bluuebunny/crossref_metadata_2025_split huggingface dataset:
497 Targeting Improvements in The Elective Aneurysm Pathway in The Dorset and Wiltshire Vascular Network (DWVN)
Authors: Cruikshank N , Harris L , Richards S , Metcalfe J , Page B , Watson A , Wijesinghe L 
Published: May 2021

Abstract

Introduction
Two consecutive NVR reports identified the DWVN as the 7th slowest network to treat patients with AAAs. We aimed to detect if there were any significant delays in our pathway.

Method
We performed a retrospective audit of patients having elective open and endovascular repair. 144 patients who had AAA repair between 30/06/2016-01/08/2018 were included. Data were collected on the following stages: the date the AAA reached ≥55mm, referral date, date clinician reviewed, CT scan date, CPET testing date, MDT date and operation date. The time in days between each stage was recorded and any delays documented.

Results
At RBH the longest delay was between MDT and surgery (median 73 days, IQR 32 days-130 days). At DCH the major delay was between CPET and MDT (median 28.5 days, IQR 10 days-31 days). At SDH the longest stage was between MDT and operation (median of 88 days, IQR 37 days-154 days).
Examples of reasons for delays across the three hospitals included awaiting specialist opinions, patient being unwell and no ITU beds available.

Conclusions
The pathway for elective AAA treatment in the DWVN is slow across all three hospitals. The greatest delay is often between MDT and surgery. Targeting this stage could significantly shorten the pathway.
527 Selective Approach to Gallbladder Histopathological Examination Following Cholecystectomy. Would Incidental Gallbladder Cancers Be Missed?
Authors: Ryska O , Atwan M , Nowinka Z 
Published: May 2021

Abstract

Background
The incidental finding of gallbladder carcinoma on histopathological examination following cholecystectomy is rare and thus, a selective approach should be evaluated as it could be more cost-efficient.
The primary aim of this retrospective study was to assess the incidence of gallbladder cancer in a single hospital trust. The secondary aim was to evaluate the predictive value of macroscopic changes.

Method
A retrospective analysis of all cholecystectomies performed at a hospital trust between November 2017-November 2019. Discharge notes, operation notes, histopathology reports were evaluated.

Results
In total, 966 patients were included. All gallbladder specimens had been sent for histopathological examination. The histology was normal in 21 patients (2.1%) and inflammatory changes reported in 930 cases (96.3%). Gallbladder dysplasia was found in 14 specimens (1.5%) and macroscopic abnormalities were seen in 11 of those. One case (0.1%) was reported as incidental gallbladder carcinoma and macroscopic abnormalities were observed intra-operatively.

Conclusions
Gallbladder carcinoma detected incidentally after cholecystectomy is rare. Gallbladder dysplasia and cancer are associated with macroscopic abnormalities and thus selective approach could potentially replace routine histopathological examination - provided all gallbladders are dissected and inspected at the time of surgery.
746 COVID-19: Changing the Future of Emergency Epistaxis Management
Authors: Devabalan Y 
Published: May 2021

Abstract

Introduction
Acute epistaxis can be a life-threatening airway emergency. Therefore, the majority of patients in whom conservative management (including cautery) has failed are admitted. However, due to the COVID-19 pandemic, our management has shifted towards a more outpatient centred approach.

Method
A single centre retrospective study was undertaken of all epistaxis patients managed by the ENT team at our centre over a five-month period from 1st January to 31st May 2020. The first 10 weeks (Pre-COVID-19) were managed using pre-existing guidelines. The following 10 weeks (COVID-19) were managed using the new COVID-19 standard operating procedures which aimed to minimise inpatient admissions.

Results
142 patients, with similar demographic data, were seen across the 5-month period. There were significantly more patients aged over 65 presenting in the COVID-19 group (p = 0.04). There was a significantly increased use of local haemostatic agents (Nasopore ® and Surgiflo ®) and decreased use of nasal packing in the COVID-19 group. There were significantly fewer admissions (p &lt; 0.0005) in the COVID-19 group, but similar rates of representation, length of stay and morbidity.

Conclusions
The COVID-19 pandemic has accelerated the shift towards the use of local haemostatic agents and outpatient management of epistaxis, which is as safe and effective as previously well-established epistaxis management.
893 Intestinal Stoma - A challenge for the Patient
Authors: Bhatia M , Hafeez R , Smedley F , Read L , Abbas W , Ahmed R 
Published: May 2021

Abstract

Introduction
Formation of intestinal stoma is a widely performed surgical procedure worldwide. It is associated with variable complications which can impact physical and mental health of the patient. The purpose of this study is to study the aspects (indications, complications, change in quality-of-life etc) and make necessary recommendations for quality improvement and to make patient experience better.

Method
study included 150 patients with stoma formation. Data categorised according to indications, complications, based on their response to change to quality of life.

Results
A total of 150 patients were included in this study. There were 89 male (59.3%), female (40.6%). 63 patients (42%) had loop ileostomy;38 patients (25.3%) had transverse colostomy. 77 patients (51.3%) had bowel malignancy, diverticular perforation in 19.3%. 21 patients (14%) mentioned change into their self-esteem following the surgery, 14% patients reported decline in their sexual life.

Conclusions
Pre & postoperative assessments should be carried out in detail with the patient to help them understand the implications of having a “stoma”. Stoma nurse involvement helps the patient to accept the changes to their life after the surgery. Psychological &sexual consultation helps in improving patient’s response to the challenge it may impose.
900 An Audit of Effectiveness of Inhaled Methoxyflurane (Penthrox) Use for Reduction of Shoulder Dislocation
Authors: Adewusi M , Richards O , Hickey B , Barlow D 
Published: May 2021

Abstract

Introduction
Shoulder dislocation is a painful injury best treated by early closed reduction. Patients often require intravenous sedation, with airway monitoring in a safe setting. We implemented methoxyflurane inhalational analgesia (Penthrox) to aid shoulder dislocation reduction without the need for sedation and evaluated the effectiveness and adverse events.

Method
Patients presenting to the minor injury’s unit at Wrexham Maelor Hospital between 01/04/2020 and 26/05/2020 with only shoulder dislocation were included. Patients had Penthrox and underwent closed reduction. Pre and post reduction shoulder radiographs were reviewed to determine reduction success and time between radiographs was evaluated. Adverse events were recorded. Reduction success and times between radiographs were compared to a consecutive retrospective cohort of patients who underwent closed shoulder dislocation reduction with sedation before implementing Penthrox.

Results
22 patients were included. Mean patient age was 44.6 years. Majority were male (72%). Penthrox was used in 11 patients. All patients had their shoulder dislocation reduced successfully. Mean time between reduction radiographs for the Penthrox group was 40.8 min (95%CI 27.4 to 54.3). This was shorter than the intravenous sedation group mean 157.7 minutes (95%CI 92.3 to 223.2, p = 0.0026). No documented adverse events with Penthrox.

Conclusions
Simple shoulder dislocations can be reduced safely, quickly, and effectively using Penthrox.
921 Audit of Pre-Radiation Therapy Extractions at Dublin Dental University Hospital
Authors: Fahy E , Pierse D 
Published: May 2021

Abstract

Introduction
The time between diagnosis of head and neck cancer and commencing treatment involves multi – disciplinary input from several specialities. Dental assessments are carried out prior to radiotherapy in order to instigate preventive care and remove all unrestorable teeth. Post – radiation dental extractions have been shown to increase the risk of osteoradionecrosis (ORN).

Method
Our hospital handles the majority of the pre - radiotherapy dental assessments in the east of Ireland. We examined the patient records of all patients attending the radiotherapy clinics between January 2018 and December 2019, assessing the time interval between the removal of teeth prior to radiotherapy and the start of radiotherapy. A secondary aim was to determine from the patient records whether any diagnosis of ORN was established post – radiation.

Results
15 out of 147 patients had extractions less than 2 weeks prior to radiotherapy. In total, three patients developed ORN. One had extractions less than 2 weeks prior to radiotherapy, one had post radiotherapy extractions, while the other’s timing was unknown.

Conclusions
Most patients received timely care. A referral for dental assessment early in treatment planning is desirable. Despite the small sample size, an association between ORN and extractions just before and following radiotherapy was found.
958 Pre-operative Pregnancy Testing in Paediatric Patients
Authors: Ashraf S , Bogden M 
Published: May 2021

Abstract

Introduction
NICE emphasises the importance of pregnancy testing before surgical procedures as a patient safety precaution, especially in 13-16-year-olds. This is because, in the UK, a third of females will have been sexually active by the age of 16, meanwhile, in England there are 67,000 operations involving females aged 12-15 annually.

Method
Guidance from NICE and RCPCH was used to create standards to compare against current practice. Surgical admissions involving females aged 13-16 were retrospectively analysed over a one-year period and compared to these standards. Changes, including creation of a protocol, revision of the clerking proforma and staff education, were implemented to improve compliance and patient data was re-audited following this.

Results
Initially, 27% of patients did not have pregnancy testing before their procedure and consent for pregnancy testing was not documented. However, when pregnancy tests were performed, the result was documented 100% of the time. After implementing changes, 100% of patients had pregnancy testing before their procedure and documentation of consent had improved.

Conclusions
Initial practice showed poor compliance with NICE and RCPCH standards. Changes implemented have shown increased compliance to NICE and RCPCH standards and these changes could be used as a model to improve clinical compliance in further areas.
966 Implementation of Regional Scalp Blockade for Painless Removal of ICP Bolts: A Quality Improvement Project
Authors: de Gouveia M , Craven C L , Goel A , Asif H , Das P , Thorne L , Watkins L , Toms A 
Published: May 2021

Abstract

Introduction
Intracranial pressure (ICP) monitoring through insertion of a bolt is a common neurosurgical procedure for diagnosing cerebrospinal fluid disorders. The first step of our quality improvement project identified ICP bolt removal the most painful part of the procedure. We implemented and tested the efficacy of a scalp nerve block for bolt removal.

Method
Two groups were identified: (A) receiving oral analgesia only and (B) receiving ipsilateral supraorbital and supratrochlear nerve blocks. We then retrospectively compared satisfaction ratings of insertion versus removal process for the two bolt types using a telephonic questionnaire

Results
Eighty-five patients had ICP bolts (32M:53F, mean age 42.7±16.0 SD). Fifty-four were removed with oral analgesia (A) and 31 with oral and regional anaesthesia (B). Removal experience was reported as worse for group A than for group B (p &lt; 0.01). Most patients (66%) reported would have preferred local anesthetic during removal. No complications occurred from the block.

Conclusions
Regional nerve blocks are a safe and effective adjuvant for the painless removal of frontal ICP monitoring bolts. The final stage of the project was to implement nerve blocks as standard practice for bolt removal, to improve patient experience.
977 The Role of Group and Save Samples in Perioperative Management of Laparoscopic Appendicectomies: A 2-Cycle Quality Improvement Project (QIP)
Authors: Afshari S J , Toi T H H , Chicken W 
Published: May 2021

Abstract

Introduction
Group and Save samples (G&S) are routinely performed before laparoscopic appendectomies (LA). Cycle-1 of this QIP showed &lt;1% of patients required blood products perioperatively. We recommended and implemented that a G&S request should be at the clinician’s discretion and not routinely performed. Cycle-2 assesses the impact of our recommendation.

Method
In Cycle-1 patients who had undergone LA and laparoscopic conversion to open appendicectomies between January - December 2018 were identified using Operating Room Management Information System. Patients who had G&S performed and patients receiving blood products were identified using the hospital’s electronic patient records and online pathology reporting service. Patients from December 2019 to June 2020 formed Cycle-2 of this QIP.

Results
124 patients were included in Cycle-2 (versus 263 in Cycle-1). 58% of patients had G&S taken (versus 99.6% in Cycle-1). 0.81% required a transfusion post-operatively (versus 0.76% in Cycle-1). The average number of G&S per patient was reduced by 1.19, saving the Trust £23.80 per patient.

Conclusions
Blood products are not routinely required peri-operatively, therefore G&S should be ordered at the clinician’s discretion. This safely saves the Trust significant cost and improves patient experience by eliminating the discomfort of unnecessary blood tests.
22 Volumetric MRI; A Potential Outcome Measure of Muscle Reinnervation
Authors: Wilcox M , Canas L D S , Hargunani R , Tidswell T , Phillips J , Modat M , Ourselin S , Quick T 
Published: May 2021

Abstract

Introduction
Improved outcome measures of muscle reinnervation would facilitate clinical translation of new therapies which hope to enhance human peripheral nerve repair. Valid outcome measures should be receptive to the biological process of muscle reinnervation and correlate with clinical assessments of muscular function. This study investigated the responsiveness of volumetric MRI to the biological process of muscle reinnervation and its relationship with clinical indices of muscular function.

Method
Twenty-five patients who underwent nerve transfer to reinnervate elbow flexor muscles were followed-up at a median time of 258 days (-86 to 1698 days) post-operatively for a mean of two (one to three) volumetric MRI assessments. Medical Research Council (MRC) grade, peak volitional force (PVF), muscular fatigue, co-contraction and Stanmore Percentage of Normal Elbow Assessment (SPONEA) was also measured at each appointment. The responsiveness of each parameter was compared using Pearson or Spearman correlation as appropriate.

Results
Elbow flexor muscle volume per unit BMI demonstrated responsiveness to the biological process of muscle reinnervation (R2=0.73, p &lt; 0.001) and correlated with patient reported impairments of reinnervated muscle; co-contraction (R2=0.63, p = 0.02) and muscle fatigue (R2=0.64, p = 0.04).

Conclusions
Volumetric MRI may is an excellent candidate as an outcome measure of muscle reinnervation.
186 Acute Kidney Injury in Skeletal Trauma Admissions to Intensive Care: An Under-Estimated Complication
Authors: Brown O , Crisp T , Flatman M , Hing C 
Published: May 2021

Abstract

Introduction
Acute kidney injury (AKI) is associated with prolonged admission and 3.5 times increased mortality for trauma patients requiring intensive care (ICU) treatment. Blunt trauma confers greater risk of AKI than penetrating trauma, potentially related to long bone fracture. The relationship between skeletal trauma and AKI in ICU has not previously been investigated.

Method
Retrospective data was analysed from 202 consecutive adult patients admitted to ICU with skeletal trauma from 01/06/2018 to 01/06/2019. AKI was defined by creatinine rise &gt;1.5 times baseline.

Results
AKI was found in 70/202 (34.65%) patients aged 16-99 years, 138 males and 64 females. Mean limb Abbreviated Injury Scale (AIS) was significantly higher in AKI (AIS= 2.57 (SD 0.53) versus non-AKI AIS=2.38 (SD 0.61), p = 0.027). Other body regions and total Injury Severity Score (ISS) were non-significant.
AKI was associated with a significantly worse Glasgow Outcome Score (AKI 3.28 (SD 1.52) versus 4.02 (SD 1.08) p &lt; 0.001), increased intensive care stay (AKI 7.03 (SD 8.30) days versus non-AKI 3.8 (SD 4.1) days p &lt; 0.001) and increased 30-day mortality (AKI 18/70 (25.71%) versus non-AKI 10/132 (7.58%) p &lt; 0.001)

Conclusions
Skeletal trauma patients have a high incidence of AKI, which was significantly correlated with severity of skeletal limb trauma but not overall ISS.
240 Aetiology and Outcomes of Head and Neck Free Flaps in Patients Aged ≥ 65 Years: The Cambridge Experience
Authors: Hjalmarsson C , Chan T , Chawla R , Patel A 
Published: May 2021

Abstract

Introduction
Elderly patients often present to the Head & Neck Plastic Surgery department with complex reconstructive needs, for which free flaps are the gold-standard management. In order to provide appropriate, patient-centred care, it is imperative to understand how increasing age and related factors affect long-term free flap outcomes.

Method
The authors carried out a retrospective review of all patients 65+ years who underwent free flap surgery at Addenbrooke’s Hospital from 2008-2019. Patient, operative, and flap characteristics, and outcomes, were analysed using Excel and RStudio.

Results
163 patients were identified (54F, 109M). The majority were ALT (n = 74), radial forearm (n = 35), and fibula flaps (n = 23).
Of pre-operative comorbidities, only neurological comorbidities (n = 16), were significantly associated with long-term flap failure (p = 0.016). There was no significant association between number of comorbidities and flap outcome. There was no association between age group and length of stay.
Flap site complications, and particularly venous complications, were significantly associated with later failure (p = 0.001). No other complications were statistically associated with flap failure.

Conclusions
The high success rate supports the use of free flaps in the 65+ population. This data supports a case-by-case approach to assessing fitness for free flap surgery rather than excluding patients on the basis of age or specific comorbidities.
268 Efficacy and Safety Profiles of Surgical Resection in Patients with Metastatic Gynecologic Melanoma on Immune Checkpoint Inhibitors: A Retrospective Cohort Study
Authors: Naderi-Azad S 
Published: May 2021

Abstract

Introduction
Malignant vulvovaginal melanoma is a rare, aggressive malignancy with poor prognosis and no consensus regarding treatment. Few studies to date have comprehensively examined the efficacy and safety of surgical procedures alongside immunotherapy in their treatment.

Method
We retrospectively analyzed 169 patients with advanced-stage metastatic melanoma who received at least one dose of immunotherapy between June 2012 to December 2018. Descriptive statistics were used, as well as Chi-square statistical analysis to examine associations between immune-related adverse events (irAEs) and treatment response. P-values &lt;0.05 were statistically significant.

Results
Surgical resection was performed in 63.6% of patients with vulvovaginal melanoma, which was comparable to other melanoma subtypes. From patients with vulvovaginal melanoma who received prior surgery, 80% had progressive disease and 20% response to treatment, compared with 100% progression in patients without prior surgery. Furthermore, patients with vulvovaginal melanoma developed irAEs in 53.8% of the cases. Cutaneous adverse events were overall the most common irAEs and were significantly associated with patient response to ICIs (p = 0.01).

Conclusions
The majority of patients received surgery prior to immunotherapy. Those who received prior surgery had greater response to immunotherapy compared to those without prior surgery. Surgery and immunotherapy is a unique therapeutic regime to control metastatic vulvovaginal melanoma.
402 A Systematic Review and Meta-Analysis of Autologous vs Titanium Cranioplasty Implants
Authors: Capitelli-McMahon H , Kahlar N , Rahman S 
Published: May 2021

Abstract
Aim: There is currently no gold standard reconstructive material for cranioplasty, with autologous and numerous synthetic materials currently in use. The emerging role of titanium due to its strength and biocompatibility has made it a good option. Titanium has been compared in numerous studies with autologous bone for cranioplasty however there is currently no meta-analysis within the literature to guide craniofacial surgeons on the optimal method.

Method
A systematic review and meta-analysis was performed as per the PRISMA guidelines and a search of electronic information was conducted to identify all randomised control trials and observational studies comparing autologous implants vs. titanium implants in cranioplasty following craniectomy. Re-operation rates and cosmesis were the primary outcome measures and incidence of complications such as bone resorption and infection were the secondary outcome measures.

Results
Six studies (n = 1909) were identified. Autologous cranioplasty using bone had a higher re-operation rate (p &gt; 0.007), due to higher bone reabsorption seen in this group. There was no significant difference between the two groups in cosmetic outcome. Both had comparable infection rates (p &gt; 0.18) and costs involved.

Conclusions
Titanium implants for cranioplasty offer lower re-operation rates compared to autologous based reconstruction without significantly increasing adverse outcomes such as post-operative infection rates or cost.
441 Intravenous Tranexamic Acid Given at Femoral Fragility Fracture Surgery Reduces Blood Transfusion Requirements Four-Fold
Authors: Powell-Bowns M , Olley R , McCann C , Balfour J , Brennan C , Scott C 
Published: May 2021

Abstract

Introduction
Tranexamic acid (TXA) is proven to reduce blood loss in several surgical fields, but its use in femoral fragility fracture (FFF) management is ill defined. This study examined the effect of intraoperative TXA on the rate of postoperative blood transfusion following FFF.

Method
A prospective non-randomized case-control study of 361 consecutive patients admitted to the study centre with FFFs over a 4-month period was performed. Intravenous TXA 1g was administered intraoperatively at the discretion of the operating team: 178 patients received TXA and 183 did not.

Results
Patients given TXA required fewer blood transfusions: 15/178 (8.4%) vs controls 58/183 (31.7%), (p &lt; 0.001). Calculated blood loss (mean difference -222ml (-337 to -106, 95%CI), p &lt; 0.001) and percentage drop in Hb (mean difference -4.3% (-6.3 to -2.3, 95%CI), p &lt; 0.001) were significantly lower in the TXA group. The difference in CBL was greatest following intramedullary nail (n = 49: mean difference -394ml, p = 0.030) and DHS (n = 101, mean difference -216ml, p = 0.032). There was no significant difference in complication rates: venous thromboembolism TXA 2/178 vs control 1/182 (p = 0.620); MI/stroke/TIA 2/178 vs 0/182 (p = 0.244)

Conclusions
Intraoperative intravenous TXA significantly reduced calculated blood loss and blood transfusion requirements following femoral fragility fracture surgery without increasing the rate of complications.