bluuebunny/crossref_metadata_2025_split huggingface dataset:
1309 Cochlear Implantation in Patients with Usher Syndrome: A Systematic Review of The Literature
Authors: Cornwall H L , Lam C M , Chaudhry D , Muzaffar J , Monksfield P , Bance M L 
Published: October 2021

Abstract

Introduction
Usher syndrome is a common cause of deaf-blindness characterised by progressive visual loss with congenital (types 1 and 2) or adult-onset (type 3) sensorineural hearing loss. Cochlear implantation is one of few effective options to enable patient access to useful sound. Auditory rehabilitation after cochlear implantation may be limited by deterioration of retinal function. Our objective was to evaluate the auditory outcomes of cochlear implantation in patients with Usher syndrome.

Method
Systematic review of Medline via PubMed, Ovid EMBASE, Web of Science, CENTRAL and clinicaltrials.gov was performed up to 30/03/2020, conducted in accordance with the PRISMA statement. Patient demographics, comorbidity, details of cochlear implantation, auditory and quality of life (QOL) outcomes were extracted and summarised. CRD 42020185102.

Results
32 studies reported over 215 cochlear implants in 186 patients with Usher syndrome, comprising subtypes 1 (56 patients), 2 (9 patients), 3 (23 patients), and not specified (98 patients). Where reported, cochlear implantation improved sound detection, speech perception, speech intelligibility, and patient-reported quality of life in the majority of patients with Usher syndrome.

Conclusions
Outcomes of cochlear implantation were comparable to those of patients without multiple sensory handicap. As clinical practice has evolved to emphasise early, bilateral implantation and access to oral education it is likely that these reported outcomes may underestimate contemporary implant outcomes among young children with Usher syndrome. To avoid multisensory deficits incurred by poor cochlear implant outcomes secondary to late implantation with Usher syndrome-related progressive visual loss, early implantation is crucial in the prelingually deaf Usher group.
1326 Otorhinolaryngology Education and Training Innovation: A Literature Review of the Academic Year 2019-2020
Authors: O'Hanlon J , McKenna J , Chan J 
Published: October 2021

Abstract

Aim
We aimed to summarise the literature on educational research and training in otorhinolaryngology during the academic year of 2019-2020.

Method
A literature search was conducted on Medline, Embase and Cochrane in accordance with PRISMA guidelines for ““(ENT or otorhino* or otolaryngo* or (ear, nose, and throat)) and (educat* or train or training or teach*)””. The search was conducted independently on 13/09/20 by two authors (JOH, JM), any discrepancy was further reviewed by a third author (JC). All original research papers published between 2019-2020 were included.

Results
68 papers were included in our study. Educational research this year shifted focus on how to combat the negative impact of COVID-19 on otorhinolaryngology teaching. Although many of the interventions created for postgraduate and undergraduate education have not been formally assessed, virtual electives for medical students were found to increase interest and knowledge in the specialty. Surgical simulation represented the most common teaching method reported aside from COVID-19. 3D models were used for emergency training with an aim to increase trainee exposure to an anterior neck abscess, retrobulbar haematoma and paediatric tracheostomy. 3D models were positively rated for face and content validity and gave statistically significant improvements in confidence for trainees.

Conclusions
The otorhinolaryngology training in 2019-2020 has changed massively due to the pandemic. Improving on virtual learning and adapting simulation training are the key to maintain a positive learning environment for medical students and doctors in the short term. Research on the effect of COVID-19 on otorhinolaryngology education and training will be the focus in 2021.
1402 Impact of COVID-19 on Nasal Fracture Presentation and Epidemiology: A Retrospective Comparative Case-series Study
Authors: Hassane A , Palaniappan S , Szostok M , Shakeel M 
Published: October 2021

Abstract

Aim
Nasal fractures (NF) are the most common ENT presentation and commonly managed in the clinic or A&E. With the recent COVID pandemic, this study aims to assess the difference in demographics, incidence and aetiology in NF since the start of the first lockdown (16/03/2020) as well as management of nasal fractures.

Method
Retrospectively, data collection on demographics, history and management over 5 years (2015-2020) for all patients presenting with symptoms of nasal fracture. Data was collected on password-protected Excel spreadsheet and subsequent statistical analysis performed using IBM SPSS Statistics.

Results
A total of 346 patients were identified of which 36 were diagnosed during the lockdown. Seventy-one percent were ≤40 years old and common aetiology recorded was assault (n = 85), sports (n = 85) and falls (n = 77). Mechanical fall was the common aetiology in older patients. Across gender, falls was the most common aetiology in females (37/94) and assault for males (72/246). Epistaxis (57%) and nasal congestion (31.8%) were most commonly reported symptoms. Before lockdown, Fifty-six percent of the cohort underwent manipulation of NF under local anaesthetic and no intervention needed in 39% while 58% underwent no intervention during the lockdown. No patients were readmitted in 30 days who were treated conservatively or with local anaesthetic during the lockdown.

Conclusions
This study showed that the most common cause of NF was sports and assault while during the lockdown, falls was the leading cause. More patients were managed conservatively during the lockdown with no 30-readmission showing that conservative management was as effective as management under local anaesthetic.
1629 The Risk of Malignancy in Cytologically Indeterminate Thyroid Nodules
Authors: Jones O , Blackabey V , Bhat N 
Published: October 2021

Abstract

Introduction
Fine needle aspiration (FNA) is the gold standard for the diagnostic assessment of thyroid nodules, with cytology stratified using the Thy classification (Thy 1-5). The management of cases where cytology is indeterminate (Thy-3) is challenging and subject to controversy. The current British Thyroid Association guidelines subclassify Thy-3 lesions into Thy-3a (atypia) and Thy-3f (follicular). Repeat FNA is generally recommended for Thy-3a specimens, whilst Thy-3f lesions should proceed to diagnostic hemithyroidectomy. The aim of this study was to determine the risk of malignancy in Thy-3a and Thy-3f lesions.

Method
This was a retrospective study of all patients who underwent FNA of a thyroid nodule from 01/01/2018 – 31/12/19. Those with Thy-3 cytology were identified and results correlated with final surgical histology.

Results
In total, there were 179 patients with Thy-3 cytology: 37 Thy-3a and 142 Thy-3f. The rate of malignancy was 21.6% (n = 8) for Thy-3a lesions and 20.4% (n = 29) for Thy-3f. When excluding microcarcinoma, the rates fell to 20.4% (n = 7) and 12.7% (n = 18) respectively. There was no statistically significant difference in malignant conversion between the two groups (p = 0.20).

Conclusions
This study does not demonstrate any statistically significant difference in the risk of malignancy between the Thy-3a and Thy-3f groups, suggesting that this subclassification does not add any additional utility to clinical decision making. Consideration should be given to the use of local malignant conversion rates to guide further management and pre-operative patient counselling in the Thy3 group.
1525 How Far Do Cultural Values Between First and Second Generational Medical Students Differ According to GMC Guidelines
Authors: Anwar S , Jha V 
Published: October 2021

Abstract

Aim
There are a disproportionately higher number of fitness to practise issues reported to the GMC within the BAME medic group than that any other ethnic group. This research seeks to compare differences in cultural nuances, if any, between second generation BAME medical students and whether there is an opportunity to address these within medical training.

Method
We conducted 4 qualitative one to one interviews of second generation medics (Those whose parents were not from the UK, but were themselves brought up in the UK) and medics who were both from the UK and whose parents had been brought up in the UK. An exploratory interview was conducted of what values were most important to the interviewees and how this affected their decision-making process. The interviewees were medical students from the University of Liverpool all of whom were in their clinical years between year 3-5. The interviewees were randomly chosen after expressing an interest in the research. A literature search across Pubmed and Scopus were conducted to help direct interview questions.

Results
The main themes interviewees reported impacting on decision making included difficulty of balancing cultures, the impact of religion on cultural values and personal professional values. When compared to the GMC guidelines, these values mostly aligned however there were some differences, mainly in communication and whistleblowing.

Conclusions
With an increasingly diverse workforce, there should be some further research conducted to address how the differences in culture affects decision making processes with the consideration of incorporation into medical training.
864 Adherence to British Hernia Society Standards in Consenting Practice for Inguinal Hernia Repair
Authors: Binnie C , Adedeji J , Noureldin K , Shamsiddonva A 
Published: October 2021

Abstract

Objectives
Evaluation of adherence to BHS Standards in IHRs Consent. Primary goal was the documentation of “Mesh” on clinic letter and consent form. Secondary points were the enlisted postoperative complications and advice given to reduce the risk of complications.

Introduction
Mesh repair is the gold standard for elective inguinal hernias. Recurrence rate is 1-3%. Chronic pain, for different causes, is documented in 10-15% (Most frequent complication).

Method
Retrospective study looked at first 100 patients, who were subjected to open inguinal hernia repair, in one year time. Patients under 18 years, history of previous repair and laparoscopic repair were excluded. The sample was reduced to 94, as 6 cases had untraceable and insufficient records

Results
Despite using mesh in all patients, it was not written in 11.7% of the consent forms and half of the clinic letters. Postoperative readmissions were 6.4% ,8.5% and 1.1% at week, month and year, respectively. The main causes were pain (1%), wound dehiscence (1%), hematoma (2%), and recurrence (1%). Overall complications rate after one year was 5.5%. Although recurrence and chronic pain are linked to hernia repair, they were not mentioned in 10% and 15%. In contrast, non-specific complications were documented in &gt; 90%. Damage to cord structures and post-operative advice were found in 60% and 30%.

Conclusions
All grades surgeons were not adequately adherent to BHS, exposing the firm to negligence and complains. Preprepared forms and leaflets are advised to improve the quality of service, in respect to the GMC Domains.
577 Association Between the Use of Smokeless Tobacco and Cancer of Gingivobuccal Sulcus
Authors: Sahni D S , Bamania A , Ramsaha S 
Published: October 2021

Abstract

Background
Although oral cancer accounts for 2.1% of all cancer cases globally, it is surfacing as a major public threat in India. Oral cancer figures among three most common types of cancer in the Indian subcontinent, with an incidence rate of 30%. The increased availability and use of smokeless tobacco and betel quid in the recent years have further aggravated the situation. The scarcity of reports on the contribution of such risk factors in oral cancer incidence remains a prime concern. In this perspective, the association between smokeless tobacco and cancer of gingivobuccal sulcus was investigated.

Method
The medical records of 249 patients with cancer of gingivobuccal sulcus, attending the BRAIRCH, AIIMS, New Delhi, were retrospectively examined from 2009-2016. Demographic and clinical data including history of addictions (smoking, smokeless tobacco) were collected and patients were staged according to the 8thAJCC Cancer Staging (2017).

Results
Smokeless forms of tobacco were more prevalent among the patients (50.7%), in contrast to smoked tobacco (19.53%), while 29.77% were reported to consume both forms. A higher proportion of patients with smokeless tobacco addiction were diagnosed with advanced stages of cancer (56.9% in Stage III/IV). These rates were even higher (65.6%) in patients using both smokeless and smoked tobacco.

Conclusions
A strong association was observed between smokeless tobacco and gingivobuccal sulcus cancer, particularly in patients who kept the tobacco in the buccal vestibule after chewing, to suck, sometimesovernight. Elucidating the potential risk factors can be a key approach to design effective intervention programs to combat the growing pandemic of oral cancer in India.
69 The Experimental Methodology and Comparators Used For In Vivo Hernia Mesh Testing; A Ten-Year Scoping Review:
Authors: Whitehead-Clarke T , Karanjia R , Banks J , Beynon V , Parker S , Sanders D , Mudera V , Windsor A , Kureshi A 
Published: October 2021

Abstract

Aim
Before being marketed, hernia mesh must undergo in vivo testing, which often includes biomechanical and histological assessment. Currently there are no universal standards for this testing and methods vary greatly within the literature. A scoping review of relevant studies was undertaken to analyse the methodologies used for in vivo mesh testing.

Method
Medline and Embase databases were searched for relevant studies. 513 articles were identified, and 231 duplicates excluded. 126 papers were included after abstract and full text review. Data extraction was undertaken using standardized forms.

Results
Mesh is most commonly tested in rats (53%). 78% of studies involve the formation of a defect; in 52% of which the fascia is not opposed. The most common hernia models use mesh to bridge an acute defect (50%). Tensile strength testing is the commonest form of mechanical testing (63%). Testing strip widths and test speeds vary greatly (4-30mm and 1.625-240mm/minute respectively). There is little consensus on which units to use for tensile strength testing. Collagen is assessed for its abundance (54 studies) more than its alignment (18 studies). Alignment is not measured quantitatively. At least 21 histological scoring systems are used for in vivo mesh testing.

Conclusions
The current practice of in vivo mesh testing lacks standardisation. There is significant inconsistency in every category of testing, both in methodology and comparators. We would call upon hernia organisations and materials testing institutions to discuss the need for a standardized approach to this
321 The Darn Technique for Small (&lt; 2 Cm Diameter) Midline Hernias
Authors: Pawlak M , Newman M , Beaux A. De , Tulloh B 
Published: October 2021

Abstract

Aim
Primary midline hernias arising in the linea alba are common. While mesh repair has been shown to reduce recurrence rates even in small hernias, many surgeons still use a suture repair for defects of less than 2 cm. The recent European and Americas Hernia Societies Guidelines recommended suture repair only for hernias &lt;1 cm. A darn is a tension-free repair where, in effect, a “mesh” is hand-woven across the defect in situ.

Method
Eligible patients undergoing this repair between 1 January 2008 and 31 December 2017 were identified from a prospective computer-based medical record system and their case notes reviewed. Inclusion criteria were adult patients with a primary midline abdominal wall defect smaller than 2 cm at the widest point measured intra-operatively. Follow up was by telephone. Those who reported possible recurrence or other symptoms in the region of their repair were reviewed in person.

Results
47 suture-darn repairs were undertaken. Fifteen operations (32%) were performed under local anaesthesia. Forty-one patients were followed up with a mean of 80 ± 35 and median of 87 months after surgery. Six patients (13%) were lost to follow-up. Recurrence was found in two cases (5%) and one patient has since been diagnosed with a new epigastric hernia some 5 cm cranial to the previous repair.

Conclusions
The darn repair for small primary midline hernias is quick and inexpensive with promising long-term results. It can be performed under local anaesthesia. It can serve as an alternative to mesh repair for defects less than 2 cm in maximum dimension.
425 The Impact Of COVID-19 On Hernia Surgery in The Lothian Region Of Scotland
Authors: Ewing A , Hodge K , McFadyen R , Grossart C , East B , de Beaux A 
Published: October 2021

Abstract

Aim
The COVID-19 pandemic resulted in a lockdown in South East Scotland on the 23 March 2020. This had an impact on the volume of benign elective surgery able to be undertaken. The degree to which this reduced hernia surgery was unknown.
The aim of this study was to review the hernia surgery workload in the Lothian region of Scotland and assess the impact of COVID-19 on hernia surgery.

Method
The Lothian Surgical Audit database was used to identify all elective and emergency hernia operations over a six-month period from 23 March 2020, and for the same time period in 2019. Data was collected on age, gender, location of the hernia, type of hernia repair and whether elective or emergency operation.

Results
The number of hernia repairs reduced dramatically between 2019 and 2020 (570 versus 149). The majority of this can be explained by a reduction in elective operating (488 versus 87). There was, however, also a reduction in the numbers of hernias repaired as an emergency over the same study periods (82 to 62). Lockdown in 2020 had the biggest effect on elective incisional hernia repair (74 versus 2).

Conclusions
The COVID-19 pandemic has reduced both the number of elective and emergency hernia operations in 2020 compared to 2019. While the reduction in elective surgery has not resulted in an associated increase in emergency surgery over the study period, it is possible that if continuing reduced availability to elective hernia surgery continues in Lothian, the emergency hernia workload may increase.
827 Acute Appendicitis in An Amyand Hernia – A Case Report and Literature Review
Authors: Ahmad M , Fazili N , Chang T P , Abdalla H , Watfah J , Leo C. A 
Published: October 2021

Abstract

Introduction
An Amyand Hernia (AH) is the presence of an Appendix within an Inguinal Hernia. We present here our clinical management of acute appendicitis in an AH and subsequent literature review. A 73-year-old male patient presented with a two-day history of right sided irreducible inguinoscrotal hernia with tender swelling on standing and walking. This was not associated with symptoms of bowel obstruction or fevers. Blood investigations revealed a raised C-Reactive Protein of 129m/l and White Cell Count of 15x10^9/L. A Computed Tomography scan of the Abdomen and Pelvis revealed a right sided inguinoscrotal hernia arising lateral to the inferior epigastric vessels, containing an inflamed appendix and omental fat. The patient underwent an emergency open hernia repair with mesh and, considering that the appendix base was intra-abdominal, also underwent a laparoscopic appendicectomy.

Method
We conducted a literature review on Pubmed and Medline using the MeSH terms ‘Amyand Hernia’ AND ‘Appendicitis’ from 1970 to 2020.

Results
We longlisted 179 articles. Of these, 117 were excluded, as they were either paediatric cases, not relevant or mentioned in discussions. Finally, 62 relevant articles were included in the review.

Conclusions
Acute Appendicitis in Amyand Hernias has an incidence of 0.07-0.13%. Most cases remain as incidental findings however, increased use of imaging techniques has allowed accurate diagnoses and attempts at classifications. There is also weak association with Situs Inversus and atypical appendiceal tumours including adenocarcinoma, carcinoid and neuroendocrine tumour. Their management varies according to the extent of inflammation, radiological and intra-operative findings.
1598 Local Anaesthetic or General Anaesthetic: The Optimal Choice for Inguinal Hernia Repair
Authors: Mushonga K 
Published: October 2021

Abstract

Aim
Inguinal hernias occur when visceral tissue protrudes through the inguinal canal [1]. Around 20 million inguinal hernia repairs (IHR) are done annually worldwide and involve re-enforcement of the compromised wall of the inguinal canal using polypropylene mesh via open anterior approach or minimally invasive laparoscopy [2,3]. Despite gold standards in surgical approach, there’s no distinctively superior practice between local anaesthetic (LA) and general anaesthetic (GA). Therefore, the objective was to review IHR under both LA and GA and investigate which method is conductive to optimal patient outcomes.

Method
Systematically reviewed randomised control trials (RCTs) evaluating the benefits of LA over GA in IHR, by comparing factors such as post-operative nausea, urinary retention (UR), haematoma, wound infection (WI), pain, and operating time. PubMed was utilised for finding suitable studies, and data was obtained and summarised appropriately.

Results
Data assembled from RCTs evaluating benefits of LA over GA in IHR indicated no significant difference between groups when comparing nausea, UR, haematoma, WI and pain [4]. Supporting studies reviewing RCTs juxtaposing GA and LA in IHR elucidated no significant variance in operating time, haematoma and WI [5]. Patients did show less rates of UR, reduced pain scores and greater patient satisfaction under LA [5].

Conclusions
LA is used in specialised hernia clinics due to less cardiovascular risk however development of short-acting GA’s allows for suitability for day-case surgery. Future investigation is required taking into account factors like surgeon experience, patient anatomy and economic viability for a definitive gold standard.
1601 Trends in Investigation, Management and Patient Outcomes Following Emergency Presentation with Groin Hernia
Authors: Clyde D , Li L , Swan R , McLean R , Brown L 
Published: October 2021

Abstract

Aim
Groin hernias are associated with an increased morbidity and mortality following emergency presentations. This study aimed to review current practices regarding investigation and operative management of acute admissions of groin hernias in the North of England.

Method
Patients ≥18 years admitted as an emergency with femoral or inguinal hernias, between 2002-2016, across NHS trusts in the North of England were included. Data on demographics, investigations and operative interventions was collected. Outcomes of interest included rate of bowel resection, length of stay (LoS) and 30-day postoperative mortality.

Results
A total of 6165 patients were identified over 15 years: 4698 inguinal hernias and 1467 femoral hernias. 3904 (63.3%) underwent emergency surgery. Pre-operative CT scanning increased from 1.0% (2002-2006) to 12.3% (2012-2016) (p &lt; 0.001) and was associated with a reduced rate of surgical intervention (64.0% vs. 55.3%, p &lt; 0.001). Bowel resection was higher amongst patients who underwent CT (16.6% vs. 6.4%, p &lt; 0.001). Of those presenting with bowel obstruction, 11.7% required resection, 95.9% of these being small bowel. Bowel resection was associated with increased LoS (p &lt; 0.001) and 30-day postoperative mortality (16.4% vs. 2.8%, p &lt; 0.001). Laparoscopic repair, utilised in 177 procedures (4.5%), was associated with a shorter LoS compared to open repair (4.7 vs 5.5 days, p &lt; 0.001) but no difference in mortality.

Conclusions
Emergency hernia repair, particularly cases requiring bowel resection, have high mortality rates. Pre-operative CT scanning is associated with reduced rates of operative intervention. Further research is required to assess the impact these changes have on surgical decision-making, and subsequent patient outcomes.