mehra Sanjay
Published: September 2024

Objective

To develop machine-learning-models with national registry data to predict factors associated with favourable outcomes using supra-marginal ( DRI -Donor Risk Index >1,5) deceased donor kidneys

Design

A retrospective cohort study using UK Transplant Registry data from 2000-2019

Setting

National registry administered by NHS Blood and Transplant in the United Kingdom.

Participants

Adult recipients (n = 6254) of first kidney-alone transplants from very supra-marginal deceased-donors (DRI≥1.5)

Main Outcome Measures

Death-censored graft failure and patient mortality

Predictors

Comprehensive recipient, donor, and transplant characteristics.

Statistical Analysis

Bayesian neural networks, gradient boosting machines, random forest, and SMOTE-balanced bagging classifiers tuned using Bayesian optimisation Cox regression, competing risk analysis, and calibration plots

Results

Overall 5-year graft survival was 81%. The random-forest-model had excellent predictive performance for graft failure (AUC 0.88, 95% CI 0.87-0.89; RMSE 0.29). recipient age > 75-years (SHR 1.02, 95% CI 1.01-1.03), recipient-BMI >30 (SHR 1.04, 95% CI 1.02-1.07), HLA mismatches >4 (SHR 1.09, 95% CI 1.01-1.17), donor-creatinine >120mmol/L (SHR 1.002, 95% CI 1.001-1.003), and rejection- within 3-months (SHR 1.56, 95% CI 1.32-1.85) were key determinants of poor survival. Prolonged cold-ischemia-time >14hrs (SHR 1.01, 95% CI 1.007-1.015) was detrimental

Conclusions

Supra-marginal deceased-donor-kidneys can achieve excellent 5-year outcomes with careful recipient selection. Machine-learning accurately predicted factors associated with success.

Adjusted predictors of graft failureVariableSHR95% CIp-valueRecipient-age > 75 years1.021.01-1.03<0.001Recipient-BMI >301.041.02-1.070.002HLA-mismatches >41.091.01-1.170.03Creatinine at offer >120 mmol/L/ 1.4 mg/dl1.0021.001-1.003<0.001Rejection at 3 month1.561.32-1.85<0.001Cold-ischemia-time >14 hrs1.011.007-1.015<0.001SHR: subdistribution hazard ratio;
SP6.12 - Do Pregnant Females Experiencing Physical Traumatic Injury have Different Mortality Outcomes Compared to Non-pregnant Females? A Systematic Review and Metanalysis
Authors: Thorne Elizabeth , Cole Elaine , Hess Emily , Rappoport Jacqueline , Thumbadoo Ruben , Shepherd Joanna
Published: September 2024

Aims

To collate and analyse literature capturing mortality rates in pregnant and non-pregnant individuals of childbearing age who experienced physical trauma. Additionally, to identify any statistically significant differences in interventions received.

Methods

Comprehensive searches of PubMed, MEDLINE, and grey literature were conducted using MeSH terms. Data extraction by two independent reviewers was followed by quality assessments using the Newcastle-Ottawa Scale. A random effects meta-analysis assessed the effect of pregnancy on mortality post-physical trauma, employing risk ratios (RR) and 95% confidence intervals. Publication bias was evaluated through linear regression, Eggers test, and funnel plots.

Results

Twelve studies met eligibility criteria, yielding 1,113,376 pregnant and 18,185,789 non-pregnant females of childbearing age who experienced physical trauma. Low publication bias was observed. Pregnant females demonstrated a 35% mortality reduction vs. non-pregnant females (pooled RR: 0.65 [0.47-0.89], p=0.008), though significant heterogeneity existed across studies (I2 = 77%). A subgroup analysis focusing on mechanism of injury found the mortality reduction in pregnancy increased to 59% in motor vehicle accidents (pooled RR = 0.41 [0.32-0.52], p<0.001) with minimal study heterogeneity (I2 = 0%). Pregnant (vs. non-pregnant) females were less likely to be intubated (pooled RR = 0.69 [0.58, 0.81], p=<0.001, I2 = 9), but there were no other significant differences in the types of intervention received.

Conclusions

Pregnant females have a lower mortality risk from physical trauma than non-pregnant counterparts, particularly where the mechanism of injury is a motor vehicle accident. Additional research is warranted to elucidate the underlying factors contributing to this observed difference.
SP7.10 - Awareness and Knowledge of Medical Coding Education Amongst Vascular Surgeons: A National Survey
Authors: Dhahri Adeel Abbas , Seabrook Max , Rao Ahsan , Darwish Nourelhuda , Essa Nazar , Rajagopalan Sriram
Published: September 2024

Aims

Accurate medical coding plays a critical role in optimising healthcare delivery, facilitating appropriate reimbursement, supporting research and data analysis, and providing a foundation for public healthcare databases and policies. This survey aims to explore the familiarity and comprehension of medical coding among vascular surgeons.

Methods

Ninety-five responses were gathered from participants across diverse levels of vascular surgery. A notable 77.7% (n=73) of respondents indicated a lack of formal training in medical coding. Additionally, 70.5% (n=67) of vascular surgeons advocated for including medical coding within surgical training programs. Regarding assessing medical coding proficiency, 61.1% (n=55) correctly identified ‘BSS’ as an example of non-medical coding classification. Moreover, 67.7% (n=63) accurately recognised ‘OPCS-4’ as the classification system employed by the NHS for coding surgical procedures.

Results

Ninety-five questionnaire responses were collected from participants working in vascular surgery of various levels. A notable 77.7% (n=73) of the participants reported receiving no formal training in medical coding. Additionally, 70.5% (n=67) of vascular surgeons expressed that medical coding should be included in surgical training. Regarding assessing medical coding knowledge, 61.1% (n=55) of respondents correctly identified ‘BSS’ as the non-example of medical coding classification. When asked about the classification system used by the NHS to code surgical procedures, 67.7% (n=63) correctly identified ‘OPCS-4.’

Conclusion

The study's findings reveal the need for more awareness, knowledge, and formal training in medical coding. Augmented education and training in medical coding, potentially through concise courses, are imperative for ensuring equitable reimbursement for healthcare services, facilitating data analysis for research and quality enhancement endeavours, and fostering effective inter-professional communication within the healthcare domain.
SP9.9 - Psychological recovery after emergency laparotomy; Giving patients Grief
Authors: Silva Louise , Smith Laurie , Watts Tessa , Bisson Jonathan , Jared Torkington , Cornish Julie Ann
Published: September 2024

Aims

Recent work demonstrated 8% of emergency laparotomy (EmLap) survivors were referred to mental health following surgery, suggesting it carries a significant psychological burden.

This exploratory work aims to describe patients’ psychological response 1 year after EmLap using a qualitative approach.

Methods

POLO is a prospective cohort multicentre, mixed methods study on EmLap patients. (IRAS 301310, ClinicalTrials.Gov NCT05281627). Purposive sampling identified a subgroup to undergo 2 semi-structured interviews at 6 and 12-months post-discharge, either in person/videoconferencing, using a pre-formulated topic guide. Interviews were recorded, transcribed verbatim, and analysed using Braun and Clark’s six-step approach.

Results

12 participants provided interviews at both time points. 75% were female; average age was 52 years. Patients underwent significant psychological adjustment following EmLap, similar to the Kuber-Ross Grief Reaction model; transitioning through shock, anger, bargaining, depression to eventual acceptance. Patients’ recollection of early response was disbelief, followed by anger towards their care. Bargaining centred around having restorative surgery. Depression was exacerbated by physical issues; fatigue, stoma stigma and ongoing medical treatment. Most patients reached acceptance stage by the 12-month interview.

Conclusion

This is the first study to describe the psychological response following EmLap. This work parallels the psychological response with other significant traumatic events, such as grief. These findings may suggest that the negative effect on patients’ mental health following surgery, observed by an increase in referral, are part of a “normal” trajectory, rather than pathological. More work is needed to understand how, and when, the response becomes problematic to functioning and long-term wellbeing.
WP2.8 - Patient experience of surgeon-patient communication in general surgery in Northern Ireland: a qualitative analysis
Authors: Montgomery Michael
Published: September 2024

Aims

This project explores the patient experience and perception of surgeon-patient communication in general surgery in Northern Ireland. Through qualitative analysis of patient feedback, this project aims to identify pertinent aspects of communication that significantly impact the patient experience within the context of inpatient surgical care, and compare this to existing literary consensus.

Methods

Patient feedback data was collected from Care Opinion, accessed at https://www.careopinion.org.uk. Search parameters included stories about general surgery and communication, spanning a period of twelve months, submitted from the five health and social care trusts in Northern Ireland. 121 of 178 search returns met the inclusion criteria for analysis. Braun and Clarke’s Thematic Analysis framework was selected for coding data and identifying themes and understand participant experiences within the data set.

Results

Three themes emerged from analysis of patient feedback. These themes were the aspects of patient-doctor communication that were valued most by patients during admission. They include the pitch at which information is delivered, the frequency of updates patients were given regarding their care, and provision of question and answer opportunity with their surgeon.

Conclusions

The important discovery from this analysis is that contemporary literary knowledge does not fully represent the patient experience of doctor-patient communication in Northern Ireland. Instead, analysis of patient feedback has identified new aspects of communication that most impact patient experience, and has yielded new means of understanding and achieving patient-centred practice.
WP2.10 - The Future of Artificial Intelligence (AI) in Surgery
Authors: Cheruvu Chandra , Davies Alexander , Lu Yanqiang , Mak Richard , Ingley Paul
Published: September 2024

Aims

Artificial intelligence (AI) has revolutionised many industries, especially in the field of medicine. However, its application in medical surgery has been limited.

Our study aims to review current literature surrounding AI’s use in surgery and identify potential future application of this new technology. We look at the preoperative, intra-operative, and postoperative phases of a patient’s surgical journey and see how AI can improve each component.

Methods

A selective literature review was conducted by gathering 19 relevant research papers of interest related to AI in surgery. These studies were collected from PubMed and papers only published from the past 5 years were included. Of the 19 papers 11 were included in the final review.

Results

This review reveals numerous applications of AI in surgery, primarily showcasing its accuracy in preoperative patient data analysis with high sensitivities of 89%. Secondly intra-operatively AI can provide guidance through supervised machine learning and computer vision with accuracies as high as 95%. Finally, postoperatively AI has been shown to have a high accuracy at preoperative prediction of surgical site readmission rates, diabetes remission and personalised weight loss trajectories.

Conclusions

The findings of this review demonstrate the transformative ability of AI on various stages of the surgical journey. While demonstrating significant promise, challenges such as ethical considerations and regulatory frameworks need to be addressed to ensure responsible and safe integration. The new advancements shown in AI provide the foundation for future research into the technology.
WP3.12 - The influence between frailty, sarcopenia and physical status on mortality in patients undergoing emergency laparotomy
Authors: Thu May Myat , Ng Hwei Jene , Moug Susan
Published: September 2024

Aims

Frailty and sarcopenia predict mortality in emergency laparotomy (EmLap) and both can be indicative of poor physical status. We aim to assess the prevalence of frailty, sarcopenia and physical status in EmLap and explore the relationship between these factors and 30-day, 90-day and 1-year mortality.

Methods

Retrospective analysis was performed on two Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA) databases (2017-2019) which included patients ≥18years. Clinical frailty scale was used to classify frailty (score ≥4 as frail). Sarcopenia was assessed via total psoas index. Poor physical status (PPS) was defined by American Society of Anaesthesiologists physical status classification (ASA)≥4. One-way ANOVA and logistic regression were used for statistical analysis.

Results

215 patients were included with 57.2% female and median age of 64years. Frailty was present in 17.2%, sarcopenia in 25.1% and 14.5% had PPS; 3.3% had all three factors. Frail patients had significantly higher risk for 30-day (p=0.003), 90-day (p=0.006) and 1-year mortality (p=0.032). Sarcopenic patients did not show significant differences in mortality risks up to 1 year. Patients with PPS had significantly higher mortality rates at 30-day (p<0.001), 90-day (p<0.001) and 1-year (p=0.001). Patients with all three factors had higher 30-day (p<0.001), 90-day (p=0.005) and 1-year mortality (p=0.049) than patients who have none of the factors.

Conclusions

Frailty, sarcopenia and PPS are prevalent in EmLap. Frailty and PPS were independently associated with short and long-term mortality but not sarcopenia. While overlap exists between frailty, sarcopenia and PPS, more studies are required to understand the complex interplay.
WP5.13 - National Emergency Laparotomy (NELA) critical care admissions: A cohort study
Authors: Gok M A , Bughio M , Mathieson N O M , Zaidi M , Sadat M M , Khan U A
Published: September 2024

Aims

NELA is committed to enhancing quality of peri-operative care of patients undergoing emergency laparotomy. NELA emphasizes importance of identifying high risk patients, who are associated with significant morbidity & mortality. Critical care allows close monitoring, organ (basic/advanced) support. Aim of study is to review the NELA critical care patients.

Methods

Cohort study of NELA patients that received post-operative ITU care (direct/indirect admission) at single centre. Descriptive demography, and outcomes were evaluated. NELA parsimonious risk & CCMDS ITU scores used. NELA patient that did not require ITU care were controls.

Results

NELA critical care (n = 400) NELA non critical care (n = 466) Mann Whitney U (p value) Deaths (n) - (n) Age(yrs) 71.8 64.0 < 0.0001 Sex(M:F) 173 : 227 220 : 246 NS ASA 3 2 < 0.0001 BMI(kg/m2) 26.3 25.0 NS Lap(n) 67 168 Open(n) 333 293 Op time(mins) 131.0 109.4 < 0.0001 LOS(days) 18 9.5 < 0.0001 Deaths 30 day 50 25 60 day 66 37 90 day 73 40 Lactate(mmol/L) 2.4 1.8 <0.01 WCC(x109/L) 13.0 11.8 <0.05 CRP(mg/L) 90.1 56.6 <0.0001 Physiological-score 25.6 19.8 <0.0001 Operative-severity-score 17.9 15.9 <0.0001 Prepossum-score 21.6 7.5 <0.0001 PPmortality-score 11.9 4.9 <0.0001 PPmorbidity-score 77.3 55.7 <0.0001 Survival Rate (%) 1styear 75.4 86.2 5thyear 53.8 70.8 Logrank 10thyear 41.1 58.7 p<0.0001

Conclusion

NELA critical care patients had poorer survival rates in our study. Theatre return or indirect critical care transfers can adversely affect survival. These patients were older, frail, multiple co-morbid status. NELA parsimonious mortality risk score >5% should encourage consultant level supervision, mortality risk score >10% should encourage direct critical care involvement.
WP7.9 - Evaluation of outcomes of early laparoscopic cholecystectomy for acute gallstone disease using Traffic Light Booking system
Authors: Ehigie Naomi , Fallaha Mohammad , Osuchukwu Joshua , Forster Henry , Gray Jack , Ayantunde Abraham
Published: September 2024

Introduction

Delayed cholecystectomy leads to recurrent admissions with potential increased preoperative, operative, and postoperative complications.

Aim

To evaluate the outcomes of early laparoscopic cholecystectomy using traffic light booking system.

Methods

A quality improvement early gallbladder service was designed using the weighted scores of patients’ demographics, BMI, comorbidities, LFTs, imaging findings, confirmed diagnosis and associated gallstone complications. The scores were stratified into traffic light system colours of green (0-3), amber (4-6) and red (>7) to predict the operative difficulty and allocated operative time. Early cholecystectomy was performed within 6 weeks of the onset of symptoms. Operative difficulty grading use was by Nassar et al.

Prospectively data was analysed using SPSS to present the outcomes.

Results

207 patients had early cholecystectomy from February 2022 to January 2024. Median age was 50.5 years and 71.5% were females. Diagnoses were 60 biliary colic, 102 acute cholecystitis, 41 pancreatitis and 4 cholecystitis with biliary obstruction.

Traffic light scores were 114 green, 76 amber and 17 red while operative difficulty grading was 44 mild, 73 moderate, 54 severe and 36 extreme difficulties. Median time to surgery was 21 (21-42) days and median operative time was 75 (25-205) minutes. 13.5% of the patients were operated at the index admission, 67.1% as day cases, 20.3% stayed overnight and 12.6% as inpatient stays.

None were converted to open but four procedures were abandoned. Complication and readmission rates were 4.8% and 5.3% respectively with one patient returning to theatre.

Conclusion

Early laparoscopic cholecystectomy service can be safely delivered with the majority done as day cases.
WP7.11 - An Audit of Geriatric Input and Analysis of The Barriers For Elderly Patients Undergoing Emergency Laparotomy
Authors: Govind Garima , Jayasankar Balaji , DiFranco Filippo
Published: September 2024

Background

Older people over the age of 65 years are recognized as higher risk surgical candidates and it is therefore recommended that their care should be coordinated through a multidisciplinary team (MDT) approach involving senior geriatricians, anaesthetists and surgeons. We audited 150 geriatric patients for medical input. Further in addition to the liaison services we analysed the characteristics of this group that would have benefitted from a liaison service.

Methods

An audit of 150 geriatric patients undergoing emergency laparotomy was carried. Our primary outcome was to look at input from geriatricians following laparotomy. Further we assessed the clinical characteristics of these patients and analysed the complexity of medical needs to benefit from a physician input.

Results

Only around 10% patients received a medical/geriatric input following an emergency laparotomy. Our audit highlighted the gap that exists in the clinical care for geriatric population against the NELA recommendations. Further we were able to work out a model of implementation for a geriatric liaison service.

Conclusions

Management of older patients with complexity requires surgical, critical care and geriatricians to collaborate. Implementing a local service with regular MDT’s will only serve to improve care and outcomes.
WP7.16 - Usefulness of Cross-Sectional Imaging and Biochemical Markers in Diagnosing Necrotising Soft Tissue Infections
Authors: Pha Sai Yan , Asfour Aref , Christie Hannah , Burke Joshua , Peckham-Cooper Adam
Published: September 2024

Introduction

Diagnosis of Necrotising Soft Tissue Infections (NSTI) remains clinical, however pre-operative investigations and radiology may be useful for cases of diagnostic uncertainty or pre-operative planning.

Aims

To identify if cross-sectional imaging is useful in the diagnosis of NSTI's. To identify if Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score supports the diagnosis of NSTI’s.

Methods

Retrospective data collection of all relevant clinical data for all histologically confirmed NSTI’s in a single centre from 2012 to 2022 inclusive.

Results

73 total cases of NSTI were confirmed. 27 patients underwent CT imaging as a direct result of their presenting complaint. CT was performed for the following reasons,Patient NoReason for CT10Clinically confirmed - CT to assess extent of involvement4Clinically suspicious – CT to confirm diagnosis5No clinical diagnosis – CT features of NSTI8Incidental findings – CT for alternative diagnosis

Only 3 patients had a prospective documented LRINEC score. As such retrospective LRINEC scores were calculated for each case in this cohort. Average scores were 7.71 (Range 4-13), which is above the reported threshold value of 6.

Conclusion

CT scans are useful in clinically confirmed or suspected NSTIs for further assessment, however with regards to diagnosing NSTIs, clinical diagnosis remains the preferred modality. There remains limited data to suggest that a CT scan should be gold standard in identifying and confirming NSTI’s.

LRINEC scoring however should be utilized for all suspected NSTI’s, it remains poorly utilized but would provide significant value and diagnostic guidance when above threshold values.
WP8.15 - Systematic Review and Meta-Analysis of Non-Interactive multimedia interventions used In the Informed Consent Process
Authors: Clements Joshua Michael , Clements Jake Simon , Clarke Mike , Kirk Stephen
Published: September 2024

Introduction

Non interactive multimedia interventions in the form of educational videos regarding a proposed intervention have been increasingly used to enhance information given during informed consent. This review aimed to assess the impact of this modality.

Methods

This was a subgroup analysis of a larger systematic review and meta-analysis conducted in accordance with a predefined protocol registered on PROSPERO (CRD42023380406). Five databases were searched using pre-defined search criterion in December 2022 for randomised trials of non-interactive multimedia interventions designed to improve the informed consent process. Adults > 18 years with the capacity to consent were included. The Cochrane risk of Bias (ROB) tool was used to assess study quality. Effect measurements were assessed using standard mean differences and risk ratios for continuous variables and dichotomous variables respectively. Meta- analyses were performed using Review Manager (RevMan) version 5.4.

Results

49 studies contributing 6149 patients met the inclusion criteria. 43 studies were conducted in an elective setting across a variety of surgical, radiological, endoscopic, oncological, and medical disciplines. Statistically significant Improvement was demonstrated, in subjective understanding (SMD 0.31, 95% CI 0.07 to 0.54 I2 = 0%), immediate (SMD 0.97, 95% CI 0.78 to 1.17, I2=75%), short (SMD 0.77, 95% CI 0.21 to 1.34, I2 = 90% ), long-term knowledge (SMD 1.23, 95% CI 0.26 to 2.19, I2=86%) and satisfaction the informed consent process. (SMD 0.32, (95% CI 0.16 to 0.49, I2 = 74%).

Conclusions

This review provides a global overview of the impact of non-interactive multimedia interventions demonstrating improvement in numerous outcomes measures. These intervention types should be considered as an informational adjunct during the informed consent process.
ThP1.3 - Oncoplastic Surgery and Magseed Markers: A five-year snapshot of ambition and evolution in breast conserving surgery
Authors: Bell Emma , Gray Karen , Lang Anne , Lannigan Alison , Murphy Dermot , McIlhenny Jennifer
Published: September 2024

Aim

Oncoplastic surgery and localisation markers allow breast conservation in patients who might previously have been treated with mastectomy.

We aimed to evaluate breast conservation across a five-year period spanning widening adoption of oncoplastic conservation, and the introduction of Magseed localisation.

Method

All patients diagnosed with breast cancer or DCIS, screening or symptomatic, in NHS Lanarkshire during the first 6 months of 2017 and 2022 were reviewed. These dates were chosen to eliminate the effects of Covid-19 on practice as much as possible.

Results

531 patients (244 in 2017; 287 in 2022) were diagnosed within the study period.

Groups were comparable for age (median 62 (32-96) and 61 years (28-94); P=0.4), and tumour size (median 19 (3-150) and 21 mm (4-123); P=0.4).

Breast conservation as first operation rose from 69.1% to 85.5%. Use of localisation also increased, from 52.7% of procedures using wires in 2017, to 71.2% using one or more Magseeds in 2022 (P<0.001). Oncoplastic breast conservation rose from 3% to 7% of procedures.

Re-excision rates remained in line with national outcomes (20.4% in 2017 and 20.0% in 2022); and ‘failure’ of breast conservation resulting in completion mastectomy also reduced from 8.0% to 4.7%.

Overall mastectomy rate (+/- reconstruction) fell from 36% to 18% (P<0.001). A reduction in mastectomy for multifocal or diffuse disease requiring localisation or bracketing was also observed, from 56.2% to 35.5%, though this didn’t reach statistical significance (P=0.13).

Conclusion

Increasing success in breast conservation has coincided with greater adoption of oncoplastic breast conservation and novel localisation technology. Reassuringly, this has not resulted in an increase in re-excision, nor completion mastectomy rate.
ThP2.12 - Evaluation of hand-assisted laparoscopic surgery of small intestine neuroendocrine tumors as an alternative surgical treatment for open surgery
Authors: Klimacek Branislav , Stalberg Peter , Norlen Olov , Hellman Per
Published: September 2024

Aims

Small intestinal neuroendocrine tumor (SI-NETs) is the most common malignancy of the small bowel. Curative treatment is exclusively operative and explorative laparotomy is still considered to be the standard procedure. The purpose of this retrospective cohort study was to assess the outcome of minimally invasive surgery in patients with SI-NETs, at our endocrine surgery unit in 2019, compared to the open approach.

Methods

Patients who underwent surgery for SI-NETs between 2013 and 2023 were included. Descriptive variables such as operative time, length of hospital stay, use of analgesia and radiciality were compared primarily between groups of patients operated before and after 2019 and secondarily between open and hand-port assisted laparoscopic surgery (HALS).

Results

Of 97 patients with SI-NET included in the study, 58 (59.8 %) had an open and 39 (40.2 %) minimal invasive surgery. While difference in the operative time, 121 min (91.3-150.3) vs 108 min (83-141), the length of hospital stay, 6 days (4-7) vs 5 days (4-8) and surgical radicality in patients with stage II-III, 79.3% vs 85%, (p-value 0.313) was not significant, 86.2% of patients with explorative laparotomy required epidural analgesia compared to 23.1% with HALS (p-value = <0.001).

Conclusion

Hand-port assisted laparoscopic surgery of SI-NETs was assessed to be a feasible approach without compromising radical resection and enhancing postoperative recovery with lower amount of required analgesia postoperatively.
ThP2.14 - Staged laparoscopic traction orchidopexy (SLTO) for impalpable testes
Authors: Keene David , Elmousili Mahmoud , Wilkinson David , Melling Charlotte
Published: September 2024

Aim

SLTO enables elongation of the testicular vessels without division by Shehata (JPS 2015).

We presented first UK data in 2020 assessing SLTO. It was suggested that a single stage traction procedure may be possible in some patients. We now present follow up data including the single stage traction technique.

Methods

Data was collected prospectively from a single centre and grouped into 2 time periods: Group A (March 2017 to July 2019), Group B (November 2020 to December 2023).

The gubernaculum was divided. If the vascular pedicle was long enough to allow the testis to reach the contralateral inguinal ring the testis was brought down to the scrotum using an 11mm STEP port and secured in a subdartos pouch with 2/0 Ti-cron. If the vascular pedicle was short, 2-stage traction was performed by securing the intra-abdominal testis to the contralateral anterior abdominal wall using a 2/0 Ti-cron stitch. 3-6 months later the testis was brought down to the scrotum as described above.

A prospective database was used for data collection and analysis. Outcome measures included presence of a palpable testis in the scrotum at follow-up, ultrasound determined testicular volumes and percentage difference compared to contra-lateral testis where applicable and complications. Follow up was 6 months following the 2nd stage procedure.

Results

The later cohort (Group B) demonstrated a higher proportion (32%) of single stage procedures compared to Group A (0%). The success rates for both groups were high 95-100%, with a significantly reduced complication rate (9%) seen in Group B compared to Group A (33%) p=0.048.