bluuebunny/crossref_metadata_2025 huggingface dataset:
382 Compliance With Current Excision Margin Guidelines for Non-Melanoma Skin Cancer: Do We Make the Cut?
Authors: Kungwengwe G. , Li Z. , Nijran A. , Ibrahim Y. , Tang L.
Published: February 2022

Aim

Non-melanoma skin cancers (NMSC) are the most common malignancies worldwide, with basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) constituting an ever-growing clinical burden within Plastic & Reconstructive Surgery. In this 3-cycle Quality Improvement (QI) initiative we sought to evaluate and improve our unit’s compliance with British Association of Dermatology (BAD) guidance on excision margins for NMSCs.

Method

Following results from two Plan-Do-Study-Act (PDSA) cycles, a third retrospective review of clinic letters, operative notes and histopathology reports was undertaken to identify NMSCs that were excised during May 2021 and assess compliance with recommended excision margins according to risk stratification.

Results

The dissemination of cycle 1 findings at departmental meetings, as well as the implementation of guideline posters and operative note templates conferred a significant improvement in both clinical documentation (12% to 100%) and local compliance with excision margin guidelines for BCCs (53% to 71%) and SCCs (50% to 79%). Following the adoption of new BAD guidelines on SSC margins in early 2021, a third cycle comprising 42 lesions demonstrated a sustained improvement in clinical documentation (100%) after a 7-month period and similar guideline compliance rates for both BCC (67%) and SCC (78%).

Conclusions

Adequate excision margins in cutaneous malignant pathology are vital to ensure complete removal, thus minimising the risk of recurrence. Although improvement across the PDSA cycles has been sustained despite the introduction of new SCC margin guidelines, we aim to introduce further interventions such as a knowledge and practice survey to continue improving excision margin compliance.
386 Consent Practices in General Surgery – the Importance of the “Process”?
Authors: Martyn C.J. , McGowan K.E. , Clements J.M. , Kirk S.
Published: February 2022

Aim

Achieving valid informed consent is an essential component of the shared decision-making process. National guidance exists on the content of consent discussions. However, controversy exists as to when consent should be obtained. We aimed to assess consent practices in our institution.

Method

A Prospective snapshot audit was conducted on consecutive general surgical patients undergoing elective surgery over a 4-week period. Information on consent discussions were obtained from electronic patient care records and from the written consent form prior to surgery. Local audit approval was granted.

Results

56 patients underwent an elective general surgical procedure in August 2021. Median age was 55. 73% (n = 41) were female. 63% of cases were for malignant disease (n = 35). All patients had capacity. 95% (n = 53) completed their consent form on the day of surgery. 54 patients had documented pre-operative consultant consultations with all patients receiving a diagnosis and discussion regarding treatment. 69% of patients underwent discussion about alternative options. Discussion about surgical risk took place in 30% of cases.

Conclusions

Variation exists in pre-operative consent discussions. However, these discussions reflect consent as a “continuum” which may carry greater importance than the act of signing a consent form at an isolated time point.
392 Outcomes of Anatomical Custom Patient-Specific Implants After 3D CT Pre-Operative Planning for Complex Hip Conditions
Authors: Petohazi A. , Musbahi O. , Akilapa O. , Gee M. , Harnett P.
Published: February 2022

Aim

Primary THA in complex hip conditions presents a challenge for an orthopaedic surgeon. Often, the anatomical restoration is less than ideal with an “off the shelf” implant. The use of 3D planning with customized implants is an emerging technology to meet this challenge. However, patient outcomes are unknown. In this study, we present the 1-year results of patients with complex hip conditions undergoing custom implants and 3D pre-operative planning.

Method

We conducted a retrospective review of all patients that underwent 3D planning and custom Total Hip Arthroplasty implant. Demographic data and indications were collected. Operative details and postoperative complications were reviewed. Post-operative radiographic assessment and measurements were reviewed. Oxford Hip scores at 1 year were compared with national standards.

Results

Sixteen patients underwent Total Hip Replacement after Symbios 3D Preoperative planning with custom made implants at 1 Major Trauma Centre. The mean age was 43 consisting of 8(50%) females and 8 males. The most common indication was hip dysplasia(5/16). Mean Operative time was 114mins(range80–200mins). Mean operative blood loss was <500ml and length of stay were 3 days. Mean Oxford Hip Scores at 1 year was 45/48. There were no signs of radiographic loosening or dislocation.

Conclusions

Custom implants after 3D planning is an effective treatment for restoring anatomy and improving functional outcomes. Outcomes were comparable to national standards to patients undergoing primary total hip arthroplasty for osteoarthritis.
403 The Difficulties of Managing Trauma in Elderly Patients in a West of Scotland Trauma Unit
Authors: Nair G. , Silverwood R. , Jeyakumar G. , Davison M. , Bailey O.
Published: February 2022

Aim

An increasing number of elderly patients require admission to Trauma & Orthopaedic units throughout Scotland with admissions often complex and lengthy. We aimed to assess the current standard of care within a west of Scotland trauma unit against the 2019 British Orthopaedic Associations Standard of Care (BOAST) - “The care of the older or frail orthopaedic trauma patient” and devise a multi-disciplinary quality improvement strategy.

Method

All patients over the age of 65 admitted to the Trauma & Orthopaedic department of the University Hospital Wishaw between the 1st-14th of August 2020 were included. Online medical records were assessed and compared to the BOAST guideline. Results were presented to Orthopaedic and Care of the elderly (COTE) team and postgraduate teaching before being re-audited from 1st-14th May 2021. Data was analysed using Chi- Squared test.

Results

Cycle one vs Cycle two:

Falls risk assessment was carried out in 50/57(87.7%) vs 49/57(86.0%); Nutritional assessment carried out in 53/57(93.0%) vs 50/57(87.7%); Delirium assessment carried out in 54/57(94.7%) vs 47/57(82.5%). More patients were reviewed by Acute Care of the Elderly nurses 24/57(42.1%) vs 30/57(52.6%). No significant improvement was seen in the percentage of patients reviewed by a COTE consultant:15/57(26.3%) vs 17/57(29.8%) (P = 0.68).

Conclusions

Both cycles show good concordance with the BOAST criteria, including physiotherapy reviews, falls and delirium assessment, however significant deficiencies exist, including the provision of COTE input. This has prompted a reconfiguration of orthogeriatric input for trauma patients, with significant investment in the recruitment of COTE medical staff.
406 SARS-CoV-2 Vaccination Modelling for Safe Surgery to Save Lives: Data from an International Prospective Cohort Study
Authors: Gohar M. , Simoes J. , Nepogodiev D.
Published: February 2022

Aim

Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling.

Method

The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty.

Results

NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year.

Conclusions

As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.
416 Venous Thromboembolism Prophylaxis in Emergency Surgical Admission: The Power of a Checkbox in Reducing Errors. a Closed Audit
Authors: Dhannoon A. , Hogan A.
Published: February 2022

Introduction

Hospital-acquired venous thromboembolism (VTE) is considered a significant cause of morbidity and mortality in all inpatients. It is potentially preventable with adequate thromboprophylaxis. All surgical patients should be assessed and commenced on an appropriate dose of anticoagulant agent.

Drug charts of 40 patients admitted under general surgery teams at Galway University Hospital were reviewed and audited against the Irish VTE prophylaxis guidelines release in 2019.

Results

A total of 40 (21 M, 19 F) patients were included, 2 out of the 40 patients (30%) were adequately assessed not suitable for chemoprophylaxis, two patients were not missed in the absence of risk factors of bleeding. Of the remaining 36 patients, 29 were adequately treated with chemoprophylaxis and 7 patients were undertreated or overtreated by doses inadequate to their weight and renal clearance. 35 out 40 patients were charted for TED stockings this falls under the 100% standard.

Intervention: An educational presentation, along with collaborative agreement with the pharmacy department to add two checkboxes on the prophylactic anticoagulant page of the carder to highlight the renal function and the weight to the prescriber.

Re-audit: On re-auditing the data, 40 patients were included, 2 patients have contraindications factors for anti-coagulant. out of 38 patients remaining, 37 of them received weight and renal function-adjusted doses of prophylactic anticoagulants. All 40 patients received TED stockings.

Conclusions

Check boxes on the prescription sheet act as effective reminders for the busy junior doctor prescriber to highlight the importance of weight and renal function when prescribing anti-coagulants.
1 Mobile Health Apps in Burns: Where Is the Quality Control?
Authors: Patel B. , Edwards T. , Schrire T. , Senn S.
Published: February 2022

Aim

High quality mobile health applications (mhealth apps) have the potential to enhance the prevention, diagnosis, and treatment of burns. The primary aim of this study was to evaluate whether the quality of mhealth apps for burns care is being adequately assessed. The secondary aim was to determine whether these apps meet UK regulatory standards.

Method

We searched AMED, BNI, CINAHL, Cochrane library, Embase, Emcare, Medline and PsychInfo to identify studies assessing mhealth app quality for burns. The PRISMA reporting guideline was adhered to. Two independent reviewers screened s to identify relevant studies. We analysed whether seven established domains of mhealth app quality were assessed: design, information/content, usability, functionality, ethical issues, security/privacy, and user-perceived value.

Results

Of the 28 included studies, none assessed all seven domains of quality. Design was assessed in 4/28 studies; information/content in 26/28 studies; usability in 12/28 studies; functionality in 10/28 studies; ethical issues were never assessed in any studies; security/privacy was not assessed; subjective assessment was made in 9/28 studies. 17/28 studies included apps that met the definition of ‘medical device’ according to MHRA guidance, yet only one app was appropriately certified with the UK Conformity Assessed (UKCA) mark.

Conclusions

The quality of mHealth apps for burns are not being adequately assessed. The majority of apps should be considered medical devices according to UK standards, but only one was appropriately certified. Regulatory bodies should support mhealth app developers, so as to improve quality control whilst simultaneously fostering innovation.
44 Early and Long-Term Outcomes of Re-Sternotomy Aortic Valve Replacement (AVR) With Previous Coronary Artery Bypass Grafts (CABG)
Authors: Okorocha C. , Sarvananthan S. , Malvindi P. , Luthra S. , Ohri S.
Published: February 2022

Introduction

With the wider use of biological prosthetic valves and increasing life expectancy, the number of patients requiring redo surgery for aortic valve replacement (AVR) is increasing. This carries its own risks particularly in those with previous cardiac surgery - from graft injury and myocardial jeopardy. Transcatheter valve replacement provides a safer option for high-risk patients that do not require any additional cardiac surgery. This project aims to evaluate the early and long-term outcomes of redo-sternotomy AVR after previous CABG.

Method

Retrospective study of patients that underwent redo sternotomy AVR with (Group 1) or without (Group 2) concomitant cardiac procedure(s) from 2000–2019. Pre-operative, operative and post-operative data collected for each patient. Statistical analysis done with significance p-value <0.15.

Results

178 patients included during this time-period (Group 1 = 90 and Group 2 = 88). Mean age of 75 years and EuroSCORE of 17. In hospital-mortality was 7.8% with key contributing factors of heart failure (NYHA III-V), perioperative IABP insertion and cardiovascular injury - 12% of cases and most commonly effecting the left internal mammary artery (LIMA). Survival at 5 years in both groups is significantly worse for patients with post-operative complications and cardiovascular injury. However, long-term survival is better in Group 1 than in Group 2.

Conclusions

Risk of injury to LIMA increases operative mortality. Peripheral cannulation and pre-sternotomy cardiopulmonary bypass can help manage this - although numbers in this study too small. Alternatives to redo valve surgery are to be considered in high-risk patients and a multidisciplinary approach continued to be adopted for each case.
52 Evaluating the Outcomes of Anal Squamous Cell Carcinoma with Curative Intent- a 10-Year Experience
Authors: Noureldin K. , Ayantunda A. , Issa M. , Jones L.
Published: February 2022

Background

Our 10-year experience in treating anal squamous cell carcinoma (ASCC) with curative intent.

Method

Clinical and pathological data were analysed between January 2011 and December 2019. All patients underwent the standard workup and treated accordingly. Patients were followed up according to the network protocol. The outcome measures were clinicopathological characteristics, treatment modalities, response, recurrence, disease-free and overall survival.

Results

117 patients followed up over the 10-year. 26 patients treated palliatively, 11 patients with adenocarcinoma, 1 melanoma, 1 Paget disease and 1 carcinoid tumour were excluded. Median age was 65 (38–90) years with male to female ratio of 1:1.9. 3 patients were HIV+ve and 52% of the patients had AIN of varying degree of dysplasia. AJCC stages were I (16), II (18), IIIA (19), IIIB (9) and IV (15). 88.3%% of the patients had radical chemoradiotherapy while 9 patients with tumour ≤2cm underwent wide local excision. 81.8% of the patients treated with radical chemoradiotherapy had complete response while (5/77) had partial response.4 patients with incomplete response underwent salvage APER. Recurrence rate was 13%.

The overall mean survival time was 99.82 (95% CI 88.87–110.77) months with 5-year survival rate 78.0%. Overall recurrence rate was 13.0%. Mean disease-free survival time in 77 patients was 111.82 (95% CI 102.38–121;26) months. 75.3% of the patients were alive at the end of the study with an overall mortality rate was 24.7% and disease-specific mortality was 15.6%.

Conclusions

Recurrent anal SCC occurred in 1 in 10 after radical chemo-radiotherapy with disease-specific mortality of 26%.
126 The Theatre Training Checklist: A Toolkit to Improve Operative Training
Authors: Aldoori J. , Burke J. , Robson A. , Al-Attar A. , Giwa L. , O'Regan D. , Peter M.
Published: February 2022

Aim

The operating theatre is expensive, costing approximately £1200 per hour to run. It is a crucial learning environment for many different trainees: anaesthetists, surgeons, operation department practitioners, etc. For individuals to achieve their training requirements, the operating theatre as a training environment must be shared between all trainees, requiring excellent teamwork and leadership. This could be improved by the adoption of innovative training strategies.

Method

The Theatre Training Checklist is a simple framework that aims to facilitate awareness, understanding, coordination and cooperation of training for all team members. It is a practical strategy that can be adopted in any setting. Usually, trainers discuss informally with their trainees about their individual skills, experience, expectations and what is achievable in a theatre list. However, there is currently limited opportunity to discuss this between different disciplines and the wider team. This tool aims to refine communication, optimize training, manage expectations, and ensure equity across the board.

Results

The checklist is completed at the start of the list during the theatre brief. It identifies all trainees and their specific needs within the operating theatre session to the whole team. An agreed strategy is developed on how to achieve identified training goals. Feedback undertaken from the MDT after local trailing of the checklist has been positive.

Conclusions

The toolkit is available for use and consists of the checklist tool and an instructional video. The checklist is being piloted in some centres and we hope to have the opportunity to present some early findings to the ASiT Innovation Summit.
150 Muscle Quantity at C3 And/or L3 on Routine Trauma Series Computed Tomography Correlate with Brain Frailty and Clinical Frailty Scale: A Cross-Sectional Study
Authors: Gomindes A. , Welch C. , Chugh R. , Appleton J.
Published: February 2022

Background

Sarcopenia is increasingly recognised to impact the quality of life and patient outcomes. The relationship with brain frailty is unknown.

Objectives

Assess if muscle mass at C3 correlates with muscle mass at L3 on routine trauma imaging. Assess for associations between muscle-mass, brain-frailty, and Clinical Frailty Scale (CFS) on routine trauma imaging.

Method

Routine trauma-series CT scans were retrospectively analysed for patients aged ≥16-years-old admitted to Queen-Elizabeth-Hospital in January2020. Paravertebral, sternocleidomastoid, and total muscle cross-sectional-area (CSA) at C3 (C3-SMM), and total psoas muscle CSA (TPA), total muscle CSA (L3-SMM), and total adipose CSA at L3 were calculated. Brain-frailty scores were calculated assessing for leukoaraiosis, cerebral atrophy, and old vascular lesions/infarcts. CFS was calculated retrospectively from clinical notes. We assessed for correlation against age, CFS, muscle-mass, and brain-frailty using Pearson’s correlations.

Results

We included 111 patients in this study (mean age 49, SD 25.6; 65.8% female). C3-SMM strongly correlated with L3-SMM (r=0.746, p<0.001). Paravertebral and sternocleidomastoid CSA correlated with C3-SMM (paravertebral: r=0.814, p<0.001; sternocleidomastoid: r=0.814, p<0.001). TPA strongly correlated with L3- SMM (r=0.800, p<0.001). Sternocleidomastoid CSA and TPA both negatively correlated moderately with age (sternocleidomastoid: r=−0.460, p<0.001; TPA: r=−0.468, p<0.001), CFS (sternocleidomastoid: r=−0.414, p<0.001; TPA: r=−0.431, p<0.001), and brain frailty (sternocleidomastoid: r=−0.395, p<0.001; TPA: r=−0.436, p<0.001). Adipose CSA at L3 did not correlate with age, CFS, brain-frailty, or muscle-mass.

Conclusions

Muscle-mass at C3 relates to muscle-mass at L3. Muscle-mass on routine trauma-imaging is negatively associated with age, CFS, and brain-frailty.
176 Did Hand Washing and Use of Personal Protective Equipment (PPE) Reduce Transmission of Surgical Site Infections During the SARS-CoV-2 Pandemic?
Authors: Hunt A. , Nasr H. , Willmott H. , Patel P.
Published: February 2022

Aim

A retrospective case-control study comparing Surgical Site Infections (SSIs) following primary hip and knee arthroplasty before and during the SARS-CoV-2 pandemic across East Sussex NHS Trust (ESHT). The aim of this study was to evaluate whether the government advice relating to increased vigilance surrounding hand hygiene and use of personal protective equipment (PPE) reduced SSIs following elective arthroplasty.

Method

Data was obtained from Public Health England website relating to SSIs following primary hip and knee arthroplasty between April 2019 and March 2020 (pre-pandemic) performed at ESHT and compared to April 2020 to March 2021 (pandemic).

Results

A total of 454 patients underwent a total hip replacement (THR) during the pre-pandemic period with 12 patients developing an SSI (2.6%). Comparatively, during the pandemic period, 146 patients underwent a THR with 4 reporting an SSI (2.7%). A total of 449 patients underwent a total knee replacement (TKR) during the pre-pandemic period with 11 reporting an SSI (2.5%). In contrast, 9 of the 138 patients undergoing a TKR during the pandemic group developed an SSI (6.5%).

Conclusions

As the data shows, there was no significant difference observed between SSIs following THR performed at ESHT prior to and during the pandemic. Surprisingly, there was a 2.6-fold increase in SSI following TKR during the pandemic period compared with pre-pandemic. Both of these findings seemingly reject the null hypothesis that increased vigilance to hand hygiene and use of PPE mandated by the government and echoed by healthcare trusts during this time would reduce transmission of infections.
276 Safety of Maintaining Elective and Emergency Surgery During the COVID-19 Pandemic with the Introduction of an Innovative Protected Elective Surgical Unit (PESU): A Cross-Specialty Evaluation of 30-Day Outcomes in 9925 Patients Undergoing Surgery in a University Health Board
Authors: Minto T. , Abdelrahman T. , Jones L. , Shivakumar N. , Wheat J. , Ansell J. , Seddon O. , Cronin A. , Tomkinson A. , Theron A. , Trickett R. , Kynaston H. , Sagua N. , Sultana S. , Clark A. , McKay E. , Johnson A. , Behera K. , Towler J.
Published: February 2022

Aim

High quality mobile health applications (mhealth apps) have the potential to enhance the prevention, diagnosis, and treatment of burns. The primary aim of this study was to evaluate whether the quality of mhealth apps for burns care is being adequately assessed. The secondary aim was to determine whether these apps meet UK regulatory standards.

Method

We searched AMED, BNI, CINAHL, Cochrane library, Embase, Emcare, Medline and PsychInfo to identify studies assessing mhealth app quality for burns. The PRISMA reporting guideline was adhered to. Two independent reviewers screened s to identify relevant studies. We analysed whether seven established domains of mhealth app quality were assessed: design, information/content, usability, functionality, ethical issues, security/privacy, and user-perceived value.

Results

Of the 28 included studies, none assessed all seven domains of quality. Design was assessed in 4/28 studies; information/content in 26/28 studies; usability in 12/28 studies; functionality in 10/28 studies; ethical issues were never assessed in any studies; security/privacy was not assessed; subjective assessment was made in 9/28 studies. 17/28 studies included apps that met the definition of ‘medical device’ according to MHRA guidance, yet only one app was appropriately certified with the UK Conformity Assessed (UKCA) mark.

Conclusions

The quality of mHealth apps for burns are not being adequately assessed. The majority of apps should be considered medical devices according to UK standards, but only one was appropriately certified. Regulatory bodies should support mhealth app developers, so as to improve quality control whilst simultaneously fostering innovation.
280 IRT30 [Inadvertent Returns to Theatre Within 30 Days]: Highlighting the Value of This Novel Metric as a Measure of Surgical Performance
Authors: Kakos C. , Clements J.S. , Clements B.W.D.
Published: February 2022

Introduction

Unplanned return to theatre is commonly associated with a problem at the original operation. IRT30 is a potentially valuable but underutilised metric. Use of this metric in Governance Meetings allows for standardisation of the selection of patients, objective assessment of morbidity & mortality, and can facilitate an improvement in surgical performance and ultimately outcome.

Method

The complications associated with IRT30 can be graded from Type I to V ranging from Avoidable/Understandable/Major/Serious through to ‘Never events’. We reviewed all emergency procedures prospectively from February to April 2021. Planned returns and returns after 30 days from index operation were excluded. Patients’ notes were individually reviewed, and cases were grouped by subspecialty [Colorectal, Upper Gastrointestinal (UGI) and General] and ‘IRT30 graded’ accordingly.

Results

A total of 486 cases were performed. 20 were unplanned returns to theatre (4.3%). The majority of cases were Colorectal [75% (15/20)] with 20% UGI (4/20)]. There were 3 Type 1, 6 Type 2 and 11 Type 3 IRT30. 4 patients with perianal sepsis required further surgery (Type 2). Bleeding, ischaemia, and anastomotic leak were most commonly associated with IRT30. No ‘serious’ or ‘never’ events were recorded.

Conclusions

IRT30 is an underutilised useful objective metric that can be employed routinely in Governance meetings to improve surgical performance and outcomes. Perianal sepsis requires experienced involvement at the index operation. Bile leaks are more frequent than perhaps we expect following laparoscopic cholecystectomy, but a proactive approach should be encouraged.
63 Effects of Surgery, Chemotherapy, and Radiation on Hepatocellular Carcinoma Patients: A SEER-Based Cohort study
Authors: Kar I. , Qayum K.
Published: February 2022

Aim

To assess the effect of surgery, chemotherapy, and radiation on the mortality risk in hepatocellular carcinoma (HCC) patients.

Method

A retrospective cohort study, obtaining HCC patients' data from the Surveillance, Epidemiology, and End Results (SEER) database. We used Pearson's chi-square test for evaluating the association between the different variables, the Kaplan–Meier, and the Cox regression tests in the univariate and multivariate analyses respectively.

Results

A total of 68270 HCC patients were analysed. In patients who performed surgery, the mortality risk was higher in patients aged ≥50 years, Black, single, and widowed, regional, and distant stages, and grades II, III, and IV (HR, 1.143), (HR, 1.057), (HR, 1.095), (HR, 1.284), (HR, 1.341), (HR, 2.291), (HR, 1.125), (HR, 1.711), and (HR, 1.894) respectively. In patients who received chemotherapy, the risk was lower in females (HR, 0.948), but higher in widowed (HR, 1.143), in regional and distant stages (HR, 1.479), and (HR, 2.439) respectively, and grades III, and IV (HR, 1.741), and (HR, 1.688) respectively. In patients who received beam radiation, the risk was higher in Black (HR, 1.195), widowed (HR, 1.181), regional (HR, 1.439), and distant stages (HR, 2.287), and in grades III (HR, 1.594), and IV (HR, 1.694).

Conclusions

In HCC patients, Black, widowed, regional, and distant stages, grades III and IV had higher mortality risks in several treatment options. In patients who underwent surgery, ≥50 years years and grade II also had a higher risk. We recommend future research to assess the radiation sequence with surgery.
92 Evaluation of an Artificial Intelligence (AI) System to Augment Clinical Risk Prediction of Trauma Induced Coagulopathy: A Prospective Observational Study
Authors: Marsden M. , Perkins Z. , Marsh W. , Christian M. , Lyon R. , Davenport R. , Tai N.
Published: February 2022

Introduction

The potential of AI systems to support pre-hospital clinical decision-making is significant. However, whilst such algorithms are increasingly available, far less attention has been paid to understanding the impact of such systems on clinical performance. This study had two aims; first, to compare the performance of expert clinicians against an AI system in a real-world clinical setting and second, to assess the impact of augmenting expert clinical prediction with an AI system.

Method

We performed a prospective study at two UK Air Ambulances services over a six-month period. Expert pre-hospital clinicians’ judgement of the risk of Trauma Induced Coagulopathy (TIC) in injured patients was assessed and compared to the performance of an AI system. Two TIC risk predictions were generated for every patient: an AI prediction and a human prediction.

Results

Overall, 51 expert clinicians were enrolled in the study providing 184 patient interactions for analysis.

Aim 1

The AI system performed better than clinicians; higher discrimination [AUROC 0.87 (0.79, 0.95) versus 0.83 (0.74, 0.92)] better calibration [0.37 (-0.14, 0.89) versus -1.19 (-1.73, -0.65)] and more accurate [Brier Skill Score 0.34 (0.19, 0.48) versus 0.00 (-0.41, 0.30)].

Aim 2

Risk prediction was better in all performance metrics when clinicians were assisted with the AI system [AUROC 0.88 (0.80, 0.95) versus 0.83 (0.74, 0.92)]

Conclusions

AI systems can improve human risk prediction in the pre-hospital setting. In settings of low resources where a lack of senior clinical expertise may affect outcomes, the benefit of implementing predictive AI is substantial.
Profitability and drug discovery
Authors: Işık Enes , Orhangazi Özgür
Published: February 2022

Pharmaceutical firms are highly profitable due to high markups enabled by high drug prices. This is justified by the argument that high profits provide incentives for innovation and help fund high research and development (R&D) costs. We investigate the link between past profitability and drug discovery for large publicly-listed pharmaceutical firms between 1980 and 2018. Our sample includes 118 firms with 2534 firm-year observations and in terms of sales corresponds to 55% of the global spending on drugs. By merging three data sets on firm financials, new patent applications, and new drug approvals, we show that pharmaceutical firms’ markups and profitability are consistently higher than average nonfinancial firm profitability, with secularly increasing trends since 1980. Whereas R&D spending has also increased, the number of new drug approvals has not increased at the same pace and the productivity of R&D spending has been declining. In statistical analysis, we fail to identify any strong positive relationship between profitability and new drug discovery. Results are broadly in line with the earlier findings of research on the pharmaceutical industry and provide a contribution to the discussion on the link between profitability and innovation as well as on formulating policies for increasing drug innovation and ensuring the provision of essential drugs while keeping their costs low.
Well-rounded pharmacists: a longitudinal evaluation of a multi-sector pre-registration programme
Authors: Bartlett Sophie , Bullock Alison , Broad Bethan , Doyle Laura
Published: February 2022

Introduction

Pharmacists traditionally work in either hospital or community settings and increasingly in primary care. As demands on health care continue to rise, pharmacists need a well-rounded understanding of the patient journey and transfer of care and be capable of working in any setting. In response, Health Education and Improvement Wales (HEIW) launched a multi-sector pre-registration pharmacy training programme. Trainees experience all three pharmacy settings throughout the year, in contrast to the traditional, single-sector programmes.

Objectives

To explore the views of the now-qualified pharmacists, their tutors and line managers on the multi-sector programme and how it prepares pharmacists for practice.

Methods

This longitudinal study followed pharmacists through the multi-sector programme, to approximately 1 year post-registration. Data were collected via interviews (n = 27) with pharmacists, tutors and line managers. All data were pattern coded and analysed thematically.

Key findings

Pharmacists maintained that they benefited from the multi-sector training programme and would choose this option again. Pharmacists, tutors and line managers considered that the programme provided a more holistic perspective of pharmacy than single-sector programmes and a greater understanding of patient journeys and transfer of care. Nonetheless, there remains a lack of consensus on how the programme is best structured, and there is scope to increase the hands-on experience in primary care settings.

Conclusions

Greater communication across sectors and smoother transfer of patient care benefit employers and patients as well as the pharmacists. Recommendations for future multi-sector programmes are suggested.
Fighting Organized Crime by Targeting their Revenue: Screening, Mafias, and Public Funds
Authors: Daniele Gianmarco , Dipoppa Gemma
Published: February 2022

Repressive policies to fight criminal organizations are often met with a violent response from criminal groups. Are non-repressive strategies more effective? Targeting criminal revenues can be a powerful tool if the threat of investigation is credible and if criminals are unable to displace their activity to avoid controls. We study an Italian policy designed to tackle mafia misappropriation of public funds by screening companies applying for subsidies over 150,000 Euros. Using all subsidies to firms co-financed by the European Union from 2008 to 2015, we find that a group of firms starts self-selecting below the threshold immediately after its introduction. Those firms are concentrated in mafia-affected cities, are lower performing, operate in typical mafia sectors, and have balance sheet indicators of money laundering. While avoiding violence, non-repressive strategies might have different unintended consequences: criminal organizations react with an immediate strategic displacement which reduces states’ capacity to detect them, highlighting the importance of designing policies that anticipate the sophistication of criminal organizations.
Perceptions of Symptom Duration are Associated With Emotional Distress and Functioning in Adolescents With Protracted Concussion Recovery
Authors: Plourde Vickie , Silverberg Noah D , Cairncross Molly , Virani Shane , Brooks Brian L
Published: February 2022

Adolescents with persisting post-concussive symptoms often report high levels of emotional distress, which can impact their daily functioning. The associations between modifiable factors, such as perceptions of recovery, and emotional distress have not been investigated in this age group.

Objective

To evaluate perceptions about recovery duration (e.g., “my symptoms will last a long time”, “my symptoms will be permanent rather than temporary”) and its associations with emotional distress and functioning in children and adolescents with a slower post-concussive recovery.

Methods

Participants (N = 49, 69% girls, 11–17 years old, M = 15.8 years old, SD = 1.8) were recruited from a concussion clinic on average 7.7 months after injury (SD = 2.5). Measures included the Illness Perception Questionnaire Revised (perceived duration of symptoms only) to evaluate recovery expectations, the Health and Behavior Inventory (self and parent reports) to evaluate current post-concussive symptoms (cognitive and somatic symptoms), the emotional distress subscale of the Strengths and Difficulties Questionnaire (SDQ—self-report), and the emotional functioning subscale of the Pediatric Quality of Life Questionnaire (PedsQL—self-report).

Results

Regression analyses (linear models with all covariates entered at once) suggested that greater expectations for symptom persistence were significantly associated with higher emotional distress on both SDQ and PedsQL subscales, after controlling for post-concussive symptom severity and other confounds. Emotional distress/functioning was not associated with perceptions of symptom duration reported by parents, severity of post-concussive symptoms (self- and parent reports), age, number of concussions, time since injury, or a history of mental health concern or diagnosis (parent-reported).

Conclusions

This study suggests that pessimistic attitudes for recovery duration may be more strongly associated with emotional distress than current post-concussive symptom severity or a history of mental health concern or diagnosis.
Energy justice in a net-zero world
Authors: Tomain Joseph P
Published: February 2022

Net-zero energy (NZE) plans have been announced by federal and state governments, international corporations and domestic utilities, and by think tanks and non-governmental organizations (NGOs). These plans often identify one or more of the five dimensions of energy justice. This article finds that individual NZE plans emphasize different dimensions of energy justice. Think tanks, as an example, address distributive justice while corporate and utility plans provide for procedural and recognition justice. The article concludes by noting that energy justice is not well served in many NZE plans and closes with recommendations for greater attention to energy justice in an NZE future.
Prologue
Authors: Gussak David E.
Published: February 2022

This Prologue introduces the genesis and evolution of the questions that guide this book, particularly what is this interrelationship between art and violence. Drawing from some of the author’s personal experiences, it presents a summary of the overall project and describes the several parts that make up the manuscript—“The Dance Between Creation and Destruction,” “Art of Psychopathy,” and “Art for Change”—and each chapter that falls within these parts. Furthermore, this brief chapter examines the various lenses used to examine the theme, presents a justification on the particular artists chosen, and offers an explanation on how and why the metaphor of “the frenzied dance” was applied to frame this text.
Extremes on the Same Continuum
Authors: Gussak David E.
Published: February 2022

Two well-known multiple murderers were conspicuously excluded from the previous chapter: Charles Manson and John Wayne Gacy, arguably two of the most infamous multiple murderers of the twentieth century in the United States. They were also quite prolific in their artistic output. They represented the extremes along the continuum of multiple murderers, differing greatly in personality, crimes, and even their art. This chapter relies on Manson’s and Gacy’s psychobiographies, criminal narratives, and artistic output to explore their extreme variations in psychopathic personalities and how such tendencies were reflected through their creative attempts. Ultimately, the author believes that, despite their extreme disparities, their art emerged from the same self-aggrandizement and grandiosity as those in the previous chapters and that no amount of creating would curb their monstrous impulses; on the contrary, in some ways, their art reinforced them.
Helium absorption in exoplanet atmospheres is connected to stellar coronal abundances
Authors: Poppenhaeger K
Published: February 2022

Transit observations in the helium triplet around 10 830 Angstrom are a successful tool to study exoplanetary atmospheres and their mass loss. Forming those lines requires ionization and recombination of helium in the exoplanetary atmosphere. This ionization is caused by stellar photons at extreme ultraviolet (EUV) wavelengths; however, no currently active telescopes can observe this part of the stellar spectrum. The relevant part of the stellar EUV spectrum consists of individual emission lines, many of them being formed by iron at coronal temperatures. The stellar iron abundance in the corona is often observed to be depleted for high-activity low-mass stars due to the first ionization potential (FIP) effect. I show that stars with high versus low coronal iron abundances follow different scaling laws that tie together their X-ray emission and the narrow-band EUV flux that causes helium ionization. I also show that the stellar iron to oxygen abundance ratio in the corona can be measured reasonably well from X-ray CCD spectra, yielding similar results to high-resolution X-ray observations. Taking coronal iron abundance into account, the currently observed large scatter in the relationship of EUV irradiation with exoplanetary helium transit depths can be reduced, improving the target selection criteria for exoplanet transmission spectroscopy. In particular, previously puzzling non-detections of helium for Neptunic exoplanets are now in line with expectations from the revised scaling laws.
More about Poverty and Public Benefit— Re Jim Crerar Charitable Trust
Authors: Nitikman Joel
Published: February 2022

In a recent decision, the British Columbia Supreme Court held that a trust created to assist people who had been terminated improperly from their employment was not established for a valid charitable purpose because (a) it was an inefficient method of relieving poverty and (b) may not have assisted a sufficiently large segment of society. Joel Nitikman outlines the facts and reasoning of the Court and suggests that its reasons may not have been altogether correct.
Muscle Splitting Augmentation Mastopexy: A l3-year Analysis and Outcome of Primary and Secondary Procedures
Authors: Khan Umar Daraz
Published: February 2022

Background:

The muscle splitting technique is a submuscular pocket used for augmentation mammoplasty. Its use and results following primary and secondary procedures are presented.

Methods:

A retrospective study that analyzed complication and revision rates following primary and secondary mastopexy with augmentation in a muscle splitting pocket performed between April 2007 and March 2020 was carried out. Data were divided into two groups: primary and secondary single-stage mastopexies with augmentation.

Results:

A total of 169 patients had a primary procedure and 49 had secondary procedures. The mean ages of patients in the primary and secondary were 32.3 ± 9.89 and 38.2 ± 9.63 years, respectively. Five (3.0%) patients had periprosthetic or wound infections in the primary group when compared with 0% in secondary surgery group. Wound breakdown was seen in 13 (7.7%) patients with a primary procedure compared with one patient (2%) with a secondary procedure. One patient had partial nipple loss and another had total nipple loss in the primary group (1.2%) when compared with one patient (2.0%) who had partial nipple loss in the secondary group. Revision surgeries were carried out in 16 (10.1%) of the primary procedures compared with five (10.2%) of the secondary procedures.

Conclusion:

Even though there was a higher prevalence of complications in the primary procedures group than in the secondary procedures group, the overall complications following muscle splitting mastopexy with augmentation are within an acceptable range.
Prevalence of Deep Venous Thrombosis in Abdominoplasty Patients after COVID-19 Convalescence: An Alarming Flag
Authors: Reyad Khaled A. , Abelhalim Mohamed M. , Tallal Raghda E.
Published: February 2022

Background:

The incidence of thrombotic manifestations during aesthetic procedures may be overwhelming, as it may endanger patients’ lives. Lipoabdominoplasty is one of the precarious aesthetic treatments with risk for thrombosis. COVID-19 convalescent patients may have an abnormally high rate of thrombotic events, which should be studied further. Patients with a history of COVID-19 infection who undergo the aesthetic procedure may have a greater risk of thrombosis than non-COVID-19 patients who undergo lipoabdominoplasty.

Methods:

Thirty-seven patients who underwent lipoabdominoplasty were followed retrospectively for the occurrence of thrombotic events postoperatively and their relationship to previous COVID-19 infection. The study design comprised an examination of their medical records for prior COVID-19 infection, a history of thrombotic events before, during, or following COVID-19 infection, and D-dimer levels during and after COVID-19 infection. Thrombotic signs were studied in COVID-19 convalescent and non-COVID-19 patients following lipoabdominoplasty. The universal prophylactic measures for anticoagulation were followed.

Results:

Four patients out of 37 (10.18%) had thrombotic manifestations, with a high incidence in the COVID-19 convalescent group. The occurrence rate in COVID-19 patients was 30.7%, much higher than the global rate (0.2%). The presence of D-dimers was discovered to be abundant.

Conclusion:

Additional precautions should be taken to closely monitor patients with a prior history of COVID-19 infection who seek aesthetic surgery, particularly riskier procedures such as lipoabdominoplasty.
Effects of different doses of canagliflozin on blood pressure and lipids in patients with type 2 diabetes: a meta-analysis
Authors: Geng Qiang , Hou Fangjie , Zhang Yonghuan , Wang Zhengzhong , Zhao Meiling
Published: February 2022

Background:

Canagliflozin is a sodium glucose-cotransporter-2 receptor inhibitor approved for the treatment of type 2 diabetes mellitus (T2DM). However, it is less prescribed due to increased LDL cholesterol (LDL-C), high incidence of urinary tract infection (UTI), high cost. Data on the effect of canagliflozin on blood pressure (BP) are also limited. We conducted a meta-analysis of randomized controlled trials (RCTs) to review dosedependent effects of canagliflozin on BP and lipids in patients with T2DM.

Methods:

A meta-analysis of RCTs in patients with T2DM was conducted. MEDLINE, the Cochrane Library of Trials and Clinicaltrials.gov were searched for relevant studies from January 2008 to May 2021.

Results:

Compared with placebo, canagliflozin 100 mg reduced SBP by 3.43 mmHg and DBP by 1.05 mmHg. Canagliflozin 100 mg increased LDL-C by 0.10mmol/l and HDL cholesterol (HDL-C) by 0.05 mmol/l. Compared with placebo, canagliflozin 300 mg reduced SBP by 4.75 mmHg and DBP by 1.69 mmHg. Canagliflozin 300 mg increased LDL-C by 0.16 mmol/l and HDL-C by 0.06 mmol/l. Compared with canagliflozin 100 mg, canagliflozin 300 mg further reduced SBP by 1.21 mmHg and DBP by 0.64 mmHg, and further increased LDL-C by 0.06 mmol/l and HDL-C by 0.02 mmol/l. Compared with placebo and canagliflozin 100 mg, canagliflozin 300 mg increased the risk of UTI.

Conclusion:

The current meta-analysis provides new evidence on different doses of canagliflozin as an antihypertensive agent in T2DM complicated by hypertension; however, LDL-C and the risk of UTI should be monitored.
The Protective Effects of Soft Contact Lenses for Contact Sports: A Novel Porcine Model for Corneal Abrasion Biomechanics
Authors: Hou Andrew , Jin Man Li , Goldman David
Published: February 2022

Purpose:

The aim of this study was to determine whether soft contact lenses provide protection for the corneal surface.

Methods:

Fresh porcine eyes were inflated to intraocular pressures of 11 to 22 mm Hg and secured to a Styrofoam head. Newton meters affixed with artificial acrylic nails were placed at angles of 0°, 45°, and 90° from a porcine corneal surface. The force of impact was recorded at which corneal abrasions were induced. The experiment was repeated with Senofilcon A and Lotrafilcon A soft contact lenses placed upon porcine eyes.

Results:

The mean forces required to induce a corneal abrasion with force at 0°, 45°, and 90° from corneal surface were 11±5.09, 9.18±2.76, and 7.72±2.61 Newtons, respectively. With soft contact lens barrier, the maximum measurable force of 50 Newtons could not produce a corneal abrasion.

Conclusion:

The force required to create corneal abrasions varies depending on the angle of the force vector. The use of contact lenses can withstand a minimum of five times the average force needed to create corneal abrasions.