bluuebunny/crossref_metadata_2025_split huggingface dataset:
556 A Prospective Review of Risk Factors, Clinical Presentation and Management Outcomes for Chronic Pancreatitis
Authors: Akula B , Sugumar K , Deshpande A 
Published: October 2021

Abstract

Aim
and objectives: To identify the risk factors, symptoms, and severity of Chronic pancreatitis (CP) on admission. To determine the relationship between pancreatic duct diameter and severity of pain and to assess extent of pain relief achieved by medical, endoscopic, and surgical intervention.

Method
75 patients with CP were admitted over 2 years. Data collected included etiology, symptoms, pain scores and CT/MRCP findings. Patients were classified into mild, moderate, and severe category according to Cambridge classification. Type and response to treatment was recorded. Statistical correlation of the pancreatic duct diameter and pain severity as well as the comparison of pain scores after medical, surgical and endoscopy was performed using Chi square test (p value &lt;0.05)

Results
Median age of presentation of CP was 43 years. Male: female ratio was 3:1. Alcohol was the etiology in 66 %, 99% presented with pain, 65 % belonged to severe category. There was no statistical correlation between pain severity and duct diameter. Pain relief following medical management was 66 %, endoscopic - 73% and surgical - 83 %. There was no correlation between Cambridge classification and pain severity. There was no statistical difference between pain relief offered by either of the three modalities. However, there was a statistically significant correlation between duct diameter and type of intervention.

Conclusions
There is no consensus on the best treatment modality for CP as pain relief was equivalent amongst all the modalities. Therefore, the choice of intervention for patients suffering from chronic pancreatitis should be based on imaging characteristics and symptomology.
566 A Study to Investigate CRP and WBC As Early Prognostic Tools in Severe Pancreatitis
Authors: Rajjoub Y , Zourob M , Khan S 
Published: October 2021

Abstract

Aim
To establish the prognostic value of raised inflammatory markers on Day 3 in patients with severe acute pancreatitis

Method
A retrospective study between 01/02/18 till 31/01/19 including all patients with acute pancreatitis. Patient demographics, the aetiology, treatment, severity (as per modified Atlanta's criteria) and inflammatory markers on Day 3 of the hospital admission were included. ROC curves were subsequently generated.

Results
127 patients were included with a median age of 59 years. 113 patients were diagnosed with mild acute pancreatitis while 14 patients had severe acute pancreatitis. The ROC curve illustrates that the value of CRP which maximises discrimination was 176 mg, with a sensitivity of 83% and specificity of 76%. For WBC with a value of 12.11 showed 100% sensitivity and 80% specificity.

Conclusions
This study highlights that elevated CRP and WBC on Day 3 could both be good predictive tools for patients who develop severe pancreatitis.
589 Role of Liver Support Systems in The Management of Post Hepatectomy Liver Failure: A Meta-Analysis and Systematic Review of Literature
Authors: Pufal K , Lawson A , Hodson J , Bangash M , Patel J , Weston C , Gulik T. van , Dasari B V M 
Published: October 2021

Abstract

Aim
Post hepatectomy liver failure (PHLF) is a rare but serious complication following liver resection. PHLF is associated with high mortality of up to 50% in severe cases. With limited treatment options available, there is a need to evaluate the role of systems that support the function of the liver as treatment modalities following PHLF development.

Method
The aim of this study was to review the literature and summarise the role of liver support systems (LSS) in the management of PHLF. Publications of interest were identified using systematically designed searches. Following screening, data from the relevant publications were extracted, pooled where possible, and analysed.

Results
Systematic review identified ten studies, which used either Plasma Exchange (PE) or Molecular Adsorbent Recirculating System (MARS) as LSS after PHLF development. The sample sizes of included studies were small, ranging from N = 2 to N = 13. Across all studies, the pooled 90-day mortality rate was 40% (95% CI: 15% - 68%). However, there was substantial heterogeneity (I2=64%), likely since the studies used a variety of definitions for PHLF and had different selection criteria for patient eligibility for LSS treatment.

Conclusions
Despite potential benefits, the current evidence is insufficient to recommend LSS for the routine management of severe PHLF, with the current literature consisting of only a limited number of studies. There is a definite need for larger, multicentre, prospective studies evaluating the conventional and newer modalities of support systems with a view to improve the outcomes in this group of patients.
788 Variation Between Observed and Perceived Volume of Antireflux Operations Completed by Upper-Gastrointestinal Surgeons at a University Teaching Hospital
Authors: Ashmore C , Hunter D , Boddy A 
Published: October 2021

Abstract

Aim
Increased institutional volume and surgeon experience with antireflux surgery has been shown to improve patient outcomes. We have sought to illustrate the discrepancy between the perceived (self-reported) and observed annual volume of anti-reflux operations completed by each surgeon.

Method
A retrospective questionnaire was delivered to all upper-gastrointestinal (UGI) surgeons performing antireflux surgeries (ARS) at a University Teaching Hospital. Surgeons were asked to estimate the quantity of NHS antireflux cases completed annually. Objective, anonymised data was retrieved from the Surgical Workload Outcomes Audit Database (SWORD) from 2017 to 2020 for comparison.

Results
127 ARS were completed by 6 UGI consultants between January 2018 and December 2020. The average number of ARS completed per surgeon was 5.8 (2-10) in 2018, 8.7 (4-11) in 2019 and 6.7 (1-11) in 2020. Conversely, the average number of self-reported annual procedures per surgeon was 22.4 (12-35). On average, participants overestimated the number of NHS ARS completed by 14.5 (4-27) cases or a factor of 2.08. No surgeon correctly or underestimated the number of ARS performed.

Conclusions
We conclude that self-reported operation volume should not be relied upon for the purposes of assessment or audit. Estimations of annual ARS procedures could be up to triple that suggested by objective data. We recommend that all surgeons maintain a database of ARS for the purpose of self-assessment and audit.
964 Stage Migration in Newly Diagnosed Oesophago-Gastric Cancer During the First Wave Of COVID-19 Pandemic
Authors: Khan K , Chuntamongkol R , McCollum C , Gall L , Forshaw M 
Published: October 2021

Abstract

Aim
Covid-19 has significantly disrupted elective and emergency health care provision including cancer care within the UK. The aim of the study was to investigate the impact of the pandemic on the staging of oesophago-gastric cancers at presentation, determine the time delay in performing gastroscopy and the multidisciplinary team (MDT) treatment outcomes.

Method
A retrospective cohort study of all newly diagnosed oesophago-gastric cancers (adenocarcinoma and squamous cell carcinoma) in a single regional MDT was performed between 1st October 2019 and 30th September 2020. Electronic records were interrogated and patients dichotomised into two groups with those presenting before the introduction of the UK national lockdown of 23rd March 2020 compared to those presenting post-lockdown.

Results
349 new oesophago-gastric cancer patients were discussed in the MDT (192 pre-lockdown versus 157 post-lockdown). Demographics were evenly matched between the two groups. More patients presented as an emergency admission post-lockdown (28.0% vs 12.5%, p &lt; 0.001). Median waiting time for gastroscopy was longer post-lockdown (23 vs 14 days, p = 0.035). Metastatic disease at presentation was more frequent post-lockdown (47.8% vs 33.3%, p = 0.008). Overall, more patients had a palliative rather than curative treatment intent post-lockdown (71.3% vs 57.8%, p = 0.005).

Conclusions
The Covid-19 pandemic has had a significant negative effect on the stage of oesophago-gastric cancers at presentation. This has translated into more patients receiving palliative treatment and ultimately having a poorer prognosis. This study highlights the importance of maintaining cancer services during Covid-19 pandemic.
1040 Evaluation of The Use of Biopatch In Haemodialysis Lines: Are We Reducing the Risk of Infection?
Authors: Win M , Banerjee D , Deng J , Fraser N 
Published: October 2021

Abstract

Aim
Children who had the central venous lines inserted for prolonged vascular access usually experience the catheter-related blood stream infection (CRBSI). CRBSI is known to be associated with high morbidity which increases the cost of the healthcare and the chances of mortality. Clinical evidence suggests that the use of biopatch (chlorhexidine-impregnated dressing) is effective in reducing the rate of infection in central venous lines. The aim of our study was to evaluate whether the use of biopatch actually reduced the CRBSI in children who had had haemodialysis lines at our institution.

Method
Theatre logs and electronic records of 46 patients who had haemodialysis lines inserted between 2015-2019 were retrospectively reviewed. These patients were randomly selected.

Results
The total number of lines inserted in 46 patients were 104. The mean of line per patient was 2.2. Out of 104 lines, 22 lines (21%) had confirmed infection.

Conclusions
Infection of the central line is still a significant problem. Infections were more prevalent in cases which did not use biopatch according to the documentation. We believe the rate of infection can be reduced by encouraging the use of biopatch on regular basis for the haemodialysis lines and the proper documentation of its use in the operation notes.
1124 Is Delayed Presentation A Prognostic Factor for The Survival of Patients with Esophageal Atresia More Than Associated Anomalies? Comparison Between Different Social Realities
Authors: Arora A , Raffaele A , Agarwala S , Parigi G B , Manzoni F , Klersy C , Bhatnagar V 
Published: October 2021

Abstract

Background
The aim is to evaluate if different social reality could represent a prognostic factor as associated anomalies affecting survival of neonates with esophageal atresia (EA).

Method
Retrospective analysis of records of neonates with EA with or without Tracheoesophageal Fistula (TEF) from January 2011 to September 2018 at Policlinico San Matteo Pavia, Italy(SMAT) and the All India Institute of Medical Sciences New Delhi, India (AIIMS).Survival was correlated with the presence of anomalies, different types and the number of organ systems involved.Age at presentation and birth weight were considered to find an association with mortality.

Results
Out of 180 patients,162 were from AIIMS and 18 from SMAT.The overall mortality was 28.85%, which occurred at AIIMS, being 0% at SMAT.83.33% at SMAT and 72.84% at AIIMS had associated anomalies.The mortality was 25% for neonates without an anomaly, being 26.15% for those with one (p &gt; 0.05).No statistically significant correlation between outcome and associated anomalies was found.Instead, survival declines gradually as the age at presentation increases.

Conclusions
The presence of associated anomalies paradoxically does not affect the outcome because incidence of delayed presentation has a stronger effect than the presence of associated anomalies. Sensibilization is necessary to improve survival in EA neonates in developing countries, such as India.
1185 Acute Paediatric Appendicitis(AA)-Decreasing The Negative Rate Of Appendicectomy
Authors: Karagiannidis G , Toma O , Mallidis E , Youssef F 
Published: October 2021

Abstract

Aim
The COVID -19 pandemic has forced changes in the management of Acute Appendicitis (AA), such as prioritising conservative management and avoiding laparoscopic procedures. This observational study aims to monitor and reduce the negative rate of paediatric appendicectomy and optimise the acute paediatric management following the newly introduced workflow.

Method
Retrospective patient data collection via electronic sources for all paediatric patients(0-16 years old) admitted with AA between March 23rd and October 31st 2020.

Results
During this period 74 patients were admitted with suspected AA. Conservative treatment was performed in 16 (22%) patients and operative management in 58 (78%), of which 15 (26%) had an open appendicectomy, while 43 (74%) underwent laparoscopic appendicectomy. The first trimester the negative appendicectomy rate was 25%, which dropped to 11% because of the newly introduced paediatric AA workflow and the more extensive use of US in the context of diagnosis of appendicitis.In the beginning of the study, the percentage of US scanning was 72% and was increased to 90% after the end of the 3rd period.

Conclusions
The introduction of the paediatric AA workflow and the more extensive use of US helped to decrease the percentage of negative rate of paediatric appendicecomy the number of children who underwent unnecessary operation.
1491 Hemi-Nephroureterectomy For Duplex Kidney in Children - The Resulting Effect on Renal Function
Authors: Wadham B , Connolly T , DeSilva A , Alshafei A , Keene D , Hennayake S 
Published: October 2021

Abstract

Introduction
Urinary duplication systems occur in approximately 1% of the population, and may present with recurrent UTIs, incontinence, or be incidentally detected on imaging. DMSA (dimercaptosuccinic acid) imaging is used in these patients to assess split renal function. If found significantly reduced in a single moiety, children may be offered hemi-nephroureterectomy (HNU). We analysed the rate of remnant moiety loss following HNU comparing age and affected moiety.

Method
All HNUs performed at our paediatric tertiary centre 2005-2019 were analysed. Children &lt;16yrs, with pre– and post-operative DMSA imaging were included. Renal loss was categorised as: significant (≥50% of pre-existing function), non-significant (≥25% pre-existing function), no renal loss (&lt;25%), and complete loss (post-operative remnant moiety function ≤5%). Subgroup analysis was performed using χ² statistic.

Results
73 patients were included, mean age 2.1yrs. Median pre-operative function of the affected kidney was 42%. 12 patients (16.4%) had significant renal loss, 13 (17.8%) non-significant loss and 6 (8.2%) had complete renal loss. Children &lt;2yrs had significant and complete renal loss more frequently than those aged ≥2yrs (9/35 and 5/35 vs 3/38 and 1/38 respectively, p = 0.069). Patients with upper moiety HNU (UMHNU) had higher rates of significant and complete renal loss than lower moiety HNU patients (12/53=significant, 6/53=complete vs 0/20 significant/complete, p = &lt;0.05).

Conclusions
HNU for duplex kidney is associated with high rates of remnant moiety damage, with ¼ of patients experiencing significant or complete renal loss. Subgroup analysis suggests this risk is higher in children &lt;2yrs or UMHNU. HNU should therefore only be reserved for symptomatic patients failing conservative management.
18 The Impact of Social Deprivation on TNM Staging of Non-Melanoma Skin Cancers: An Initial Review
Authors: Miles J 
Published: October 2021

Abstract

Aim
Over 150,000 cases of non-melanoma skin cancer (NMSC) are diagnosed per year in the UK [1], with greatest incidence in less deprived socioeconomic groups [2]. The association between social deprivation and melanoma staging has been reported [3], however is not as well considered in Basal or Squamous Cell Carcinomas (BCCs/SCCs).

Method
A pilot review of 200 NMSC excision biopsies completed at a single hospital was undertaken. Specimens were identified via the histopathology database and included all excising specialities and anatomical locations. Registered postcodes were categorised into a decile via the English Indices of Deprivation 2019 database (1= most deprived, 10= least deprived). Tumour staging was identified from the histopathology report.

Results
200 specimens were reviewed including 9 deprivation deciles ranging from Decile 2 to Decile 10. Decile 6 was the most common decile, incorporating 20% of all specimens. pT1 BCCs were the most commonly excised lesion at 68.5%, pT3 BCCs and SCCs were least commonly excised (1.5% of specimens each). Increased proportions of pT2 BCCs and SCCs occurred in less deprived deciles, contrasting with pT3 BCCs which clustered in Deciles 6 and 7. pT3 SCCs comprised 11.1% of excised lesions in Decile 4, the greatest proportion outside of pT1 lesions.

Conclusions
This initial review suggests that the distribution of NMSC staging is not even across social deprivation levels. Increased proportions of pT2 staged lesions occurred in less deprived cohorts. Further expansion of the dataset is justified to assess the degree to which social deprivation may affect NMSC stage at excision.
258 Are Electronic Algorithmic Referral Systems the Future of Triage? Evaluating the Use of The Oxford Acute Referrals System (OARS) For Plastic Surgery
Authors: Prokopenko M , Freethy A , Layton T , Brady M , Abou-Abdallah M , Kent N , Kanabar S , Tucker S 
Published: October 2021

Abstract

Introduction
A traditional referral involves transfer of information over a telephone call and is typically documented in an unstructured format on paper notes, producing poor continuity of referrals between shifts, increasing the risk of error, and compromising patient safety. The Oxford Acute Referrals System (OARS) is an electronic platform that keeps a complete record of referrals, whilst providing the referring clinician with step-by-step specialist advice according to inbuilt BSSH guidelines. This audit demonstrates our experience of its’ use in a tertiary centre Plastics department.

Method
One week of referrals in 2019, prior to the implementation of OARS, were compared with the equivalent week in 2020 once OARS was established. Data was collected retrospectively using electronic patient records.

Results
In one week in 2019, 120 cases were reviewed in the emergency clinic compared with 155 OARS referrals for the equivalent week in 2020. Following OARS implementation, 69% of referred cases did not footfall in the emergency clinic. 46% were managed locally with specialist advice from Plastic Surgery. 10% were brought directly into a theatre list, of which 7% were subsequently treated conservatively. A Plastic surgery consultant reviewing OARS referrals taken by juniors, changed the decision of how or where to manage the patient in 6% of cases.

Conclusions
OARS is an effective triage system that has considerably reduced footfall in the emergency clinic, whilst simultaneously expediting patient care down the correct treatment pathway. Its use led to safe management of patients remotely, which has important implications during a pandemic.
292 Paediatric Dog-Bites: Are ‘Pandemic Puppies’ A Cause for Concern?
Authors: de Berker H , Zhao J , Souéid A 
Published: October 2021

Abstract

Introduction
There has been a substantial increase in dog ownership during the COVID-19 pandemic, in part due to national lockdowns prompting many to seek canine companionship. Published studies from the US have associated this with increased paediatric presentations with dog-bites to the emergency department (ED). However, this has yet to be elucidated in the UK.

Method
All attendances to ED and referrals to our regional paediatric plastic surgery service with paediatric dog-bites between 23/03/2020 and 01/06/2020 (UK national lockdown) were compared with the same period in 2019 (control). The location of bites and total ED attendances were also collected. Chi-squared test was used to determine statistical significance, p ≤ 0.05 taken as significant.

Results
Fewer overall paediatric attendances to ED were noted between the lockdown period compared to control (4429 vs 9620). Similarly, fewer children presented with dog-bites during lockdown compared to control (25 vs 45). Proportionally, this data represents 5.6 bites per 1,000 ED attendances during lockdown vs 4.7 during the control period (p = 0.44). Facial bites were more common during lockdown accounting for 60% vs 47% in the control period (p = 0.28).

Conclusions
Despite reports of increased dog ownership, our findings do not demonstrate significantly more paediatric dog-bite presentations. Although not statistically significant, more facial bites were noted during lockdown. We speculate this may be due to parents presenting with self-perceived more “serious” injuries. Thorough research and careful consideration are essential prior to bringing a new dog into a home with young children.
325 Pretibial Injury and 1 Year Mortality
Authors: Peberdy D 
Published: October 2021

Abstract

Aim
Frailty is increasingly recognised as an important factor for patients under the care of surgical departments. Pre-tibial injury is a common presenting problem to plastic surgery units across the UK. We wanted to assess the 1-year mortality of this patient cohort presenting to our unit.

Method
Retrospective cohort analysis of prospectively maintained clinical database across a calendar year from June 2017 to June 2018. This was perforemd at a UK Regional Plastic Surgery Centre analysinig patients presenting to the Royal Devon and Exeter Hospital. Patients were scored as either frail (Rockwood ≥ 5) or Non-Frail (Rockwood ≤ 4) taken from initial clinical assessment proformas.

Results
A total of 85 patients were included in the study. Mean age was 76.4 (± 18 years), and mean Rockwood Frailty Score of 3.4. Across all patients presenting to the plastic surgery department with pre-tibial injury there was a 20% (17/85) mortality at one year. In frail patients 1 year mortality was 47.6% (10/21). In Non-Frail patients 1 year mortality was 10.9% (7/64). The difference in mortalitly at 1 year was found to be significantly different in Frail vs Non-Frail patients with P = 0.00009 in an unpaired Student's t Test.

Conclusions
Frailty is a common condition in patients presenting with pre-tibial injury. This is a significant predictor of 1 year mortality in patients presenting with pre-tibial injury. Standardised evidence-based pathways of care for these patients could help optimise their management. Opportunities for MDT involvement in their care may improve outcomes.