bluuebunny/crossref_metadata_2025_split huggingface dataset:
P69 Intra-ocular pressure measurement in eye casualty: Which is the Fairest of Them All?
Authors: Smith Chanelle , Mamtora Sunil 
Published: April 2021

Abstract

Introduction
A survey completed by junior doctors who routinely run eye casualty clinics identified Goldmann applanation tonometry (GAT) as the single most time-consuming element of a standard consultation. IOP can be measured with a range of devices in the eye clinic. By identifying the most accurate and time efficient method we can save time in consultations as well as provide better outcomes for the patient.

Purpose
To compare four tonometry techniques: Goldmann applanation tonometer(GAT), Non-contact tonometer(NCT), Tonopen(TP) and Icare tonometer(ICT) to determine the most accurate and efficient method.

Method
20 subjects presenting in the casualty eye clinic were used in the study ranging between 36-75 years. Once undergoing routine ophthalmic examination from the same clinician, IOP was recorded with all devices. Three readings were taken before calculating an average value and time taken for each device for each patient. No patients were excluded from the study.

Results
The average IOP with GAT, NCT, TP and ICT was 8.5 ± 2.7, 10.3 ± 4.2, 8.6 ± 3.1, and 8.4 ± 4.5 mmHg, respectively. The average time taken with GAT, NCT, TP and ICT was 56, 132, 38 and 23 seconds, respectively. There was no significant difference in IOP measured by GAT and TP and ICT however, NCT (10.3 mm Hg, P &lt; 0.01) measured significantly higher IOPs compared to GAT.

Conclusion
When compared to Goldmann applanation tonometer, Icare was the most accurate and efficient method. While Tonopen was fairly accurate some patients were unable to tolerate it. NCT was significantly slower compared to other devices.
P74 Long-term Survival After Minimally Invasive Resection versus Open Pancreaticoduodenectomy for Pancreatic Cancers: A Systematic Review and Meta-analysis
Authors: Gujjuri Rohan R , Kamarajah Sivesh K , Bundred James R , Jiao Long R , Hilal Mohammed Abu , White Steven A 
Published: April 2021

Abstract

Introduction
It remains unclear whether minimally invasive pancreaticoduodenectomy (MIPD) and open pancreaticoduodenectomy (OPD) influences long-term survival in periampullary cancers. This review aims evaluate long-term survival between MIPD and OPD for periampullary cancers.

Methods
A systematic review was performed to identify studies comparing long-term survival after MIPD and OPD. The I2 test was used to test for statistical heterogeneity and publication bias using Egger test. Random-effects meta-analysis was performed for all-cause 5-year (main outcome) and 3-year survival, and disease-specific 5-year and 3-year survival. Meta-regression was performed for the 5- year and 3-year survival outcomes with adjustment for study (region, design, case matching), hospital (centre volume), patient (ASA grade, gender, age), and tumor (stage, neoadjuvant therapy, subtype (i.e. ampullary, distal bile duct, duodenal, pancreatic)). Sensitivity analyses performed on studies including pancreatic ductal adenocarcinoma (PDAC) only.

Results
The review identified 31 relevant studies. Among all 58,622 patients, 8716 (14.9%) underwent MIPD and 49,875 (85.1%) underwent OPD. Pooled analysis revealed similar 5-year overall survival after MIPD compared with OPD (HR: 0.78, 95% CI 0.50–1.22, p = 0.2). Meta-regression indicated case matching, and ASA Grade II and III as confounding covariates. The statistical heterogeneity was limited (I2 = 12, c2 = 0.26) and the funnel plot was symmetrical both according to visual and statistical testing (Egger test = 0.32). Sensitivity subset analyses for PDAC demonstrated similar 5-year overall survival after MIPD compared with OPD (HR 0.69, 95% CI: 0.32–1.50, p = 0.3).

Conclusion
Long-term survival after MIPD is similar to OPD. Thus, MIPD can be recommended as a standard surgical approach for periampullary cancers.
P80 Meeting urological cancer targets during Covid-19
Authors: Dirie J , Hart E , Mahesan T , Fawcett W , Perry M , Janardanan S , Moschonas D , Krishnaji P , Abou-Chedid W 
Published: April 2021

Abstract

Introduction & Objectives
The pandemic caused by Covid-19 has caused significant strain on healthcare professionals across the globe.
Without downplaying the devastating effects of the virus itself, the collateral damage – specifically in cancer targets – has only compounded an already difficult time in medicine. Therefore, it was of the utmost importance that we: strived to continue to meet our cancer targets, and we analysed our success in addressing this.

Materials & Methods
A key factor was the proximity of a private Nuffield hospital (GN) to the primary trust. GN acted as a ‘clean site’. From 6th April 2020, 2 Xi Da Vinci robots and dedicated staff were relocated to day surgery theatres with direct: access to GN. Endoscopic procedures occurred in GN theatres. Post-operative recovery happened in GN. National guidelines were followed including COVID-19 symptom screening, isolation and preoperative nasopharyngeal swabs. All theatre staff were swabbed weekly and worked solely at GN. Patients were risk stratified prior to admittance. Cancer features and patient risk factors for COVID-19 were taken into account. Standard enhanced recovery principles were applied throughout the patient’s journey. In theatre, we worked to ensure minimal staff numbers for safe practice were present. We reviewed operations performed, alongside cancer (prostate & bladder) pathway data from March to June 2020. For comparison identical data from August to November 2019 was collected.

Results
There were a total of 369 cancer operations performed at our Trust from March until June 2020. In comparison, 407 cancer operations were performed in the 4 months from August until November 2019. For both timeframes, a: variety of robotic, endoscopic and open surgeries were carried, with similar numbers seen in each.
In total, we received 80 referrals for possible prostate malignancies from March – June 2020, and 150 from August – November 2019. Days to MRI was slightly better in March to June, but we did not find a statistical difference. We: found a statistically significant decrease in the number of days it took for a patient to go from referral to diagnosis.
Furthermore, we also improved on the proportion of patients who had their diagnosis told to them within 28 days, from 74% to 87%.
In total, we received 134 referrals for possible bladder malignancies from March – June 2020, and 81 from August – November 2019. We improved on days to OPA for patients and time to flexible cystoscopy, with both results carrying statistical significance. We were able to reduce time to OPA from 8 to 6 days, and time to flexible cystoscopy from 26 to 12 days.

Conclusions
This study demonstrates that with rapid development of separate ‘clean’ and ‘COVID’ sites, we successfully delivered a comparable, safe and effective cancer service. As we potentially face a second wave we share our success to see if these changes can be replicated elsewhere.
P85 Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic
Authors:   Covidsurg Collaborative
Published: April 2021

Abstract

Aim
This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic.

Method
This was an international cohort study of patients undergoing elective colon or rectal cancer resection, without preoperative suspicion of SARS-CoV-2. Centres entered data from their first recorded case of COVID-19 until 19 April 2020. The primary outcome was 30-day mortality. Secondary outcomes included anastomotic leak, postoperative SARS-CoV-2, and a comparison with a pre-pandemic European Society of Coloproctology cohort data.

Results
From 2073 patients in 40 countries, 1.3% (27/2073) had a defunctioning stoma and 3.0% (63/2073) had an end stoma instead of an anastomosis only. 30-day mortality was 1.8% (38/2073), the incidence of postoperative SARS-CoV-2 was 3.8% (78/2073), and the anastomotic leak rate was 4.9% (86/1738). Mortality was lowest in patients without a leak or SARS-CoV2 (14/1601, 0.9%), and highest in patients with both a leak and SARS-CoV-2 (5/13, 38.5%). Mortality was independently associated with an anastomotic leak (adjusted odds ratio 6.01, 95% confidence interval 2.58-14.06), postoperative SARS-CoV-2 (16.90, 7.86-36.38), male sex (2.46, 1.01-5.93), age &gt;70 years (2.87, 1.32-6.20), and advanced cancer stage (3.43, 1.16-10.21). Compared to pre-pandemic data, there were fewer anastomotic leaks (4.9% versus 7.7%), an overall shorter length of stay (6 versus 7 days), but higher mortality (1.7% versus 1.1%).

Conclusion
Surgeons need to further mitigate against both SARS-CoV-2 and anastomotic leak when offering surgery during current and future COVID-19 waves based on patient, operative, and organisational risks.
P95 Preliminary Findings on Patient Satisfaction with Telepsychiatry – A Systematic Review
Authors: Tokell Marisa , Lin Chung M A , Dave Subodh , Abraham Seri , Ramkisson Roshelle , Mahalingappa Sridevi S , Pillai Anilkumar S , Matheiken Shevonne , Iliani Yaara Z , McNally Rosalind , Bamrah J S 
Published: April 2021

Abstract

Introduction
During the COVID-19 pandemic, mental health services have been presented with the unique challenge of providing effective and safe patient care whilst maintaining safety regulations. Telepsychiatry has emerged as a potential solution to this and is now being used across the UK to diagnose and manage mental health conditions. Evidence has shown that its effectiveness is comparable to face to face consultations, however, is much less clear regarding patient satisfaction. We therefore initiated a systematic review to establish whether patients are satisfied with tele-delivery of psychiatric care, and to identify the predictors of a positive experience with telepsychiatry.

Methods
A preliminary search was performed using five databases (MEDLINE, EMBASE, Cochrane Library, CINAHL, PsycINFO), with a date restriction between 2010-2020 to reflect advances in technology over the past decade.

Results
Preliminary data shows that patient views on telepsychiatric services are largely positive. Factors that arose in literature potentially affecting this include location, cost, privacy, digital literacy and technological issues including audio/video quality.

Conclusion
Our study so far shows that patient views on telepsychiatry are generally positive. The review is still in process, however, we anticipate that it will only further support our preliminary findings. These findings will be used to improve patient-centred delivery and provision of telepsychiatric services. We intend to produce a checklist of factors affecting patient satisfaction and test this in a national multicentre study. We are hoping that the study results and the resulting checklist will encourage greater patient involvement in setting up and delivering telepsychiatric services.
P99 Quantitative Assessment of Visual Function for Pituitary Macroadenomas: A Practical Scoring Algorithm
Authors: Lee Keng Siang , Jeffrey Sam , Bradley Karin , Atan Denize , Williams Adam , Abhinav Kumar , Teo Mario , Nelson Richard 
Published: April 2021

Abstract

Background
There is a myriad of existing terms by which visual capacity is recorded. The lack of a standardised categorisation of observations commonly result in ambiguities. We report the utility of a visual function score (VFS) in patients managed by transsphenoidal surgery.

Methods
A VFS (expressed as a percentage) with a maximum score of 20 was calculated for each eye using the Snellen VA (40% weighting: score 0-8) and Humphrey Allergan 30-2 automated visual field (60% weighting: score 0-12).

Results
280 patients (560 eyes) underwent transsphenoidal pituitary adenoma resections with complete pre and post-operative visual function assessment. Mean age 56 years; 56.4% male. 26.1% were treated by endoscopic technique and 73.9% by microscopic technique. Pre-operative vision was normal in 38.0% eyes and had full post-operative vision. In patients with pre-operative visual loss, the mean pre-operative VFS rose from 70.8% to 87.5% post-operatively. 43.8% eyes attained full post-operative vision, 28% improved, and 25.6% remained unchanged. 9 patients (2.6%) had worse immediate post-operative vision.

Discussion
The VFS is a convenient single measure of visual function that may facilitate local and national audit of transsphenoidal surgery. Studies are planned to correlate this with patient reported visual quality of life measures
P107 Safety and Efficacy of Tranexamic Acid to Minimise Perioperative Bleeding in Extrahepatic Abdominal Surgery: a systematic review and meta-analysis
Authors: Koh Amanda , Adiamah Alfred , Gomez Dhanny , Sanyal Sudip 
Published: April 2021

Abstract

Introduction
Perioperative bleeding is a major risk during and after surgery, which can result in increased mortality and morbidity. Tranexamic acid (TXA) in the setting of trauma, minimises perioperative bleeding and its associated risks. However, there is a lack of evidence of its use in elective abdominal surgery. This meta-analysis of randomised controlled trials (RCTs) evaluated the effectiveness and safety of TXA in elective extrahepatic abdominal surgery.

Method
A comprehensive search of Pubmed, Embase, and Clinicaltrial.gov databases was undertaken to identify RCTs from January 1947 to May 2020. The primary outcomes of intraoperative blood loss, and the secondary outcomes of need for perioperative blood transfusion, thromboembolic events, and mortality were extracted from included studies. Quantitative pooling of data was based on the random effects model.

Results
Nineteen studies reporting on 2205 patients were included. TXA reduced intraoperative blood loss (weighted mean difference (WMD) -188.35mL; 95% CI -254.65 to -121.72) and the need for perioperative blood transfusion (odds ratio (OR) 0.43; 95% CI 0.28 to 0.65). Importantly, TXA had no impact on the incidence of thromboembolic events (OR 0.49; 95% CI 0.18 to 1.35). There were no reported deaths in any of the studies.

Conclusion
TXA reduces intra-operative blood loss without an increase in complications.
P112 SMILE: Sustaining Medical Education In a Lockdown Environment.Using social media to develop a free online access medical education platform during lockdown
Authors: Pascoe John , Foster Paul , Quddus Muntasha , Kosti Angeliki , Guest Francesca , Stevens Sian , Bamford Richard , Coulston James 
Published: April 2021

Abstract

Introduction
SMILE is a free online access medical education (FOAMEd) platform created by two UK surgical trainees and a medical student that delivered over 200 medical lectures during lockdown.

Method
The role of Social Media in the development of SMILE was interrogated using a survey sent to all SMILE participants and by analysing activity on SMILE social media platforms.

Results
1306 students responded to the online survey with 57.2% saying they heard of SMILE through Facebook. Engagement using facebook remained highest with 13,819 members, over 800 user comments and &gt;16,000 user reactions.
4% of the students heard of SMILE through Twitter or Instagram.
Facebook analytics revealed the highest level of traffic when lectures were most commonly held suggesting students used Facebook to access lectures.
Other educators were able to find SMILE on social media, leading to collaborations with other platforms.
Throughout the survey many mentioned how social media created and maintained a community of medical students enhancing group-based learning

Conclusions
We demonstrate that social media platforms provide popular and cost-effective methods to promote, sustain & deliver medical education for students and educators.
P115 Students experiences of graduate attribute development, a qualitative study
Authors: O'Connor Diarmuid , Geoghegan Rosemary 
Published: April 2021

Abstract

Introduction
Graduate attributes are recognised as the skills and values that should be acquired by all students in tertiary education, regardless of their field of study. Graduate attributes have significant relevance to employability and in enhancing students’ personal development.
This research aimed to explore students’ lived experiences of developing two graduate attributes embedded within their undergraduate medical curriculum: communication and collaboration skills.

Methods
Phenomenology was the validated, qualitative research method most suited to address the research question. Phenomenology allows one to better understand peoples’ direct, lived experiences of a particular phenomenon; in this case, graduate attribute development.
Purposefully sampled participants were chosen for semi-structured interviews, all of whom had completed the same undergraduate medical education programme. Semi-structured interviews were performed until thematic saturation occurred, at participant eight. The Braun and Clarke method of thematic analysis was utilised to identify recurring themes from the interview process.

Results
The five key themes that emerged were (1) the value placed on graduate attribute development, (2) the presence of graduate attribute learning opportunities, (3) the presence of barriers against graduate attribute development, (4) graduate attribute literacy and preconceptions and (5) the students’ transition into employment.

Conclusions
There is a need for improved graduate attribute assessment methods and the development of meaningful learning strategies that promote transformative learning opportunities.
Barriers against communication and collaboration skills development exist and need to be addressed.
Students need to better understand the relevance of communication and collaboration skills to their future professional careers before the student-to-doctor transition has occurred.
P118 The 134-year-old problem meets the 1-year-old problem: lessons learned in managing acute appendicitis during the COVID era
Authors: Fernando Sherwin , Sarma Diwakar Ryali 
Published: April 2021

Abstract

Introduction
The Right Iliac Fossa Pain Treatment (RIFT) study highlighted the rate of negative appendicectomies in the UK as one third of all procedures. However, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2/COVID) pandemic has changed surgical practice. New practices in the COVID era have changed the rate of negative appendicectomies.

Methods
A retrospective analysis was conducted of patients admitted with appendicitis from March 2020 to June 2020.

Patient Demographics
58 patients were identified, 43 (74%) were adults and 15 (26%) were children. The median age of the adults was 33 (range 18-80) and the median American Society of Anaesthetists (ASA) grading was 1. The median age of children was 11 (range 4-17) and all were ASA grade 1.

Results
73.8% (31) of adult patients had a Computerised Tomography (CT) scan as part of their workup. 40% of paediatric patients underwent an ultrasound scan of the abdomen whilst the remaining 60% were diagnosed clinically. The open approach was favoured in both cohorts (39.5% and 46.7% respectively). No negative appendicectomies were performed.

Conclusion
COVID19 has changed practice resulting in better outcomes for colorectal units. Further studies (COVID SURG and COVID HAREM) are needed to fully assess the role of imaging in reducing the number of negative appendicectomies.
Starting an aortic valve repair program: is it worthwhile? Aortic valve repair compared to replacement
Authors: Meuris Bart , Vervoort Dominique , De Praetere Herbert , Rex Steffen , Van De Bruaene Alexander , Herijgers Paul , Rega Filip , Verbrugghe Peter 
Published: April 2021

Abstract

OBJECTIVES
Increasing evidence suggests that aortic valve (AV) repair may have better long-term outcomes than AV replacement for aortic insufficiency. However, most literature is limited to centres of excellence and has not sufficiently been replicated in nascent programs. This single-centre experience of a newly established AV repair program aims to compare short-term outcomes of AV sparing versus replacement surgery.

METHODS
A retrospective cohort study of patients who underwent elective surgery for aortic regurgitation or aortic root dilatation at the Leuven University Hospital between 2013 and 2018 was performed. Patients with a critically ill presentation, endocarditis, aortic stenosis or requiring redo surgery were excluded. Patients were assigned to repair versus replacement based on preoperative intention to preserve the AV. Nearest neighbour propensity score matching was performed to compare both groups. Safety (mortality, morbidity), efficiency (cross-clamp and bypass times) and efficacy end points (repair rate, postoperative echocardiography) were compared.

RESULTS
One hundred and seven patients underwent AV surgery (48 repair, 59 replacement), from which 2 groups of 23 matched patients were created. There were 1 death and 2 reoperations after repair and no death and 1 reoperation after replacement. Extracorporeal circulation and aortic cross-clamp time were significantly longer while ventilation and total hospital stay were significantly shorter after AV repair. Echocardiographic follow-up showed comparable aortic regurgitation but lower transvalvular gradients after repair. Freedom from major complications was comparable in both cohorts.

CONCLUSIONS
Early results suggest the feasibility of replicating experienced centres’ perioperative and short-term outcomes in nascent programs.
A comprehensive history of motility and Archaellation in Archaea
Authors: Jarrell Ken F , Albers Sonja-Verena , Machado J Nuno de Sousa 
Published: April 2021

ABSTRACT
Each of the three Domains of life, Eukarya, Bacteria and Archaea, have swimming structures that were all originally called flagella, despite the fact that none were evolutionarily related to either of the other two. Surprisingly, this was true even in the two prokaryotic Domains of Bacteria and Archaea. Beginning in the 1980s, evidence gradually accumulated that convincingly demonstrated that the motility organelle in Archaea was unrelated to that found in Bacteria, but surprisingly shared significant similarities to type IV pili. This information culminated in the proposal, in 2012, that the ‘archaeal flagellum’ be assigned a new name, the archaellum. In this review, we provide a historical overview on archaella and motility research in Archaea, beginning with the first simple observations of motile extreme halophilic archaea a century ago up to state-of-the-art cryo-tomography of the archaellum motor complex and filament observed today. In addition to structural and biochemical data which revealed the archaellum to be a type IV pilus-like structure repurposed as a rotating nanomachine (Beeby et al. 2020), we also review the initial discoveries and subsequent advances using a wide variety of approaches to reveal: complex regulatory events that lead to the assembly of the archaellum filaments (archaellation); the roles of the various archaellum proteins; key post-translational modifications of the archaellum structural subunits; evolutionary relationships; functions of archaella other than motility and the biotechnological potential of this fascinating structure. The progress made in understanding the structure and assembly of the archaellum is highlighted by comparing early models to what is known today.
Enumerating Non-Stable Vector Bundles
Authors: DU Peng 
Published: April 2021

Abstract
In this article, we establish a motivic analog of an enumeration result of James–Thomas [ 28] on non-stable vector bundles in topological setting. Using this, we obtain results on enumeration of projective modules of rank $d$ over a smooth affine $k$-algebra $A$ of dimension $d$, recovering in particular results of Suslin and Bhatwadekar on cancellation of such vector bundles. Admitting a conjecture of Asok and Fasel, we prove cancellation of such vector bundles of rank $d-1$ if the base field $k$ is algebraically closed. We also explore the cancellation properties of symplectic vector bundles.