bluuebunny/crossref_metadata_2025_split huggingface dataset:
209 A Comparison of Soft Tissue Reactions Seen with Different Bone Anchored Hearing Aid Abutments: Smooth-Titanium Vs Hydroxyapatite-Coated
Authors: George R , Wasson J 
Published: October 2021

Abstract

Aim
Bone Anchored Hearing Aids allow hearing via stimulation of the cochlear through bone conduction. These devices are largely successful; however, soft tissue reactions often hinder their benefit. The type of abutment used could contribute to complications. We aimed to investigate whether using smooth-titanium abutments instead of hydroxyapatite-coated abutments reduced the rate of soft tissue reactions and need for revision surgery.

Method
A retrospective cohort analysis of all patients who received a Bone Anchored Hearing Aid during a 3-year period. An electronic database was screened for skin reactions and surgical revisions. A comparison was made between patients who received a hydroxyapatite-coated abutment and smooth-titanium abutments. The same surgical technique, linear incision skin preservation surgery, was used for inserting both abutments.

Results
Sixty-six patients received a Bone Anchored Hearing Aid. Forty-five patients received hydroxyapatite-coated abutments and twenty-one received smooth-titanium abutments, two patients had smooth-titanium inserted bilaterally. The groups were significantly similar with regards to age and gender. Significantly more patients who received hydroxyapatite-coated abutments recorded soft tissue reactions, 77.78% vs 23.81% (p &lt; 0.0001). Significantly more patients who received hydroxyapatite-coated abutments required surgical revision, 40% vs 9.52% (p = 0.0197). 17.14% underwent skin revision and change of abutment. 5.7% had the abutments removed and were not immediately replaced.

Conclusions
When utilising skin preservation surgery for Bone Anchored Hearing Aid insertion smooth-titanium abutments have a favourable complication profile; with less soft tissue reactions and subsequent need for revision surgery, in comparison with hydroxyapatite-coated abutments. The reasons behind these differences warrant further investigations.
558 Summarising the Reporting of Outcomes in Studies of Robot Assisted Cholecystectomy: A Systematic Review
Authors: Jones C S , Kirkham E , Gourbault L , Hollowood F , Dada M , Baker W , Pathak S , Blencowe N ,   On behalf of the RoboSurg Collaborative
Published: October 2021

Abstract

Background
Robot-assisted cholecystectomy (RC) has seen increasing adoption into clinical practice despite a lack of evidence to demonstrate superiority over conventional methods. Consistency in outcome selection, definition and reporting between studies is required for effective evidence synthesis and to minimise research waste. The aim of this study was to conduct an in-depth analysis of the outcomes reported in studies of RC. This work will inform the need for a core outcome set (COS).

Method
Systematic searches identified all published studies reporting RC, from inception to February 2020. Outcomes reported in each manuscript were recorded verbatim and categorised into domains. All outcomes were coded in duplicate. Where reported, the follow up period of each study was documented.

Results
Of 1425 abstracts screened, ninety studies met the criteria for inclusion. A total of 878 outcomes were reported. Each study included a median of 8 outcomes (range 3-26). Outcome selection was heterogeneous, with those relating to technical/operative factors (n = 383, 88 studies), complications (n = 245, 81 studies) and health economics (n = 139, 72 studies) used most frequently. No single outcome, or outcome domain, was reported in all studies. Only 30 studies reported a follow-up period, which ranged from 14 days to 46 months. In thirteen, the follow-up was for less than or equal to one month.

Conclusions
We identified significant heterogeneity in the selection and reporting of outcomes in studies of RC and support calls for standardisation and development of a COS.
1237 Optimising Outpatient Care After Paediatric Burns: The Development of a Chatbot To Identify Complications And Provide Clinical Advice
Authors: Geoghegan L , Harrison C , Collins D , Gardiner M , Rodrigues J 
Published: October 2021

Abstract

Aim
More than 6000 children require specialist care from one of fourteen regional burns services in England and Wales each year. Families often have to travel long distances and may not have access to specialist care with restricted services due to Covid-19. This quality improvement project aimed to:

Method
We conducted a national service evaluation of children’s burns services in England and Wales. We then conducted a PRISMA compliant systematic review up to September 2020 to identify studies reporting chatbot use to deliver outpatient care. A chatbot was then developed using Dialogflow to identify complications and provide advice to families.

Results
Across England and Wales, 11 children’s burns services reported outpatient practice: six services follow up all children at three months, three have variable follow-up and two discharge all patients. Our systematic review identified 10 studies reporting chatbot use although none were used following burns. A frame-based system-focused chatbot was developed in conjunction with expert burns surgeons and patient representatives.

Conclusions
Chatbots are effective and acceptable alternatives for in-person follow up. We demonstrate national variation in the provision of outpatient paediatric burn care and have developed a chatbot that can address clinical concerns and provide reassurance to patients and family members. Future studies will determine the acceptability and safety of this chatbot.
564 Freedom from Urethral Catherisation – Using QI Methodology to Improve Patient Outcome and Experiences
Authors: Odedra A , Allchorne P , Parker M , Lee J , Moyo-Gnahui S , Green J 
Published: October 2021

Abstract

Aim
To reduce catheter burden on patients who could instead be free of urethral catheter and taught intermittent self-catheterisation (ISC).

Method
2 PDSA (Plan, Do, Study, Act) cycles were performed over a 21-month period from February 2018 to November 2020. Using multiple nurse-led TWOC clinics, data was extracted using nurse-completed proformas and electronic patient records to determine: TWOC rate; urethral catheter-free rate; and ISC rate. Following baseline measurement, interventions were made, such as centralisation of TWOC services, emphasis on ISC teaching and the introduction of industry-nurse led clinics.

Results
At baseline, TWOC rate, urethral catheter-free rate and ISC rate were 55.7%, 68% and 28.2%, respectively. Following centralisation of TWOC services and emphasis on ISC teaching in Cycle 1, urethral catheter-free rate rose to 77.8% whilst ISC rate fell to 25%. Cycle 2 followed the introduction of industry-nurse led clinics. Following this, urethral catheter-free rate rose further to 81.6%, with ISC rate rising dramatically to 56.3%

Conclusions
To those capable, ISC frees patients of catheter burden and its sequalae. Evidently, a greater onus on ISC training will increase the number of patients left catheter-free.
1164 St Andrew’s COVID Surgery Safety (StACS) Study: Skin Cancer
Authors: Miranda B , Jica R , Pinto-Lopes R , Mopuri N , Sood M , Tare M , Shelley O , El-Muttardi N ,   St Andrew`s Collaborative
Published: October 2021

Abstract

Background
Skin cancer represents the most common malignancy worldwide and it is imperative that we develop strategies to ensure safe and sustained delivery of cancer care which are resilient to the ongoing impact of COVID-19.

Objective
This study prospectively evaluates the COVID-19 related patient risk and skin cancer management at a single tertiary referral centre, which rapidly implemented national COVID-safety guidelines.

Method
A prospective cohort study was performed in all patients who underwent surgery for elective skin cancer service management, during the UK COVID-19 pandemic peak (April-May 2020). ‘Real-time’ 30-day hospital database deceased data were collected. Random selection was undertaken for patients who either underwent operative (surgery group) management or remained on the waiting list (control group); these groups were also prospectively followed-up within a controlled cohort study design and telephoned at the end of June 2020 for the control group or 30 days post-operatively.

Results
Of the 767 patients who had operations, there were no COVID-19 related deaths. Both the surgery (n = 384) and control (n = 100) groups were matched for age, sex, ethnicity, BMI, presence of comorbidities, smoking and positive COVID-19 contact. There were no differences in post-operative versus any symptom development (1.3%, 5/384 vs. 4%, 4/100, p = 0.093), or proportion of positive tests (8.6%, 33/384 vs. 8%, 8/100; p = 0.849), between the surgery and control groups.

Conclusions
These data support continued and safe service provision, and no increased risk to skin cancer patients who require surgical management, which is vital for continuation of cancer treatment in the context of a pandemic.
800 The Impact of the COVID-19 Pandemic on The Management of Patients with Vascular Conditions: The Vascular and Endovascular Research Network (VERN) COVID-19 Vascular Service (COVER) Tier 3 Study
Authors: Birmpili P ,   Vascular and Endovascular Research Network (VERN) COVER Study Collaborative
Published: October 2021

Abstract

Introduction
The COVID-19 pandemic has had significant impact on healthcare delivery internationally. The aim of this study was to evaluate the changes in the management of vascular conditions during the COVID-19 pandemic compared to pre-pandemic standards.

Method
An international multicentre prospective cohort study was conducted over a 4-week period from March 2020. All patients referred to vascular services with acute vascular conditions were eligible to participate. Data on patient demographics, diagnosis and treatment delivered during the pandemic were collected. If there was a deviation from the pre-pandemic management plan, this ‘ideal’ plan was recorded, and the severity of modification scored on a 5-point scale.

Results
A total of 1801 patients from 52 centres in 19 countries were included in the study, most commonly referred with lower limb conditions (54.4%). Only 2.3% of patients had a confirmed diagnosis of COVID-19. A deviation from the pre-pandemic treatment standard occurred in 35% of unruptured ≥5.5cm diameter abdominal aortic aneurysms, 24.7% of patients with carotid disease, 17% with acute or chronic limb-threatening ischaemia and 12.7% with diabetic foot conditions. Of these modifications, 40.7% were significant, such as endovascular instead of open aneurysm repair or treatment delays, 38.1% major, such as non-operative management of carotid and lower limb disease, and 4.9% life-changing/ending including major amputation or palliation.

Conclusions
The COVID-19 pandemic has significantly impacted upon the management decisions for vascular conditions, independent of COVID status, with 17% of all-referred patients receiving suboptimal care due to limited resources and difficulty accessing services.
954 An International Multi-Centre Appraisal of The Management of Acute CHOLEcystitis During The COVID-19 Pandemic: The CHOLECOVID Study
Authors: Spiers H V M ,   CHOLECOVID Collaborative
Published: October 2021

Abstract

Aim
National guidance issued in response to COVID-19 resulted in adoption of non-surgical modes of treatment in emergency surgery, including acute cholecystitis (AC). The aim of the CHOLECOVID Study is to understand the changes in management and outcomes of AC during COVID19, since becoming the definitive global study on the subject.

Method
Patients &gt;18 years admitted to hospital with radiologically confirmed AC, during two predefined 8-week time periods: P1 (pre-pandemic) 12/09/19-12/11/19; P2 (during the pandemic) 12/03/20-12/05/20, were included. The primary outcome was 30-day all-cause mortality. Secondary outcomes included severity of AC, radiological diagnostic modalities implemented, definitive management and pulmonary complications.

Results
9,615 patients were included from 39 countries (P1:5,381; P2:4,234). 30-day mortality was higher in P2 (1.7%vs2.4%;p&lt;0.015). Higher rates of moderate and severe AC were seen in P2 (30.1%vs35.1%;3.7%vs4.1%). First-line CT imaging was more common in P2 (36.3%vs46.3%;p&lt;0.001). There were higher failure rates of conservative management in P2 (37.4% vs 44.4%; P &lt; 0.001). Cholecystostomy rates were higher in P2 (5.8%vs8.8%;P&lt;0.001). Overall, 4.6% (n = 193) of P2 patients were COVID-19 positive, with overall mortality of 0.7% (n = 30). There was no significant difference in pulmonary complications between COVID-19 positive or negative patients.

Conclusions
During the COVID-19 pandemic, a small increase in mortality among AC patients was noted, when compared to the pre-pandemic cohort. Patients during the COVID-19 pandemic presented with more severe AC, resulting in altered trends in diagnosis and management. New guidance and clear pathways are required to safely manage AC moving forward, in the face of further waves of COVID-19.
204 A Systematic Review of Clinical Outcomes for Outpatient vs Inpatient Shoulder Arthroplasty
Authors: Perera E , Flood B , Madden K , Goel D , Leroux T , Khan M 
Published: October 2021

Abstract

Aim
Outpatient shoulder arthroplasty is growing in popularity as a cost-effective and potentially equally safe alternative to inpatient arthroplasty. We investigated literature relating to outpatient shoulder arthroplasty, looking at clinical outcomes, complications, readmission, and cost compared to inpatient arthroplasty.

Method
We systematically searched Medline, Embase, PubMed using relevant search terms. Methodological quality of included studies was assessed using Methodological Index for Non-Randomised Studies score.

Results
We included 17 studies in our review with 11 included in the meta-analyses. A meta-analysis of hospital readmissions demonstrated that there was no statistically significant difference between outpatient and inpatient cohorts (OR = 0.89, 95% CI: 0.63-1.25, p = 0.49, I2=56%). Pooling results for all post-operative complications identified decreased complications in those undergoing outpatient surgery (OR = 0.70; 95% CI: 0.52-0.94, p = 0.02, I2=50%). No statistically significant difference was identified with respect to medical complications (OR = 0.86, 95% CI: 0.74-1.01, p = 0.07, I2=0%) or surgical complications (OR = 0.71, 95% CI: 0.45-1.12, p = 0.14, I2=26%). Considerable cost saving of between $3 614 – $53 202 (19.7 – 69.9%) per patient were present in the outpatient setting.

Conclusions
Shoulder arthroplasty in the outpatient setting is as safe as shoulder arthroplasty in the inpatient setting, with a significant reduction in cost. There is no demonstrable statistically significant difference with regards to readmissions between outpatient and inpatient shoulder arthroplasty. In the appropriately selected patient, outpatient shoulder arthroplasty is safe and cost-effective; however, we still need to work towards understanding who the appropriate patients are for this post-operative care pathway.
275 Validation of The Radiographic Union Score for Humeral Fractures (RUSHU) For Prediction of Humeral Shaft Nonunion
Authors: Arora N 
Published: October 2021

Abstract

Aim
To validate the use of RUSHu score in prediction of humerus non union.

Method
All patients having radiographs of humerus performed between Jan 2016 to December 2018 were assessed based on inclusion and exclusion criteria. The RUSHu scoring system as published was used to score each 6-week radiograph, separately by 2 blinded observers. 6 months was used as end point to assess outcome. Cohort of 188 observations were used to assess utility of scoring system to predict non union.

Results
94 suitable fractures were identified. Union rate of 72.3% was observed. Mean score in union group was 9.6, 6.4 for non-unions. There was substantial inter-observer reliability with an ICC of 0.73. Rate of union progressively increases with increasing RUSHu scores. ROC curve analysis identifies 8 as most suitable for use as threshold. Area under the curve is high (0.9)

Conclusions
A low RUSH score at 6 weeks is a reliable predictor of non union down the line. If a score 7 or lower is observed, it should trigger a discussion with the patient and review of correctable factors contributing to development of non union. Consideration of surgical fixation should be made at this stage if instability is felt to be a major contributing cause. A patient with score of 8 or higher is more likely to go on to union. Routine use of RUSHu score can aid in clinical decision making and introduce an element of objectivity in clinical assessment. It has potential to prompt earlier intervention and reduce morbidity duration.
328 Patellar Height After Anterior Cruciate Ligament Rupture Reconstruction Using the Autologous Bone-Patellar Tendon-Bone Graft Technique in The Maltese Population
Authors: Psaila R , Bugeja K 
Published: October 2021

Abstract

Aim
The primary aim of this study is to determine whether there is a change in patellar height after closure of the patellar tendon defect after a bone-patellar tendon-bone graft harvesting. The secondary aim is to evaluate clinical and functional outcomes.

Method
A retrospective observational study was conducted. Patients who were diagnosed with ACL injury and underwent reconstruction of ACL using the B-p-T-B graft technique from 2015 to 2020 were included (56 patients). All patients underwent the same procedural steps in the same centre. All patients had pre- and post-operative knee radiographs (antero-posterior and lateral views). The Caton- Deschamps Index was used to measure patellar height pre- and post-operatively. The International Knee Documentation Committee-Subjective Knee Evaluation Form was used to assess functional outcome. Clinical outcome was assessed by reviewing patient records.

Results
There was a change from the pre-op index 0.995 +/- 0.144 (mean +/- SD) to the post-op index 0.948 +/- 0.150. With a statistically significant decrease in index of 0.048 +/- 0.131 (p value 0.009) was found. The null hypothesis (that there is no change) is rejected and therefore the alternative hypothesis (a decrease in patellar height) is accepted. The mean IKDC-SKF score was 76.851 +/- 15.015 (SD) ranging from 40.2 to 100

Conclusions
Performing ACL reconstruction using the B-pT-B technique, although predisposing to a decreased patellar height, it does not increase the incidence of patella baja. An overall good functional outcome was achieved, mean IKDC-SKF 76.85. However, no clear association between change in patellar height and PF symptoms could be demonstrated.
Diagnostic accuracy using low-dose versus standard radiation dose CT in suspected acute appendicitis: prospective cohort study
Authors: Haijanen Jussi , Sippola Suvi , Tammilehto Ville , Grönroos Juha , Mäntyoja Siiri , Löyttyniemi Eliisa , Niiniviita Hannele , Salminen Paulina 
Published: October 2021

Abstract

Background
Contrast-enhanced CT is the reference standard used in diagnostic imaging for acute appendicitis in adults. The radiation dose has been of concern. This study aimed to assess whether a lower radiation dose would affect the diagnostic accuracy of CT.

Methods
This was a prospective single-centre cohort study of patients (aged over 16 years) with suspected appendicitis evaluated for enrolment in concurrent APPAC II–III trials. The diagnostic accuracy of contrast-enhanced low- and standard-dose CT was compared with study protocols guiding imaging based on BMI; this enabled direct CT imaging comparison only in patients with a BMI below 30 kg/m2. The on-call CT diagnosis was compared with the final clinical diagnosis.

Results
Among all 856 patients investigated, the accuracy of low-dose (454 patients) and standard-dose (402 patients) CT in identifying patients with and without appendicitis was 98·0 and 98·5 per cent respectively. In patients with a BMI under 30 kg/m2, respective values were 98·2 per cent (434 patients) and 98·6 per cent (210 patients) (P = 1·000). The corresponding accuracy for differentiating between uncomplicated and complicated acute appendicitis was 90·3 and 87·6 per cent in all patients, and 89·8 and 88·4 per cent respectively among those with a BMI below 30 kg/m2 (P = 0·663). The median radiation dose in the whole low- and standard-dose CT groups was 3 and 7 mSv respectively. In the group with BMI below 30 kg/m2, corresponding median doses were 3 and 5 mSv (P &lt; 0·001).

Conclusion
Low- and standard-dose CT were accurate both in identifying appendicitis and in differentiating between uncomplicated and complicated acute appendicitis. Low-dose CT was associated with a significant radiation dose reduction, suggesting that it should be standard clinical practice at least in patients with a BMI below 30 kg/m2.
The Key-Dependent Capacity in Multidimensional Linear Cryptanalysis
Authors: Cao Wenqin , Zhang Wentao , Zhao Xuefeng 
Published: October 2021

AbstractThe capacity is an important parameter in multidimensional linear attack. In this paper, we firstly explore the distribution of the key-dependent capacity. Based on the magnitude of the correlation contributions, we divide the linear approximations subspace into two sets: one set consists of the strong linear approximations, and the other set consists of the weak linear approximations. We construct two statistics using the linear approximations in the two sets, respectively. Under reasonable assumptions, both of the two statistics follow Gamma distribution. Thus, the capacity is the sum of two statistics that follow Gamma distribution. Secondly, the accuracy of the model is verified by experiments on SMALLPRESENT[4]. Our experimental results show that this model can estimate the variance of the key-dependent capacity more accurately. Thus, we obtain more precise knowledge of the data complexity of the multidimensional linear attack. We derive the upper bound of the data complexity for multidimensional linear attack. Finally, based on our theoretical results, we explore the data complexity of Cho’s multidimensional linear attack on PRESENT. Our results are the smallest data complexity for the same round attack so far.