bluuebunny/crossref_metadata_2025_split huggingface dataset:
P5 A Cut Throat approach to post thyroidectomy care
Authors: McGovern J , Kurup V J , Bhaskar P , Slinger C A , McGovern Julia 
Published: April 2021

Abstract

Introduction
Across the UK, approximately 10,000 elective neck dissection surgeries (thyroidectomy/parathyroidectomy) are performed each year. The recognised post-operative complications of such surgeries range from mild post-operative hypocalcaemia to life threatening wound haematoma .

Aim
This project aimed to establish the awareness of the British Association of Endocrine and Thyroid Surgeons (BAETS) post thyroidectomy guidelines and provide targeted education in order to improve any identified failings in the management of this patient group.

Methods
A nine point questionnaire was generated based on the guidelines published by BAETS. This questionnaire was disseminated to the junior doctors and nurse practitioners based on the surgical unit of North Tees General Hospital.

Results
Results were analysed from twenty respondents. 92% opted to call a registrar or consultant during a critical airway emergency secondary to wound haematoma rather than attempt to open the wound on the ward. Respondents displayed poor understanding of the risks of thyroid surgery (55%) and struggled to identify symptoms of hypocalcaemia (25%).
Participants showed good understanding of the need for post-operative thyroxine (100%), the correct dose of calcium gluconate required for treatment of hypocalcaemia (90%) and normal calcium levels (85%).
A video was created and distributed which highlighted front of neck anatomy and steps involved in releasing a wound haematoma. This included the ‘SCOOP’ video created by Endocrine Surgery Oxford. Data collected following the session found 93% of respondents would be more confident to intervene in future.

Conclusion
It is vital that junior doctors are well educated and equipped to deal with post-operative patients, especially those who may develop imminent airway obstruction. Our “cut throat” approach aims to ensure our first responders are decisive and effective in carrying out life saving interventions.
P16 An audit of elderly patients with a femoral fracture: is the quality of care received by patients affected by where in the femur the fracture occurs?
Authors: Javed O A , Khan M J , Abbas Y , Pillai S , Hristova K , Chiang M , Mason W 
Published: April 2021

Abstract

Introduction
Elderly patients with femoral fractures are often frail and require a multidisciplinary approach to optimise medical care, rehabilitation and prevention of further injury. Previously, neck of femur fracture patients were the focus of such an approach, but NICE and BOAST guidelines emphasise extending this care to other elderly trauma patients.

Methods
A retrospective analysis of 43 patients over 60 years old at Gloucestershire Hospitals NHS Foundation Trust in 2019 with a femoral fracture other than a neck of femur fracture. BOAST guideline standards were surgery within 36 hours, orthogeriatric assessment within 72 hours, a documented ceiling of treatment, falls risk assessment, bone health review, nutritional assessment and physiotherapy review.

Results
Our study showed worse outcomes in all standards for patients with femoral shaft, distal femur and periprosthetic femur fractures compared to neck of femur fractures: surgery within 36 hours (63.9% vs. 66%); orthogeriatric assessment within 72 hours (32.6% vs. 91.9%); falls risk assessment (76.7% vs. 99.6%); bone health review (41.9% vs. 99.7%); nutritional assessment (55.8% vs. 99.6%); physiotherapy review (97.7% vs. 98.9%). The group also had worse outcomes for average length of stay (19 days vs. 14 days) and 30 day mortality (9.3% vs. 8.6%).

Discussion
Our study showed a discrepancy in care received by elderly patients with femoral fractures other than neck of femur. We will introduce a proforma for all femoral fractures, present our findings to orthogeriatric, bone health and physiotherapy teams to involve them in the care of such patients and re-audit following these recommendations.
P17 An audit of Trakcare discharge times for Laparoscopic Cholecystectomy
Authors: Rapier Jacob , Hornby Steven 
Published: April 2021

Abstract

Introduction
Nationally 61,220 Laparoscopic Cholecystectomies are carried out annually. Those carried out as day-cases reduce providers’ costs and increase income through the best practice tariff. The system in our trust to record discharges is ‘Trakcare’.
The aim of this audit was to accurately measure the discharge times of patients undergoing elective Laparoscopic Cholecystectomies, to try and reduce the number of patients recorded as having an overnight stay by accurate data collection.

Methods
Initial data was collected for all elective Laparoscopic Cholecystectomy discharge times on Trakcare, over a 1 month period.
This data was then re-audited prospectively both from Trakcare and discharges reported by nurses/patients.
A comparison was then made of Trakcare against reported discharge times.

Results
Initially 54 operations were recorded, with 30 completed as day cases (55.6%). The re-audited data (on Trakcare) recorded 47 operations, with 15 completed as day cases (37.91%). Of these discharges we were able to capture 26 (55.32%) manually, and 11 were completed as day cases (42.31%).
Measuring these 26 with the same operations on Trakcare we were unable to show a difference in the number of cases completed as a day case (11 vs 11), with only a 33 minute decrease in the average length of stay.

Conclusion
Trakcare is a reliable tool for measuring the date of discharge for patients. The recommendations in are: scheduling surgery for a time pre-13:00 shows a higher proportion of patients discharged the same day, and continue to use Trakcare to record discharge times.
P18 An audit on the delivery of Bristol Royal Children's Hospital paediatric orthopaedic services in response to BOAST COVID-19 guidance
Authors: Benning Matthew Singh , Berwin James , Knapper Thomas , Crosswell Sebastien , Carpenter Charlotte , Kenall John , Monsell Fergal , Thomas Simon 
Published: April 2021

Abstract

Introduction
The COVID-19 pandemic raised concerns regarding the spread of infection by asymptomatic children. Guidance from the British Orthopaedic Association Standards for Trauma (BOAST) for the ‘management of patients with urgent orthopaedic conditions and trauma during the coronavirus pandemic’, helped structure our service in response to the pandemic. We assessed our compliance with ‘BOAST COVID-19 standards’ pertaining to children to determine whether it is possible to run a safe and effective paediatric orthopaedic service.

Methods
Between the 16th March and 30th April 2020, we performed a prospective audit of clinic and theatre data from the paediatric orthopaedic department at the Bristol Royal Children’s Hospital against the ‘BOAST COVID-19 standards’. We also performed a retrospective audit between 16th March and 30th April 2019 for comparison.

Results
Patients booked into acute fracture clinic (AFC) and fracture clinic follow-up (FFO) reduced by 40% and 48% respectively from 2019 to 2020. A virtual fracture clinic (VFC) was implemented with increasing trend in VFC consultations. From 2019 to 2020, the number of patient initiated follow-up appointments increased in AFC and FFO from 16% to 75% and 12% to 35% respectively. Radiography was reduced; only 17% and 39% of AFC and FFO patients respectively required radiographs. On-call referrals and trauma cases reduced by almost 50% with a similar case mix year-on-year. All elective operating was cancelled in 2020.

Conclusion
By reducing clinic admissions and theatre throughput, it was possible to run an effective paediatric orthopaedic service in a busy tertiary referral centre. Our aim now is to determine the long-term efficacy.
P20 Anatomical Education during Covid-19: Ramifications for Students’ Learning
Authors: Franchi Thomas 
Published: April 2021

Abstract

Introduction
The world is experiencing an ongoing and serious pandemic, and as both an anatomy student and anatomy demonstrator, I felt it necessary to comment on the impact this pandemic has had and is having on students’ anatomical education, and on my concerns about the implications it might have on the future of current anatomy students.

Methods
In the form of an extended Letter to the Editor, I present some of my reflections on the above matter and suggest a number of points for anatomy students, demonstrators and institutions to consider as we move forwards.

Results
When students lost access to dissection rooms, they lost access not only to cadavers, but also to a range of other optimal learning modalities: prosections, models, pathology specimens, skeletons, and others. Previous authors have highlighted that the modern medical curriculum already restricts students’ exposure to anatomy, and indeed this pandemic has further shortened the contact time current students have received. As a result, current anatomy students are being taught anatomy without access to practical-based learning materials, be that cadavers, prosections, or models.

Conclusion
Whilst the educational disruption caused by the pandemic is clearly severe, it also presents an opportunity for pedagogical evolution and innovation. Here, I have offered a host of recommendations to those involved in anatomical education. The lasting impacts of the pandemic are still unknown, but the anatomical community has responded creatively and adaptively.
P23 Associate Principal Investigators in Trauma Trials
Authors: Bretherton Chris , Exell Lauren , Achten Juul , Costa Matt 
Published: April 2021

Abstract
Oxford Trauma has designed a collection of randomised clinical trials to answer important clinical questions in trauma and meaningfully engage trainees and associate principal investigators (aPI’s) with research.
These include: Children’s Radius Acute Fracture Fixation Trial (CRAFFT): • Weight-Bearing in Ankle Fractures (WAX): • Blood cEll Salvage and autoTransfusion (BEST): • Fractured Ankle Management Evaluation (FAME): • Surgery or Cast for Injuries of the EpicoNdyle in Children's Elbows (SCIENCE): • The HUmeral SHaft fracture trial (HUSH) Trainee engagement is promoted via: • Registration for the NIHR associate PI scheme with corresponding “how-to guide” for study set-up. Individually tailored points system for collaborative authorship. Automatic emailing of certificates for recruitment of participants (For ARCP evidence). A central database listing trial sites and contacts for aPI’s.
https://www.ndorms.ox.ac.uk/Oxford-Trauma-and-Emergency-Care/trainee-involvement
This has led to the recruitment of sites and participants ahead of target, including sites aPI’s have set-up from scratch.
We would love for you to join as an aPI or help us refine the model and share it with other collaborative groups!: Contact Christopher.Bretherton@ndorms.ox.ac.uk
P28 Breast Lymphedema after breast conservative surgery; an up-to-date systematic review
Authors: Abouelazayem Mohamed , Elkorety Mohamed , Monib Sherif 
Published: April 2021

Abstract

Background
While arm lymphedema following breast cancer treatment is a common complication; breast lymphedema following treatment is not uncommon. Several risk factors were found to contribute to breast lymphedema, including axillary surgery, high BMI, increased bra cup size, adjuvant chemotherapy, locoregional and radiotherapy boost and upper outer quadrant tumours.

Aim
We aimed to provide an up to date systematic review to help avoiding or managing breast lymphoedema after Breast conservative surgery for breast cancer.

Methods
The search term 'breast lymphedema' was combined with 'breast conservative surgery' and was used to conduct a literature research in PubMed and Medline. The term lymphedema was combined with breast, conservative and surgery to search Embase database. All papers published in English were included with no exclusion date limits

Results
A total of 2155 female patients were included in this review; age ranged from 26 to 90. Mean body mass index was 28.4, most of the studies included patients who underwent conservative breast surgery.
Incidence of breast lymphedema ranged from 24.8% to 90.4%. Several risk factors were linked to breast lymphedema after conservative breast surgery, such as body mass index (BMI), breast size, tumour size, tumour site, type of surgery and adjuvant therapy.
Treatment options focused on decongestive lymphatic therapy, including Manual lymphatic drainage (MLD), self-massaging, compression bras or Kinesio taping.

Conclusion
Breast lymphedema is a relatively common complication, yet there is no clear consensus on the definition or treatment options.
P33 Changes to acute vascular care management during the COVID-19 pandemic: The Vascular and Endovascular Research Network (VERN) COvid-19 Vascular sERvice (COVER) Tier 3 study
Authors:   VERN COVER Study Collaborative
Published: April 2021

Abstract

Introduction
The COVID-19 pandemic forced rapid adaptations to healthcare provision. The COvid-19 Vascular sERvice (COVER) Study aimed to contemporaneously report changes to practice and subsequent outcomes of vascular patients managed during the pandemic.

Methods
COVER is a three-tiered international multi-centre observational cohort study aiming to quantify the specific impact of the pandemic on the provision of vascular and endovascular surgery and the adjustments made to standard vascular practice during this time. The primary outcome of Tier 3 was to identify how the management of all referred urgent vascular cases changed throughout the COVID-19 pandemic. Secondary outcomes included longitudinal data to identify condition-specific outcomes for these patients at 3, 6 months and 1 year. Over a minimum four-week period, contributing vascular centers contemporaneously collected prospective data on the management of all urgent referrals received during this time.

Results
Data from over 1693 patients worldwide has been obtained and is currently undergoing analysis. Provisional results suggest that approximately 18% of patients had significant changes to their care during the pandemic. Full descriptive results of management changes during the pandemic itself will be reported at the NRCM meeting.

Conclusions
It is anticipated that this work will highlight significant deviation in the management of urgent vascular referrals when compared to pre-pandemic best practice guidelines. It will be crucial to identify and monitor the ongoing impact this has on patient care.
P34 Characteristics, diagnosis and management of Cushing’s disease - A systematic review and meta-analysis
Authors: Koh Chan Hee , Khan Danyal Z , Digpal Ronneil , Horsfall Hugo Layard , Marcus Hani J , Korbonits Marta 
Published: April 2021

Abstract

Introduction
The clinical practice and research in the diagnosis and management of Cushing’s disease remains heterogeneous and challenging to this day. We sought to establish the characteristics of Cushing’s disease, and the trends in diagnosis, management and reporting in this field.

Methods
Searches of PubMed and Embase were conducted. Study protocol was registered a-priori. Random-effects analyses were conducted to establish numerical estimates.

Results
Our screening returned 159 papers.
The average age of adult patients with Cushing’s disease was 39.3, and 13.6 for children. The male:female ratio was 1:3. 8% of patients had undergone previous transsphenoidal resection. The ratio of macroadenomas: microadenomas:imaging-undetectable adenomas was 18:53:29. The most commonly reported preoperative biochemical investigations were serum cortisol (average 26.4µg/dL) and ACTH (77.5pg/dL). Postoperative cortisol was most frequently used to define remission (74.8%), most commonly with threshold of 5µg/dL (44.8%). Average remission rates were 77.8% with recurrence rate of 13.9%. Median follow-up was 38 months.
Majority of papers reported age (81.9%) and sex (79.4%). Only 56.6% reported whether their patients had previous pituitary surgery. 45.3% reported whether their adenomas were macroadenoma, microadenoma or undetectable. Only 24.1% reported preoperative cortisol, and this did not improve over time. 60.4% reported numerical thresholds for cortisol in defining remission, and this improved significantly over time (p = 0.004). Visual inspection of bubbleplots showed increasing preference for threshold of 5µg/dL. 70.4% reported the length of follow up.

Conclusion
We quantified the characteristics of Cushing’s disease, and analysed the trends in investigation and reporting. This review may help to inform future efforts in forming guidelines for research and clinical practice.
P43 Did COVID-19 Pandemic change Anaesthesia Practices in India: A Multi-centre Cross-sectional Study
Authors: Shah Priyansh , Sarang Bhakti , Gadgil Anita , Bhandoria Geetu , Khajanchi Monty , Veetil Deepa Kizhakke , Bhandarkar Prashant , Gupta Monali Mohan , Goh Dylan , Roy Nobhojit 
Published: April 2021

Abstract

Introduction
The anaesthetic management for surgeries during the COVID-19 pandemic has posed unique challenges. Safety of all healthcare workers is an additional concern along with heightened risk to patients during General Anesthesia (GA). COVID-19 pneumonia and aerosol generation may be exacerbated during airway intervention and GA. We aimed to assess the change in the mode of anaesthesia due to the pandemic.

Methods
A research consortium led by WHO Collaboration Centre for Research in Surgical Care Delivery in Low and Middle Income countries, India, conducted this retrospective cross-sectional study in 12 hospitals across the country. We compared the anaesthesia preferences during pandemic (April 2020) to a corresponding pre pandemic period (April 2019)

Results
A total of 636 out of 2,162 (29.4%) and 156 out of 927 (16.8%) surgeries were performed under GA in April 2019 and April 2020 respectively, leading to a fall of 13% in usage of GA. A 5% reduction in GA and a 12% increase in the usage of regional anaesthesia was observed for cesarean sections. There was no significant change in anesthesia for laparotomies and fracture surgeries. However, 14% increase in GA usage was observed in surgeries for local soft tissue infections and necrotic tissues.

Conclusion
Though overall usage of GA reduced marginally, the change was mainly contributed by anesthesia for caesarean births. The insignificant change in anaesthesia for other surgeries may be attributed to the lack of facilities for spinal anaesthesia and may reflect the risk taking behaviour of healthcare professionals in COVID-19 pandemic.
P45 Effect of One Anastomosis Gastric Bypass on Liver Function Tests: A comparison between 150 cm and 200 cm Bilio-Pancreatic Limb
Authors: Sam Miraheal Adadzewa , Hussain Abdulzahra , Pegler Maya Elizabeth , Bligh Pearson Emma Jane , Boyle Maureen , Singhal Rishi , Mahawar Kamal 
Published: April 2021

Abstract

Introduction
The effect of One Anastomosis Gastric Bypass (OAGB) on Liver Function Tests (LFTs) is unclear. The purpose of this study was to find out the effect of OAGB on LFTS and also if a Bilio-Pancreatic Limb (BPL) of 150 cm (OAGB-150) would deliver better outcomes than that with a BPL of 200 cm (OAGB-200).

Methods
We investigated our prospectively maintained records to obtain information on patients who underwent an OAGB-200 or OAGB-150 until 31st July 2018 in our unit.

Results
A total of 405 patients underwent an OAGB-200 (n = 234) or OAGB-150 (n = 171) in our unit between October 2012 -July 2018. There were significant improvements in Gamma-Glutamyl-Transpeptidase (GGT) levels at 1 and 2 years after OAGB-200 and significant worsening in the levels of Alkaline Phosphatase (ALP) and albumin at 1 and 2 years follow up. There was a significant improvement in GGT levels at 1 and 2 years after OAGB-150, and in Alanine Transaminase (ALT) levels at 1 year follow up. There was a significant worsening in ALP and albumin levels at both follow-up points in this group. There was no significant increase in the number of abnormal values for any of the tests in either group at both follow-up points. OAGB-150 group had a significantly lower bilirubin level at 1 year and significantly fewer abnormal ALP values at 2 years in comparison with OAGB-200 patients.

Conclusion
This study demonstrates the overall safety of OAGB with regards to its effect on LFTs with no remarkable difference between OAGB-150 and OAGB-200.
P55 FutureCOVID: Exploring the perspectives of doctors & nurses of student response during the COVID-19 pandemic
Authors:   Incision UK, The Royal Society of Medicine Students Section, MedEd collaborative (Steering group):, Veerappan Vigneshwar Raj , Kawka Michal , Dawidziuk Aleksander , Sravanam Sanskrithi , Bandhyopadhyay Soham , Byrne Matthew 
Published: April 2021

Abstract

Introduction
The training medical students receive means they can be used as auxiliary healthcare staff during pandemics and disasters. During COVID-10, many medical students volunteered in healthcare settings in clinical and non-clinical capacities. While there has been research into students’ perceptions of the pandemic and their role within the NHS, the perceptions of healthcare staff perceive this student response has not been explored.

Methods
COVIDAssist is a survey based cross sectional observational study of medical student volunteering during COVID-19. The study consists of a cross sectional survey of doctors & nurses who worked alongside medical students in the NHS during the pandemic. We will use qualitative and quantitative methods to analyze responses.

Results
The primary objective of the study is to assess how effective student response was in reducing the burden on healthcare teams during the pandemic. Secondary objectives are: to identify the broad specialty (e.g. medicine, surgery, primary care) and healthcare roles medical students were most beneficial) ; the GMC outcome-based skills students exhibited; the training provided to students before volunteering and what additional training could have been provided to students.

Conclusion
The outcomes of this study will help inform current and future guidance on effective student deployment during pandemics and disasters. The results are also expected to provide insight into necessary training adaptations.
P61 Impact of the COVID-19 pandemic on the presentation and management of acute appendicitis: a single-centre analysis
Authors: Pringle H , Donigiewicz U , Bennett M , Fowler G F , Walker E , Ball S , Narang S , Bethune R M 
Published: April 2021

Abstract

Introduction
The COVID-19 pandemic has influenced the delivery of healthcare. In accordance with the UK Joint Royal Colleges’ advice the management of acute appendicitis (AA) changed with greater consideration for non-operative management (NOM) or open appendicectomy where operative management (OM) s sought. Our aim is to share our experience of the presentation, management and outcomes for patients presenting to our Trust with AA to guide care for future viral pandemics.

Methods
This single-centre retrospective cohort study included patients diagnosed with AA in March to July 2019 compared with March to July 2020. Medical records were used to evaluate demographics, inflammatory markers, imaging, severity, management, histology, length of stay (LOS), complications and 90-day outcomes.

Results
There were 149 and 125 patients in the 2019 and 2020 cohort, respectively. 14 patients (9.4%) had NOM in 2019 versus 31 patients (24.8%) in 2020 (p = 0.001). In the 2019 OM group 125 patients (92.6%) had laparoscopic appendicectomy versus 69 (73.4%) in 2020. 59 patients (39.6%) had a CT in 2019 versus 70 (56%) in 2020. The median LOS was 4 days (interquartile range (IQR) 3 to 6 days) in 2019 and 3 days (IQR 2 to 5 days) in 2020 (p = 0.03). Two patients in each year who received NOM had treatment failure (14.3% in 2019 and 6.5% in 2020). Three patients in 2019 who had OM had treatment failure (2.2%). Of 95 patients tested for COVID-19 all but one was negative.

Conclusion
During the COVID-19 pandemic there was no observed increase in severity of AA, patients had a shorter LOS and were more likely to have imaging. NOM proportionally increased with no observed change in outcomes.