bluuebunny/crossref_metadata_2025 huggingface dataset:
767 Magnetic Resonance Imaging in the Assessment of Patients with Breast Cancer Undergoing Neoadjuvant Chemotherapy: Evaluation of the Prognostic Value of Mid-Chemotherapy and Post-Chemotherapy Scans
Authors: Davenport M , Okhiria R , Barrett E , Highton L
Published: May 2021

Introduction

Magnetic Resonance Imaging (MRI) is used to assess the response to Neoadjuvant Chemotherapy (NAC) when used in patients with breast cancer.

Method

This retrospective observational study compared patterns of tumour response at mid-chemotherapy and post-chemotherapy MRIs to histological outcomes. 118 cases of breast cancer, from a local database, were included.

Results

There was a significant association between complete pathological response in resected breast tissue and complete radiological response on both mid-chemotherapy MRI (p = 0.007) and post-chemotherapy MRI (p < 0.001). In patients who had both scans,100% of those with complete response at mid-chemotherapy scan maintained this response pattern. In those who had both scans, complete response at the mid-chemotherapy scan had a PPV for complete pathological response in resected breast tissue of 92% compared to 64% in those with complete response that was not achieved until the post-chemotherapy scan. There was a trend towards an association between early complete radiological response and complete pathological response (p = 0.124).

Conclusions

Both scans have significant prognostic value. A mid-chemotherapy scan may have superior prognostic value when complete response is achieved, though larger studies are needed to determine the significance. 100% maintenance of complete radiological response after the mid-chemotherapy scan highlights the possibility that some post-chemotherapy scan could be avoided.
778 Management of Colorectal Anastomotic leaks: The East of England Experience
Authors: Aker M , Askari A , Rabie M , Aly M , Adegbola S , Currow C , Hadjitoffi C , Hollingshead J , Nun R
Published: May 2021

Introduction

Colorectal anastomotic leaks (AL) are an unfortunate occurrence and are associated with a high mortality. The aim of this multi-centre study is to explore the different management strategies used and compare outcomes in the management of AL.

Method

All patients who had an AL were included at seven hospitals across the East of England. Morbidity, mortality, and survival were compared across the different management strategies.

Results

A total of 247 consecutive patients were included of which 60.3% were male and the median age was 68 (IQR 57-77). Half of patients were initially managed conservatively, a further 10.5% had a radiological procedure. 39.7% required surgery as an initial treatment. Of those who initially did not have a surgical intervention (n = 149), 10.7% (n = 16/149) eventually required laparotomy. Ultimately, 42.7% (n = 106/248) required a laparotomy. The 30- and 90-day across the entire population mortality were 3.6% and 4.9% respectively. There were no significant differences in mortality or long-terms survival between the different initial treatment modalities.

Conclusions

Despite initial conservative, antibiotic and radiological intervention being successful in the majority of patients, two out of five patients will still require a laparotomy. A consensus approach is required to standardise management in these difficult scenarios.
780 Effectiveness of Colonic/Rectal Washout in Reducing Risk of Local Recurrence in Rectal and Distal Left Sided Colonic Cancer Resection. A Meta-Analysis
Authors: Majeed T
Published: May 2021

Background

Lab and clinical studies have shown evidence that local recurrence (LR) occurs due to free cancer cells at resection sites. Evidence for the effectiveness of rectal washout (RW) in washing out these cells and reducing the incidence of local recurrence in the literature is equivocal.

Aims

To determine whether intraoperative RW can effectively reduce the incidence of LR in rectal and distal colonic tumour resection.

Method

A literature search was conducted according to PRISMA guidelines. The primary endpoint was incidence of local recurrence of cancer after rectal cancer surgery.

Results

The meta-analysis revealed that at 5 year follow up, local recurrence in the washout group (WO) was 6.08% compared to 9.48% in the no-washout group (NWO) group (OR 0.63, 95% CI = 0.51 –0.73, Chi2 = 6.76, df = 7, p = 0.45). Based on this study we found the number needed to treat would be 29.3 (95%CI 20.9 –56.6) in order to prevent one local recurrence at 5 years.

Conclusions

RW reduces the risk of LR in patients with distal colorectal cancer resection in the long term follow up. A small number of patients needed to be treated to avoid one local recurrence in the five year follow up.
805 Eluting Electrodes for Hearing Preservation – the Future of Cochlear Implantation?
Authors: Nikookam Y , Radotra A , Metcalfe C , Muzaffar J , Monksfield P , Bance M
Published: May 2021

Introduction

Cochlear implants (CIs) utilising eluting electrodes are a relatively new phenomenon. CI surgery can lead to a variety of complications, namely electrode insertion trauma. This affects CI function leading to a loss of residual hearing. To minimise this, electrodes eluting anti-inflammatory or growth-promoting agents can be used to protect and enhance residual hearing through the sustained release of an agent. Eluting agents include glucocorticoids, steroids, growth factors and neurotrophins.

Method

Systematic review and narrative synthesis.

Databases

searched

MEDLINE, EMBASE, CENTRAL, ClinicalTrials.gov and Web of Science.

Results

Searches identified 66 abstracts and 37 full texts. Of these, 15 studies met the inclusion criteria, reporting outcomes in 469 animals and 24 humans, with at least 233 implants. Eluting electrodes included dexamethasone (n = 13), growth factor (n = 1) and neurotrophins (n = 1). Audiological outcomes improved across all studies following cochlear implantation with an eluting electrode to a greater extent when compared to a standard electrode. Outcomes improved significantly when a higher concentration of dexamethasone was used.

Conclusions

Audiological outcomes with eluting electrodes following cochlear implantation are generally superior to the omission of medication following cochlear implantation. An electrode elution enables a sustained, localised release of anti-inflammatory or anti-apoptotic agents, therefore reducing the advent of fibrosis, scarring and subsequent impedance.
842 Safety and Efficacy of Tranexamic Acid to Minimise Perioperative Bleeding in Extrahepatic Abdominal Surgery: A Systematic Review
Authors: Koh A , Adiamah A , Sanyal S
Published: May 2021

Introduction

Perioperative bleeding is a major risk during and after surgery, which can result in increased mortality and morbidity. Tranexamic acid (TXA), in the setting of trauma, minimises perioperative bleeding and its associated risks. However, there is a lack of evidence of its use in elective abdominal surgery. This meta-analysis of randomised controlled trials (RCTs) evaluated the effectiveness and safety of TXA in elective extrahepatic abdominal surgery.

Method

A comprehensive search of PubMed, Embase, and Clinicaltrial.gov databases was undertaken to identify RCTs from January 1947 to May 2020. The primary outcomes of intraoperative blood loss, and the secondary outcomes of need for perioperative blood transfusion, thromboembolic events, and mortality were extracted from included studies. Quantitative pooling of data was based on the random effects model.

Results

Nineteen studies reporting on 2205 patients were included. TXA reduced intraoperative blood loss (weighted mean difference (WMD) -188.35mL; 95% CI -254.65 to -121.72) and the need for perioperative blood transfusion (odds ratio (OR) 0.43; 95% CI 0.28 to 0.65). Importantly, TXA had no impact on the incidence of thromboembolic events (OR 0.49; 95% CI 0.18 to 1.35). There were no reported deaths in any of the studies.

Conclusions

TXA reduces intra-operative blood loss without an increase in complications.
865 Variation in the Branching Pattern of the Anterior Branches of the External Carotid Artery
Authors: Elsllabi M
Published: May 2021

Aims

The external carotid artery (ECA) shows a variable branching pattern of its stemming vessels. The aim of this study is to investigate the origin of the three primary anterior branches of the external carotid artery (ECA): the superior thyroid (STA), lingual (LA), and facial arteries (FA).

Method

The branching pattern of the external carotid artery was studied on 15 Thiel embalmed cadavers of Scottish population (7 males and 8 females). The carotid triangle was dissected bilaterally in order to assess the origin sites of the main anterior branches of the ECA (STA, LA and FA) in relation to the carotid bifurcation (CB).

Results

The STA arises more frequently from the ECA (60%) than from the CCA (40%). The STA, LA and FA emerged as individual branches in 90% of cases. The distances from the origin site to the CB were (8.11 ± 2.77), (19.38 ± 8.85) and (27.95 ± 10.15), for the STA, LA, and FA respectively.

Conclusions

In-depth knowledge of the branching pattern of the external carotid artery is of great importance. The current findings have confirmed that the ECA branching pattern is highly variable. Therefore, considering some radiological imaging before conducting any invasive procedure in the neck region is vital to prevent iatrogenic injuries.
888 Challenges in The Management of Lower Gastrointestinal Bleeding in General Surgery: Developing Consistent Practice and Application of BSG Guidelines
Authors: Bhojwani A , Ahmed M , Mahmood F , Sellahewa C , Desai C
Published: May 2021

Introduction

Lower gastrointestinal bleeding (LGIB) accounts for 3% of all surgical referrals in the UK, with an in-hospital mortality of 3.4%. The BSG 2019 guidelines recommend risk stratification as per Oakland scoring, inpatient lower GI endoscopy for admissions and CT-angiography for unstable patients. This study evaluates the delivery of these outcomes in a district hospital setting.

Method

Retrospective audit assessing all acute LGI bleed admissions from 01-07-2019 to 28-02-2020 at Russells Hall Hospital. Shock Index (SI) and Oakland score used to stratify patients into unstable, stable-major and stable-minor LGIB. Compliance with BSG standards was assessed by review of investigations and emergent patient management.

Results

143 patients (Median age = 70years) evaluated, with 64 admissions having no formal risk stratification (OAKLAND-score) documented. Only 12 admissions underwent inpatient LGI endoscopy with sigmoid diverticulosis the most common pathology (39.3%). CT-angiogram was the initial investigation for 75% of patients admitted with unstable LGIB.

Conclusions

OAKLAND-scoring is a sensitive tool to stratify LGIB patients based on clinical parameters. Application of BSG-2019 guidelines and developing consistency in management is challenged by the lack of routine access to LGI endoscopy and tools to manage bleeding endoscopically.
979 Delayed Surgery for Localised and Metastatic Renal Cell Carcinoma: A Systematic Review and Meta-Analysis for the COVID-19 Pandemic
Authors: Chan V W S , Ong W L K , Chiu P K F , Teoh J Y C
Published: May 2021

Introduction

COVID-19 have delayed treatments for cancer; hence we performed a systematic review on the oncological effects of active surveillance (AS), delayed intervention (DI) and sequencing of cytoreductive nephrectomy (CN) and target therapy (TT) on localised and metastatic renal cell carcinoma (RCC). PROSPERO: CRD42020190882

Method

Both randomised controlled trials and observational studies related to the study were included in this review after a comprehensive search and screening.

Results

A total of 2065 potential eligible records were identified. 23 studies were included for quantitative analysis. In meta-analysis, no significant difference was found between the patients who underwent AS/DI and PN/RN for overall survival (OS) (HR 1.36, 95% CI 0.99-1.87, p = 0.06), while cancer-specific survival is significantly worsened (CSS) (HR 1.67, 95% CI 1.23-2.27, p < 0.01) in AS/DI patients. In other localised stages, results are contradicting amongst literature. Upfront TT followed by deferred CN is associated with better OS when compared to upfront CN followed by deferred TT (HR 0.53, 95% CI 0.41-0.69, p = 0.00) in metastatic patients.

Conclusions

Based on low quality evidence, AS and DI is no inferior to immediate surgical intervention in well selected T1a patient’s OS but not CSS. Upfront TT followed by deferred CN improves OS and progression free survival.
1005 Antibiotic-Impregnated Calcium Sulfate Beads Are Not Effective in the Primary Prevention of Infection in Open Femur and Tibia Fractures
Authors: Fung A , Ward A , Patel K , Krkovic M
Published: May 2021

Introduction

Infection is a major complication of open fractures. Antibiotic-impregnated calcium sulfate (AICS) beads are widely used as an adjuvant to systemic antibiotics. Whilst their efficacy in the secondary prevention of infection is established, we present the first retrospective study evaluating AICS beads in the primary prevention of infection in open fractures.

Method

214 open femur and tibia fractures in 207 patients were reviewed over a seven-year period. 148 fractures received only systemic antibiotic prophylaxis. 66 fractures also received AICS beads. The occurrence of acute infection (wound infection and acute osteomyelitis) was recorded, as well as that of long-term complications (chronic osteomyelitis, non-union and death).

Results

Fractures that received AICS with systemic antibiotics had an overall acute infection rate of 42% (28/66), compared to 43% (63/148) in fractures that received only systemic antibiotics (p > 0.05). There was no significant difference in infection rate even when fractures were stratified by Gustilo-Anderson grade. There was also no significant difference in the rate of long-term complications.

Conclusions

Our results indicate that the adjuvant use of AICS beads is not effective for the primary prevention of acute infection or long-term complications in open leg fractures. Further research is needed to elucidate the factors influencing the outcomes of AICS use.
43 Digital Human Project: 3D Photogrammetry for Human Cadaveric Pelvic Specimens: An Innovation in Colorectal Anatomical Education
Authors: Fletcher J , Heinze T , Wedel T , Miskovic D
Published: May 2021

Introduction

Cadaveric dissection remains an essential aspect of anatomical education but is not readily available to the majority of surgical trainees. 3D photogrammetry is the process of creating a 3D model from a series of 2D images and has tremendous potential in anatomical education. We describe a novel low-cost single-camera 3D photogrammetry technique to reconstruct cadaveric specimens as digital models.

Method

A formalin preserved hemipelvis was mounted on a turntable. Photos were taken sequentially at 5 o increments through 360° at three different fixed viewing angles (n = 216 photos) using a mirrorless camera with a 12-60mm f3.5-5.6 kit lens. Four surroundings LED standing lights were used to ensure diffuse ambient lighting of the specimen. Photos were imported into Agisoft Metashape software in order to generate a point cloud and produce the final virtual model composed of a polygon mesh.

Results

The specimen was successfully reconstructed and can be visualised at; https://sketchfab.com/3d-models/pelvic-sidewall-b76450b787824c968f864791d47318f2. The total processing time was 20 hrs.

Conclusions

Through this technique, we can produce accurate, interactive, and accessible 3D prosection models for surgical education. The method could be employed to establish a digital library of human anatomy for surgical training worldwide.
224 Use of Novel Decellularized Cadaveric Dermis (dCELL) In Single-Stage Resection and Reconstruction of Non-Melanomatous Skin Cancer of The Head and Neck
Authors: Mantelakis A
Published: May 2021

Background

This study examines the use DCELL, a novel acellular dermis product produced in the UK for the reconstruction of these skin defects.

Method

This was a single-centre, prospective study of patients undergoing single stage wide local excision of non-melanomatous skin cancer and reconstruction with decellularised dermis. Our inclusion criteria included any patient that required a curative excision but had risk factors where conventional local flap or free tissue transfer could have a potential adverse outcome.

Results

Thirty-seven wounds were treated with DCELL in thirty-one patients. Mean age was 81.6 years (range 61-94 years) and at the time of operation, 25 patients (80.7%) were ASA 3 or above. The scalp was the most common anatomical area operated on (n = 28, 75.7%). The overall proportion of wounds with complete closure was 89.2% (33 out of 37 wounds), with a failure rate of 10.8% (4 complete graft failures). Device-related complications included one episode of crusting over the graft which resolved with topical antibiotics, and a hypertrophic scar over the wound edges. Cosmesis was satisfactory in all cases.

Conclusions

DCELL demonstrated a very good take rate with equally satisfactory cosmetic outcomes in patients where standard reconstructive approaches may have adverse outcomes.
817 Robotic Semi-Automated Transcranial Doppler Assessment of Cerebrovascular Autoregulation in Post Concussional Syndrome: Methodological Considerations
Authors: Khan D Z , Placek M M , Smielewski P , Budohoski K P , Anwar F , Hutchinson P J A , Bance M , Czosnyka M , Helmy A
Published: May 2021

Introduction

Post-concussive syndrome (PCS) refers to a constellation of physical, cognitive, and emotional symptoms after traumatic brain injury (TBI). Despite its incidence, the underlying mechanisms are unclear. We hypothesised that impaired cerebral autoregulation (CA) is a contributor.

Method

A prospective, observational study was integrated into outpatient clinics at a tertiary neurosurgical centre. Data points included: demographics, symptoms (Post-Concussion Symptom Scale [PCSS]), neuropsychological assessment (Cambridge Neuropsychological Test Automated-Battery [CANTAB]) and cerebrovascular metrics (Mxa co-efficient and the transient hyperaemic-response ratio [THRR]) - via transcranial Doppler (TCD), plethysmography and bespoke software (ICM+).

Results

12 participants were recruited with 2 excluded after unsuccessful cerebrovascular TCD insonation. 10 participants (5 TBI patients, 5 healthy controls) were included in the analysis (median age 26.5, male:female 7:3). Median PCSS scores were 6/126 (TBI subgroup). Median CANTAB percentiles were 78 (healthy controls) and 25 (TBI). Mxa was calculated for 90% and THRR for 50% of participants. Median study time was 127.5 minutes and feedback (n = 6) highlighted the perceived acceptability of the study.

Conclusions

This pilot study has demonstrated a feasible and reproducible assessment of PCS and CA metrics (non-invasively) in a real-world setting. By scaling this methodology, we hope to test whether CA changes are correlated with symptomatic PCS in patients post-TBI.
833 Hyper Acute Dialysis Access Pathway (HADAP) – Undertaking Creation of Arteriovenous Fistulae in The Renal Ward
Authors: Shetty S , Chowdary P , Dabare D , Seet C , Ahmed R , Barlas A , Lindsey B
Published: May 2021

Introduction

The impetus to apply the “lean method” to creation of arteriovenous fistulae came with the pandemic restricting access to theatres. Here we present HADAP implemented in a dedicated procedure room in the Renal ward.

Method

Between April and September 2020, 44 patients underwent ward-based arteriovenous fistula operations with no more than 3 people in the room – surgeon, runner and patient. The parameters assessed were duration of operation, complications, patency, patient and surgeon feedback and financial implications.

Results

The service was predominantly registrar-led who created 91% of the fistulae. 95% operations were completed successfully with a 2-week primary patency of 73% and no surgical site infections. 40% of the procedures were radiocephalic fistulae. 14% procedures required surgical assistance by the runner. The average operating time reduced from 90 minutes for the first 10 cases to 50 minutes for the last 9. A structured questionnaire showed positive feedback from both patients and surgeons (4-5 out of 5). This service has cleared potentially 9 main theatre lists for more complex procedures.

Conclusions

Our study demonstrates the successful implementation of a novel operating environment allowing expedited care for renal failure patients. It has enhanced our ability to deliver a dialysis access program despite the challenges of COVID.
191 Performance at Medical School and Foundation Programme Selection Can Predict Success in The MRCS Examination
Authors: Ellis R , Scrimgeour D , Brennan P , Lee A , Cleland J
Published: May 2021

Background

Identifying factors that predict success in the Membership of the Royal College of Surgeons (MRCS) examination can aid trainees’ exam preparation and help deaneries identify candidates likely to require additional support. We assessed whether performance at Medical School and UK Foundation Programme selection (Educational Performance Measurement (EPM) and Situational Judgement Test (SJT)) predicted MRCS success.

Method

We analysed data from the UKMED Database for UK graduates who had attempted MRCS Part A (n = 1,975) and Part B (n = 630) between 2013-2017. Univariate analysis examined the relationship between performance and the likelihood of passing MRCS at first attempt. Logistic regression identified independent predictors of MRCS success.

Results

Each additional EPM decile increased the chances of passing MRCS by 52% for Part A (odds ratio 1.52 [95% confidence interval 1.46-1.60]) and 27% for Part B (1.27 [1.18-1.38]). Each EPM point awarded for degrees increased the likelihood of passing Part A by 29% (1.29 [1.12-1.48]). SJT score was not a statistically significant independent predictor of MRCS success (P>0.05).

Conclusions

This is the first study to investigate the relationship between UK medical school performance and postgraduate surgical exam success. Higher ranked students are more likely to succeed in the MRCS compared to their lower ranked peers.
525 Automated Continuous Instrument Tracking in Laparoscopic Box Trainers Predicts Performance at Assessment: A Prospective Cohort Study in Core Surgical Trainees
Authors: Shivank K , Ilin R , Walker K , Brennan P
Published: May 2021

Introduction

Box-trainers enable deliberate practice of laparoscopic skills and can be equipped with instrument tracking metrics to provide feedback. However, the relationship between metrics, assessment outcomes and practice are unclear.

Method

Core surgical trainees were provided take-home box trainers with SurgTrac™ instrument tracking metrics for practice (eoSurgical Ltd., Scotland, UK). Practice was incentivised by certification and video assessment of a basic task, peg capping. Assessment was by consultant general surgeons, using objective structured assessment of technical skills (OSATS). The following metrics were analysed: task duration, distance moved by instruments, average instrument speed, average instrument acceleration, left- or right-handedness and instrument smoothness. Metrics were correlated to OSATS scores using regression analysis. Threshold for significance was p = 0.05.

Results

During the study period, there were 1639 peg capping performances by 85 trainees; 103 video recordings were submitted for assessment. All metrics were significantly associated with OSATS score, except instrument acceleration. The multiple linear regression model was highly correlated with actual scores (Pearson correlation 0.658; p < 0.001). Practice was positively correlated with regression model predicted OSATS score (regression analysis; ANOVA p < 0.001).

Conclusions

Instrument tracking metrics reliably predict OSATS performance and practice improves predicted score. Trainees can use metrics in unsupervised practice and gauge whether they are improving as expected.
548 “The New Normal”? How We Adapted Simulation Training in The Midst of the Coronavirus Pandemic
Authors: Metcalfe K , Pollard J , Jeffreys D , Thomas I
Published: May 2021

Introduction

Delivering high quality teaching during an international pandemic is challenging but becomes increasingly important when trainees are taking on new roles and responsibilities. Instead of ceasing our simulation programme, we adapted it to comply with local infection control guidelines. We devised in-situ high-fidelity ward round simulations for all levels of trainee, from newly qualified doctors to senior registrars.

Method

The ward round consisted of three simulated patients with a range of conditions appropriate for the level of trainee, role-played by faculty members. The simulations were offered to all Foundation Year Doctors, Junior Middle Grade Doctors and Surgical Speciality Trainees with all participants wearing Personal Protective Equipment (PPE) according to COVID-19 infection control policy.

Results

A total of 81 trainees took part in the simulations. Almost all reported it as ‘very useful’ and that it improved confidence in progressing to the next stage of their career. Trainees also found it enjoyable and that personalised feedback allowed them to identify areas for development.

Conclusions

We have shown that ward round simulations can be run safely and effectively despite current COVID-19 restrictions. Even senior trainees found that a ward round simulation was useful and were keen to see it become a regular part of deanery teaching.
967 COVID READY Study: Cross-Sectional Survey of Medical Students Volunteering During the Coronavirus Pandemic (COVID-19) In the United Kingdom
Authors: Byrne M , Ashcroft J , Wan J , Alexander L , Harvey A , Schindler N , Brassett C
Published: May 2021

Introduction

We aimed to identify the willingness, attitudes, and practice of medical students towards volunteering in a clinical capacity during the COVID-19 pandemic.

Method

We distributed a cross-sectional survey from 2/5/2020 to 14/6/2020 to all medical students at UK medical schools.

Results

A total of 1145 medical students from 36 medical schools completed the questionnaire. 82.7% of students were willing to volunteer, but only 34.3% had volunteered. The strongest predictors of willingness to volunteer on multiple linear regression were the beliefs that volunteering to work would benefit their medical education (estimate=0.35±0.03, adjusted P < 0.001) and that they would have a positive impact (estimate=0.33±0.03, adjusted P < 0.001). The majority of students were willing to take up a clinical role and were confident in having the necessary skills, but there was a discrepancy between the role’s students were comfortable performing and those they were assigned. Thematic analysis of the issue’s students would face when volunteering identified five themes: safety, professional practice, pressure to volunteer, finances and logistics, and education.

Conclusions

This study identifies areas for consideration from those responsible for workforce planning, healthcare provision, and student safety. We provide recommendations to facilitate a volunteering process that is safer for students, staff, and patients.
145 Outcomes of Unstable Distal Radius Fractures – A Meta-Analysis of Bridging External Fixation Versus Volar Plating
Authors: Mulrain J , Joshi K , Doyle F , Abdulkarim A
Published: May 2021

Introduction

Distal radius fractures are common and trends for fixation have changed with increased use of volar locking plates in recent time. A meta-analysis will summarise the best evidence for treatment.

Method

A systematic review was conducted using PRISMA methodology to identify studies that reported clinical and/or radiological outcomes in patients with AO type C distal radius fractures when treated with external fixation versus ORIF.

Results

10 randomised trials were included in this review, reporting on 967 patients. Clinical outcomes are in favour of volar plating at 3 months post-operation, but no difference between the two groups is seen at 6 or 12 months. Analysis of complication rates shows a minute increase in risk-ratio for volar plating versus external fixation. Subgroup analysis showed significantly higher re-operations after plate fixation and significantly higher infection after external fixation.

Conclusions

Internal fixation of complex distal radius fractures confers an improved clinical outcome at early follow up only and a minimally increased risk of complications. The improved grip strength with volar plating is only superior at early follow up and no long-term superiority is seen with either intervention. The type of surgery in this injury type therefore remains at the surgeon’s consideration on a case-by-case basis.
455 Proton Beam Therapy in Rectal Cancer: A Systematic Review and Meta-Analysis
Authors: Fok M , Toh S , Maducolil J E , Fowler H , Clifford R , Parsons J , Vimalachandran D
Published: May 2021

Introduction

Radiotherapy for locally advanced rectal cancer is conventionally performed using photon-based radiotherapy (PBR), carrying significant risk of toxicity to organs at risk (OAR). Proton beam therapy (PBT) potentially delivers equivalent dosimetric radiation to the targeted tissue with improved sparing of OAR. We aimed to compare dosimetric irradiation of OAR for PBT versus PBR in patients with rectal cancer and assess any oncological outcomes.

Method

An extensive electronic literature search was performed from inception till April 2020 and subsequent meta-analysis performed.

Results

Six articles met the inclusion criteria. Dosimetric data of irradiation delivered to OAR for PBT and PBR were calculated for the same patients. PBT had significantly less irradiated small bowel compared to 3DCRT and IMRT, (MD -16.95, 95% CI [-24.03, -9.88], p < 0.00001) and (MD -6.96, 95% CI [-12.99, -0.94], p = 0.02) respectively. Similar results were observed for bladder and pelvic bone marrow. Two studies reported clinical and oncological results for PBT in recurrent rectal cancer with overall survival reported as 43% and 68%.

Conclusions

Dosimetric treatment plans have less irradiation of OAR for rectal cancer with PBT compared to PBR. There is a need for further research in PBT and rectal cancer, as promising results have been shown in recurrent rectal cancer.
490 The Relationship Between Aortic Calcification Along with Cardiopulmonary Function and Postoperative Complications in Patients Undergoing Colorectal Cancer Resection
Authors: Ong W H
Published: May 2021

Introduction

The degree of aortic calcification (AC) visible on the preoperative CT and cardiopulmonary exercise test (CPET)-derived measures of fitness have been proposed as predictors of postoperative complications (POC). This study aims to examine the relationship between AC, CPET and POC in patients undergoing CRC resection.

Method

Patients who had undergone CPET prior to CRC resection in a single centre were identified from a prospectively maintained database. Oxygen uptake (VO2) at the anaerobic threshold (AT) and peak exercise were recorded. Visual scoring of AC was performed. POC were recorded as infective and non-infective using the Clavien-Dindo (CD) scale.

Results

A total of 48 patients were included. AC was more common in older patients. A trend was reported between greater burden of proximal AC and major complications (CD 3-5) while AT < 11 was found to be associated with non-infective complications. No statistically signification association was noted between either AC or CPET variables and POC.

Conclusions

This study shown possible association between AC or preoperative CPE-derived measures of exercise tolerance and POC after colorectal resection. Relationship between AC and CPET variables was not clearly defined due to small sample size. Further work is warranted to investigate these relationships in a larger cohort.
463 “The ABCD Team – Reducing Patient Harm: Non-Technical Skills-Based Education”
Authors: Mohamed M
Published: May 2021

Background

Although health-care workers are trained to provide basic, intermediate, or advanced life support from a technical perspective, working as a team is a more complex process in acute situations. Responding to the emergency buzzer from the ward staff, and before the medical emergency arrival, could be sometimes chaotic. This may result in deficient initial management or missing basic measures.

Context

The “ABC Team” is a project, aimed to enhance the health care providers' skills in dealing with emergency situations, within the surgical ward, in an organized manner.

Innovation

Guidance for the staff was created to identify an exact job for every health care provider in the shift by assigning one job/person. Over a period of 5 months, individual training was given to the ward staff. Roles are assigned in the shift handover and A, B, C, D cards (to be attached to the ID) were printed with the information needed for a quick response. Simulation training sessions were organized before launching the project.

Implications

Streamline patient care significantly improved and ABCD assessment time is broken down to half. Pre and post project surveys showed approximately 80% of staff are now satisfied, confident and clear with their role in the emergency event.
635 Can Virtual Clinics Streamline Urology Referrals from Primary to Secondary Care?
Authors: Madathilethu S C , Sarmah P B , Khan M F
Published: May 2021

Introduction

The COVID-19 pandemic caused the UK to enter lockdown from 23rd March to 8th May 2020, necessitating Urology clinics to be conducted virtually. Our study aimed to assess whether new Urology referrals could be triaged and have an outcome arranged virtually before being seen by a specialist in clinic, thereby reducing referral to investigation wait-times.

Method

Retrospective data was collected from 23rd March to 8th May 2020 of new patient referrals consulted virtually in Urology outpatient clinics. Referrals were grouped into categories of presentation and outcome.

Results

642 new patients were consulted virtually during the study period. 181 (28.1%) had further imaging requested; of these, the presentations with the greatest proportion of patients with this outcome were those referred with imaging findings (50%), UTI/cystitis (43.1%) and scrotal symptoms (34.3%). 116 patients (18.1%) were added to the waiting list for procedures; 85 were for flexible cystoscopy, for which the commonest indications were UTI/cystitis (36; 55.4%) and haematuria (15; 55.5%).

Conclusions

Certain urological presentations can be triaged straight to investigation by when directly referred from Primary Care, thus reducing referral to investigation wait-time and increasing outpatient protocol efficiency.
606 Mortality and Pulmonary Complications in Patients Undergoing Upper Extremity Surgery at The Peak of the SARS-Cov-2 Pandemic in the UK: A National Cohort Study Presented on Behalf of The Corona Hands Collaborative
Authors: Dean B , Duncan J
Published: May 2021

Introduction

This study reports the 30-day mortality, SARS-CoV-2 complication rate and SARS-CoV-2 related hospital processes at the peak of the first wave of the pandemic in the UK.

Method

This national, multicentre, cohort study at 74 centres in the UK included all patients undergoing any surgery below the elbow at the peak of the UK pandemic. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients.

Results

This analysis includes 1093 patients who underwent upper limb surgery from the 1st to the 14th of April 2020. The overall 30-day mortality was 0.09% and the mortality of day case surgery was zero. The SARS-CoV-2 complication rate was 0.18% (2 pneumonias) and the overall complication rate 6.6% (72 patients). Both SARS-CoV-2 related complications occurred in patients who had been hospitalised for a prolonged period before their surgery and a total of 19 patients (1.7%) were SARS-CoV-2 positive.

Conclusions

The SARS-CoV-2 related complication rate for upper limb surgery even at the peak of the UK pandemic was low at 0.18% and the mortality was zero for patients admitted on the day of surgery. Urgent surgery should not be delayed pending the results of SARS-CoV-2 testing.
702 Evaluation of Risk Prediction Models for Postoperative Pulmonary Complications in Adults Undergoing Major Abdominal Surgery: A Systematic Review and External Validation Study in The Respiratory Complications After Abdominal Surgery (RECON) Cohort
Authors:   STARSurg Collaborative
Published: May 2021

Introduction

Postoperative pulmonary complications (PPCs) following major abdominal surgery result in substantial morbidity and mortality, yet stratifying patients for risk-modifying interventions remains challenging. This study aimed to identify and externally validate PPC risk prediction models in an international, prospective cohort.

Method

A systematic review was conducted to identify risk prediction models for PPC following abdominal surgery. External validation was performed using data from a prospective dataset of adult patients undergoing major abdominal surgery from January to April 2019 in the UK, Ireland, and Australia. The primary outcome was identification of PPC within 30-days (StEP-COMPAC criteria definition). Model discrimination and diagnostic accuracy were compared.

Results

Six unique risk prediction models were eligible from 2819 records (112 full texts). These were validated across 11,591 patients, with an overall PPC rate of 7.8% (n = 903). The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score provided the best discrimination (AUROC: 0.709 (95% CI: 0.692-0.727), yet no risk prediction model demonstrated good discrimination (AUROC >0.7).

Conclusions

The risk of PPC for patients following major abdominal surgery in the pre-covid era is not well described by existing prediction tools. New prediction tools are required to account for additional variation introduced for patients affected by SARS-CoV-2 infection.
926 CSF Rhinorrhoea After Endonasal Intervention to The Skull Base (CRANIAL): Multicentre Pilot Study
Authors: Khan D Z , Marcus H J ,   CRANIAL Collaborative
Published: May 2021

Introduction

CRANIAL (CSF Rhinorrhoea After Endonasal Intervention to the Skull Base) is a prospective, multicentre observational study seeking to determine: the scope of skull base repair methods used, and the corresponding rates of postoperative CSF rhinorrhoea in endonasal transsphenoidal (TSA) expanded endonasal approaches (EEA) for skull base tumours.

Method

A prospective, observational cohort pilot study was carried out at eleven neurosurgical units, via NANSIG and BNTRC collaboratives.

Results

192 cases were included – 167 TSA (87%), 25 EEA (13%). The most common (MC) pathologies included: pituitary adenomas (n = 150/192), craniopharyngiomas (n = 7/192) and meningiomas (n = 4/192). The MC skull base repair techniques used were tissue glues (n = 135/192, MC Tisseel®), grafts (n = 94/192, MC fat or Spongostan™) and vascularised flap (52/192, MC nasoseptal). These repairs were most frequently supported by nasal packs (n = 127/192) and lumbar drains (n = 23/197). Biochemically confirmed CSF rhinorrhoea occurred in 10/167 (6%) TSA and 4/25 (16%) EEA. 5 cases required operative management for CSF rhinorrhoea (CSF diversion or direct repair). Qualitative feedback was largely positive (e.g., user-friendly data collection), demonstrating acceptability.

Conclusions

Our pilot experience highlights the acceptability and feasibility of CRANIAL. There is clear precedent for multicentre dissemination of this project, in order to establish a benchmark of contemporary skull base neurosurgery practice.
13 Medical Students’ Mood Adversely Affected By COVID-19 Pandemic: An Interim Analysis from the SPICE-19 Prospective Cohort Study Of 2075 Medical Students and Interim Foundation Doctors
Authors: Bandyopadhyay S , Georgiou I , Baykeens B , Gillespie C , de Andres Crespo M , Bashir M , Handa A , Saunders K
Published: May 2021

Introduction

In order to appropriately support medical students and foundation year doctors, it is imperative that we understand the impact the COVID-19 pandemic has had upon them. This study assessed the effects of the COVID-19 pandemic on medical students and interim foundation year doctors across the United Kingdom (UK), and the support that they received and sought.

Method

A prospective, observational, multicentre study was conducted. All medical students and interim foundation year doctors were eligible to participate.

Results

A total of 2075 individuals participated. There was a decrease in participants’ mood when comparing their mood before the pandemic to during the pandemic (p < 0.0001). Social distancing negatively impacted the mood of the greatest number of participants. All areas of life included in the study were found to have been significantly more negatively impacted than positively impacted (p < 0.0001). 931 participants wanted more support from their university.

Conclusions

When medical students return to their universities, there is likely to be a need for enhanced wellbeing support, adaptations in the short-term and long-term strategies for medical education, and provision of financial guidance. If no action is taken, there may be a knock-on effect on workforce planning and the health of our future workforce.
693 Are Virtual Clinics the New ‘Normal’? – A Single-Institution Comparative Analysis of Outcomes and Cost-Effectiveness of Virtual and Face-To-Face Clinics
Authors: Hassanzadeh-Baboli D , Pavithran A , Khawaja I , Maan Z , Deshpande A
Published: May 2021

Introduction

The coronavirus (COVID-19) pandemic has had a profound impact on clinicians, hospital resources and patients. Urology Virtual clinics (VCs) were initiated at our institution to ensure continued provision of service during the pandemic. The study aim was to analyse outcomes and cost-effectiveness of VCs compared to pre-COVID-19 face-to face (F2F) clinics.

Method

We retrospectively analysed the VCs from 18th March 2020 to 1st July 2020 and compared them to F2F clinics in the same period in 2019. Clinical outcomes were compared, and potential financial savings were estimated to see if VCs can be incorporated into future practice.

Results

1317 patients were reviewed in 2020 as compared to 1941 in 2019. We noted similar rates of discharges [25.4% (2020) v/s 24.1% (2019)], follow-ups (48.7% (2020) v/s 48.4% (2019)] and patients who did not attend/answer (6.8% (2020) v/s 6.6% (2019)]. Potentially, over £100,000 can be saved by changing 50% appointments to VCs.

Conclusions

Our data shows that VCs are non-inferior to F2F clinics and have allowed continued effective service provision during the COVID-19 pandemic. There is potential to incorporate VCs into future practice without compromising on efficacy. Further data collection and analysis is ongoing at our institution on a larger scale.
1013 Preoperative Nasopharyngeal Swab Testing and Postoperative Pulmonary Complications in Patients Undergoing Elective Surgery During The SARS-Cov-2 Pandemic
Authors:   COVIDSurg Collaborative
Published: May 2021

Introduction

This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery.

Method

International cohort study including adult patients undergoing elective surgery for cancer in areas affected by SARS-CoV-2 up to 19 April 2020 (NCT04384926). Patients suspected preoperatively of SARS-CoV-2 infection were excluded. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery.

Results

Of 8784 patients (432 hospitals, 53 countries), 2303 patients (26.2%) underwent preoperative testing: 1458 (16.6%) had a swab test, 521 (5.9%) CT only, and 324 (3.7%) swab and CT. The overall pulmonary complication rate was 3.9% and SARS-CoV-2 infection rate was 2.6%. After risk adjustment, only a nasopharyngeal swab test (adjusted odds ratio 0.68, 95% confidence interval 0.68-0.98, p = 0.040) was associated with lower rates of pulmonary complications. Swab testing remained beneficial before major surgery and in high SARS-CoV-2 population risk areas but not before minor surgery in low incidence areas.

Conclusions

Preoperative nasopharyngeal swab testing was beneficial before major surgery and in high SARS-CoV-2 incidence areas. There was no proven benefit of swab testing before minor surgery in low incidence areas.
35 Comparative Performance of Prediction Model, Non-Expert and Tele-Diagnosis of Common External and Middle Ear Disease Using A Patient Cohort from Cambodia That Included One Hundred and Thirty-Eight Ears
Authors: Schuster-Bruce J , Shetty P , O'Donovan J , Mandavia R , Sokdavy T , Bhutta M
Published: May 2021

Introduction

Globally 6% of the population suffers from disabling hearing loss and the majority resides in low- and middle-income countries, but diagnosis and treatment are hampered by poor availability of expert diagnosis. We compared the utility of tele-diagnosis, non-expert diagnosis, and prediction model diagnosis as a screening tool for common external and middle ear disorders.

Method

We recruited consecutive adult and paediatric patients presenting with ear or hearing symptoms to ENT outpatients at Children’s Surgical Centre, Cambodia. Each participant underwent sequential symptomatic and otoscopic assessment by a non-specialist and an ENT specialist. The non-specialist captured data using a novel automated symptom questionnaire loaded onto a smartphone otoscope. An ENT specialist in the UK subsequently reviewed these data.

Results

138 ears were recruited. The prediction model performed poorly, but absence of otorrhoea was found to reliably exclude a diagnosis of chronic suppurative otitis media (negative predictive value=0.99). Both on-site non-expert and expert tele-diagnosis had high diagnostic specificity (90-99% and 86-99%), but low sensitivity (<43% and 32-100%).

Conclusions

We report the first study to directly compare approaches for non-specialist diagnosis of disorders of the middle/external ear, which shows suboptimal but comparable performance using an automated questionnaire, on site non-expert diagnosis, or remote expert diagnosis
182 Treating Distal Femur Fractures Without Fluoroscopy: Comparison of Implants Used in a Rural Hospital in Tanzania
Authors: Allen J , Kiewsa S
Published: May 2021

Introduction

SIGN is a charity providing implants for hospitals with limited resources. There are two nails that can be inserted without fluoroscopy - the standard SIGN nail and the Fin nail. We aimed to evaluate the effectiveness of these implants in treating distal femur fractures.

Method

Retrospective analysis of SIGN database at Nkoaranga Hospital, Tanzania between July 2017 and January 2019. 28 patients (20 male, 8 female) with distal femur fractures had a standard nail (n = 14) or a Fin nail (n = 14). Inclusion criteria: distal femur fractures treated with intramedullary nail. Exclusion criteria: age<16, open injury, antegrade approach, no follow-up at 4 weeks.

Results

Mean age was 41.4 (18-81). Average time from injury to surgery was 29 days. Average first follow-up was 14 weeks (4-73). Painless weight-bearing was achieved in 93% (13/14) of standard nails and 100% (14/14) of Fin nails. Knee flexion >30° was 64% (9/14) in standard nails and 50% (7/14) in Fin nails. Screw loosening was seen in 7% (1/14) in standard nails and no patients with Fin nails. There were no instances of implant breakage, clinical deformity, or infection.

Conclusions

Patients had variable follow-up and presented late causing delayed treatment. Both nails can achieve excellent results. A larger sample size is required.