bluuebunny/crossref_metadata_2025_split huggingface dataset:
P42 Development of an algorithm for determining the stage of innovation of an invasive procedure or device
Authors: Scroggie D L , Elliott D , Avery K , Cousins S , Blencowe N S 
Published: April 2021

Abstract

Introduction
The IDEAL framework describes a series of stages through which surgical innovations typically pass. For each stage, the framework makes recommendations with the intention of improving the quality of research in surgery. Its adoption has been slow despite publication of practical guidance. It has been recognized that determining the stage of innovation of an invasive procedure or device can be problematic, and this issue may be hindering adoption of the framework. The aim of this study is to develop a practical algorithm for determining the stage of innovation of any invasive procedure or device.

Methods
Multiple data sources will be used: published literature, intra-operative video recording, interviews with stakeholders, healthcare datasets, and clinical policies and guidelines. Systematic reviews will be conducted to identify guidance relating to surgical innovation, and evaluations or critiques of guidance. Case studies of surgical innovations will be undertaken, to gain an understanding of problems encountered in determining stage of innovation. An algorithm will be developed through an iterative process of testing and refinement, triangulating data from the literature reviews and case studies.

Results
The findings of the initial systematic reviews will be presented. This will include guidance relating to surgical innovation, and evaluations or critiques of it. Recognized problems in determining stage of innovation will be summarized, including proposed solutions and suggestions for further development.

Conclusion
This study will use multiple data sources to develop a practical algorithm for determining the stage of innovation of any invasive procedure or device.
P56 Gastrointestinal manifestations of COVID-19: a retrospective analysis
Authors: Niaz Osamah , Uddin Aaliya , Thomas Sangeetha , Harries Katherine , Walton Sarah-Jane 
Published: April 2021

Abstract

Introduction
Emerging data suggests that SARS-CoV-2 acts via the angiotensin-converting-enzyme-2 (ACE2) receptors in the cells, also present in the gastrointestinal and liver cells, resulting in gastrointestinal manifestations of COVID-19. It is challenging to diagnose COVID-19 in patients presenting with only gastrointestinal symptoms, with early suspicion and visualisation of the lung bases on computerised tomography(CT) abdomen scans being helpful.

Methods
Single-centre retrospective analysis of abdominal/chest CT scans was conducted within a District General Hospital. From the 6000 CT scans between March and April 2020, 1557(26%) were abdominal, 230 of which had chest CT scans with COVID-19 positive changes. 49 patients with CT abdomen and a positive CT Chest were shortlisted. All recorded documentation was assessed using online clinical portal and tabulated using Microsoft Excel®. Subdivision into 3 groups was: 1) primary gastrointestinal symptom, normal CT abdomen, 2) common COVID-19 symptoms with gastrointestinal symptoms, normal CT abdomen 3) gastrointestinal symptoms, abdominal pathology on radiology.

Results
COVID-19 related changes were seen on CT scans with no abdominal pathology noted in 33% (n = 16) patients with primary gastrointestinal symptoms. Further 18% (9 patients) presented with gastrointestinal symptoms alongside other common COVID-19 symptoms, however abdominal CT scan was normal. CT abdomen of these 25 patients were studied by a consultant radiologist, who examined the lung bases on the abdominal CT scan for COVID-19 related changes, which was seen in 92% patients. In 8% of the cases where the lung bases on the CT abdomen were normal, COVID-19 related changes were apparent on the CT chest.

Conclusions
CT scans of the abdomen should be supplemented with CT scans of the chest, when appropriate, for early accurate diagnosis, early treatment and triage to the correct wards, especially at the height of the pandemic.
P82 NUn score validation at a district general hospital
Authors: Rapier Jacob , Hornby Steven 
Published: April 2021

Abstract

Introduction
The NUn score was created to try and predict the risk of anastomotic leak or major complications (using the Clavien- Dindo classification) from upper GI resections with an oesophageal anastomosis. A score of &gt; 10 was used to predict an increased risk. In this study we attempt validation.

Methods
A database of 101 patients was studied, who underwent an Oesophagectomy for cancer between March 2017 and 2020. 72 patients had complete Post-operative day 4 bloods, needed to calculate the score. These patients were then studied for post-operative complications.

Results
A total of 12 patients had a NUn score of &gt; 10 (16.67%).
There was 1 death (1.37%) and 11 anastomotic leaks (15.28%). Of these the NUn score did not predict the death and predicted 8 of the 11 anastomotic leaks.

From our data

Conclusion
From our analysis the NUNs score cannot be shown to be sensitive, specific or have useful positive predictive value. The average Nun score was not reliable, with confidence intervals crossing 10. There may be some merit in using the test for its negative predictive value, but further analysis into this is needed. The results of this audit are consistent with previous efforts at external validation.
P97 Protocol for a Systematic Review of Robotic Anti-reflux surgery to Examine Reporting of an Innovative Procedure: The RoboSurg Study
Authors: Huttman M , Robertson H , Wood F , Kiandee M , Sewart E , Gourbalt L , Blencowe N ,   On behalf of the RoboSurg collaboration
Published: April 2021

Abstract

Background
Innovation in surgery is growing. The rigour of reporting of innovation must therefore be examined to ensure evaluations are thorough and transparent. The Idea, Development, Exploration, Assessmemt, Long-term follow-up (IDEAL) framework was developed in 2009 to help researchers evaluate innovative procedures. However, it is not known whether the IDEAL principles have been adopted into the reporting of robotic surgery. The aim of this study is to identify and summarise published literature for robotically assisted anti-reflux surgery, to understand whether evaluations are being performed in a robust way.

Methods
Systematic literature searches were undertaken to identify studies relating to robotic anti-reflux surgery. All primary research studies pertaining to robotically-assisted surgery for adults with symptomatic gastro-oesophageal reflux disease were included. Studies examining multiple interventions, where the outcomes could not be separated, were excluded. Data will be doubly extracted using tailored online forms. Data extraction themes include: study characteristics, technique description and evolution, governance/ethical factors and outcome reporting. Data will be synthesised into tables and summarised in a narrative synthesis. A meta-analysis will not be performed as we aim to examine reporting, rather than the efficacy of robotically-assisted anti-reflux surgery.

Results
824 abstracts were identified, of which 80 were included for full text review. Summarised data will be used to propose a standard of reporting which will inform future work in the field.

Conclusion
The findings will feed in to the other six arms of RoboSurg to examine reporting in robotic upper gastrointestinal surgery more generally.
P103 Research governance audit on quality of documentation of hyperacute ATTEST 2 stroke trial, focusing on the informed consent process
Authors: Prabhu Anusha , Dixit Dr Anand , Fawcett Michelle , Woodward Stephen , Hogg Valerie 
Published: April 2021

Abstract

Background
The time constraints of hyperacute stroke trials can make documentation challenging. 70% of acutely ill patients lack capacity, thereby requiring proxy consent, and faultless documentation of informed consent in order to avoid ambiguity. This retrospective audit looked at quality of documentation, focusing on informed consent, in the ATTEST 2 trial. The ATTEST 2 trial is a multicentre randomised controlled trial comparing the efficacy of the experimental drug tenecteplase to alteplase (which is used in current practice) for IV thrombolysis to treat acute ischaemic stroke.

Methods
The consent forms and hospital notes of 13 participants of ATTEST 2 recruited into the trial at the Newcastle Royal Victoria Infirmary hospital from January-August 2018 were inspected. Criteria included documentation of all research visits (day 1, 2 and 5), inclusion and exclusion criteria being met, and presence of a dated, timed and signed consent form. Adherence to 38 criteria in patient records was assessed. Standards were based on GCP guidelines for documentation, especially section 4.8 on informed consent, and on the requirements for data recording set by the ATTEST 2 trial coordinators.
This was stratified by date to compare documentation earlier and later on in the trial.

Results
Most criteria were adequately fulfilled. However, 22% of the criteria had a compliance of less than 60%. These included recording time of consent, the day 5 follow up visit, the attempt to reconsent if patient lacked capacity earlier, the voluntary nature of the trial, the risks and benefits, and that the patient had an opportunity to ask questions. The practices with compliance less than 60% decreased from 26% from January-April 2018 to 21% from May-August 2018.

Conclusions
The level of documentation varied between patient records, and though most criteria were met, some did not meet ideal standards. This seemed to improve over the course of the ATTEST 2 trial. This audit findings were presented to the team involved. Inconsistency of documentation was discussed and documentation standards were reviewed. A re-audit should be carried out and it should be investigated whether the quality of documentation continued to improve over time.
P135 Undifferentiated round cell and spindle cell sarcomas: the current paradigm
Authors: Hardman Lotte , Ibriham Mina , Khundkar Roba , Wilson Paul 
Published: April 2021

Abstract

Introduction
The classification of soft tissue and bone neoplasms is experiencing a transformation as methods to detect gene fusions expand. Next-generation sequencing panels, anchored multiplex polymerase chain reaction systems and comprehensive RNA sequencing have all contributed to new histological categorisation. The EWSR1-NFATC2 is one such novel translocation found in a round cell sarcomas. These sarcoma sit within the WHO group of undifferentiated round and spindle cell sarcomas. They presents as either a primary bone or soft tissue tumour and exhibits distinctive histopathologic features.

Methods
This is a case study of a soft tissue mesenchymal tumour with the recently described gene fusion EWSR1-NFATC2. The case is described, with 3-month outcomes and considered in the most recent literature on this sarcoma subset (26 cases).

Results
This case study prompted a look at the current NHS paradigm for these emerging histopathologically distinctive sarcoma subgroups. At present the expertise with the sarcoma MDT, along with second opinion from other national MDTs is the format for subtype specific sarcoma management, informed by recent literature.

Conclusion
The EWSR1-NFATC2 fusion round cell sarcoma tumours are an example of a very recently emerged sarcoma subset which display oncological variance to the wider Ewing’s family. The novel literature guided the Southmead and Royal Marsden MDT opinions to proceed straight to surgical excision.
The Authors recommend a national prospective database for rare sarcoma subsets, particularly those that appear to exhibit distinctive clinicopathology characteristics. The format could be through the RSTN collaborative, secure anonymised data collection can be collected through REDCap.
O4 Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study
Authors:   COVIDSurg Collaborative, Lawday Samuel 
Published: April 2021

Abstract

Background
The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery is poorly understood. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection.

Methods
This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality. The secondary outcome measure was pulmonary complications (pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation).

Findings
This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths.
In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p &lt; 0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p &lt; 0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p &lt; 0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p = 0·046), emergency versus elective surgery (1·67 [1·06–2·63], p = 0·026), and major versus minor surgery (1·52 [1·01–2·31], p = 0·047).

Interpretation
Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than normal practice, particularly in men aged 70 years and older.
V1 Enhanced Recovery After Surgery (ERAS) compliance in elective colorectal surgery: an international multicentre survey
Authors:   EuroSurg Collaborative
Published: April 2021

Abstract

Introduction
ERAS protocols are widely endorsed after colorectal surgery. This study aims to describe compliance with the individual principles of ERAS across an international setting.

Methods
A hospital-level survey was administered. This aimed to describe hospital-level compliance to 17 principles of ERAS after elective colorectal surgery. The questionnaire was mandatory for all hospitals participating in an international cohort study on colorectal surgery between October 2017 and July 2018.

Results
A total of 422 hospitals took part in the cohort study and submitted questionnaires. Most hospitals (90%) were located in Europe. The overall median compliance was 14 out of 17 items. Only 13.7% of centres were compliant with all 17 items. High compliance was noted for items: patient counseling (91%); antibiotic prophylaxis (91.5%); venous thromboembolism prophylaxis (98.8%); early mobilization (97.2%); and avoidance of hypothermia (92.5%). Lower compliance was noted for items: preoperative oral carbohydrates (55.4%), standardized anesthesia protocol, (68.6%), early oral tolerance (69.8%), avoidance of abdominal drain (64.4%), and avoidance of mechanical bowel preparation (59.3%).

Conclusion
Overall compliance with ERAS guidelines was high however there is still scope for improvement. New strategies should be considered to attain full adherence to ERAS guidelines in the management of patients undergoing elective colorectal surgery.
V4 Management of Acute cholecystitis and CHOlecystostomy - the MACHO study
Authors:   The MACHO collaborators, Clarke Rory 
Published: April 2021

Abstract

Background
Acute cholecystitis is a common reason for surgical admission. Gold standard of care includes early laparoscopic cholecystectomy (LC). Some patients may receive a cholecystostomy drain in place of this. The use of cholecystostomy in current practice is not well defined. The aim of this study is to describe variation in practice, and outcomes of drainage in acute cholecystitis.

Methods
A multicentre retrospective observational cohort study was carried out over an interval three month period. Patients were identified through clinical coding. Demographics, clinical outcomes, and intervention descriptors were collected. Logistic regression was performed to identify characteristics of patients receiving a drain, and to propensity match for clinical outcomes.

Results
Seven centres reported on 1131 patients. Cholecystostomy rate was 6.4%. The median age of patients was 61 (16-97). Median Charlson Comorbidity Index (CCI) was 2 (range 0-13). Drain used was associated with longer length of stay and increased readmission rates. Regression modelling found positive associations between cholecystostomy and C-reactive protein, white cell count, CCI, and acute kidney injury at admission. Propensity matching of cholecystostomy vs index LC found no difference in rates of major complications.Rates of any complication were higher in cholecystostomy vs index LC (37.0% vs 11.3%, p = 0.002). Drains were not associated with any difference in complications when compared to conservative treatment (37.1% vs 21.0%, p = 0.075).

Conclusion
Cholecystostomy is deployed in a subgroup of unwell patients. It is not clear whether this leads to poor outcomes, or if this is a proxy marker of fitness.
V11 The trends of the indications and outcomes of cesarean section in Bukavu - A single-center cross-sectional study
Authors: Nteranya Daniel S , Wimba Patient M , Kanmounye Ulrick S 
Published: April 2021

Abstract

Introduction
Cesarean sections (CS) can avert maternal and fetal death and disability. The CS rate varies considerably around the world. While in underserved regions, CS rates are low, in higher income settings, there appears to be too many CS. The objective of this study was to describe the temporal evolution of the indications, practice, and outcomes of CS in Bukavu, Democratic Republic of Congo.

Methods
This cross-sectional study was conducted using the hospital records of women who delivered by CS from January 01, 2014, to December 31, 2017, at the University clinics of Bukavu. Summary descriptive, bivariate, and regression analyses were conducted. The threshold of significance of the alpha was set at 0.05.

Results
Out of the 3,772 women who gave birth, 502 delivered by CS (CS rate=13.3%). The mean age of the women was 26.1 ± 6.4 years, mean gravidity was 3.5 ± 3.0, and the mean parity was 3.3 ± 2.7. Both gravidity (p = 0.007) and parity (p = 0.013) were significant variables in the regression model. 98.2% of CS were emergent, and a general practitioner performed 97.6%. Robson group 1 (30.0%), 5 (29.5%), and 3 (27.1%) were the major CS indications. The complication rate was 7.6%. Surgeons registered 29 (5.8%) intraoperative bleeds, 4 (0.8%) bladder injuries, 5 (1.0%) postpartum hemorrhages, 3 (0.6%) functional ileus, 3 (0.6%) superficial surgical site infections, and 7 (1.4%) endometritis.

Conclusion
The frequency of CS is optimal at the University Clinics of Bukavu. Its indications are evolving with time.
Comparison between cardiac magnetic resonance stress T1 mapping and [15O]H2O positron emission tomography in patients with suspected obstructive coronary artery disease
Authors: Everaars Henk , van Diemen Pepijn A , Biesbroek P Stefan , Hopman Luuk H G A , Bom Michiel J , Schumacher Stefan P , de Winter Ruben W , van de Ven Peter M , Raijmakers Pieter G , Lammertsma Adriaan A , Hofman Mark B M , Nijveldt Robin , Götte Marco J , van Rossum Albert C , Danad Ibrahim , Driessen Roel S , Knaapen Paul 
Published: April 2021

Abstract

Aims
To compare cardiac magnetic resonance (CMR) measurement of T1 reactivity (ΔT1) with [15O]H2O positron emission tomography (PET) measurements of quantitative myocardial perfusion.

Methods and results
Forty-three patients with suspected obstructed coronary artery disease underwent [15O]H2O PET and CMR at 1.5-T, including rest and adenosine stress T1 mapping (ShMOLLI) and late gadolinium enhancement to rule out presence of scar tissue. ΔT1 was determined for the three main vascular territories and compared with [15O]H2O PET-derived regional stress myocardial blood flow (MBF) and myocardial flow reserve (MFR). ΔT1 showed a significant but poor correlation with stress MBF (R2 = 0.04, P = 0.03) and MFR (R2 = 0.07, P = 0.004). Vascular territories with impaired stress MBF (i.e. ≤2.30 mL/min/g) demonstrated attenuated ΔT1 compared with vascular territories with preserved stress MBF (2.9 ± 2.2% vs. 4.1 ± 2.2%, P = 0.008). In contrast, ΔT1 did not differ between vascular territories with impaired (i.e. &lt;2.50) and preserved MFR (3.2 ± 2.6% vs. 4.0 ± 2.1%, P = 0.25). Receiver operating curve analysis of ΔT1 resulted in an area under the curve of 0.66 [95% confidence interval (CI): 0.57–0.75, P = 0.009] for diagnosing impaired stress MBF and 0.62 (95% CI: 0.53–0.71, P = 0.07) for diagnosing impaired MFR.

Conclusions
CMR stress T1 mapping has poor agreement with [15O]H2O PET measurements of absolute myocardial perfusion. Stress T1 and ΔT1 are lower in vascular territories with reduced stress MBF but have poor accuracy for detecting impaired myocardial perfusion.
Survey on e-health knowledge and usage in general cardiology of the Council of Cardiology Practice and the Digital Health Committee
Authors: Asteggiano Riccardo , Cowie Martin R , Richter Dimitrios , Christodorescu Ruxandra , Guasti Luigina , Ferrini Marc 
Published: April 2021

Abstract
The Council for Cardiology Practice of the European Society of Cardiology (ESC), in collaboration with the Digital Health Committee (DHC), undertook an electronic survey with 15 question multiple-choice questionnaire sent to 32 461 members of the ESC with the aim to assess the knowledge and usage of digital health (DH) technologies (DHTs) by office-based cardiologists. Of 559 respondents, 57% graded their knowledge about DH as ‘fair’ and three quarters identified the correct definition of DH. Clinical information systems, mHealth Apps, and telemedicine were the most frequently used DHTs, but 41% of respondents had concerns about their ethical and data transparency. Lack of legal clarity, low patient motivation, limited DH literacy, and poor access to DH were perceived as the main barriers to the adoption of DH. Seventy percent of the respondents were aware of the DH pages on the ESC website and 76% of the educational sessions in the DH area during the ESC Congress 2019. Only 16% had not read articles on DH. Eight-eight percent of responders declared that they would ‘probably’ or definitely attend future educational initiatives on DHT.
Property Right Acquisition and Path Dependence: Nineteenth-Century Land Policy and Modern Economic Outcomes
Authors: Allen Douglas W , Leonard Bryan 
Published: April 2021

AbstractIn this paper we compare lands settled between 1862–1940 under the Homestead Act to lands that sold for cash during the same time. We combine recently digitised individual land patents with modern satellite data and find a negative effect of homesteading on modern land use that cannot be explained by land quality, title characteristics or unobserved differences in settlers. We test the hypothesis that early homestead settlement put homesteaders ‘in the way’ of future development, creating a path dependence in land use decisions for homesteads, despite the fact that their legal rights were identical to purchased lands.