bluuebunny/crossref_metadata_2025_split huggingface dataset:
TP9.2.19Factors Associated with Multiple Presentations Prior to Appendicectomy in Children Presenting with Suspected Appendicitis
Authors: Ng James Chean Khun , Tay Vi June , Malcolm Francesca Ligori , Chia Zoe , El-Sharkawy Ahmed M , Quarmby John 
Published: October 2021

Abstract

Aims
Appendicectomy is amongst the most common emergency operations in children. We aim to audit the rate of re-presentation within 30-days prior to appendicectomy in children presenting to the emergency department (ED) with suspected appendicitis and identify the factors associated with re-presentations.

Methods
Retrospective review of the medical notes of all children that had an emergency appendicectomies between June 2016 and June 2019.

Results
A total of 231 appendicectomies were performed, all presented through ED, with 8.2%(n = 19) re-presenting within 30-days prior to appendicectomy. Negative appendicectomy rates were similar in those that had appendectomy at initial presentation or when they re-presented (13.2(n = 28)%vs.15.8%(n = 3), p = 0.752), respectively. Of those that re-presented, 84.2%(n = 16) were not reviewed by the surgical team at the index presentation. Female patients accounted for 62.5%(n = 10) of those that re-presented, compared with 31%(n = 57) of those that presented once(p = 0.010). Pyrexia(p = 0.029), Rovsing's sign(p = 0.032), nausea or vomiting(p = 0.012) was associated with histological appendicitis. Absence of migratory pain(p = 0.005), anorexia(p = 0.004), right iliac fossa tenderness(p &lt; 0.001) or guarding(p &lt; 0.001) was associated with higher successful discharge rate. Among those re-presented, there was significant CRP rise between first and second presentation (median(Q1,Q3): 6(1.25,28.5)vs.95.5(27,176.5), p = 0.016) however, white cell count was comparable (median(Q1,Q3): 14.6(11.98,16.05)vs.14.0(11.02,18.58), p = 0.815).

Conclusion
Clinical symptoms and signs correlated with histological appendicitis. A significant proportion of those that re-presented were not assessed by the surgical team at initial presentation. Early surgical consultation at initial presentation may reduce rates of re-presentation.
TP9.2.26Patients admitted onto an Emergency General Surgery unit with rib fractures are mostly elderly and frail and outcomes may be poor: results of a 12-month audit
Authors: Lewis Elaine , Shamim Sarah , Guy Richard 
Published: October 2021

Abstract

Aim
An audit of rib fracture (RF) patients admitted to an EGS unit to determine demographics, injury mechanisms & outcomes.

Methods
Retrospective analysis was undertaken of all RF patients admitted between 1st Jan & 31st Dec 2019. Patient demographics, injury mechanism, comorbidities, length of stay (LOS) & outcomes were recorded. Analysis of age-related differences was undertaken using Mann Whitney U & Chi Squared tests.

Results
There were 115 patients (67 males) with median age 74 (38 patients &lt;65 yrs; 77 patients &gt;65 yrs). Seventy-three patients (63.5%) sustained injury after a fall. Eighty (69%) patients had cardiorespiratory, cerebrovascular or metabolic conditions, of whom 62 (54%) were &gt;65 yrs, & 31 (27%) were on antiplatelets or anticoagulants. Thirty-eight (33%) had a pneumothorax or haemothorax, 19 (5.4%) flail chest & 39 (34%) additional bony injuries. Some 107 (93%) were managed on a rib fracture pathway. Thirty-seven (32%) patients developed pulmonary complications (infection 27, effusion 5, contusion 5) & 8 (7%) died. Subgroup analysis revealed a significant difference in LOS (median 3 vs 6.5 days, p = 0.00144) for age &lt;65 vs &gt;65 years & gender (females 9.5 vs males 3.5 days, p = 0.00114), as well as for age &lt;65 vs &gt;65 & injury mechanism (no fall vs fall, p = 0.042).

Conclusion
RFs are commonly sustained in frail elderly patients following a fall & are associated with significant pulmonary consequences in around a third, with potentially long hospital stay. Close collaboration with Pain Teams and specialists in Medicine for the Elderly is essential.
TP10.1.1Unveiled by Covid-19: The True Rate of Emergency General Surgery
Authors: Ali Roshneen , Bignell Mark , Tebala Giovanni 
Published: October 2021

Abstract

Aims
The Covid-19 pandemic has impacted every NHS service, including the provision of elective and emergency surgery. National lockdown, travel restrictions and intercollegiate guidance on conservative management of acute surgical conditions were introduced in an effort to reduce the burden on emergency services. This service evaluation aimed to evaluate the impact of the Covid-19 pandemic on emergency general surgical presentations and operations, and to determine whether the rate of surgical intervention changed.

Methods
Patients presenting to the surgical emergency unit in a large tertiary centre were identified through electronic admission records between March to April 2019 and the same period in 2020. Data on presentation, admission and operations were collected and compared between the two periods.

Results
Presentations in 2020 reduced by 38% from 1324 to 823. Operations performed decreased by 44% from 334 to 188. The proportion of presentations requiring emergency operations was 23% in 2020 compared to 25% in 2019. Emergency laparotomies increased from 30 to 40, constituting a greater proportion of operations (9% vs. 21%). Rates of appendicectomies remained the same at 26% vs. 27%. Urgent procedures including cholecystectomies, hernia repairs and abscess drainage decreased from 55% to 42% of all cases.

Conclusions
There was an absolute reduction in emergency presentations and operations between the two periods. This reduction could be accounted for by decreased presentations of patients with non-surgical abdominal pain due to lockdown. However, more critically unwell patients presented indicated by the increased number of laparotomies demonstrating the ongoing need for emergency surgery.
TP10.1.13A model for safe elective liver resection during the SARS-CoV-2 (COVID-19) pandemic – lessons for enhanced recovery
Authors: Jitsumura Maki , Sethi Pulkit , Welsh Fenella KS , Chandrakumaran Kandiah , Rees Myrddin 
Published: October 2021

Abstract

Background
The COVID-19 outbreak in January 2020 rapidly became a pandemic, adversely impacting elective cancer services in the UK. This study describes the pandemic-driven changes to existing admission and enhanced recovery protocols, which allowed the Unit to maintain a liver resection service, and evaluates their impact on patient safety.

Methods
During the pandemic, all patients undergoing liver resection in this Unit isolated for 14 days prior to their admission, with COVID-19 testing 48 hours pre-admission. Patients were admitted on the day of surgery to the day surgery unit, a designated COVID-free environment. They underwent liver surgery, recovery and post-operative care, all within the day surgery unit. Using a prospectively collected database, short-term outcomes of consecutive patients undergoing elective hepatectomy during the COVID-19 pandemic (April - June 2020) were retrospectively compared to patients during the same period in 2019.

Results
During the pandemic, 24 patients underwent hepatectomy compared to 34 patients in 2019. There was no statistical difference in demographics, indications for surgery, intra-operative parameters or complications between these periods. The median post-operative length of stay (LOS) was significantly shorter during the pandemic [3 (IQR: 3-4) days vs. 4 (IQR; 4-7) days, p = 0.015], as was the overall LOS [4 (IQR: 4-6) days vs. 6 (IQR; 5-9) days, p = 0.006]. No patient contracted COVID-19 per-operatively.

Conclusions
Patient pathway changes during a pandemic enabled safe liver surgery to be undertaken with improved outcomes – a model that is transferrable to other Units.
TP10.2.2Adherence to the new Royal College of Surgeons (RCS) guidance pertaining to acute appendicitis management during COVID-19
Authors: Khan Rajab , Shamsad Sabina , Rahimi Umaimah , Salih Hamisha , Razzaq Humayun , Adedeji Janine 
Published: October 2021

Abstract

Aims
The mainstay of acute appendicitis treatment is a surgical approach. However, in the tumultuous COVID-19 era, the approach to acute appendicitis management has altered.
We sought to assess the applicability of the new RCS COVID-19 guidance after resolution of the global pandemic.

Methods
A retrospective study was conducted on 244 patients presenting between 01/03/2020 and 17/07/2020. Three sources of data were sought: patients presenting to A&E with signs of appendicitis, operative logs for patients who underwent removal of their appendix and all CT/US scans where the clinician had queried appendicitis in the request.

Results
139 patients were treated conservatively with antibiotics (57.0%). 35 (25.2%) represented within 6 months. Conservative treatment was successful in 92.1% of cases.
65 appendectomies were completed during that time. 45 cases presented acutely whereby the surgical management of acute appendicitis was the primary choice. The decision to operate was due to: 13 (20%) because the patient was 16 or younger. 4 cases presenting with signs of severe sepsis. 4 cases had a complicated appendicitis on their imaging results. 22 (33.8%) cases were completed without initial conservative management. 9 (3.7%) cases failed conservative treatment thus requiring surgical management.
11 (4.5%) cases represented within 6 months due to recurrent appendicitis despite successful antibiotic treatment. Therefore, the recurrence rate following conservative treatment was 7.9%.

Conclusions
There was mixed adherence to the new guidance. Surgical management remains the best approach towards acute appendicitis. However, excellent results can still be achieved with appropriately targeted antibiotic therapy.
TP10.2.7Reintroduction of elective colorectal cancer surgery following the first wave of Covid-19 in the UK – an audit of risk mitigation strategies and review of patient outcome
Authors: Malcolm Francesca , Ng James Chean Khun , Speake William 
Published: October 2021

Abstract

Aim
Perioperative acquisition of Covid-19 is associated with high mortality and morbidity. We have analysed the effectiveness of newly designed ‘green’ pathway for elective colorectal cancer (CRC) patients, which aimed to minimise risk of Covid-19.

Method
Data collected with concurrent implementation of ‘green’ pathway for all patients undergoing CRC surgery over a 6 week period following the ‘first wave’ of the Covid-19 pandemic. The standard audited were appropriately timed pre-operative CT chest, Covid-19 swabs and shielding adherence. The impact of positive pre-operative swabs and post-operative complications were analysed. Additional risk mitigation strategies included dual consultant operating, open operating, and defunctioning ileostomy for high risk anastomoses.

Results
49 operations performed of 56 planned. 1 cancelled due to patient being positive for Covid-19, 5 due to progression of cancer on restaging CT, 1 required further medical optimisation. All had a 2 week pre-operative swab and then shielded until the day of the operation. 48/49 had swab 2 days pre-op. CT chest performed in all, 37 (66.7%) were to restage. 4 (8%) had post-operative complication graded as ≥ 2 on Clavien-Dindo score; none of which were Covid related. 1 patient tested positive for Covid-19 post-operatively but remained asymptomatic. All procedures were open and performed by 2 consultants.

Conclusion
We demonstrate an effective pathway and various operative strategies which can be employed to reduce risk for patients undergoing CRC surgery in the midst of the ongoing global pandemic.
What patients with eosinophilic esophagitis may not share with their providers: a qualitative assessment of online health communities
Authors: Chang Joy W , Chen Vincent L , Rubenstein Joel H , Dellon Evan S , Wallner Lauren P , De Vries Raymond 
Published: October 2021

Summary

Background
Little is known about how patients with eosinophilic esophagitis (EoE) experience their symptoms, receive care, and cope with their disease. Patients commonly seek peer support from online communities, which provide insights on unmet needs and barriers to care. We performed a qualitative analysis of electronic health forums to characterize patient-to-patient conversations about EoE symptoms and the experience of disease.

Methods
We identified three publicly accessible electronic health forums hosting EoE communities. Conversation threads posted between July 2018 and June 2020 were coded using emergent and a priori codes based on the THRIVE conceptual framework of coping with chronic illness.

Results
Of 659 threads (4,933 posts) collected over two years, a random sample of 240 threads (30 per 3-month quarter) were selected for analysis. Thematic saturation was reached after 172 threads. Patient experience of EoE was driven by their perspectives in four key domains: (i) perception of EoE as episodic rather than chronic, (ii) treatment choices, (iii) personal definitions of success in the disease, and (iv) views of providers.

Conclusion
Online health communities are a valuable and unfiltered source of patient perspectives that can be used to understand patient needs and goals. EoE patients interpret their disease as sporadic events and lack reliable sources of knowledge, which may influence how patients prioritize treatment. If providers are to succeed in providing high-quality EoE care, they need to equip themselves with evidence-based knowledge, engage in shared decision making, and look outside of clinical settings to recognize barriers to disease management.
A new genus and species of tanager (Passeriformes, Thraupidae) from the lower Yungas of western Bolivia and southern Peru
Authors: Lane Daniel F , Aponte Justiniano Miguel Angel , Terrill Ryan S , Rheindt Frank E , Klicka Luke B , Rosenberg Gary H , Schmitt C Jonathan , Burns Kevin J 
Published: October 2021

Abstract
We describe a colorful and distinctive new species of tanager from the lower slopes of the Andes of southeastern Peru and western Bolivia. The species was first noted from southeastern Peru in 2000, but little of its natural history was uncovered until the 2011 discovery of a breeding population in deciduous forest in an intermontane valley, the Machariapo valley, in Bolivia. This species appears to be an intratropical migrant, breeding in deciduous forest during the rainy season (November–March) and spending the dry season dispersed along the lower slopes of the Andes, apparently favoring Guadua bamboo-dominated habitats in both seasons. Phylogenetic evidence suggests this tanager is embedded within a clade of thraupids that includes Ramphocelus, Coryphospingus, Loriotus, Tachyphonus, and related genera in the subfamily Tachyphoninae. Within this subfamily, the new species falls in a clade with two monotypic genera, Eucometis penicillata (Gray-headed Tanager) and Trichothraupis melanops (Black-goggled Tanager). There is strong support for a sister relationship between the new tanager and T. melanops, but because all three species in this clade are highly distinctive phenotypically, we propose erecting a new genus and species name for the new tanager.
26 Supporting the Transition to Postsecondary for Students with Mental Health Conditions: A Scoping Review
Authors: Devoe Dan , Lange Thomas , MacPherson Pauline , Traber Dillon , Perry Rosemary , Schraeder Kyleigh , Patten Scott , Arnold Paul , Dimitropoulos Gina 
Published: October 2021

Abstract

Primary Subject area
Mental Health

Background
The transition from high school to postsecondary is a critical milestone for independence and empowerment. This life stage frequently coincides with the emergence of most mental health conditions (MHCs). Without adequate support to assist with the transition to postsecondary education, the mental health of arriving students with existing MHCs is likely to decline or remain unmet. Declining mental health is strongly associated with students withdrawing from both secondary and postsecondary education. However, a scoping review of interventions aiming to support youth with MHCs transition to postsecondary has not been conducted.

Objectives
The objectives of this scoping review were to identify: (1) researched interventions that support youth with MHCs during the transition to postsecondary; (2) best practices used to support this transition; (3) methods of evaluating these interventions and any limitations; and (4) gaps where future research is warranted.

Design/Methods
A database search of MEDLINE, PsycINFO, Embase, SocINDEX, ERIC, CINHAL, and Education Research Complete was undertaken. Two reviewers independently screened studies and extracted the data. Thematic analysis and risk-of-bias assessment were conducted on included studies.

Results
Nine studies were included in this review, describing eight unique interventions (Figure 1). Sixty-two percent of interventions were nonspecific in the MHCs that they were targeting in postsecondary students. These interventions were designed to support students upon arrival to postsecondary. Peer mentorship, student engagement, and interagency collaboration were found to be beneficial approaches to supporting youth transitioning into postsecondary (Table 1). The overall quality and level of evidence in these studies was low. Three knowledge gaps were found: evidence was not generalizable to the diversity of MHCs, intervention studies were mostly cross-sectional in nature and lacked follow-up data, and sustaining intervention funding remained a challenge for postsecondary institutions.

Conclusion
The volume of research identified was limited but indicated overall that offering support during the transition to postsecondary was beneficial for students with MHCs. Further evidence is needed that is generalizable across the mental health spectrum, and that assesses intervention outcomes in relation to intervention costs.
43 The Prevalence of Serious Bacterial Infections in Infants less than 90 Days with and without Features of a Viral Infection: A Retrospective Cohort Study
Authors: Algrigri Osama , Mirza Asma , Rezk Eman , Pernica Jeffrey , Eltorki Mohamed 
Published: October 2021

Abstract

Primary Subject area
Emergency Medicine - Paediatric

Background
Prior studies suggest the prevalence of serious bacterial infections (SBI) (i.e., urinary tract infection [UTI], bacteremia, or meningitis) is lower in infants with a viral infection compared to those with fever without a source (FWS) (2-3% vs. 10-15%).

Objectives
To determine the difference in proportion of SBI in infants with and without clinical features of a viral infection.

Design/Methods
A retrospective cohort study was done on a consecutive sample of infants ≤ 90 days seen at a pediatric ED over a 5-year period ending August 30, 2019. Eligible subjects had rectal temperatures ≥ 38°C, and had ≥ 1 screening test for SBI (urine, blood and/or cerebrospinal fluid cultures). Excluded were infants who received antibiotics in the past 7 days, had congenital anomalies, required intensive care, or were preterm. We defined a clinical viral infection as &gt; 1 clinical features of a respiratory viral infection (new-onset sneezing, cough, rhinorrhea, or shortness of breath). UTI was defined as per American Academy of Pediatrics guidelines.

Results
We screened 7021 charts and 885 (12%) were eligible. Of these, 498 (56%) had a clinical viral infection and 387 (44%) did not. Blood and urine cultures were collected from 860 (97%) infants and 308 (35%) had a lumbar puncture. Overall, 84 (10%) infants had an SBI: 76 (9%) UTI, 6 (0.7%) isolated bacteremia, and 2 (0.2%) meningitis. Among those with clinical viral infection, 23 (5%) had SBI, compared to 61 (16%) without viral infection (risk difference [RD] 11%, 95% CI [7%, 15%]). Both cases of meningitis occurred in infants ≤28 days and without any viral symptoms. A logistic regression was done to ascertain the effects of clinical viral infection, known risk factors for sepsis, age ≤ 28 days, or a temperature ≥ 39°C on the likelihood of SBI. Of the 4 predictors, only clinical viral infection and the presence of known risk factors for sepsis were significantly associated with SBI (odds ratio [OR] 0.3, 95% CI [0.17, 0.48] and 2.5, 95% CI [1.4, 4.5], respectively). Proportions of contaminated blood culture and urine culture were 5% (95% CI [4%, 7%]) and 14% (95% CI [12%, 17%]), respectively.

Conclusion
SBI prevalence in infants without features of a viral infection on assessment is triple that of infants with viral symptoms. Contaminant blood and urine cultures are folds higher than true pathological cultures. Future research is needed to identify infants at low risk of SBI without invasive testing.
55 Evidence behind drug use in vascular anomalies: From infantile hemangioma to rare vascular anomalies … What do we know about what we do with local, systemic, or sclerotherapy treatment?
Authors: Marcoux Simon , Théorêt Yves , Dubois Josée , Essouri Sandrine , Pincicy Alix , Coulombe Jerome , McCuaig Catherine , Powell Julie , Soulez Gilles , Kleiber Niina 
Published: October 2021

Abstract

Primary Subject area
Clinical Pharmacology and Toxicology

Background
The most common vascular anomaly (VA) requiring medical treatment are infantile hemangiomas, but many other vascular anomalies affecting children are treated with local, systemic drugs or sclerosing agents.
Rational drug prescribing implies assessment of whether a drug’s benefits outweigh the risk of adverse effects for treatment of a specific vascular anomaly. This process relies on the quality of the literature on efficacy and safety for drug treatment of vascular anomalies.

Objectives
To evaluate the level of evidence surrounding drug use in vascular anomalies.

Design/Methods
A list of drugs used in vascular anomalies was created with existing guidelines. For each drug, the article displaying the highest level of evidence was determined, using Oxford criteria. Levels of evidence were compared between efficacy and safety data, routes of administration, pharmacological categories, and a subset of specific vascular anomalies. The influence of research quality on study results was explored by comparing the percentage of clinical efficacy between high- and low-quality studies.

Results
We identified 71 different drugs for treating vascular anomalies. The median level of evidence was low, with a predominance of retrospective cohort studies and case reports. The level of evidence was higher for efficacy than safety data and for common diseases like infantile hemangiomas. The level of evidence was lower for systemic vs. local drugs. Clinical efficacy was more frequently reported in low quality studies (retrospective cohort studies and case reports) than in high quality studies (randomized clinical trial and meta-analysis).

Conclusion
Quality of research on drugs used for treating vascular anomalies in infants is poor and challenges rational drug use. Indeed, knowledge of drug treatment in VA relies mainly on research of poor methodological quality. Despite the use of drugs carrying a significant risk of adverse effects, drug safety is also poorly reported. This is alarming because some treatments, like antineoplastic agents and immunosuppressants, display an unsafe adverse effect profile. A publication bias towards positive results probably leads to overestimation of drug efficacy in vascular anomalies. An independent international pharmacovigilance system for drug use in vascular anomalies is proposed to improve efficacy and safety reporting and promote quality drug prescribing.