bluuebunny/crossref_metadata_2025 huggingface dataset:
Substantial increase in daytime-nighttime compound heat waves and associated population exposure in China projected by the CMIP6 multimodel ensemble
Authors: Xie Wenxin , Zhou Botao , Han Zhenyu , Xu Ying
Published: February 2022

This paper presents the projected changes in daytime-nighttime compound heat waves (HWs) (i.e. concurrent occurrence of HWs both in daytime and nighttime) and associated population exposure in China under the shared socioeconomic pathway (SSP)2-4.5 and SSP5-8.5 scenarios based on the Coupled Model Intercomparison Project phase 6 simulations. A comparison with the changes in daytime HWs (i.e. occurring only in daytime) or nighttime HWs (i.e. occurring only in nighttime) is also conducted. The results generally indicate an aggravated risk of compound HWs in China in the future under warmer scenarios. On the national average, the compound HWs are projected to increase persistently toward the end of the 21st century, with larger increase under SSP5-8.5 than that under SSP2-4.5. The greatest changes occur in northwest China and southern China. Compared with the daytime or nighttime HWs, the projected increase of compound HWs is the greatest. Accordingly, the proportion of compound HWs to the total HW events tends to increase and that of daytime HWs tends to decrease toward the end of the 21st century. The substantial increases in the frequency of compound HWs are expected to cause a significant increase in population exposure across the entire country. The projected increase of nationally averaged population exposure is 12.2-fold (7.9-fold) of the current in the mid-century (2046–2065) and further enhances to 16.3-fold (12.4-fold) in the end-century (2081–2100) under SSP5-8.5 (SSP2-4.5). The largest increases are distributed in western China and southern China. These findings raise the necessity and urgency for policy-makers and the public to develop measurements to address compound HW risks.
The Results of the Families Improving Together (FIT) for Weight Loss Randomized Trial in Overweight African American Adolescents
Authors: Wilson Dawn K , Sweeney Allison M , Van Horn M Lee , Kitzman Heather , Law Lauren H , Loncar Haylee , Kipp Colby , Brown Asia , Quattlebaum Mary , McDaniel Tyler , St. George Sara M , Prinz Ron , Resnicow Ken
Published: February 2022

Background

Few intervention studies have integrated cultural tailoring, parenting, behavioral, and motivational strategies to address African American adolescent weight loss.

Purpose

The Families Improving Together (FIT) for Weight Loss trial was a randomized group cohort study testing the efficacy of a cultural tailoring, positive parenting, and motivational intervention for weight loss in overweight African American adolescents (N = 241 adolescent/caregiver dyads).

Methods

The trial tested an 8-week face-to-face group motivational plus family weight loss program (M + FWL) compared with a comprehensive health education control program. Participants were then rerandomized to an 8-week tailored or control online program to test the added effects of the online intervention on reducing body mass index and improving physical activity (moderate-to-vigorous physical activity [MVPA], light physical activity [LPA]), and diet.

Results

There were no significant intervention effects for body mass index or diet. There was a significant effect of the group M + FWL intervention on parent LPA at 16 weeks (B = 33.017, SE = 13.115, p = .012). Parents in the group M + FWL intervention showed an increase in LPA, whereas parents in the comprehensive health education group showed a decrease in LPA. Secondary analyses using complier average causal effects showed a significant intervention effect at 16 weeks for parents on MVPA and a similar trend for adolescents.

Conclusions

While the intervention showed some impact on physical activity, additional strategies are needed to impact weight loss among overweight African American adolescents.
Labiaplasty: Analysis of the National Surgical Quality Improvement Program Database
Authors: Wells Michael W , Chang Irene A , Wu Robin T , Zheng David X , Gatherwright James R , Furnas Heather J
Published: February 2022

Background

Labiaplasty is an increasingly popular procedure performed for both cosmetic and pathologic etiologies. Questions have been raised regarding the efficacy of the procedure, especially for cosmetic etiologies.

Objectives

The aim of this study was to examine the complication profiles of labiaplasties for both cosmetic and pathologic etiologies.

Methods

The 2005 to 2017 National Surgical Quality Improvement Program database was analyzed for patients who, according to the relevant Current Procedural Terminology code, had undergone labiaplasties. Our cohort was further separated into cosmetic and pathologic groups based on International Classification of Diseases codes. Information was collected on patient demographic characteristics, patient comorbidities, and operative variables. Outcomes of interest included surgical complications and delayed length of stay (DLOS). A univariate analysis and multivariate logistic regression were applied to determine statistically significant predictors of our outcomes of interest for both etiologies.

Results

There were 640 patients in the cosmetic cohort and 1919 patients in the pathologic cohort. There were no significant differences in rates of surgical complications between the 2 groups, but there was a statistically significant increase in length of stay for the pathologic group. Univariate analysis revealed operative time and plastic surgeon specialty to be predictive of DLOS in the cosmetic cohort. No covariates were implicated with multivariate analysis for either surgical complications or for DLOS in the cosmetic cohort.

Conclusions

Our findings suggest that cosmetic labiaplasty is a safe and efficacious procedure with low complication rates and no predictors of adverse outcomes.

Level of Evidence: 4
Modeling multi-scale data via a network of networks
Authors: Gu Shawn , Jiang Meng , Guzzi Pietro Hiram , Milenković Tijana
Published: February 2022

Motivation

Prediction of node and graph labels are prominent network science tasks. Data analyzed in these tasks are sometimes related: entities represented by nodes in a higher-level (higher scale) network can themselves be modeled as networks at a lower level. We argue that systems involving such entities should be integrated with a ‘network of networks’ (NoNs) representation. Then, we ask whether entity label prediction using multi-level NoN data via our proposed approaches is more accurate than using each of single-level node and graph data alone, i.e. than traditional node label prediction on the higher-level network and graph label prediction on the lower-level networks. To obtain data, we develop the first synthetic NoN generator and construct a real biological NoN. We evaluate accuracy of considered approaches when predicting artificial labels from the synthetic NoNs and proteins’ functions from the biological NoN.

Results

For the synthetic NoNs, our NoN approaches outperform or are as good as node- and network-level ones depending on the NoN properties. For the biological NoN, our NoN approaches outperform the single-level approaches for just under half of the protein functions, and for 30% of the functions, only our NoN approaches make meaningful predictions, while node- and network-level ones achieve random accuracy. So, NoN-based data integration is important.

Availability and implementation

The software and data are available at https://nd.edu/~cone/NoNs.

Supplementary information

Supplementary data are available at Bioinformatics online.
Sociogenetic structure, reproductive strategies and queen replacement in the erratic ant (Tapinoma erraticum)
Authors: De Pletincx Nathan Lecocq , Aron Serge
Published: February 2022

Ancestral eusocial insect societies were probably headed by a single and singly mated reproductive queen. However, eusocial Hymenoptera have since secondarily evolved highly diverse mating systems and social structures, which include multiple mating by queens, the coexistence of several reproductive queens within a given colony, and queen replacement over time. Here, we report pronounced plasticity in sociogenetic structure and reproductive strategies in the erratic ant, Tapinoma erraticum. Notably, colonies can be headed by one or several queens. Nestmate queens display a varying degree of genetic relatedness; they range from being unrelated to full sisters to mothers and daughters. Queens mate with one to three males. There is again variability in the degree of relatedness. The queens and their male mate(s) are sometimes related and sometimes unrelated; the same is true for the males that had mated with nestmate queens. Finally, genotypic comparisons between age-based cohorts (i.e. adult workers vs. worker larvae) indicate that new queens, both related and unrelated, appear in established colonies. We suggest that the highly plastic reproductive systems found in T. erraticum might have opened the door evolutionarily to supercoloniality and invasiveness in the genus Tapinoma.
10 Tip-Apex Distance in DHS & IM Nail Fixations for Hip Fractures
Authors: Tan G. , Ong C.T. , Kainth G.
Published: February 2022

Aim

Dynamic hip screws (DHS) and intramedullary nail (IMN) fixations have been successful in treating extracapsular hip fractures. Tip to apex distance (TAD) is defined as the total sum of distance from tip of the lag screw to the femoral head tip on both AP and lateral radiographs. Baumgartner et al. defined TAD<25 mm to be predictive of a successful result, with reduced rates of metalwork failure. Therefore, this study aims to assess if TAD principles are practiced during DHS and IMN fixations.

Method

102 patients were identified between December 2019 and February 2020. The distance was measured on AP and lateral radiographs to calculate the TAD. Patients were followed up for 1 year where the fractures either united or failed.

Results

Patients recruited had age ranges between 19–103 years old, of which 36% are male and 64% are female. 68% had underwent DHS while 32% underwent IM nail. In the DHS group, 13 patients had TAD of >25 mm, 28 with TAD of 20–25 mm, 18 with TAD of 15–20mm and 6 with TAD of <15 mm. For the IM nail group, there are 7 with TAD of 20–25 mm, 13 with TAD of 15–20mm and 10 with TAD of <15 mm.

Conclusions

There were no IM nails that exceeded TAD of 25mm, but 13 DHS fixations were >25mm. 12/13 DHS fixations >25mm TAD were performed by trainees. We advocate emphasis on the TAD principle and re-enforcing to orthopaedic trainees to improve the outcome of DHS in patients with neck of femur fractures.
28 Review of Operative and Non-Operative Time-Use During General Anaesthetic Cases in a Busy Surgical Oncology Service
Authors: Bell A. , Razzaq Z. , Mustafa H. , Redmond H.P.
Published: February 2022

Aim

To review theatre running times of all general anaesthetic cases performed in a single theatre during a set six-week period. We intend to assess the division of theatre time between operative and non-operative tasks and review areas of improvement in our department.

Method

The data was collected concurrently by a member of the surgical team (AB) at the time of surgery. Date, surgical procedure, and time elapsed from knife-to-skin (KTS) to skin closure were monitored between the hours 08:30–17:00. Results were reviewed and presented graphically using Microsoft Excel. Instances of theatre over-running were identified, and these outliers were reviewed in more detail.

Results

We identified two main time management issues in our department. The first occurs prior to the first procedure which highlighted significant delays with only one instance of KTS at 08:30 during the period of data collection. The second notable issue is the pattern of delays. There was a trend toward longer delays between cases as the day proceeds.

Conclusions

Upon review of our data, we were able to identify possible areas of improvement in the time management of our theatre group. These improvements will allow for accurate theatre planning which should be a priority for all stakeholders given the significant waiting lists created by the COVID19 pandemic. There are many peer-reviewed methods of improving the efficiency of departments such as ours. Further work is required to discuss targets for improvement with relevant stakeholders and to implement PDSA cycles to assess the impact of implemented changes in our theatre.
49 Accurate Hip Reduction and SPICA Application for DDH – the Case for Intraoperative CT
Authors: Redfern J. , Hughes T. , George H.
Published: February 2022

Aim

Accurate reduction of the hip joint and SPICA application for treatment of developmental dysplasia of the hip (DDH) is crucial for long term success – for those undergoing surgical intervention, or closed reduction only. In Alder Hey Children’s Hospital we compared two methods of confirming reduction for patients undergoing SPICA application for DDH. Those receiving either post-operative departmental computed tomography (CT) or an intra-operative CT. Specific outcome assessed were, need for repeat CT and SPICA application, return to theatre (RTT), repeat general anaesthetic (GA) (with associated risks), as well as effect on overall length of stay (LOS).

Method

Patient lists were attained from the radiography department, information regarding RTT and LOS were derived from Meditech V6. CT scans were checked on PACS imaging system.

Results

Retrospective analysis of all SPICA application cases performed, included 102 patients from 2015–2018 undergoing a departmental CT, after GA. Of these, 6 patients required a second GA, 1 patient required 3 GA’s. Mean LOS was 6 days in those requiring repeat SPICA application.

Analysis of the second group of intra-operatively CT scanned patients, included 72 patients from 2018–2020. Of these, 0 patients required a repeat GA and RTT, despite 1 patient requiring change of SPICA. Mean LOS was 4 days for these patients.

Conclusions

Intra-operative CT is crucial for getting it right first time, reducing risks of GA and cost of theatre time. It reduced the LOS for those requiring SPICA change from 6 to 4 days and reduced mean LOS by 1 day overall.
54 A Novel, Cost-Effective and Easily Reproducible Simulation Method for Teaching Fascia Iliaca Blocks Significantly Improves Peri-Operative Administration Rates in Neck of Femur Fracture Patients
Authors: Li M. , Dardak S. , Al-Wattar Z.
Published: February 2022

Despite high-level evidence supporting early fascia iliaca block (FIB) administration in patients sustaining neck of femur (NOF) fractures, administration remains suboptimal, restricted primarily by limited training opportunities. We present a novel, cost-effective and easily reproducible simulation session designed to teach the landmark technique during the Covid-19 pandemic.

A simulation mannequin was used with four absorbent swabs, two banana skins and a clear dressing were applied to the inguinal region to recreate the “two-pop” texture of the landmark technique. Ten participants attended, limited by social distancing. A 1 (poor) to 5 (excellent) feedback sheet was handed to all participants for the five domains of content, delivery, interaction, usefulness, and quality of the practical skills session, with opportunities for qualitative feedback. The FIB administration rates in all NOF fracture patients between August -October 2019, before the simulation session, were statistically compared to November-December 2020, following it.

All participants gave a 5/5 (excellent) rating for all five domains, confirming good acceptability amongst practitioners. In the time period before the session, 9/29 NOF fracture patients received a FIB, improving to 18/31 patients following it (p = 0.042; two-tailed Fisher’s exact test), a statistically significant increase in administration. The average cost per participant for the single-use materials in the session was £1.56, whereas the multiple-use items costed £7.88 per participant.

Adoption of this novel, cost-effective and widely reproducible simulation method is deemed highly useful and acceptable by a diverse range of healthcare professionals, resulting in a statistically significant increase in FIB administration in NOF fracture patients.
61 Use of Ketamine Sedation for the Treatment of Minor Plastic Surgery Procedures in the Paediatric Emergency Department
Authors: Bradley A. , Faulkner J. , Jatan A. , Stewart C.
Published: February 2022

Aim

To determine if ketamine sedation is a safe and cost-effective way of treating paediatric patients presenting with minor injuries, requiring plastic surgery procedures, in the emergency department.

Method

A retrospective cohort study was carried out over a 9-month period in children between ages 18 months and 16 years old, presenting to the paediatric emergency department at Chelsea and Westminster Hospital with minor injuries requiring plastic surgery input. The data collected included previously validated co-primary outcome measures of surgical site infection at 7 days and cosmetic appearance summary score at a minimum of 4 months. Parental satisfaction surveys were completed at 4 months to assess perceived quality of treatment. A cost analysis comparison against procedures completed under general anaesthetic was also undertaken.

Results

During the 9-month period of study, 24 minor procedures were performed under ketamine in the paediatric emergency department. There were no serious adverse events recorded. Three cases exceeded the recommended 20-minute maximum procedure duration, but there was no associated adverse outcome. No cases required further procedures under general anaesthesia and there were no cases of surgical site infections at 7 days. Parents reported extremely favourable outcomes using this technique, with an average overall satisfaction score of 9.2 (assessed over a number of parameters, where 10 is complete satisfaction).

Conclusions

Ketamine procedural sedation in the paediatric population is a safe and cost-effective method for the treatment of minor plastic surgery procedures, with low risk for surgical site infection post-operatively, and high parent satisfaction rates
64 An Audit of Same Day Theatre List Cancellations
Authors: Ramjeeawon A. , Bulstrode N.
Published: February 2022

Introduction

Given the reduction in elective operating during the Covid pandemic, efficient use of theatre time is paramount to reduce elective waiting list times. The aims of this audit were to identify the proportion of patients who were cancelled from theatre lists on the day, reasons for cancellation, and the proportion of patients who were cancelled due to non-adherence to pre-operative fasting rules.

Method

The previous 30 patients on a single surgeon’s elective operating list were reviewed using electronic patient records, admissions teams list, and surgeon recall to identify numbers of and reasons for on the day cancellations.

The standards used were the perioperative fasting in adults and children guideline from the European Society of Anaesthesiology, and a local trust guideline on pre-operative fasting.

Results

30 patients had been scheduled for elective surgery on a single surgeon’s paediatric plastic surgery list between April and May 2021. 3 patients (10%) cancelled on the day of their planned procedures. Of these patients cancelling on the day, 2 (66%) cancelled due to non-adherence to pre-operative fasting rules, 1 (33%) cancelled due to parents choosing to defer the operation.

Conclusions

Non-adherence to pre-operative fasting rules was an important reason for on the day cancellations on this elective operating list. A pre-operative fasting information sheet was developed for patients and parents to explain the fasting rules and timings. Once sufficient patients and parents receive the information sheet, the audit will be repeated. If successful, it may be sent to patients and parents for all elective operating lists.
65 A Retrospective Cohort Study of the Use of Vivostat PRF Autologous Platelet-Rich Fibrin in Patient Outcomes in Total Knee Replacement Surgery
Authors: Conchie H. , Rayner A. , Fenton R. , Warrington K. , Ali S. , McDermott I.
Published: February 2022

Aim

Vivostat PRF is an autologous platelet-rich fibrin spray that is prepared in theatre from the patient’s own blood and has shown that its use as a biological sealant intra-operatively reduces transfusion rates and decreases haemarthrosis after total knee replacement (TKR).

We undertook a retrospective time-based comparative cohort study examining relevant patient outcomes, comparing patients undergoing TKR surgery with Vivostat PRF versus without.

Method

106 patients undergoing TKR surgery between 2008 and 2017 were studied. Patients were selected for inclusion via hospital records and divided into two groups: those who had received Vivostat PRF intra-operatively (n = 59), and those who hadn’t (n = 47) (the control group).

Primary outcomes included haemoglobin drop pre- vs post-operatively, range of movement (ROM) at follow-up appointments, number of days post-operatively in hospital until the patient was able to manage stairs, post-operative pain scores and transfusion rates.

Results

There was a statistically significant difference in the haemoglobin drop between the two groups, with a drop of 27.5g/L in the study group compared to 31.9g/L in the control group (p = 0.019). ROM at day 3 post-operatively was better in the Vivostat group by 5.0o (p = 0.0018), and at 3 months post-operatively there was 7.8o greater movement (p = 0.004). No statistically significant differences were seen in the pain scores; however, early rehabilitation performance was improved in the Vivostat group, with a quicker time to being able to manage stairs post-operatively (p = 0.04). There was no statistically significant difference in transfusion rates.

Conclusions

This study showed that there are benefits in using Vivostat PRF in TKR surgery.
76 Many Forms of Bariatric Surgery Can Be Used to Treat Obese Patients. Is Laparoscopic Gastric Plication the Next Gold Standard?
Authors: Cameron F.
Published: February 2022

Aim

Obesity is growing in prevalence in today’s world. Conservative treatment methods often fail; however, bariatric procedures have been developed to help patients lose weight. While bariatric surgery takes various forms, these are often highly invasive or have high rates of complication, leading to further development by surgeons of new procedures. One of the more recently developed procedures is laparoscopic gastric plication- a surgery involving imbrication of the greater curvature of the stomach to narrow the gastric lumen. It has been hypothesised that this could be the next gold standard in the management of obesity. This paper seeks to address such hypotheses by comparing laparoscopic gastric plication with the already established laparoscopic gastric sleeve in the treatment of patients and their comorbidities.

Method

By analysing meta-analyses, systematic reviews and case studies on both laparoscopic gastric plication and laparoscopic gastric sleeve, it has been possible to compare the safety, efficacy, and cost of the two procedures.

Results

The results of the literature review undertaken indicate no significant difference when the efficacy and cost of the two procedures is compared. Laparoscopic gastric sleeve is, however, a safer procedure with fewer postoperative complications than laparoscopic gastric plication.

Conclusions

In conclusion, it is unlikely that laparoscopic gastric plication will be the next gold standard in bariatric surgery unless the procedure is standardised, and its safety record is improved.
91 Intestinal Malrotation Identified on Diagnostic Laparoscopy in a 79-Year-Old Male Presenting With Symptoms of Sub-Acute Bowel Obstruction
Authors: Procter A. , Osborne M.
Published: February 2022

Congenital malrotation of the midgut in the adult population is most likely to present with non-specific abdominal symptoms that can pose a diagnostic dilemma. If left untreated the symptoms of malrotation can have a significant impact on patients’ quality of life and the condition can lead to significant morbidity and mortality. We report a case of malrotation identified in a 79-year-old male who presented with a chronic picture suggestive of sub-acute small bowel obstruction. The patient underwent thorough clinical review including CT and MRI scan which showed evidence of dilated small bowel but failed to show an underlying cause. The absence of findings with initial tests prompted the team to consider surgical investigation. Diagnostic laparoscopy identified evidence of congenital malrotation, and this was successfully treated with a Ladd’s procedure. This case adds to the evidence that malrotation is a more common finding in adults than previously thought and emphasises the importance of pursuing a definitive diagnosis when routine tests do not demonstrate sufficient cause for a patient’s symptoms.
93 Are NSAIDs Being Prescribed First Line to Manage Renal Colic Pain? A Complete Audit
Authors: Aly K. , Aly M. , Broome J.
Published: February 2022

Introduction

NICE recommends NSAIDs as first line analgesia for renal colic pain. The aim of this audit was to evaluate NSAID prescribing at Salford Royal Hospital in this patient cohort against NICE guidelines.

Method

Using electronic patient records, patients admitted with renal colic pain over a 3-week period were identified. Data regarding the type and order of analgesia prescriptions from the time of surgical clerking were collected retrospectively. Patients with a documented contraindication to NSAIDs were excluded. A local renal colic pathway was published by the Urology Department, and we followed this with additional interventions, namely an email reminder to the juniors and a poster with a renal colic analgesia ladder illustration as an aide-memoire. Subsequently, a re-audit was undertaken.

Results

Cycle 1 identified 22 patients admitted with renal colic pain with most diagnoses supported radiologically. Only 38% of patients were found to be prescribed an NSAID for analgesia around the time of surgical clerking. In the re-audit, 50% of patients had an NSAID prescribed at the time of surgical clerking.

Conclusions

NSAIDs are clearly being underused as first line analgesia in renal colic pain despite NICE guidelines. A newly published trust renal colic pathway and targeted interventions have shown to increase their use, but further QI work is needed.
107 Retrospective Pilot Study in Preparation for Setting Up an Acute Pancreatitis MDT in a Medium Sized NHS Acute Trust in the UK
Authors: Pufal K. , Singh P. , Robinson S.J.
Published: February 2022

Aim

Within the spectrum of pancreatitis, patients with severe disease require specialist multidisciplinary care including dietician and radiology input. Therefore, certain patients would benefit from an MDT approach to coordinate their management. This retrospective study analyses data on pancreatitis admissions within our Trust, to inform the set-up of a new specialist MDT.

Method

Patients were identified using admission coding data. Relevant patient data was extracted, including demographics, disease severity (using the Atlanta classification) and relevant outcomes. Both first-time and repeat admissions were included. Incorrectly coded patients were excluded. Statistical analysis was performed using SPSS (Version 23.0).

Results

Over a study period of 489 days, 246 patients were coded as having pancreatitis.186 patients were first time admissions, and 27 patients were repeat admissions. 33 patients were incorrectly coded and excluded.

Hence, the annual acute pancreatitis admission rate was 139 patients/year, with an additional 20 readmissions. 149 (80%) admissions were mild cases, with the remaining 14 (8%) and 23 (12%) being moderate and severe respectively. 149 (80%) were acute cases, compared to 20 (11%) chronic and 17 (9%) acute-on-chronic. 52/186 cases had no cause of pancreatitis recorded; where cause was identified, gallstones were the most common aetiology.

Conclusions

Pancreatitis is a common reason for admission during a general surgery on-call in our Trust; while the majority of cases are mild, the remaining 20% of moderate–severe cases qualify for discussion at an Acute Pancreatitis MDT. This pilot has facilitated the allocation of resources in our Trust and the MDT goes live in September 2021.
113 Where Did the Ureteric Stent Disappear? – Mystery Solved
Authors: Narayan P. , Mukhtar S.
Published: February 2022

38-year-old male presented to A&E with bilateral flank and suprapubic pain associated with mild VH. A CTKUB was suggestive of 10 cm ureteric stent noted in the left distal ureter and a few left sided lower calyceal non-obstructive stones.

Patient denied any previous urological procedures or significant history. He even called up his mother in Hungary to ensure that. He was discharged with an outpatient follow up after his symptoms settled. In the clinic it was decided to carry out a CT Urogram and a flexible cystoscopy. The urine was also sent for cytology and acid-fast bacilli. His Calcium and urate profile was normal.

On a CT Urogram, mysteriously the 10cm distal stent like calcification and the lower calyceal stones were not found, and on flexible cystoscopy the bladder looked pristine. The patient’s symptoms had resolved, and he had not spotted passage of any stone as he was asked to stay vigilant.

Discussion

Flexible cystoscopy along with CT Urogram was likely the best approach in this case- as it provided a holistic approach and excluded any upper tract pathology as well as a FB or abnormality in the urinary bladder.
118 Improving the Knowledge and Confidence of Diverse NHS Workforce: An Innovated Teaching Program on Research Methodology
Authors: Win M. , Htet W. , Bharathan B.
Published: February 2022

Aim

International medical graduates (IMG) are a significant contributor to the NHS workforce. According to GMC, there has been an increase in the number of IMG joining the NHS, and their proportion was higher than the combination of UK and EEA graduates in 2020. Clinical research is one of the pillars of clinical governance in the UK; however, their exposure to research methodology in their native countries may be limited, impacting their engagement in clinical research. Our objectives were to measure their knowledge and confidence in research methodology and help them improve imperative skills.

Method

A total of seven teaching sessions were delivered virtually over two months to IMG working across the UK. The average number of attendees per session was thirty. The lectures covered research ethics, integrity, study designs, literature review, statistics, scientific writing, and critical appraisal. The change in the level of knowledge and confidence in research methodology was evaluated by analysing the responses to the survey completed before and after the novel teaching program.

Results

50% reported increase in knowledge of the research methodology

Conclusions

Substantial improvement in self-reported confidence and knowledge of research methodology was achieved among IMG featuring the high-quality support to the diverse workforce. The innovation of dedicated teaching sessions on research methodology for IMG is crucial in the development of a happy workforce as well as the maintenance of clinical governance of the UK.
121 A Novel Technique for Infected Metalwork Salvage: Negative Pressure Wound Therapy with Copious Saline Irrigation and Direct Wound Closure Over Dressing
Authors: Summers S. , Daniels N. , Thahir A. , Krkovic M.
Published: February 2022

Aim

Metalwork infection is a challenging complication, often requiring surgical removal. The senior author devised a novel technique consisting of negative pressure wound therapy (NPWT) with high-flow rate saline irrigation and direct skin closure over the standard NPWT dressing. This study aims to evaluate the utility of this modified technique in resolving metalwork infection to allow fracture union without metalwork removal.

Method

This is a retrospective chart review of 24 patients (3 upper and 21 lower limb cases) with infected orthopaedic metalwork from a single centre over a seven-year period, who were all managed with this modified technique as an adjunct to standard antibiotic therapy and surgical debridement. Demographic data, surgical data and infectious disease data were collected. Patients were followed up for signs of infection recurrence.

Results

23 of 24 (96%) patient had successful metalwork retention with infection resolution to achieve fracture union. No metalwork was removed due to infection. Original metalwork was maintained in 16 of 24 (67%) patients. The average duration of NPWT was 19 days and the average number of visits to the theatre for NPWT change or removal was 2.5 (mode: 2).

Conclusions

This series demonstrates that the modified NPWT technique is an effective adjunct therapy for infected metalwork salvage. This novel technique is safe and reliable with timely resolution of infection to allow fracture union.
125 Surgical Outcomes and Graft Use in Quadriceps & Patella Tendon Rupture Repairs
Authors: West C. , Kwaees T.
Published: February 2022

Aim

Quadriceps and patella tendon ruptures are relatively uncommon injuries affecting approximately 1% and 0.5% of the population respectively. The literature surrounding preferable surgical technique, graft implant used, and surgical outcomes are relatively obscure. We audited all quadricep and patella tendon repairs within the trust to identify whether they have the same surgical outcomes, if any factors affect surgical outcomes and if there is a graft/implant which has superior outcomes.

Method

We conducted a retrospective cohort study which included 34 patients who had undergone a patella or quadriceps tendon rupture repair, over a 5-year period. The outcomes assessed were surgical failure, long term complications and graft/implant used.

Results

Our data demonstrated that patella tendon rupture repairs carried higher failure rates (14%) and poorer surgical outcomes (42%) than quadriceps tendon rupture repairs. Within the patella cohort, revision surgery was required due to decreased range of movement secondary to loosening of the graft. A wide variety of graft/implant were used in surgical fixation, however there was no significance in surgical outcomes or complications. It was apparent that weight was a significant factor in tendon rupture injury, however co-morbidities, medications or lifestyle appeared to have no impact on surgical outcomes.

Conclusions

The findings of our single centre study are inconclusive due to small sample size; however, it is apparent that patella tendon repair ruptures are associated with higher failure rates and poorer outcomes. A regional study would provide a larger cohort of patients to help determine the objectives outlined in this study.
132 Improving the Long Term Follow Up of Bisphosphonates in the Community
Authors: Moran E.
Published: February 2022

Aim

Bisphosphonates are generally first line treatment for osteoporosis in primary care. However, long term bisphosphonate use has been associated with atypical femoral fractures. Therefore, it is recommended that bisphosphonates are reviewed every 3–5 years. This study set out to assess and improve the long term follow up of bisphosphonates in a GP practice in Leeds.

Method

System One was searched to identify patients prescribed alendronic acid or risedronate in January and February of 2021 from Aire Valley Surgery, a GP practice in Leeds. These patient’s notes were then used to see if they had planned bisphosphate follow up and if this was via a script note, scheduled task, or recall. In March of 2021 a teaching session on osteoporosis and bisphosphonates was delivered to GPs working at the practice. GPs were also asked to make sure that they planned follow up when prescribing bisphosphonates via a script note. System One was searched again to identify patients prescribed alendronic acid or risedronate in April and May of 2021.

Results

Prior to the teaching session 47.9% of patients had planned follow up with 56.4% via script note, 16.4% via scheduled task and 27.3% via recall. Following the teaching session 48.4% of patients had planned follow up with 73.1% via script note, 13.5% via scheduled task and 13.5% via recall.

Conclusions

This study has identified a group of patients who are taking oral bisphosphonates in the community without planned follow up and are therefore more likely to sustain an atypical femoral fracture.
139 Absence of Coding in an Outpatient Paediatric Orthopaedic Department – Where Does the Money Go?
Authors: Dhingra M. , Chong H. , Shyamsundar S.
Published: February 2022

Aim

Paediatric orthopaedics conditions are often managed in the outpatient department (OPD) setting. Due to the lack of official coding for these minor procedures in our OPD, the hospital receives neither financial benefit nor evidence for a formal auditing process. With the Paediatric Get It Right First Time (GIRFT) report underway, we have looked at building a coding pathway for paediatric interventions in our OPD.

Method

The number of paediatric orthopaedic interventions were collated and grouped in a 6-month period, and a clinical outcome form was created accordingly. After consulting with the coding department, a cost analysis of prospective earnings was conducted, as well as comparisons to current standard tariff rates for OPD attendance.

Results

From January 2021 to June 2021, 100 interventions were performed in our OPD with the breakdown of: 21 clubfoot serial casting, 70 serial casting for pathology such as tip toe walkers, 6 Botox injections in spastic contracture limbs and 3 Pavlik harnesses for developmental dysplasia of the hip. With the assistance of coding department, a new paediatric procedural coding form was created with 14 relevant interventions listed. A loss of £6110 was calculated due to tariff rates being solely attendance based compared to interventional based.

Conclusions

Paediatric orthopaedic OPD should have clinical coding outcomes in place for each intervention that is performed to ensure that the hospital trust receives appropriate financial commission as well as ensure a formal audit trial can be produced.
142 Amyand’s Hernia: An Extensive Review of History, Aetiopathogenesis, Symptomatology, and Management – Should We Scan, Scope & Snip?
Authors: Ballanamada Appaiah N.N. , Probert S. , Menon N.J. , Alam S.
Published: February 2022

Background

Amyand’s hernia, first described by Claudius Amyand in 1735, continues to remain a diagnostic & therapeutic challenge. By definition includes inguinal herniae that contain the vermiform appendix.

Aim

This up-to-date review aims to define and classify Amyand’s hernia and suggest appropriate management options in the current era. Aim to shed light on the value of pre-operative cross-sectional imaging and the use of laparoscopic surgery to provide a one stop solution.

Method

Published English literature was reviewed (1735–2021), using PubMed and Embase, combining the MeSH terms “hernia”, “inguinal”, “appendix”, “Amyand”, “low dose CT” and “laparoscopic herniotomy”. Most cited open access reviews, case series and case reports were chosen to provide a framework. A recent case is described with selected images (radiological, histology and intra operative).

Results

Since the original publication, by Claudius Amyand in 1735, there exists a gulf on this condition in the available British medical literature. Nearly 100,000 hernia repairs are performed in the UK annually. If Amyand’s hernia account for 1% of these (according to the most stated estimate), there should be a thousand Amyand’s herniae repaired annually in the UK alone. Unfortunately, the management options remain nonstandard.

Conclusions

Computerized tomography (CT) allows for pre-operative diagnosis and should be considered more often, even in children. Laparoscopic appendicectomy combined with a laparoscopic herniotomy is a safe one stop solution, in experienced hands, for paediatric patients.
158 Telemedicine and Cleft Care in the UK: Adequacy and Appropriateness
Authors: Takenoshita M. , Miyagi K.
Published: February 2022

Aim

The efficacy of teleconsultations for cleft lip/palate (CLP) patients is not established. Accurate speech assessment and intraoral examinations pose unique challenges. This study evaluates the adequacy, benefits, and limitations of video-consultation for CLP patients.

Method

Retrospective analysis of all cleft multidisciplinary team (MDT) clinics on the electronic hospital system, Epic, from 05/2020–03/2021 covering East Anglia, UK. Adequacy of video consultations was based on: difficulties faced during the consultation, conversion to telephone, and whether additional face-to-face appointments were generated. MDT members were surveyed to identify benefits of teleconsultation, and types of appointments deemed most suitable for teleconsultation.

Results

Of 353 cleft MDT clinic appointments, 90% were by video and 10% by telephone; 75% of video consultations were rated as ‘adequate’. 72 additional face-to-face appointments were generated, 38 (53%) of which were due to technical factors such as connectivity. Child (e.g., shyness) and carer (e.g., digital literacy) factors accounted for 8 and 4 cases respectively. Three- and five-year reviews, and those requiring formal speech assessment, generated most additional appointments, followed by surgical reviews requiring intraoral examination. Staff survey revealed reduced travel, flexibility, and regular contact as most frequently reported benefits, concerns were raised over the loss of the ‘human touch’. Overall, respondents agreed that teleconsultation is suitable for select patients, and as a screening tool.

Conclusions

Selective use of teleconsultations that considers patient preference, age, and clinical factors is necessary. Anticipated surgical examination, speech assessment, and younger patients should be scheduled for face-to-face appointments. Technical issues must be addressed as a priority.
159 The Role of Proformas in Improving the Documentation of Surgical Ward Rounds
Authors: Coyle M. , McManaman C. , Smith B.
Published: February 2022

Introduction

Several NHS trusts rely on handwritten notes, including ward round (WR) reviews. These are essential in-patient care and must be completed/documented thoroughly. The General Medical Council and Royal College of Surgeons have both published guidance on WR documentation.

Method

This was a prospective study aiming to review WR documentation within general surgery at Frimley Park Hospital. 17 WR entries were reviewed using an 18-point checklist. A proforma was created based on published guidance and gaps in reviewed documentation. This was introduced for two months before a repeat review was conducted. A third review was conducted after an additional month to monitor for sustained improvement.

Results

Strengths in the baseline included documentation of WR leads (100%) and plans (100%), legible handwriting (95%), and NEWS score (88%). Common weaknesses were documentation of full observations, anticoagulation (both 6%), and relevant bloods and imaging (both 12%). The two months post-proforma review found improvement in all 18 areas of documentation, with five elements scoring 100%. Documentation of anticoagulation improved from 6% to 94%, relevant bloods from 12% to 82%, and full observations from 6% to 76%. Higher scoring WRs were linked to pre-prepared proformas, with lower scores linked to post-take WRs. The review was repeated after an additional month, showing consistently improved results in all areas.

Conclusions

This project has shown significant and sustainable improvement in WR documentation with the proforma. This project would therefore recommend the continued use of the proforma, and an additional review after the junior doctor change over to show continued sustainability.
160 Emphysematous Epididymo-Orchitis: Is Imaging Critical in Active Management? Case Report and Literature Review
Authors: Ilangovan S. , Ghazanfar N. , Chitale S.
Published: February 2022

We hereby present a case report regarding a rare cause of acute scrotum secondary to emphysematous epididymo-orchitis (EEO), often not diagnosed until it reaches an advanced stage, when it becomes a clinical diagnosis with crepitus palpable in scrotal wall with cellulitis.

This case report details a 55-year-old man with poorly controlled diabetes who presented with an acute scrotum that failed to resolve with oral antibiotics in primary care. Following rapid detection of EEO on an early scrotal ultrasound scan, the patient had surgical debridement and a near-total orchidectomy with only a small stump of testis and tunica albuginea left behind.

This highlights the importance of timely imaging in diabetic men with an acute scrotum following a high clinical suspicion of testicular abscess and an incidental, rare but significant finding of the complication of EEO, as both but particularly the latter would warrant early surgical intervention to prevent a catastrophic sequela: Fournier’s gangrene.

This case report also emphasises that as clinicians, we should have a high index of suspicion for local complications and low threshold for intervention in patients with epididymo-orchitis refractory to adequate period of treatment with oral antibiotics (1–2 weeks), particularly in immuno-compromised and poorly controlled diabetics.
166 ReAudit - Review of Elective Procedures for Pilonidal Disease in a Single Centre, Jan 2020 – Aug 2021
Authors: William B. , Khan A.E. , Mellor S. , Naseer M. , Abraham S.
Published: February 2022

Review of elective procedures for pilonidal disease in a single centre, Jan 2020 – Aug 2021

Introduction

Pilonidal disease continues to be managed with a variety of surgical techniques. We review results with Bascom 2 operation comparing to other practices at our institution.

Method

All elective procedures for pilonidal disease reviewed from Jan 2020 to August 2021. Age, gender, previous emergency and elective procedures for pilonidal disease, follow-up, recurrence and dehiscence rates, all-cause morbidity was examined retrospectively.

Results

In the study period there were 44 procedures. Average age was 26.4 years (range 16–44). Male to female ratio was 2:1. Procedure techniques performed included modified Bascoms flap (20), excision and primary closure (20), excision and packing (3) and Rhomboid flap (1). The number of previous emergency and elective procedures in the cohort were 18 and 3 respectively. In 24 (55%) procedures there was documented follow up, at a mean time of 49 days (median 56 days, range 3–84). Overall modified Bascom dehiscence (partial / full) dehiscence and recurrence rates were 10% and 5% respectively. Overall median number of bed related days length of stay was 0 days (range 0–3 days).

Conclusions

The modified Bascoms procedure is both technically simple and reproducible and offers comparatively good dehiscence and recurrence rates relative to other pilonidal sinus procedures.