bluuebunny/crossref_metadata_2025 huggingface dataset:
397 Medical Reconciliation in Acute Surgical Patients – Are We Letting Our Patients Down?
Authors: Ash J. , Sanwu D.
Published: February 2022

Introduction

NICE guidelines state that medication reconciliation should occur within 24 hours of admission or as soon after as possible. Accurate and timely prescription of these medications is crucial to ensure optimal care. Due to the COVID-19 pandemic, primary care is busier and thus difficult to contact and with neck of kin not present, the challenges of accurate medicine reconciliation may be exacerbated.

Method

A retrospective audit was performed over a fortnight of all acute surgical admissions to a district general hospital. Data was collected as to the time regular medications were prescribed, the source of medical reconciliation and the access to GP network systems for patients.

Results

A total of 66 patients were admitted during the time period. 44 patients had regular prescriptions. Of those 68% had regular medications prescribed within 24 hours. 22% did not have regular prescriptions prescribed throughout their inpatient stay. 91% of the patients prescribed medications within 24hours had a working link to the GP network whereas only 58% of those who were never prescribed had a working system.

Conclusions

Although a good proportion of acute surgical admissions are prescribed their medications within 24 hours, the proportion who are prescribed past this point is low and a sizeable proportion are never prescribed. A significant contributing factor to this could be poor infrastructure relating to the connection between secondary and primary care and poor handover between on-call and post-take teams. Accurate drugs history during the initial clerking is crucial to mitigate these errors long term.
402 A Study to Assess Concordance Rates of Emergency Abdominal X-Ray Film Interpretation and Formal Radiological Reporting.
Authors: Masoodi S. , Van P.T.M. , Cribb E. , Pawa N.
Published: February 2022

Background

Abdominal X-rays (AXRs) were a key part of investigating acute abdominal pain prior to the advent of CT imaging. With increasing reliance on CT scanning, the utilisation and therefore reliance on the interpretation of AXRs has reduced. We investigate the concordance rates of interpretations of AXRs with the formal radiological report, along with the time taken for formal reporting.

Aim

To ascertain the concordance rates of interpretation of emergency AXRs with formal radiological reporting.

Method

All AXRs performed within the trust in a 15-day period were obtained retrospectively from our electronic imaging database. These were compared with the initial interpretations of the AXR, which was obtained from our electronic record system.

Results

248 AXRs were performed, 136 (55%) were not interpreted in the notes. Of the remaining 112, 88 (79%) of AXR interpretations were in concordance with radiological reporting. There was no difference in concordance rates between interpretation by the Emergency Department (ED) or ward-based doctors. The average time for AXRs to be reported was 1.5 days for ED, and 3 for inpatients.

Conclusions

One fifth of AXRs were incorrectly interpreted and more than half of AXRs were not interpreted at all. This brings into question not only their usefulness in general, but also the utilisation of resources to perform them. As all AXRs are reviewed by a consultant radiologist with little impact on decision making, does this still remain an effective utilisation of resources?
409 Audit of a Patient Satisfaction Survey for a Nasal Fracture Pathway?
Authors: Penny F. , Jones H.
Published: February 2022

Introduction

We present an audit of a patient satisfaction survey assessing the contentment of patients using the nasal fracture pathway created by the ENT department in University Hospital Southampton. This is a patient triggered follow-up pathway where patients presenting to the emergency department for a possible nasal fracture were given an information leaflet to self-refer if needed.

Method

The data collection took place over the phone and ranged from July to August 2021 and consisted of thirty patients. Five of which were not given the leaflet, seven were uncontactable, two did not use it and the remaining fifteen patients took part in the survey.

Results

Of the fifteen patients included 100 % were satisfied with the patient triggered pathway. The following questions were asked. Did you think the leaflet clearly explained when you should seek medical advice? 27 % said excellent, 32% very good, 32% good and 7% fair and none as poor. Did you understand when to contact ENT? 20% reported excellent, 27% very good, 32% good, 14% fair and 7% poor. Next, how easy to read was it? 27% said excellent, 32% very good, 27% good, 7% fair and 7% poor. Lastly, how well designed and formatted was it? 7% reported excellent, 60% very good, 20% good, 7% fair and none as poor.

Conclusions

This pathway was introduced due to Covid restrictions. This audit has demonstrated high user acceptability. There are resource and cost saving implications. Thus, this pathway has potential to be incorporated into routine clinical practise going forward.
410 Acute Pancreatitis Annual Review in Cumberland Infirmary
Authors: Mohamed B. , Hammouda A. , Wong A. , Canelo R.
Published: February 2022

Aim

To document the incidence and presentation of acute pancreatitis, and to audit the process and outcome of management of patients against the UK guidelines in Cumberland Infirmary.

Results

Out of the 206 patients who had acute pancreatitis and admitted to the Cumberland infirmary 116 were male and 90 were female.

Causes

The alcohol consumption and the biliary pathology were the commonest cause, were 56 and 96 patients, respectively. The pancreatic lesions were the cause in 6 patients. The other causes: two patients the cause of the inflammation were drugs (azathioprine and steroids), while the ERCP was the cause in 8 patient and mumps for the one patient. Out of the 9 patients of pancreatic necrosis one patient died. 10/206 Patients with diagnosis of pancreatitis have been referred to the Remote surveillance Programme for N. Pancreatitis to the Freeman Hospital. 6 patients of them have been diagnosed with pancreatic necrosis. The number of the patients died in Cumberland infirmary in 2020 with the diagnosis of acute pancreatitis are 10 patients 04.87%. (The national mortality rate is 4–10%).

Conclusions

To follow NICE Guidelines for management of acute pancreatitis: Pancreatitis, published Sep 2018. To continue a close teamwork in terms of referrals as well as HPB MDT. To report patients with pancreatic necrosis to the FRH surveillance.
412 Operative Fixation for Acetabular Fractures in the Elderly: A Prospective Cohort Study from a UK Major Trauma Centre
Authors: Petohazi A. , Musbahi O. , Akilapa O. , Gee M. , Harnett P.
Published: February 2022

Aim

Due to an ageing population, acetabular fractures in the elderly is on the rise. Management of this group of patients remains controversial especially as it is associated with high morbidity and mortality. With an ageing population, there will be an increasing trend in low energy associated acetabular fractures. We present the largest cohort of operatively treated acetabular geriatric patients in the UK and compare different and emerging operative techniques and technology.

Method

A review of a prospective pelvic database was conducted. All patients over the age of 60 that had an operative fixation for an acetabular fracture from 2015 to 2020 were identified. Demographic data, operative data and complications were recorded. Length of stay and in-hospital mortality were also included.

Results

109 patients were included in the study. The mean age was 73 and the mean Injury severity score was 13. The most common mechanism of injury was a fall from less than 1 meter (42%). The mean length of stay is 25 days. In-hospital mortality was 2% and 92% of patients had no in-hospital postoperative complication. A variety of metalwork was used ranging from sacroiliac screws to pelvic infix.

Conclusions

Advancements in orthopaedic implants have changed the management of geriatric acetabular fracture patients.
417 Vibrational Spectroscopy: A Rapid Tool for Soft Tissue Sarcoma Assessment
Authors: Noor Mohamed M.S. , Almond M. , Kendall C. , Dudgeon A. , Mansfield J. , Stone N. , Barr H.
Published: February 2022

Aim

Soft tissue sarcomas (STS) are a comparatively unusual cluster of tumours; they arise from mesenchymal tissues. Surgery remains the primary and the only potentially curative treatment for most STS subtypes.

Existing intraoperative margin assessment techniques are inadequate and the current gold standard for resection margin assessment of STS is post-operative histopathology, but this takes weeks to finalize. Consequently, an augmented surgical technique established by real-time non-destructive recognition of clear margins is essential to diminish the risk of local relapse, decrease the resection area, and enhance the effectiveness of surgical resection of STS.

Vibrational spectroscopy (VS) is a non-destructive evaluation of the atomic oscillation within a molecule. Every molecule has a unique set of vibrational modes called molecular fingerprint. We aim to use Raman spectroscopy to analyse biomolecular spectra of sarcoma and develop a potential tool for intra operative margin assessment

Method

Human sarcoma was tissue obtained from the biobank at QEHB. The samples were identified as Lipoma and Liposarcoma. The samples underwent spectral measurement with the Raman microscope and the tissue samples were then sent for histopathological analysis.

Results

The spectral evaluation clearly demonstrates the biomolecular difference between the two groups and has a potential to become an intraoperative tool.

Conclusions

A positive resection margin is the ultimate prognosticator of local relapse. There is a need for a rapid and reliable tool that can offer surgeons with instant feedback during primary procedure.
421 Migratory Foreign Bodies in Theaero-Digestive Tract: The Importance of Computerised Tomography (CT) Imaging
Authors: Hussain S. , Muhammad A. , K K A. , Khan M.
Published: February 2022

Aim

We discuss this case to stress the role of computerized tomography imaging in diagnosis of foreign bodies of the upper aerodigestive tract and propose an algorithm for management of such cases.

Case Presentation

A 35-year-old male presented with dysphagia and swelling in the left lower part of the neck for 2 days. He gave a history of suspected fish bone ingestion one week prior, followed by pain and discomfort in the throat. Patient underwent upper gastrointestinal endoscopy, which was inconclusive. The patient was reassured and sent home.

Examination showed 3 x 4cm soft tender swelling in the left lower part of the neck. Computed tomography showed heterogeneously enhancing soft tissue density with multiple air shadows in the left para-pharyngeal space [fig 1]. Long, narrow, calcified lesion was present in the midst of the soft tissue density, suspected to be a fish bone [fig 2].

Vertical incision was made along the anterior border of the left sternocleidomastoid muscle and 20 ml pus was drained. Carotid sheath was identified and was swollen, surrounded by extensive granulation tissue. Fish bone was found adjacent to the thyroid lobe [Fig 3], was removed - it was serrated and four cm in length [Fig 4]. Repeat endoscopy and a barium meal showed no leak. He was discharged with oral antibiotics for two weeks with no further follow up.

Conclusions

Accidental fish bone ingestion is a very common situation in otarhynological emergencies. The role of CT imaging in the management of rare instances like perforation and migration of foreign bodies can prevent serious and life-threatening complications.
5 Cervical Spine Pedicle Screw Accuracy in Open Fluoroscopic, Navigated and Template Guided Systems- a Systematic Review
Authors: Mahmoud A. , Aly M. , Shanmuganathan K. , Rocos B. , Sedra F. , Montgomery A. , Aftab S.
Published: February 2022

Aim

Pedicle screws provide excellent fixation for a wide range of indications; their adoption in the cervical spine has been slower than in the thoracic and lumbar spine, largely due to the smaller pedicle sizes and proximity to neurovascular structures in the neck. Recent years have seen the development of technology to improve accuracy and thereby safety in cervical pedicle screw placement over traditional fluoroscopic techniques, including intraoperative 3D navigation, computer assisted systems and physical templates with screw guides. We have performed a systematic review into the accuracy rates of the various systems.

Method

PubMed and Cochrane Library databases were searched; keywords "pedicle screw cervical spine" were searched; 9 valid papers involving 1427 screws were found.

Results

Accuracy rates were 80.6% for fluoroscopy, 91.4% for navigation methods, and 96.7% for templates.

Conclusions

Superior results for templates are complemented by reduced radiation exposure to patient and surgeon; however, the technology requires prolonged pre-operative planning to create the bespoke template, and the development of an infrastructure to allow for their rapid production and delivery is needed before they become more widely available.

Two broad methods of navigation currently exist: intraoperative CT scanning providing real-time 3D navigation and preoperative CT registration in relation to a fixed reference with intraoperative computer assistance. At present, these methods are more commonly used, due to their proven improved accuracy rates over fluoroscopy, availability in emergencies and alongside minimally invasive techniques.

Despite their novelty and limitations, templates provide promising accuracy scores, although practical considerations may inhibit their proliferation.
43 The Value of Endoscopic Ultrasound (EUS) in the Investigative Pathway of Acute Idiopathic Pancreatitis (AIP)
Authors: Bhatti S.l , Evans L. , Kumar B.
Published: February 2022

Introduction

The British Society of Gastroenterology (BSG) guidelines on the management of acute idiopathic pancreatitis (AIP) state the incidence of idiopathic cases to be no more than 30%. However, before a firm diagnosis of AIP is made, Endoscopic Ultrasound (EUS) may be used to determine occult causes. This approach may help prevent recurrent attacks which may evolve into chronic pancreatitis.

Method

Retrospective analysis over a one-year period of cases of AIP in a tertiary referral centre was performed to see the incidence of AIP and the role of EUS. Patients with an identifiable cause for pancreatitis were excluded, leaving only those who had received a diagnosis of AIP and the diagnostic value of EUS was examined.

Results

Of the 101 patients diagnosed with AIP, 19% (n=19) underwent an EUS successfully. 79% (n=15) had no underlying cause of pancreatitis identified on EUS. In the remaining 21% of cases (n=4), microlithiasis, ductal stones, and pus requiring drainage were common findings. Of these patents, only 1 was referred for surgery. In the patient group with negative findings on EUS, 4% were unaffected, 2% were referred for surgery, 2% died and 7% had recurrent episodes of pancreatitis.

Conclusions

The results of this study show that EUS is a valuable modality in patients with suspected AIP, with a positive diagnostic rate of 21%. Therefore, we propose EUS needs to be included in the investigative pathway of all suspected AIP. Although EUS is a relatively scarce resource, further research is required to establish guidelines for the investigation of suspected AIP.
58 Introduction of a Basic Trauma Course and an Observational Study of Attitudes to Open Fractures in a Rural Region of Sierra Leone
Authors: Gabbott B. , Mistry R. , McKnight G. , Sinclair P. , David J.
Published: February 2022

Introduction

Sierra Leone ranks in the bottom quartile of the ‘Least Developed Countries’ across the world. ‘Injury’ is responsible for an estimated 325,000 deaths per annum. Kambia is a rural district in the northwest of the country with an approximate population of 340,000 people.

We were invited to teach the regions community health care officers (CHO) the first ever trauma skills course. Our secondary aim while in Kambia was to investigate the barriers to safe open fracture care in the region.

Method

A 4day teaching course was created and co-ordinated. Questionnaires examining candidate’s trauma knowledge, were utilised. Feedback sheets were collected to assess the courses local acceptability. Three senior CHOs were invite for a semi-structured interview exploring Open Fractures. This was recorded and a thematic analysis was performed on the results.

Results

The mean pre course questionnaire score was 9.0 (SD 3.45), and post course score 19.7(SD 3.8). This gave a mean difference of 10.7(CI 9.5 – 11.8, p value 0.01). All feedback collected was positive, with 15/23 candidates reports ‘Primary Survey’ the most useful teaching session. The reported boundaries to open fracture care included local beliefs, Lack or resources and services, Lack of finances.

Conclusions

Our basic trauma course provided an effective method of teaching trauma skills to the CHO’s of Kambia. It offered a widely accepted teaching structure and was enjoyed by the local medical community. We also identified barriers to optimal open fracture care in the region of Kambia, which can be targeted for further work.
84 Morbidity and Mortality in Elderly Head Injured Patients on Pre-Injury Antithrombotics: A Systematic Review
Authors: Ogbu I.
Published: February 2022

Objectives

The main objectives of this systematic review were to synthesize the available research on outcomes in elderly patients who had experienced traumatic brain injury while using antithrombotic therapy (ATT) to determine the difference in outcome compared to non-use as well as compare outcomes in different ATT types.

Design

A systematic review whose protocol is on the International prospective register of systematic reviews (PROSPERO). The review included all English language studies conducted between 2000 and 2021.

Subjects

All studies which evaluated mortality (at any time point following the injury) and morbidity in all anticoagulated head-injured patients > 64 years.

Method

We searched all the major databases that index biomedical journals for articles that fit the inclusion criteria using pre-piloted search terms. Study screening for inclusion was done using Covidence®. Data were extracted into Excel and quality assessment was done with the ROBINS-I tool.

Results

15 of 5,644 studies, all of which were conducted in high-income countries, were included. The estimated odds of mortality were 2.32 (1.66–3.25) in favour of non-use of ATT. Mortality rates were 2–38% versus 0–23% in the ATT versus non-ATT groups respectively. There were significantly higher odds of mortality with VKA use– up to 5.18 vs 1.60 with other ATT agents. The odds of mortality were higher among individuals with therapeutic INR – 4.48 versus 1.28. Morbidity was worse with ATT use compared to non-ATT use.

Conclusions

Outcomes in head-injured elderly patients seem to be worse with the use of certain ATT agents—especially VKAs compared to other ATT groups.
157 Diagnostic Test Accuracy of Artificial Intelligence Models Used in Cross-Sectional Radiological Imaging of Surgical Pathology in the Abdominopelvic Cavity: A Systematic Review
Authors: Fowler G.E. , Blencowe N.S. , Hardacre C. , Callaway M.P. , Smart N.J. , Macefield R.C.
Published: February 2022

Introduction

Medical imaging is important for diagnostic, prognostic, and management decisions. It is reliant on an increasingly limited number of interpreters. A developing interest has explored how artificial intelligence (AI) research in medical imaging can support clinicians and provide greater efficiency in clinical care. Reviews exist for thoracic and endoscopic imaging, but one is lacking for the abdominopelvic cavity. This could benefit several specialities which use this modality of imaging to guide their clinical decision making. This systematic review examines and critically appraises the application of AI models to identify surgical pathology from cross-sectional radiological images of the abdominopelvic cavity, to identify current limitations and inform future research.

Method

Systematic database searches (Medline, EMBASE, Cochrane Central Register of Controlled Trials) to identify relevant studies were performed, adhering to the PRISMA-DTA guidelines. Study characteristics and outcomes assessing diagnostic performance were extracted. A narrative synthesis was performed in accordance with the Synthesis Without Meta-analysis guidelines.

Results

10 retrospective studies were included, comprising 3,096 and 1,432 patients for AI training and test sets, respectively. There was diversity in the speciality, intention of the AI applications and the reporting, which was unstandardised. Diagnostic performance of models varied (range: 70–95% sensitivity, 73.7%-98% specificity). Only one study used a comparator, in which AI (AUC=0.920) outperformed both senior and junior radiologists (AUC=0.791 and 0.780, respectively).

Conclusions

AI application in this field is diverse and adherence to new and developing reporting guidelines is warranted. With finite healthcare resources and funding, future endeavours may benefit from prioritising clinical need, rather than scientific inquiry.
180 Systematic Review and Meta-Analysis of Exercise Therapy for Venous Leg Ulcer Healing and Recurrence
Authors: Turner B.R.H. , Jasionowska S. , Machin M. , Onida S. , Webster C. , Davies A.H.
Published: February 2022

Aim

National guidelines recommend regular exercise for individuals with venous leg ulceration, yet data for the effect of exercise on ulcer healing and recurrence are sparse. This study aimed to quantify the evidence for exercise in venous ulcer healing with the primary outcomes of proportion of healed ulcers and rate of ulcer recurrence. Secondary outcomes were compliance and adverse events.

Method

The review followed PRISMA guidelines using a registered protocol (CRD42021220925). Medline, Embase and Cochrane Databases were searched on 15th March 2021 and included articles comparing exercise to compression therapy. Meta-analysis was performed to pool the data.

Results

After screening 994 articles, six reports were included with 109 participants allocated to exercise and 113 to compression. All articles were randomised-controlled trials and reported ulcer healing at 12 weeks, with a pooled relative risk of 1.35 ulcers for exercise versus compression (95% CI 1.07 – 1.71). Only one article reported on recurrence and data pooling was not performed, but no difference between exercise and usual care was demonstrated. Adverse events were inadequately reported and seen to be more frequent in the exercise arm. Compliance with exercise ranged from 33–81%.

Conclusions

There is increasing evidence for exercise as an adjunct to ulcer healing, however, trials were low quality with high risk of bias. This is a crucial innovation as many ulcers recur or fail to heal in spite of surgical correction of underlying venous insufficiency. There is paucity of evidence examining leg ulcer recurrence after exercise programmes and currently no evidence of benefit.
217 Can Virtual Reality Enhance the Patient Experience During Awake Invasive Procedures? a Systematic Review and Meta-Analysis of Randomised Controlled Trials
Authors: Boyce L. , Jordan C. , Sivaprakasam R.
Published: February 2022

Aim

Procedural anxiety and pain negatively impacts surgical outcomes and contributes towards patient non-attendance for awake, invasive procedures (AIPs). Providing patients with virtual reality (VR) headsets may optimise their intraprocedural experience. This meta-analysis assesses the effect of VR on subjective pain, anxiety and satisfaction scores, and patient requirements for sedative and analgesic medication during AIPs.

Method

This review was performed according to PRISMA guidelines. PubMed, EMBASE, CENTRAL, and medrxiv databases were systematically searched for randomised controlled trials investigating the use of VR to enhance the patient experience in adults during AIPs. Meta-analyses were conducted for patient-reported anxiety (n=7), pain (n=7) and satisfaction (n=3) scores, and for total doses of sedative (n=3) and analgesic (n=3) medication administered to patients.

Results

9 studies were included. Patients underwent endoscopic diagnostic procedures (n=5), minimally invasive surgery (n=2) or orthoplastic operations (n=2), under local (n=4) or regional anaesthesia (n=2), conscious sedation (n=2) or simple analgesia alone (n=1). Meta-analysis revealed a significant effect in favour of using VR to alleviate procedural anxiety (SMD: -0.51, 95%CI: -0.85 to -0.16, p=0.004), when one study was omitted. Sub-group analysis of studies where AIPs was performed without anaesthesia, showed a significant reduction in pain scores for VR cohorts (MD: -1.33, 95%CI: -2.57 to -0.09, p=0.04). No significant differences between groups were found for patient satisfaction or requirements for sedative and analgesic medication.

Conclusions

This review supports using VR to reduce procedural anxiety and attenuate pain during AIPs performed without anaesthesia. The effect of VR on patient satisfaction and requirements for sedative and analgesic medications remains unclear.
222 Robotic Surgery: Public Perceptions and Current Misconceptions
Authors: Arshad S. , Brar G. , Xu S. , Ramesh N. , Talajia K. , Anwar M. , ter Wal A.
Published: February 2022

Aim

While surgeons and robotic companies are key stakeholders involved in the adoption of Robotic Surgery (RS), the public's role is often overlooked. However, given that patients hold ultimate power over their healthcare decisions, public acceptance of RS is crucial. This study aims to identify public understanding, opinions and misconceptions on RS and present solutions to facilitate its wider integration.

Method

An online questionnaire distributed via social media platforms between February and May 2021 identified the views of UK adults on RS. The data was evaluated using thematic analysis, descriptive statistics, and statistical analysis. Statistical differences in age, gender, education level, and presence in the medical field were also sought.

Results

263 responses were obtained, with 216 (82.1%) analysed. Demographic differences provided significantly different results. Participants were relatively uninformed about RS, with a median knowledge score of 4.00(2.00–6.00) on a 10-point likert scale. Fears surrounding increased risk, reduced precision and technological failure were identified, alongside misconceptions on what RS entails, including it being autonomous. However, providing factual information in the survey about RS statistically increased participant comfort (p=<0.0001). Most (61.8%) participants believed robot manufacturers were responsible for malfunctions, but doctors were held accountable more by older, less educated, and non-medical participants.

Conclusions

This study highlights the role of negative and inaccurate public perceptions surrounding RS in impeding its widespread adoption. Greater emphasis must be placed on patient education in RS to mitigate misconceptions and ensure greater diffusion of its benefits
31 Quality or Quantity? An Analysis of the Colorectal Cancer Resection Volume-Outcome Relationship From the 2019 National Bowel Cancer Audit Data
Authors: Gujjuri R. , Kawka M. , Murphy J.
Published: February 2022

Aim

Despite increasing evidence supporting cancer services centralisation, no consensus exists in the association between high-hospital or high-surgeon volume and mortality following colorectal cancer surgery. This study aimed to identify and characterise a volume-outcome relationship in colorectal cancer.

Method

National Bowel Cancer Audit (NBOCA) dataset was combined with the Association of Coloproctology of Great Britain and Ireland (ACPGBI) Clinical Outcomes Publication (COP) 2019 report. Adjusted 90-day and 2-year mortality were derived from patients included in the 2018 and 2016 datasets, respectively. The impact of centre volume, surgeon volume and ACPGBI membership rates on outcomes was assessed. Cumulative sum (CUSUM) analysis was performed to identify the centre and surgeon volume threshold.

Results

144 hospitals were included, with 17,235 and 17,703 patients from the 2018 and 2016 datasets, respectively. 781 surgeons were identified, with 478 holding ACPGBI memberships. No significant difference was found between centre or surgeon volumes for adjusted 90-day and 2-year mortality. High ACPGBI membership rates were significantly associated with a reduced 90-day (p=0.006), but not 2-year mortality (p=0.198). CUSUM analysis found 36 per year as threshold centre volume (p=0.003) and 15 surgeries per year as the threshold surgeon volume (p=0.241).

Conclusions

The high degree of existing centralisation for cancer services in the UK limits the number of true low-volume centres compared to other countries. Surgeon volume may be a better predictor of colorectal cancer surgery outcomes than centre volume. More granular data is needed to improve the current understanding of the association between surgeon volume, ACPGBI membership and outcomes in colorectal surgery.
59 Robotic-Assisted Knee Replacement Surgery & Infection: A Systematic Review and Meta-Analysis
Authors: Kwakye M.A. , Raj S. , York T.
Published: February 2022

Aim

An increasing proportion of knee arthroplasties are performed using robotic-assisted surgical techniques. While these techniques are associated with shorter lengths of stay, better patient outcomes and lower revision rates, the increase in intra-operative time and requirement for extra instrumentation, such as array pins, may lead to an increased risk of infection. Therefore, this review reports summary rates of surgical site infection (SSIs) in robotic-assisted knee arthroplasties.

Method

The protocol for this review was prospectively registered on PROSPERO. Embase, PubMed/MEDLINE, Cochrane and CINAHL databases were searched from 2004 to November 2020 to reflect modern robotic surgical practice. The primary outcome was overall number of SSIs that occurred within one year of the primary operative procedure, which was sub-classified into either deep or superficial and pin-site infections. Risk of bias was assessed via the Cochrane RoB2 tool. Conventional Q and I2 tests for heterogeneity were performed with subsequent meta-analysis using a DerSimonian-Laird random-effects model.

Results

From 1052 studies identified, 17 were included, of which 13 were deemed to have an overall ‘low’ risk of bias. This review included 4400 unicompartmental and 1883 total knee arthroplasties. The summary rate of overall SSIs within one year of primary robotic knee arthroplasty was 0.568% (SE=0.183, 95% CI=0.209–0.927). This rate fell to 0.154% (SE=0.069, 95% CI=0.018–0.290) for deep infections and 0.347% (SE=0.109, 95% CI=0.133–0.561) for superficial and pin-site infections.

Conclusions

The rates of surgical site infection were found to be low in robotic knee arthroplasty, however, further research is required to compare outcomes with conventional knee arthroplasty.
Difference Between the ICJ and the CERD Committee: A Comment on the Application of the International Convention on the Elimination of All Forms of Racial Discrimination (Qatar v. United Arab Emirates) Case
Authors: Pan Kaijun
Published: February 2022

In the Qatar v. UAE case, the Court reached, without giving much explanation, an interpretation different from that of the CERD Committee over the phrase “national origin” in the International Convention on the Elimination of All Forms of Racial Discrimination. This, in fact, marks a deviation from the Court’s previous case law. Through a close reading of the Court’s judgment and the Committee’s decision, this comment argues that their diverging interpretations bring to the surface the structural differences between these two institutions. These differences had been obscured in the Court’s jurisprudence, and a more principled approach towards human rights treaty bodies is needed for the Court in the future.
Local Politics and Fluctuating Engagement with China: Analysing the Belt and Road Initiative in Maritime Southeast Asia
Authors: Wang Zhaohui , Fu Yuheng
Published: February 2022

The past few years have witnessed that the success (or failure) of the Belt and Road Initiative (BRI) depends to a large extent upon engagement with and responses from recipient countries. The article explores the impact of Southeast Asian countries’ domestic socio-political factors on their foreign policymaking and BRI projects in Southeast Asia. Based on comparative political sociology, the article develops a conceptual typology of foreign policymaking and an explanatory typology of socio-political risks, both of which are further applied to studying the socio-political risks that BRI projects entail in the four maritime Southeast Asian countries of Malaysia, Indonesia, the Philippines, and Singapore. The empirical study suggests that the Philippines’ ‘populist’ type of foreign policymaking creates the highest level of risks—both political and societal—for BRI projects and that Singapore’s ‘procedural’ type produces the lowest. Malaysia’s ‘arbitrary’ type and Indonesia’s ‘democratic’ type, meanwhile, generate medium-level political or societal risks. These findings have important policy implications for Chinese-funded overseas projects.
A novel optimized adaptive servo-ventilation setting for a patient with severe heart failure based on the echocardiogram: a case report
Authors: Sekiguchi Haruki , Tanino Sae , Serizawa Naoki , Hagiwara Nobuhisa
Published: February 2022

Background

Adaptive servo-ventilation (ASV) is a non-invasive positive-pressure ventilation therapy considered beneficial for treating heart failure (HF) in patients with central sleep apnoea. However, to the best of our knowledge, there is no evidence indicating that this therapy increases the mortality in HF patients. We hypothesized that ASV settings are important for HF patients with reduced ejection fraction. Therefore, to determine the suitable ASV setting for such patients, we optimized these settings to improve the left ventricular (LV) output during the therapy.

Case summary

We present a case of HF caused by dilated cardiomyopathy in a 45-year-old man. He was hospitalized due to HF; his LV ejection fraction was ∼20%, and haemodynamics analysis revealed his HF grade was Forrester subset IV. During hospitalization, he was diagnosed with sleep apnoea; therefore, we induced ASV with our optimized setting using an echocardiogram evaluating stroke volume (SV). Using this method, we could determine the appropriate setting that increased his SV and improved his apnoea–hypopnoea index. At the 5th-year follow-up, he had no dyspnoea on effort (New York Heart Association Functional Classification I). He continued using the ASV with good adherence, and no hospitalization for ventricular arrhythmia and HF was reported.

Discussion

Our ASV optimized setting showed beneficial effects in an HF patient with reduced ejection fraction. This method improved the patient’s SV and apnoea–hypopnoea index, indicating that this novel method should be considered for HF patients with reduced ejection fraction.
Political power of the press in the Weimar Republic
Authors: Nguyen Bang Dinh
Published: February 2022

This paper examines how changes in newspaper circulation affected voter turnout, party vote shares, and mass polarization in Weimar Berlin. My empirical strategy exploits variation in the development of railway system across historical districts of Berlin, which influenced the circulation of newspapers. I find that an increase in newspaper circulation significantly induced higher turnout in fourteen outer districts and a higher degree of mass polarization. Partisan newspapers benefitted party vote shares, with stronger effects in federal elections than in local elections. The electoral influence of newspapers was driven by tabloids and mass newspapers, and not by elite political newspapers.
Genetic and clinical determinants of abdominal aortic diameter: genome-wide association studies, exome array data and Mendelian randomization study
Authors: Portilla-Fernandez Eliana , Klarin Derek , Hwang Shih-Jen , Biggs Mary L , Bis Joshua C , Weiss Stefan , Rospleszcz Susanne , Natarajan Pradeep , Hoffmann Udo , Rogers Ian S , Truong Quynh A , Völker Uwe , Dörr Marcus , Bülow Robin , Criqui Michael H , Allison Matthew , Ganesh Santhi K , Yao Jie , Waldenberger Melanie , Bamberg Fabian , Rice Kenneth M , Essers Jeroen , Kapteijn Daniek M C , van der Laan Sander W , de Knegt Rob J , Ghanbari Mohsen , Felix Janine F , Ikram M Arfan , Kavousi Maryam , Uitterlinden Andre G , Roks Anton J M , Danser A H Jan , Tsao Philip S , Damrauer Scott M , Guo Xiuqing , Rotter Jerome I , Psaty Bruce M , Kathiresan Sekar , Völzke Henry , Peters Annette , Johnson Craig , Strauch Konstantin , Meitinger Thomas , O’Donnell Christopher J , Dehghan Abbas ,   VA Million Veteran Program
Published: February 2022

Progressive dilation of the infrarenal aortic diameter is a consequence of the ageing process and is considered the main determinant of abdominal aortic aneurysm (AAA). We aimed to investigate the genetic and clinical determinants of abdominal aortic diameter (AAD). We conducted a meta-analysis of genome-wide association studies in 10 cohorts (n = 13 542) imputed to the 1000 Genome Project reference panel including 12 815 subjects in the discovery phase and 727 subjects [Partners Biobank cohort 1 (PBIO)] as replication. Maximum anterior–posterior diameter of the infrarenal aorta was used as AAD. We also included exome array data (n = 14 480) from seven epidemiologic studies. Single-variant and gene-based associations were done using SeqMeta package. A Mendelian randomization analysis was applied to investigate the causal effect of a number of clinical risk factors on AAD. In genome-wide association study (GWAS) on AAD, rs74448815 in the intronic region of LDLRAD4 reached genome-wide significance (beta = −0.02, SE = 0.004, P-value = 2.10 × 10−8). The association replicated in the PBIO1 cohort (P-value = 8.19 × 10−4). In exome-array single-variant analysis (P-value threshold = 9 × 10−7), the lowest P-value was found for rs239259 located in SLC22A20 (beta = 0.007, P-value = 1.2 × 10−5). In the gene-based analysis (P-value threshold = 1.85 × 10−6), PCSK5 showed an association with AAD (P-value = 8.03 × 10−7). Furthermore, in Mendelian randomization analyses, we found evidence for genetic association of pulse pressure (beta = −0.003, P-value = 0.02), triglycerides (beta = −0.16, P-value = 0.008) and height (beta = 0.03, P-value < 0.0001), known risk factors for AAA, consistent with a causal association with AAD. Our findings point to new biology as well as highlighting gene regions in mechanisms that have previously been implicated in the genetics of other vascular diseases.
SegmentGeometry: A Tool for Measuring Second Moment of Area in 3D Slicer
Authors: Huie Jonathan M , Summers Adam P , Kawano Sandy M
Published: February 2022

Synopsis

Second moment of area is a measure of how well the cross-section of a beam will resist bending because of its shape. Many have used second moment of area to investigate the mechanical adaptations of biological structures from stingray jaws to animal limb bones. In this context it is important to acknowledge the assumptions of beam theory, in which second moment of area plays a key role, if reasonable results are desired. For example, to minimize shear the structure should be at least 10 times longer than it is wide and deflection should be minimal. Analyzing the internal geometry of biological structures has never been easier or more accessible given the wide, and growing availability of micro-CT scans. Here, we offer a guide on the care that needs to be taken when interpreting second moment of area, and present open-access, open-source software that can process hundreds if not thousands of structures in a short time frame. SegmentGeometry, an extension for the open-source imaging platform 3D Slicer, iterates slice-by-slice through 3D structures to calculate second moment of area and other cross-sectional properties. We analyzed 2 case studies to demonstrate the power of this tool and to highlight interpretations that can be gleaned from second moment of area. Second moment of area is just one part of the Euler–Bernoulli beam theory and considering the full equation would greatly increase the number and diversity of questions that can be answered.
Multiple secondary outbreaks of NDM-producing Enterobacter hormaechei in the context of endemic NDM-producing Klebsiella pneumoniae
Authors: Izdebski R. , Biedrzycka M. , Urbanowicz P. , Papierowska-Kozdój W. , Dominiak M. , Żabicka D. , Gniadkowski M.
Published: February 2022

Background

Consecutive Polish regions have become endemic for NDM-1-producing Klebsiella pneumoniae ST11, followed by K. pneumoniae ST147. Since 2017 a significant increase in NDM-positive Enterobacter hormaechei cases has been observed.

Objectives

To investigate the origin and character of this increase in NDM-positive E. hormaechei.

Methods

The analysis included 160 NDM-producing Enterobacter cloacae complex isolates, recovered in 2015–20 in 37 centres of 9/16 regions. These were typed by PFGE and MLST, and screened by PCR-mapping for NDM-1-encoding Tn125-like elements. Forty-four isolates were sequenced by MiSeq. Species identification was based on whole-genome average nucleotide identity; clonality and phylogeny were inferred by SNP approaches. The structural plasmid analysis was done for 12 isolates sequenced by MinION.

Results

The isolates belonged to 11 STs, predominantly ST89 (65.6%), followed by ST146 (15.6%), ST198 (7.5%) and ST1303 (3.7%), representing different E. hormaechei subspecies. Most of the isolates contained the Tn125A variant of the K. pneumoniae ST11 lineage, and several had Tn125F of the ST147. Individual E. hormaechei genotypes represented various epidemiological situations, from sporadic cases to single-hospital, city and regional outbreaks, including one caused by ST89 organisms with 82 cases in 17 centres. Acquisitions of the Tn125A/Tn125F determinants by the E. hormaechei strains occurred around 10 times and were plasmid-mediated, with a significant plasmid rearrangement in case of Tn125F.

Conclusions

The increase in E. hormaechei NDM-1 cases in Poland is a consequence of the uncontrolled spread of NDM-1-producing K. pneumoniae genotypes. Several E. hormaechei lineages have acquired NDM-encoding plasmids in different locales which started ‘secondary’ progressive outbreaks.
The value, challenges and practical considerations of conducting qualitative research on antimicrobial stewardship in primary care
Authors: Wanat Marta , Santillo Marta , Borek Aleksandra J. , Butler Christopher C. , Anthierens Sibyl , Tonkin-Crine Sarah
Published: February 2022

In order to design appropriate antimicrobial stewardship (AMS) programmes, it is crucial to understand challenges to tackling antibiotic resistance (AMR) specific to each healthcare setting. Antibiotic prescribing in primary care accounts for most prescriptions with a significant proportion considered clinically inappropriate. Qualitative research has a long history in social sciences, but its value and contribution are still contested in medical journals including in the AMR/AMS field. However, through its focus on understanding, meaning making and explaining, qualitative research can offer insights in how to improve AMS efforts in primary care. This paper provides an overview of unique considerations, contributions and challenges related to using qualitative research in AMS to help the AMS community new to qualitative research to utilize its potential most fully. First, we discuss specific considerations for AMS in relation to the stages of conducting a qualitative study, including identifying a research question and choosing a suitable methodology; sampling appropriate participants; planning a recruitment strategy; choosing a method of data collection; and conducting data analysis. These are illustrated with examples of qualitative AMS studies in primary care. Second, we highlight the importance of patient and public involvement throughout all stages of the project and ensuring quality in qualitative AMS research. Finally, drawing on these considerations, we make a further case for the value and contribution of qualitative methodologies in AMS/AMR research while outlining future directions for both AMS and qualitative research, including the need for studies with diverse actors; interdisciplinary collaborations; and complex decisions on methodologies and timelines.
The Frenzied Dance of Art and Violence
Authors: Gussak David E.
Published: February 2022

Artists like Caravaggio, Cellini, Pollock and Dali, demonstrated volatile, violent—sometimes murderous—behavior. Some, like Goya, Beckmann, Picasso, and Vann Nath, created amazing works despite—or because of—the global destruction and overwhelming societal conflict that surrounded them. Great Britain’s notoriously violent inmate channeled his impulses once he began to draw. Heinous multiple murderers like Gacy, Manson, and Rolling drew and painted works that society finds repelling and compelling. For 30 years as an art therapist working with violent offenders, the author has subscribed to the notion that the impulses that drive one to destruction may be the same that compel one to create, while simultaneously recognizing that making art mitigates and redirects destructive energy. The Frenzied Dance focuses on one charge: to explore and understand this interrelationship between art and violence. To inform this dynamic, this book relies on various psychological and sociological perspectives of violence and aggression, psychobiographies of violent artists and those whose work emerged from violence, the art of multiple murderers and violent offenders, and the author’s own reflections as an art therapist with people who are violent This book also explores society’s fascination with the products of violent perpetrators, how others have used art to foment peace and combat violence, and how art can be used as a therapeutic tool to assuage violence and aggression. The resultant series of essays provide a far-reaching examination of this dynamic interdependence.
Monte Carlo simulations of multiple populations in globular clusters: constraints on the initial size of the second generation from binary stars
Authors: Sollima A , Gratton R , Lucatello S , Carretta E
Published: February 2022

We present the result of a survey of Monte Carlo simulations of globular clusters hosting two generations of stars including a large ($f_{b}=50{{\ \rm per\ cent}}$) fraction of primordial binaries in both populations. The dynamical evolution of the two stellar populations is followed for a Hubble time taking into account the effect of the tidal field, two-body relaxation, stellar evolution, and three/four-body interactions. The fraction of surviving binaries, once accounted for the observational bias and uncertainties, is compared with the available radial velocity time-series performed in real globular clusters, and it is used to constrain the initial spatial concentration of the second generation. The fraction of second generation binaries appears to depend only on the ratio between the total cluster mass and the initial size of the second generation that determines the average velocity dispersion across the extent of this stellar population. In spite of the various uncertainties, we find that the observed fraction can be obtained only assuming a strong initial concentration of the second generation ($r_{h,S}\sim 0.1~(M/10^{6} \, \mathrm{M}_{\odot })\, \mathrm{pc}$). The evolution of the first generation binary fraction is more sensitive to the tidal field strength (with a non-negligible effect of the cluster orbital eccentricity) since the tidal field has a direct impact on the first generation structural properties.