bluuebunny/crossref_metadata_2025 huggingface dataset:
952 Digitalisation: Does This Improve Doctors' Documentation of Communication with Families? a Quality Improvement Project
Authors: Gill S , Moin S , Berstecher R
Published: August 2024

Aim

The London hospital where this QIP took place recently transitioned to a digitalised system. While appearing straightforward, this transition is imperfect. This QIP focusses on one patient's satisfaction with the hospital experience. If communication with patients’ families is optimised and documented, the doctors/surgeons benefit from medicolegal protection and patients benefit from an improved hospital experience. The question of whether this communication Is happening, but remains undocumented, or not happening at all remains unanswered. We aimed to assess if digitalisation of medical documents affects the number of documented episodes of communication with patients’ family/friends/carers.

Method

Patient notes on the two main surgical wards were screened for written evidence of communication with family/friends/carers of patients. Patient: date of admission; sex; age and diagnosis were recorded. Patients were surveyed for insight. A poster was placed in both doctors’ offices. 1st cycle data was presented at the surgical X-ray meeting, the 2nd cycle data was collected and analysed.

Results

No significant differences in episodes of communication with families/friends/carers were found on either ward (p=0.904 and p=0.24). This was identical in the orthopaedic and general/colorectal patients (p=0.214 and p=0.582).

Conclusions

Overall, there were no significant changes in documented episodes of communication with families after digitalisation. There are faults with the implementation of the digital system in this hospital. We found several solutions, such as mandatory instructive e-learning for a new system. Further, more specific, data is required to assess if communication is happening but not being documented.
697 Updated Surveillance Guidance for Intra-Ductal Pancreatic Mucinous Neoplasm (IPMN) – a 10-Year Cohort Study in a Tertiary Care Surgical Unit
Authors: Shah M , Neelankavil Davis G , Jain S , Dorkeh D C , Ganesh R
Published: August 2024

Aim

To investigate the adequacy of current frequency of surveillance of IPMN in a single tertiary surgical unit.

Method

A retrospective cohort study over a 10-year period (2013-2023), patient age range 30-85 years old. The data collected included gender, age at diagnosis, size(mm) of largest cyst, high risks(HRF) or worrisome features(WRF), and interventions required. Analysis undertaken pertaining to the incidence of IPMN with malignant potential as well as progression of disease on surveillance.

Results

Total of 61 patients On presentation - Cyst size <1cm – 51%, 1-2cm- 33%, 2-3cm- 16% <1cm group - no growth on surveillance scans and no interventions required. 1-2cm group - 35% had HRF, 25% of which underwent surgical intervention. 15% showed WF of which 33% required surgical intervention. 2-3cm group - 20% of patients with WF showed growth in cyst size. 40% of patients with WF - underwent surgery.

Conclusions

The malignant potential of IPMN correlates with the initial cyst size. Guidelines recommend that cysts <1cm should be under 2-yearly surveillance. However, when compared to those with cyst>1cm, none of the patients with cyst size<1cm displayed progression. Therefore, we propose that for patients with an initial cyst size of less than 1cm, who are above the age of 70 and/or Performance status(PS) =>2 – no active surveillance is required. If the PS <2 and patients are less than 70 years old, we recommend 5-yearly surveillance. For patients with cyst size >1cm, we recommend adhering to the current guidance. With this revised guidance, already scarce resources may be better utilised.
1269 Comparing Patient Outcomes for Drain vs Drain-Less Technique in Abdominal Donor-Site Closure Following Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Systematic Review
Authors: Wong P Y , Chansiriwongs A
Published: August 2024

Aim

Deep Inferior Epigastric Perforator (DIEP) flap is the gold standard for autologous breast reconstruction. Conventionally, abdominal drains are placed to reduce seromas, haematomas, and wound dehiscence. However, evidence to support this is lacking. We aim to systematically review patient outcomes following the use of abdominal drains versus drain-less techniques in patients who received DIEP flap breast reconstruction.

Method

Literature search across Ovid MEDLINE and EmBase were performed according to PRISMA guidelines. Patients >18 years old who underwent drain-less DIEP flap breast reconstruction were included. Outcomes considered include postoperative complications (seroma, haematoma, wound dehiscence), length of stay (LOS), and postoperative pain. We included observational studies and randomised controlled trials (RCTs) published in English. Both authors independently performed literature screening, data extraction, and bias assessment.

Results

Search strategy revealed 1 cross-sectional study, 4 cohort studies, and 1 RCT. 580 patients, of which 316 received drain-less techniques, were included. These include donor-site simple direct closure, PTS application, and adhesive use. Postoperative wound dehiscence, seroma and haematoma formation were not significantly different between groups (reported by 6, 6, and 5 studies respectively). 1 of 2 studies showed reduced postoperative pain in the drain-less group. LOS (reported in 4 studies) was significantly longer for patients with abdominal drains. Quality of evidence is low.

Conclusions

Drain-less techniques are non-inferior to abdominal drain in reducing postoperative complications, with benefits of reduced LOS and post-operative pain. Further RCTs are required to investigate the potential of simple direct closure +/- adhesives compared to PTS closure as this could confer shorter operation time.
794 Making the Cut: Assessing the Knowledge of and Compliance to Guidelines for Skin Cancer Excision Biopsy Margins Amongst Junior Doctors in Plastic Surgery
Authors: Pieracci G , Ward A , Baker H , Dupre S , Odili J
Published: August 2024

Aim

Junior doctors in Plastic Surgery commonly perform excision biopsies of suspected skin cancers, but previous studies have shown that they are less likely than dermatologists to perform complete excisions of non-melanoma skin cancers (NMSCs). This study aimed to (i) assess plastic surgery junior knowledge of, and compliance to, BAD guidelines regarding excision biopsy margins, and (ii) explore reasons for incomplete excisions of NMSCs at St George’s Hospital.

Method

A questionnaire assessed the knowledge of excision biopsy margin guidelines for NMSCs in plastic surgery juniors (SHO to Registrar). Teaching sessions were delivered, and posters of schematised BAD guidelines were displayed in procedure rooms. The same questionnaire was subsequently repeated. Retrospective data collection of excision biopsies performed by junior doctors within two 4-week periods was performed to assess compliance with guidelines before and after the interventions.

Results

Junior doctors, particularly those with little-to-no plastics experience, were not familiar with the BAD guidelines (37.5% correctly recalled excision margins, n=3/8). Following our interventions, knowledge of excision margin guidelines improved (62.5% correct, n=5/8), but remained suboptimal. Furthermore, guideline compliance and subsequently rates of incomplete excision improved following the interventions.

Conclusions

Educational measures improved knowledge of and compliance to excision guidelines. However, juniors are often responsible for carrying out excision biopsies independently. This study emphasises the need for better education about BAD guidance, as well as senior supervision to decrease the observed rates of incompletely excised skin cancers and improve patient outcomes.
1128 A Quality Improvement Project on the Understanding of Patients Undergoing Urological Procedures
Authors: Khan F , Gado M , Pai A
Published: August 2024

Aim

In this Quality Improvement project, we aimed to enhance patient understanding of urological procedures. Our approach involved designing a BAUS QR code poster and integrating paperless leaflets into consultations, with the future goal of sustainability.

Method

Initial data collection from 30 patients, through a questionnaire during urology consultations, guided the project. The introduction of QR code posters linked to BAUS leaflets was assessed through a re-audit involving 25 patients.

Results

Results showed that all 55 participants used smartphones, with 71% utilizing them for medical searches. While 56% were initially familiar with QR codes, patient satisfaction remained consistently high before and after the QR code poster implementation.

Among pre-operative patients, 85% received patient information leaflets initially, increasing to 100% patients receiving patient information leaflet post QR code poster implementation. Post-operative patients receiving patient information leaflets was only 40% but incremented to 72% after the QR code poster implementation.

Conclusions

The project demonstrated that QR codes, complementing verbal consultations and paper leaflets, effectively provided information on urological procedures and lifestyle advice. Importantly, this innovation supports the transition to a paperless approach, contributing to long-term sustainability.
930 Single-Centre Experience in Establishing a Robotic General and Colorectal Surgery Programme in the UK
Authors: Broadhurst W , Rajaratnam K , Bevan K , Georgiades F
Published: August 2024

Aim

To describe our centre’s experience in establishing a robotic programme for general and colorectal surgery procedures.

Method

Data from a prospectively maintained database were collected for all robotic-assisted procedures carried out in our centre since the procurement of the robotic platform.

Results

38 cases were completed with the DaVinci Xi (Intuitive Surgical Inc, USA) robotic platform under the care of 2 consultant surgeons between April - November 2023. 37% (n=14) of the cases were proctored and 92% (n=35) were bowel resections for malignancy. 60.5% (n=23) of the patients were male with a median age of 69.5 years (IQR 56.7-76.7 years) and a median BMI 26.5 Kg/m2 (IQR 23.9-28.6 Kg/m2). 17 patients (44.7%) were classified as ASA 3 due to their comorbidities. No cases were converted to open or laparoscopy with a median total console time of 284 minutes (IQR 160-335 min). There was no difference in total console time if the case was proctored (p=0.204, Student t-test). A stoma was formed in 12/35 (34.3%) of bowel resections, which all were planned preoperatively. All anastomoses were stapled with 16/30 (53.3%) being intracorporeal. The median length of stay was 5 days (IQR 4-8 days); the presence of a proctor did not significantly impact this (p=0.679, Mann-Whitney-U test). 5.3% (n=2) had a significant postoperative complication (Clavien-Dindo ≥3). No mortalities or hospital readmissions were recorded within 30 days of the procedure.

Conclusions

The presence of a proctor had no impact on total console time or patient outcomes in our centre’s small cohort.
199 Teaching Basic Surgical Skills Using a More Frugal, Near-Peer, and Environmentally Sustainable Way: Mixed Methods Study
Authors: Smith B , Paton C , Ramaraj P
Published: August 2024

Aim

To evaluate the impact of a novel program of weekly, lunchtime BSS sessions on quantitative and qualitative factors.

Method

A weekly, lunchtime BSS course was designed to achieve the outcomes of the Royal College of Surgeons BSS course over one foundation doctor rotation. Sessions included knot tying, suturing, abscess drainage, application of plaster of Paris, joint aspirations and reductions, abdominal wall closure, and basic laparoscopic skills. The hospital canteen sourced unwanted pig skin and belly from the local butcher. Out-of-date surgical equipment was used. Pre- and post-session feedback was assessed for perceived increase in confidence. Thematic analysis of voluntary semi structured interview transcripts were performed to understand the impact of the course on perceived well-being, quality of training, and interest in a surgical career.

Results

There were 64 responses. Confidence was significantly improved from 47% to 73% (95% CI 15%-27%; P<.001; t13=5.3117) across all surgical skills over 4 iterations. In 7 semi-structured interviews, 100% of the participants reported improved perceived well-being, value added to training, and positivity toward near-peer teaching and 71% preferred local weekly teaching. Interest in a surgical career was unchanged.

Conclusions

This course was feasible around clinical workloads, resourced locally at next to no cost, environmentally sustainable, and free to attend. The course offered junior doctors not only a weekly opportunity to learn but also to teach. Peer-led, decentralized surgical education increases confidence and has a positive effect on perceptions about well-being and training. We hope to disseminate this course, leading to reproduction in other centres, refinement, and wide implementation.
369 Addressing Inconsistencies in Surgery Teaching at UK Medical Schools Through Near Peer-Led Interventions
Authors: Irfan M , Asim N , Fouda S S , Alberto I
Published: August 2024

Aim

The UK's medical education struggles with inconsistent surgical teaching, causing gaps in students' grasp of principles. Existing studies note varied competence levels in graduates, citing knowledge, motivation, and confidence gaps in surgery. To tackle this, St. George’s Medical Education Society offers structured near peer-led sessions on surgical specialties. Delivered by junior doctors with insights into students' challenges, this program aims to standardise and enhance learning for future surgeons.

Method

Six sessions were organised, covering surgical specialties like breast surgery, trauma, and orthopaedics, targeting crucial clinical scenarios and exam content. The curriculum delved into prevalent conditions, management strategies, and exam-focused topics, offering a comprehensive grasp of surgical principles. Interactive sessions included case discussions, group activities, and specific examples, enriching learning through speakers' personal experiences. Surveys using 5-point Likert Scales evaluated improvements in student confidence, understanding, and motivation, gauging the intervention's impact on surgical knowledge and confidence levels.

Results

Before the sessions, average scores for understanding, confidence, and motivation (n=67) were 2.0, 2.3, and 4.5 respectively, on a 5-point Likert Scale where (1) was poor and (5) was most confident. After the sessions, these increased to 4.0, 4.0, and 4.3. This resulted in increases: 88.64% in understanding, 109.95% in confidence, and 15.85% in motivation.

Conclusions

These sessions connected theory with practice, preparing students for surgical complexities while instilling a deeper appreciation for the challenges and rewards of a medical career. This experiential learning is crucial, ensuring students' readiness and competence in the dynamic field of surgery.
813 Improving Surgical Education Through Gamification – the Creation of SurgiPlay, a Surgical Education Game
Authors: Davies B L J , Ransome M , Eardley N
Published: August 2024

Aim

Gamification is the process of making a task more engaging by adding game-like elements. Gamification has become a considerable component of education and has forged its way into medical education. Literature praises gamification, and with technological advancement, its use has widened, providing new ways of learning. This project aimed to improve surgical induction and education at a District General Hospital (DGH), using gamification, through the creation of SurgiPlay.

Method

SurgiPlay is an interactive board game created to aid surgical education and provide a thorough surgical induction that is engaging and consistent. This game looks at four key elements of a “junior surgical doctors” job – ward jobs, clerking, clinical skills, and post-operative complications. It also includes the key induction processes, including referral pathways, staffing, and prioritising. Surgical Foundation doctors completed pre-SurgiPlay and post-SurgiPlay questionnaires to analyse the effectiveness of the game.

Results

The induction process was inconsistent, left questions unanswered, and was not engaging enough for the trainees to remember key elements. A fundamental problem was the need for more staff to cover induction/teaching. Surgiplay retracts this need, allowing new doctors to induct themselves without impacting patient care and clinical commitments. In the post-SurgiPlay questionnaires, 78% of respondents felt confident upon commencing their placement, with 66.6% feeling confident in their basic surgical skills. Further, respondents felt the gamewas “interactive”, “different” and “motivated through a new type of learning.”

Conclusions

Continual adaptations will be made to SurgiPlay, with hopes it will pioneer a new route for gamification in medical education.
941 Building the Ideal Home Practice Models for Surgical Skill Development
Authors: Balaji A , O’Regan D
Published: August 2024

Aim

In surgical education, the development of proficient skills is paramount. We discuss the concept of crafting the ideal home practice models for surgical skill enhancement with a focus on low-cost, sustainable, and efficient methods to practice outside the operating room, supported by the literature, evaluation of courses, and anecdotal experience.

Method

Building on the literature, we examine specific organic models that can be easily sourced, such as bananas, baked potatoes, and poached eggs, and their unique advantages in surgical training. We explore the inherent characteristics of these models that align with the needs of surgical skill development.

Results

Organic models offer a cost-effective and sustainable solution for surgical practice at home, corroborated by previous research. They provide active feedback through tactile sensations, mimicking real tissue characteristics. The banana, with its immediate feedback and haptic qualities, excels in needle entry, rotation, and exit practice. Due to the change in colour from oxidation, trainees can clearly see the needle path and evaluate their performance. The baked potato allows for practice of various needle angles and discourages skimming of tissue. The friable poached egg provides fine skill refinement with real-time feedback by practicing lightness of touch and appropriate needle rotation to prevent tearing into the yolk subsequently causing a leak.

Conclusions

The ideal model necessitates affordability, minimal setup effort, sustainability, and effective real-time immediate feedback, supported by realism. As we explore innovative approaches to surgical education, these models emerge as valuable allies, enabling learners to refine their skills in a convenient and impactful manner.
1132 The Best Way to Develop a Surgeon: An International Comparison of Medical Education and Surgical Training
Authors: Bucknor A , Pedreira R , Bhat D , Zamani M , Furnas H
Published: August 2024

Aim

Currently, interest in surgical careers is declining globally. Surgeons share ideas internationally without sharing much about training. This study compares international pathways toward surgeon development with the aim of seeking improvements.

Method

A 70-question anonymous survey was distributed internationally to surgeons of all specialties. Data were analysed in SPSS Statistics for Macintosh (IBM). A value of p<0.05 indicates statistical significance.

Results

The 463 respondents from the U.S. (59%); U.K. (16%); Europe (10%); Canada (5%), and the Rest of the World (RotW)(10%) averaged age 46; 64% were female. Non-U.S./Canadians (93%) attended 5- and 6-year medical schools; U.S. respondents were far more likely (91%) to attend non-medical 4+-year university before medical school. Weekly training-hour weekly mandates spanned <48 (9%) to 80+ (45%); 76% surpassed mandate hours; 9% reported accurate hours. Average educational debt ranged from $14,000 (Europe) to $179,000 (U.S.). Few (19%) felt training allowed family building. Nearly all U.S./Canadians felt competent after training, versus U.K. (81%), RotW (74%) and Europe (70%).

Conclusions

The outlook of surgery as an attractive career depends on the way we develop future surgeons. Based on best practices from different countries, the authors recommend a 6-year maximum university/medical education requirement; elimination of mandatory non-surgical training years; single-program surgical training; 60-hour work-weeks; competency-based training; AI tools for training and tasks; advanced-care providers for non-educational tasks; certifying at completing of training; and support of childbearing and childcare.
1163 Do UK Core Surgical Trainees Lead Healthy Lifestyles?
Authors: Ramjeeawon A , Parfitt C , Khudr J , Eckersley M , Ziolkowska K , Kungwengwe G , Iqbal M , Lim J Y
Published: August 2024

Aim

To understand whether UK Core Surgical Trainees (CSTs) lead healthy lifestyles as per NHS and government issued guidance on health behaviours, and whether their poor health behaviours are related to the demands of being a CST.

Method

An anonymised questionnaire addressing five areas of health (exercise, diet, smoking, alcohol, and sleep) was distributed in UK Deaneries to CSTs with a minimum of 6 months of CST training.

Results

151 CSTs in eight deaneries responded (average Deanery response rate: 27%). 19% exercised ≥4 times per week. 41% exercised >2 hours per week. 33% reported sleeping ≥7 hours per night; 87% reported sleeping less since becoming a CST. 25% ate 5 portions of fruit or vegetables a day, 46% reported eating a balanced diet. 20% drank ≥7 cups of fluid per day. 72-93% of individuals reporting poor health behaviours in these areas stated these were due to the demands and stressors of being a CST. 11% stated they smoked and 3% reported drinking ≥14 units of alcohol per week, 88% and 19% respectively reported deteriorations in these behaviours due CST demands and stressors.

Conclusions

Most CSTs do not lead healthy lifestyles regarding exercise, sleep, and diet. While it is recognised that surgical training is demanding, trainees must be encouraged to value these health behaviours to promote long-term quality of life, career longevity, and mental well-being for the individual. From an institution perspective, the health of surgical trainees should be promoted and supported to ensure an appropriate surgical workforce to meet the demands of our population.
1249 Supporting Emergency theatre Teams with the Use of ENT Equipment
Authors: Sattar Z , Kelly M , an Hutson K
Published: August 2024

Aim

Emergency theatre teams may not always be familiar with the use of ENT equipment out of hours, especially given the relative infrequency of ENT emergencies compared with other surgical specialties. This was one of the factors identified at our district general hospital in a delay to theatre for an emergency ENT case. We aimed to deliver a reference guide and educational session to theatre staff at our hospital as part of a quality improvement project to minimise the risk of delays to theatre in ENT emergencies.

Method

We created an infographic presentation detailing correct use and set up of both the mastoid and endoscopic sinus surgery kits. We delivered an interactive education session and measured the pre- and post-session confidence of the staff using a quantitative rating scale and qualitative feedback.

Results

Sessions were delivered to 14 theatre staff members at our hospital. 100% of respondents reported the minimum level of confidence with the use of ENT equipment prior to the session. 100% of staff reported either 4/5 or 5/5 confidence after the session.

Conclusions

Our project demonstrated positive change and increased staff confidence in using ENT equipment. It may serve as a template for other provider teams with a demonstrated educational need for staff unfamiliar with the use of surgical equipment and kits that are used infrequently. Our project also demonstrates a low-cost and effective method of education for surgical staff and may also be useful as a ‘refresher’ resource for ENT theatre teams.
477 Patient Reported Outcomes and Surgical Site Infection in Surgically Treated Soft Tissue Facial Injury: A Meta-Analysis
Authors: Wong Z Y , Richards M , Wormald J C R
Published: August 2024

Importance

Soft tissue facial injuries (STFI) constitute a significant portion of craniofacial trauma cases and are burdensome to emergency departments. Therefore, this study aims to investigate the risk of surgical site infection (SSI) and the patient-reported outcomes (PROs) for operative management of STFI.

Data Sources A PRISMA-compliant search was conducted and included studies measuring any PRO or the risk of SSI by any classification or diagnostic method. Meta-analysis was performed using R. Pooled effects of primary outcomes were estimated using the DerSimonian and Laird random-effects model/generalised linear mixed model, when feasible.

Results

Out of 8,897 screened studies, 40 were included. 12 studies reported PROs, while 31 reported SSI risk following operative treatment for STFI. The pooled Patient Scar Assessment Scale (PSAS) score at 6-12 months post-intervention (5 studies, n=217) was 16.16 (95%CI 15.34-16.97, p < 0.001). Cosmetic outcomes did not differ across various techniques or suture. Limited evidence was found regarding the effect of surgical treatment in terms of quality of life and psychological impact compared to conservative management. The pooled SSI risk (n=13,524) was 2.68% (n=657; 95%CI 1.59%-4.50%).

Conclusions and Relevance

Our findings emphasise the limited and unreliable evidence available on SSI and PROs following operative treatment for STFI. Future studies employing robust methodologies are needed to investigate optimal approaches for managing STFI effectively.
1020 Drug-Eluting Bead, Irinotecan (DEBIRI) Therapy for Refractory Colorectal Liver Metastasis: A Systematic Review
Authors: Soomro F H , Ansar M , Nazir I , Razzaq A , Khalid M A
Published: August 2024

Introduction

Colorectal cancer and related mortality present a profound challenge in its management, even in this modern age. DEBIRI is a new technique that involves embolisation of the feeding vessels to the tumour and delivering irinotecan for its chemotherapeutic effects. A significant amount of literature compares DEBIRI as an adjunct to various lines of chemotherapy. However, so far, not much data is available on DEBIRI as a singular treatment for those patients who have had multiple chemotherapies and still progressed and are not fit for liver resection. In this systematic review, we aim to highlight and bring together the results of those studies which focused on this specific patient group.

Method

A systematic review of the literature, was conducted to identify articles documenting patients who had disease progression despite chemotherapy and were not fit for surgical resection. The level of evidence and quality was assessed by two independent reviewers.

Results

Out of seven studies that met the final criteria, we found a pooled cohort of 302 patients.The majority of the studies reported only G1/G2 toxicities among the patients, with maximal toxicity of G4 in a few selected patients. The median overall survivll in our pooled cohort was 19.52 months. The median progression-free survival in our data was 5.76 months.

Conclusions

Our systematic review concludes that DEBIRI is undoubtedly a useful treatment modality with an acceptable toxicity profile. This treatment offers a good overall survival benefit for refractory colorectal liver metastasis.
512 Evaluation of Computed Tomography Artefacts of Carbon-Fiber and Titanium Implants in Patients with Spinal Oligometastatic Disease Undergoing Stereotactic Ablative Radiotherapy
Authors: Rijs Z , Saha P , Kawsar K A , van de Sande M , Lui D
Published: August 2024

Aim

This study evaluated artefacts on computed tomography (CT) images using Hounsfield units (HU) in patients with spinal oligometastatic disease (OMD) that received carbon fibre (CF) or titanium spine implants and underwent stereotactic ablative radiotherapy (SABR). Pre- and postoperative HU were measured at the vertebral body, pedicle, and spinal cord at three different levels: the lower instrumented vertebra, the level of metastatic spinal cord compression, and an uninvolved level.

Method

This retrospective single centre study included patients ≥18 years with spinal OMD who received CF or titanium spinal implants (including pedicles, screws, and rods) between 2018 and 2020.A closely matched gender and age group of patients that received CF (n=11) and titanium implants (n=11) was selected because gender- and age-related osteoporotic changes in bone density could potentially influence CT artefact measurements.

Results

Significant differences in HU were observed at the vertebral body, the pedicle, and the spinal cord at the lowest instrumented vertebra level for both CF and titanium (average increase 1.54-fold and 5.11-fold respectively). At the metastatic spinal cord compression level, a trend towards a higher HU-increase was observed in titanium compared with CF (average increase 2.51-fold and 1.43-fold respectively).

Conclusions

The relatively high postoperative HU-increase after insertion of titanium implants indicated CT artefacts, while the relatively low HU-increase of CF implants was not associated with artefacts. Therefore, we propose a CT artefact grading system based on postoperative HU-increase. This could be used in future studies to assess if less CT artefacts lead to better tumoricidal effects and decreased adverse effects after SABR.
1008 Can the Nottingham Hip Fracture Score (NHFS) Predict Mortality After a Fragility Distal Femur Fracture?
Authors: Vaghela M , Benson D , Rogers B , Chan G
Published: August 2024

Aim

Fragility distal femur fractures (DFFs) are associated with comparable 30-day and 1-year mortality rates to fragility hip fractures. Since 2020/21 fragility DFFs have been included in the NICE Best Practice Tariff mechanism, with increasing focus on their outcomes. The Nottingham Hip Fracture Score (NHFS) is a validated risk stratification tool for predicting 30-day mortality after a fragility hip fracture. A NHFS >5 is associated with significantly increased risks of mortality. This study aims to assess the validity of the NHFS in predicting 30-day and 1-year mortality after a fragility DFF.

Method

A retrospective review of all fragility (patients >60-years-of-age) DFFs at a high-volume major trauma unit between October 2014 and December 2021 was performed. Native and periprosthetic DFFs were included. The NHFS was calculated as per the original description by Wiles et. al. Receiver operator characteristic curves (ROC) were constructed and the area under the curve (AUC) was used to assess the reliability to predict mortality.

Results

A total of 183 patients (with 73 periprosthetic DFFs) were included with an overall 2.7% 30-day and 24.6% 1-year mortality. The AUC for 30-day and 1-year mortality ROC showed outstanding and acceptable discrimination respectively (AUC 0.929 and 0.724). These results were maintained when native DFFs and periprosthetic DFFs were analysed individually. A NHFS >5 was associated with a significant increase in mortality risk at 30-day and 1-year (p<0.01).

Conclusions

The NHFS is accurate in predicting 30-day mortality after DFFs in both native and periprosthetic injuries, whilst providing a good indication to 1-year mortality.
1016 Qualitative Account of an Arthroplasty Elective Experience at the Hospital for Special Surgery in New York
Authors: El-Hassan M
Published: August 2024

Aim

Junior doctors applying for Core Surgical Training are awarded points for completing a surgical elective. As a final year medical student in 2023, I travelled to The Hospital for Special Surgery (HSS) in New York, at the Complex Joint Reconstruction Centre for four-weeks. I aim to showcase the benefits of travelling abroad for UK medical students interested in orthopaedic surgery.

Method

This is a qualitative account of my experiences working with attendings and research fellows in the Complex Joint Reconstruction Centre at HSS.

Results

I attended clinics and scrubbed into theatres using a variety of innovative robotic technology in knee arthroplasty, including robotic-assisted knee arthroplasty (Mako Smart Robotics™ and ROSA® Knee System) and computer-assisted technology (Intellijoint KNEE® Surgical Inc, Kitchener, Ontario). I was actively involved in departmental research meetings, drafting two case reports in cementing techniques to improve Varus-Valgus alignment in Total Knee Arthroplasty (TKA). I attended 3D printing workshops which produced custom-implants for complex revision cases.

Conclusions

An elective at HSS gave me an insightful experience with furthering my understanding of complex orthopaedic conditions, taught by pioneering orthopaedic surgeons in the USA. I broadened my experience in Trauma & Orthopaedics, which has allowed me to make a more informed decision in pursuing this specialty. I encourage medical students and junior doctors to pursue similar experiences to further their passion for orthopaedic surgery.
344 Effectiveness of Intra-operative Antibiotics in Reducing Post-Orchidectomy Infection Rates and Subsequent Delays in Chemotherapy
Authors: Rahman I , Raza K , Douglas-Moore J
Published: August 2024

Aim

Radical inguinal orchidectomy is the gold standard treatment for Testicular cancer. Further adjuvant chemotherapy reduces recurrence. Thus, it is imperative to prevent delays in post-operative chemotherapy. Concerns were raised by our Oncology department regarding post-operative infection rates causing such delays. This audit was undertaken to compare our infection rates with that of BAUS’s generally accepted rate of 2-10% post-orchidectomy and determine if our current local practice of using intra-operative antibiotics with no subsequent antibiotic prophylaxis is sufficient.

Method

Patients who underwent radical orchidectomy from January 2022 to January 2023 were retrospectively reviewed. Orchidectomies performed for suspected testicular malignancy were identified and their final histology was noted. Electronic notes were read to check for post-operative infection and delays in chemotherapy.

Results

In total, 29 radical orchidectomies were performed, 10 of which were for suspected testicular malignancy. 2 patients had benign histology. In the other 8 patients, histology confirmed testicular cancer. From these, 6 patients showed no post-operative infection and no delay. 1 patient developed infection, which was managed in primary care, also with no delay to subsequent chemotherapy. 1 patient lacked available notes, so couldn’t be followed up.

Conclusions

Our audit in a large tertiary centre suggests that our current local practice of using a single dose of intra-operative antibiotics is sufficient to prevent post-operative infection and there is no indication for the routine use of post-operative antibiotic prophylaxis. This was a small cohort of patients. Nonetheless, it contributes to the growing evidence demonstrating that routine post-operative antibiotics aren’t indicated in clean urological surgery.
1068 The Clinical and Financial Impact of Unplanned Nephrostomy Dislodgement in the Urology Department
Authors: Wijayasuriya D , McCauley N , Saunders H , Eylert M
Published: August 2024

Aim

Nephrostomies are inserted electively and in the emergency setting to relieve urinary tract obstruction. Local adherence to the national recommended target rate of 10% for nephrostomy reinsertion was measured to assess the quality of patient nephrostomy aftercare. The financial burden of unplanned nephrostomy reinsertion was also measured.

Method

Data was collected retrospectively using the computer software programme for fluoroscopic images to retrospectively identify all patients undergoing nephrostomy insertion in the health board during June-July 2023. The local online clinical portal was used to collect further data for analysis. Further information was collected to calculate the financial implications of nephrostomy re-insertion.

Results

The cost of a nephrostomy insertion was estimated at £1000-1500 per episode when including an overnight stay for observation. A total of 25 nephrostomy insertions were recorded. Of these, 5 required reinsertions during the audit period and 3 unplanned dislodgements occurred within 2 weeks of insertion. These results were presented at a multi-disciplinary education day on the topic of Nephrostomy management with external speakers in attendance. A second cycle of the audit was performed after which demonstrated no perceivable improvement.

Conclusions

Education of staff alonenwas not satisfactory in creating demonstrable improvement in the rate of unplanned nephrostomy dislodgement. The local rate of 16% is much higher than the national acceptable rates of dislodgement. A patient nephrostomy aftercare information leaflet is currently being trialled for the next PDSA cycle. A solution providing patient autonomy and ownership in nephrostomy aftercare may be the key to sustained demonstrable improvement in re-insertion rates.
Alpha transcranial alternating current stimulation as add-on to neglect training: a randomized trial
Authors: Middag-van Spanje Marij , Nijboer Tanja C W , Schepers Jan , van Heugten Caroline , Sack Alexander T , Schuhmann Teresa
Published: August 2024

Visuospatial neglect is a common and debilitating condition following unilateral stroke, significantly impacting cognitive functioning and daily life. There is an urgent need for effective treatments that can provide clinically relevant and sustained benefits. In addition to traditional stroke treatment, non-invasive brain stimulation, such as transcranial alternating current stimulation, shows promise as a complementary approach to enhance stroke recovery. In the current study, we aimed to evaluate the additive effects of multi-session transcranial alternating current stimulation at alpha frequency when combined with visual scanning training in chronic stroke patients with visuospatial neglect. In this double-blind randomized controlled trial, we compared the effects of active transcranial alternating current stimulation at alpha frequency to sham (placebo) transcranial alternating current stimulation, both combined with visual scanning training. Both groups received eighteen 40-minute training sessions over a 6-week period. A total of 22 chronic visuospatial neglect patients participated in the study (active group n = 12, sham group n = 10). The median age was 61.0 years, with a median time since stroke of 36.1 months. We assessed the patients at six time-points: at baseline, after the first, ninth and eighteenth training sessions, as well as 1 week and 3 months following the completion of the combined neuromodulation intervention. The primary outcome measure was the change in performance on a visual search task, specifically the star cancellation task. Secondary outcomes included performance on a visual detection task, two line bisection tasks and three tasks evaluating visuospatial neglect in daily living. We found significantly improved visual search (primary outcome) and visual detection performance in the neglected side in the active transcranial alternating current stimulation group, compared to the sham transcranial alternating current stimulation group. We did not observe stimulation effects on line bisection performance nor in daily living. Time effects were observed on all but one outcome measures. Multi-session transcranial alternating current stimulation combined with visual scanning training may be a more effective treatment for chronic visuospatial neglect than visual scanning training alone. These findings provide valuable insights into novel strategies for stroke recovery, even long after the injury, with the aim of enhancing cognitive rehabilitation outcomes and improving the overall quality of life for individuals affected by this condition.

Trial registration: ClinicalTrials.gov; registration number: NCT05466487; https://clinicaltrials.gov/ct2/show/NCT05466487
Efficacy and Safety of Long-Acting Subcutaneous Lenacapavir in Heavily Treatment-Experienced People with Multidrug-Resistant HIV-1: Week 104 Results of a Phase 2/3 Trial
Authors: Ogbuagu Onyema , Molina Jean-Michel , Chetchotisakd Ploenchan , Ramgopal Moti N , Sanchez William , Brunetta Jason , Castelli Francesco , Crofoot Gordon E , Hung Chien-Ching , Ronot-Bregigeon Sylvie , Margot Nicolas A , Wang Hui , Dvory-Sobol Hadas , Rhee Martin S , Segal-Maurer Sorana
Published: August 2024

Background

Lenacapavir is a long-acting human immunodeficiency virus type 1 (HIV-1) capsid inhibitor for treatment of HIV-1 infection. We evaluated the efficacy and safety of lenacapavir in combination with an investigator-selected optimized background regimen (OBR) after 104 weeks in adults with multidrug-resistant HIV-1.

Methods

This ongoing, international, Phase 2/3 trial at 42 sites included 72 adults living with multidrug-resistant HIV-1. Following a 2-week oral lenacapavir loading phase, participants received subcutaneous lenacapavir every 26 weeks with an OBR. HIV-1 RNA, CD4 cell counts, and adverse events were assessed over 104 weeks. One participant did not enter the extension phase.

Results

At Week 104, 44 of 71 participants (62%, 95% confidence interval [CI]: 50; 73) had HIV-1 RNA <50 copies/mL via US Food and Drug Administration (FDA) snapshot algorithm. When missing data (including discontinuations) were excluded, 44 of 54 participants (82%) had HIV-1 RNA <50 copies/mL at Week 104, mean CD4 cell count increased by 122 cells/µL (95% CI: 80; 165), and the proportion of participants with CD4 cell count <200 cells/µL decreased from 64% (46 of 72) at Baseline to 29% (16 of 55). Fourteen participants had treatment-emergent lenacapavir resistance; 7 resuppressed (HIV-1 RNA <50 copies/mL) while maintaining lenacapavir use. There were no Grade 4 or serious treatment-related adverse events. One participant discontinued study drug due to an injection site reaction.

Conclusions

Treatment with subcutaneous lenacapavir in combination with an OBR was well tolerated and resulted in a high rate of virological suppression over 104 weeks. Lenacapavir represents an important treatment option in people with multidrug-resistant HIV-1.
Estimating glomerular filtration in young people
Authors: Delanaye Pierre , Derain-Dubourg Laurence , Björk Jonas , Courbebaisse Marie , Couzi Lionel , Gaillard Francois , Garrouste Cyril , Grubb Anders , Jacquemont Lola , Hansson Magnus , Kamar Nassim , Legendre Christophe , Littmann Karin , Mariat Christophe , Rostaing Lionel , Rule Andrew D , Sundin Per-Ola , Bökenkamp Arend , Berg Ulla , Åsling-Monemi Kajsa , Åkesson Anna , Larsson Anders , Nyman Ulf , Pottel Hans
Published: August 2024

Background

Creatinine-based equations are the most used to estimate glomerular filtration rate (eGFR). The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), the re-expressed Lund-Malmö Revised (r-LMR) and the European Kidney Function Consortium (EKFC) equations are the most validated. The EKFC and r-LMR equations have been suggested to have better performances in young adults, but this is debated.

Methods

We collected data (GFR) measured by clearance of an exogenous marker (reference method), serum creatinine, age and sex from 2366 young adults (aged between 18 and 25 years) both from Europe and the USA.

Results

In the European cohorts (n = 1892), the bias (in mL/min/1.73 m²) was systematically better for the EKFC and r-LMR equations compared with the CKD-EPI equation [2.28, 95% confidence interval (1.59; 2.91), –2.50 (–3.85; –1.76), 17.41 (16.49; 18.47), respectively]. The percentage of estimated GFR within 30% of measured GFR (P30) was also better for EKFC and r-LMR equations compared with the CKD-EPI equation [84.4% (82.8; 86.0), 87.2% (85.7; 88.7) and 65.4% (63.3; 67.6), respectively]. In the US cohorts (n = 474), the bias for the EKFC and r-LMR equations was better than for the CKD-EPI equation in the non-Black population [0.97 (–1.69; 3.06), –2.62 (–5.14; –1.43) and 7.74 (5.97; 9.63), respectively], whereas the bias was similar in Black US individuals. P30 results were not different between the three equations in US cohorts. Analyses in sub-populations confirmed these results, except in individuals with high GFR levels (GFR ≥120 mL/min/1.73 m²) for whom the CKD-EPI equation might have a lower bias.

Conclusions

We demonstrated that both the EKFC and r-LMR creatinine-based equations have a better performance than the CKD-EPI equation in a young population. The only exception might be in patients with hyperfiltration.
Unravelling monocyte functions: from the guardians of health to the regulators of disease
Authors: Mildner Alexander , Kim Ki-Wook , Yona Simon
Published: August 2024

Monocytes are a key component of the innate immune system. They undergo intricate developmental processes within the bone marrow, leading to diverse monocyte subsets in the circulation. In a state of healthy homeostasis, monocytes are continuously released into the bloodstream, destined to repopulate specific tissue-resident macrophage pools where they fulfil tissue-specific functions. However, under pathological conditions monocytes adopt various phenotypes to resolve inflammation and return to a healthy physiological state. This review explores the nuanced developmental pathways and functional roles that monocytes perform, shedding light on their significance in both physiological and pathological contexts.
Long-term outcomes among out-of-hospital cardiac arrest survivors with reversible vs. non-reversible causes
Authors: Barcella Carlo Alberto , Grunau Brian E , Guan Meijiao , Hawkins Nathaniel M , Deyell Marc W , Andrade Jason G , Helmer Jennie S , Wong Graham C , Kragholm Kristian H , Humphries Karin H , Christenson Jim , Fordyce Christopher B
Published: August 2024

Aims

A reversible cause of out-of-hospital cardiac arrest (OHCA) is vaguely defined in international guidelines as an identifiable transient or potentially correctable condition. However, studies evaluating long-term outcomes of patients experiencing OHCA due to reversible and non-reversible causes are lacking. We aimed to determine differences in long-term outcomes in OHCA survivors according to different aetiology.

Methods and results

From the British Columbia Cardiac Arrest registry, adults with non-traumatic OHCA (2009–2016) surviving to hospital discharge were identified. Patients were categorized by OHCA aetiology combining reversibility and underlying ischaemic aetiology. The primary outcome was a composite of all-cause mortality, recurrent OHCA, or re-hospitalization for sudden cardiac arrest or ventricular arrhythmias. Using the Kaplan–Meier method and multivariable Cox regression models, we compared the risk of the composite outcome according to different OHCA aetiology. Of 1325 OHCA hospital-discharge survivors (median age 62.8 years, 77.9% male), 431 (32.5%) had reversible ischaemic, 415 (31.3%), non-reversible ischaemic, 99 (7.5%), reversible non-ischaemic, and 380 (28.7%), non-reversible non-ischaemic aetiologies. At 3 years post discharge, the Kaplan–Meier event-free rate was highest in patients with a reversible ischaemic aetiology [91%, 95% confidence interval (CI) 87–94%], and lowest in those with a reversible non-ischaemic aetiology (62%, 95% CI 51–72%). In multivariate analyses, compared with non-reversible non-ischaemic cause, reversible ischaemic cause was associated with a significantly lower hazard ratio (HR; 0.52, 95% CI 0.33–0.81), reversible non-ischaemic cause with a significantly higher HR (1.53, 95% CI 1.03–2.32), and non-reversible ischaemic cause with a non-significant HR (0.92, 95% CI 0.64–1.33) for the composite outcome.

Conclusion

Compared to other aetiologies, the presence of a reversible ischaemic cause is associated with improved long-term OHCA outcomes.