bluuebunny/crossref_metadata_2025_split huggingface dataset:
1577 Using CTS5 Calculator to Predict The 5-10-Year Risk of Late Distant Recurrence for Women With ER-Positive Breast Cancer Who Are Recurrence-Free 5 Years After Endocrine Therapy and To Reduce the Number of Patients Needing Discussion for The Extended Endocrine Therapy in The Breast MDTs: A Quality Improvement Project
Authors: Ahmed S , Kiruparan P , Debnath D 
Published: October 2021

Abstract

Introduction
The increasing number of patients has created a pressure on the services provided that aim to ensure the maximum level of care, particularly MDT meetings. Using the CTS5 calculator can readily reduce the number of patients needing discussion for EET. This is will prevent delays in decisions made for patients and more importantly, an evidence-based tool will be used for more accurate results.

Method
A retrospective data collection was undertaken from the Breast MDT records, initially dating from January to December 2018. Then when the optional use of CTS5 was established, data were retrieved from August to October 2019. As per guidance for the use of the CTS5 calculator; Women were deemed low risk if their 5–10-year risk is less than 5%, intermediate if between 5–10%, and high risk if their 5–10-year risk is more than 10%. Finally, a prospective data collected from January to March 2020 where an agreement was made for all involved Surgeons to use the CTS5 calculator.

Results
Before Introducing the CTS5 Calculator, in 2018, the number of patients was 1523 from which 66 were for EET 4.3%. When CTS5 Calculator was first introduced, 1st of August - 31st October 2019, the percentage reduced to 4.1% and from January to March 2020, a further reduction 3.9% was noticed.

Conclusions
The CTS5 calculator is an effective evidence-based tool used to predict the risk of 5-10 years recurrence in breast cancer patients. Implementing it will reduce the number of patients needing discussion in Breast MDTs, sparing meetings’ and patients’ time.
1646 Breast Cancer Awareness Among Female Nurses in Pakistan: About Time to Scrub Off Assumptions!
Authors: Farooq R , Ahmad Khan M , Isani Majeed A 
Published: October 2021

Abstract

Aim
The main aim of this research is to assess whether the clinical experience influence the knowledge, attitude and practices of female nursing staff and nursing students regarding breast cancer and to provide a baseline for monitoring trends of breast cancer awareness in them.

Method
A cross-sectional study of 280 female nurses was conducted at a tertiary care hospital in Islamabad, Pakistan. A pre-tested structured questionnaire with additional variables like cultural barriers to seeking medical help was used.1 The scores for outcome variables including knowledge, attitude and practices were pre-defined. Data was analyzed using SPSSv23.

Results
Of the 280 participants, with a p-value of 0.018, nurses aged more than 30 years, faced more practical, financial, emotional, and service barriers as compared to women younger than 30 years of age. By application of Chi-square test, there was a significant correlation between marital status and cultural barriers to seeking medical help, showing that single women (58.7%) shy away from talking about breast cancer considering it a taboo (p-value 0.028) whereas, more married nurses (59.2%) were apprehensive that they might be considered at fault by the society. (p-value 0.038)

Conclusions
Our study recognizes the need for delivering effective information to the female nurses regarding breast cancer in the biggest hospital of the capital city. Educating patients is likely to be effective if the female nurses play their part and have correct attitudes towards breast cancer practices. Therefore, we recommend arrangement of special courses and seminars for all healthcare professionals including the nursing staff.
158 Effect of Preoperative Continuation of Aspirin on Postoperative Bleeding After Off-Pump Coronary Artery Bypass Grafting (OPCABG)
Authors: Al-Manzo M I S , Biswas S , Das Gupta S , Rahman Md.Z , Basak B , Talukder Q I , Chanda P K , Biswas S K , Ahmed F 
Published: October 2021

Abstract

Background
Despite ample evidence of continued preoperative aspirin to improve outcomes in coronary artery bypass surgery, practice for routine continued preoperative aspirin use is still inconsistent due to concern for increased postoperative bleeding. The purpose of this study was to investigate preoperative aspirin use and its effect on postoperative bleeding after off-pump coronary artery bypass grafting (OPCABG).

Method
This cohort study involved patients (n = 74) who underwent OPCABG at a single center between August 2017 to January 2018. After considering the inclusion and exclusion criteria, they were divided into two groups: one (n = 37) received tablet Aspirin 75mg till the day of surgery and for the other group (n = 37) aspirin was stopped 5 days before surgery. Postoperative bleeding was recorded in both groups. After considering preoperative, intraoperative, and postoperative variables statistical analysis was done.

Results
There was no significant difference between the two groups concerning preoperative and peroperative variables. No significant difference was also observed between the two groups in chest tube drainage at 1sthour, 2ndhour, 3rdhour, 24thhour, next 24 hours (at 48th hour), and next 24 hours (at 72nd hour) (p = 0.845, 0.126, 0.568, 0.478, 0.342 and 0.717 respectively). No significant difference was seen in the transfusion requirement of blood and fresh frozen plasma (FFP).

Conclusions
Continuation of preoperative aspirin till the day of surgery is not associated with an increase in chest tube drainage, re-operation for bleeding complications, or transfusion of blood and FFP.
174 Semi-Skeletonized Versus Pedicled Internal Mammary Artery Harvesting: A Systematic Review
Authors: Shafi A M A , Mellor S , Iddawela S , Brown L , Harky A 
Published: October 2021

Abstract

Objectives
To compare semi-skeletonized with pedicled harvesting technique of the internal mammary artery for coronary artery bypass surgery.

Method
A comprehensive literature search was performed on PubMed, Cochrane database, Embase, Google Scholar and Ovid identifying articles that compared semi-skeletonised to pedicled internal mammary artery in the use of coronary artery bypass surgery. Databases were evaluated and assessed from inception to July 2020.

Results
Only five studies fulfilled the criteria for this review. There was no reported incidence of sternal wound infection, myocardial infarction, or mortality. The length of the IMA graft was longer in the semi-skeletonized group compared to the pedicled group, 16.06cm versus 14.63cm respectively (p &lt; 0.001). The intraoperative diastolic flow was significantly greater in the semi-skeletonized grafts than in the pedicled grafts during (p = 0.003) and after (p = 0.005) cardiopulmonary bypass. The incidence of pleural effusion (pedicled, 52.6%; semi-skeletonized, 23.6%; p = 0.002) and atelectasis (pedicled, 42.1%; semi-skeletonized, 20.0%, p = 0.015) were significantly higher in pedicled group. Post-operative chest tube drainage was significantly higher in the pedicled group (608 ± 58 mL compared to 470 ± 48 mL; p = 0.027). Additionally, FEV1 was significantly decreased in the pedicled group 6 days after surgery (pedicled:76.0% ± 1.6%; semi-skeletonized: 83.2% ± 1.6%; p = 0.020).

Conclusions
These results demonstrate that the semi-skeletonized preparation technique is associated with satisfactory outcomes during harvesting the internal mammary artery. Yet, due to limited numbers of studies, there is need for larger comparative studies to assess post-operative outcomes with a longer period of follow up.
415 Clinical outcomes and Patient satisfaction with Bilateral Radial Artery harvest in coronary surgery
Authors: Moawad Nader , Ghaddar Jamal , Nguyen Bao , Marchbank Adrian 
Published: October 2021

Abstract

Aim
Coronary artery bypass graft surgery remains an effective treatment strategy for complex coronary disease.There paucity of data regarding the use of bilateral radial artery conduits with wound, neurological and functional complications following surgical revascularisation.

Method
We reviewed the outcomes with retrospective analysis of prospectively collected clinical data from our database and identified 30 patients who underwent CABG requiring the use of bilateral radial harvest.Patient satisfaction was assessed using a quality of life questionnaire with the descriptors on a Likert Scale.

Results
The mean duration of follow-up was 29.8 ± 8.5 months.The mean age of patients was 69.0 ± 10.8 years.The commonest indications for bilateral radial harvest were existing bilateral varicose veins or previous bilateral vein surgery (combined 74% of cases) precluding venous conduit use. Three out of 24 (12.5%) patients reported arm pain or discomfort ‘rarely’ or ‘sometimes’ whilst all the others (87.5%) were asymptomatic.Three patients (12.5%) reported long term permanent sensory deficit with a further six (25%) patients having some other less significant sensory loss. Significant motor dysfunction was reported in one patient (4.2%) whilst 5 (20.8%) reported milder forms of motor deficit. 95.8% of patients considered the aesthetic outcome of the radial harvest site appearance to be at least acceptable (54.1% rated the appearance as excellent). One patient (4.2%) reported a ‘moderate’ functional change otherwise, the remaining patients reported ‘minimal’(12.5%) or ‘no change’ (83%).

Conclusions
Open bilateral radial artery is acceptable to patients as a conduit choice when alternatives are not favourable for surgical revascularisation.
485 Unexpected Pathological Findings In 189 LVRS Patients: Clinical Relevance
Authors: Ahmadi N , Preston S , Barbar J , Aresu G , Peryt A , Mahadeva R , Coonar A 
Published: October 2021

Abstract

Objectives
LVRS improves survival and quality of life in selected patients with emphysema. In view of the great improvement in the detailed information available from CT, it is important to evaluate the benefit of routine pathological assessment of the resected specimen. We reviewed the histopathological findings in our contemporary LVRS series to determine the rate of pathological findings in addition to emphysema.

Method
Prospectively collected data from a specialised higher volume LVRS centre. The CT and histopathology reports of 189 consecutive LVRS procedures were reviewed. One underwent thoracotomy, 188 were by VATS, of which one was converted to thoracotomy and of which 22 were by a subxiphoid approach. The target reduction volume was 30-50% of the lung.

Results
All patients were reported to have emphysematous changes in both CT and histology. Ten patients, all with radiographic evidence of a lesion preoperatively, had squamous carcinoma (x2), adenocarcinoma, atypical adenomatous hyperplasia (AAH) (x2), squamous metaplasia (x2), carcinoid tumourlet, chondroid hamartoma, and DIPNECH. There were 39 neoplastic histological findings which were not radiologically reported; these were adenocarcinoma (1), AAH (10), squamous metaplasia (7), carcinoid tumourlet (5), squamous dysplasia (3), neuroendocrine hyperplasia (2), and chemodectoma. In addition, 21 inflammatory/infective cases were also reported.

Conclusions
Our systemic retrospective CT and histopathology review of LVRS operations shows that the rate of additional findings is 32%. Of these 83% were not reported on the pre-operative review of the CT. This supports the value of systematic pathological assessment of resected samples.
570 Solitary Fibrous Tumours of the Pleura: Case Series
Authors: Ishak L , Kostoulas N 
Published: October 2021

Abstract

Introduction
Solitary fibrous tumours of the pleura (SFTP) are rare tumours with poorly recognised presentations and aetiology.

Aim
to evaluate the presentations, risk factors, investigations, management and follow up for 4 cases of SFTP

Method
retrospective review of medical records of 4 patients diagnosed with SFTP at the Golden Jubilee National Hospital between January-October 2020. Data was collated on presenting signs and symptoms, co-morbidities, risk factors, investigations, management and follow. A literature review was conducted, and findings discussed.

Results
All cases were males aged 62-85. All were referred from the same geographical area. Pre-disposing risk factors included exposure to cold-dust (1), asbestos (1) and smoking (1). Presenting symptoms were cough (3), shortness of breath (1), weight loss and fatigue (1). Associated co-morbidities were coagulopathy(2) and hyperglycaemia (1). Patients were investigated pre-operatively with chest x-ray (4), pulmonary function tests (4), PET-CT scan (4) and CT biopsy (3). One patient had genetic studies for chromosome 18 translocation. Three out of 4 patients were managed surgically with wedge resection (3) via video-assisted thoracoscopic surgery (2) or open thoracotomy(1), followed by excision biopsy studies (3). Tumours originated from the visceral (1), mediastinal (1) and parietal (1) pleura. Recurrence risk for all patients was deemed to be 20%. Follow up was with 6 monthly CT scans for 5 years (1).

Conclusions
SFTP is a rare tumour which presents with non-specific symptoms. Better understanding of the aetiology, presentation and investigations is needed to aid definitive diagnosis and tailored management
747 A Case Report: Spontaneous Recovery of Type B Aortic Dissection
Authors: Sherif M , Witharana P 
Published: October 2021

Abstract

Introduction
An aortic dissection occurs when there is a tear in the intimal and medial layer of the aorta, leading to a false lumen within the media. Type B aortic dissections (TBAD), according to the Stanford Classification are where the entry tear is located distally from the left subclavian artery. Resolution of a Type B aortic dissection (TBAD) by medical therapy is a very rare event.

Case Presentation
58-year-old gentleman presented with sudden onset central chest pain. A CTPA was organised following a high d-dimer. This showed a TBAD extending from the origin of the left subclavian artery to the level of the diaphragm. His blood pressure was aggressively controlled with IV labetalol and IV isosorbide dinitrate and was monitored for 2 weeks. He was then discharged home on oral antihypertensive medication. A follow up CT aortogram was done 7 months later which showed that the false lumen of the TBAD has improved from 18mm to 2 mm.

Discussion
The anti-inotropic effect of beta blockers reduces the stress on the aortic wall and therefore prevents further dilatation. Aggressive control of blood pressure and heart rate comes with its own disadvantages. It had been shown, patients managed conservatively were more likely to develop renal failure (43%) compared to those having endovascular repair. About half of those patients required surgical treatment. There are not many cases in literature where a TBAD had resolved with medication.

Conclusions
As evident from this case, rigorous management of blood pressure may help with cases of Type B Dissection.
753 Should Mini-Sternotomy Be Favoured Over Conventional Full-Sternotomy Approach in Aortic Valve Replacement
Authors: Aljanadi F , Moawad N , Beattie G , Nzewi O , Jones M , Ahmed A 
Published: October 2021

Abstract

Aim
In view of the increasing interest in Upper mini-sternotomy (UMS) as an alternative approach for conventional full sternotomy AVR (FS), we aimed to compare early and mid-term results between UMS and Full-sternotomy AVR.

Method
This is a retrospective study of 231 patients who had aortic valve replacement via upper mini sternotomy (UMS) compared with 231 patients had their AVR via full sternotomy (FS). Baseline characteristics, operative and postoperative outcomes were compared. Patients’ data are presented as median (interquartile range) or as percentages.

Results
The two groups were almost comparable in terms of preoperative characteristics. Though patients with age &gt;80 were more in UMS AVR group (11.25% vs 8.6%), this was statistically insignificant (p &gt; 0.05). Females were significantly more in UMS AVR group (104 vs 66, p &lt; 0.05), as well as in high BMI patients (120 vs 89, p &lt; 0.05). There was no significant difference in 30-day mortality( 0.43%vs 2.2%, P &gt; 0.05) between the two groups, as well as in cardiopulmonary bypass time (109 vs 103 min, p &gt; 0.05), aortic cross-clamping time (82 vs 83 min, p &gt; 0.05) and the duration of operation(218 vs 213, p &gt; 0.05).Results showed no significant difference in the incidence of major and minor postoperative complications apart from FS AVR patients had a higher incidence of postoperative pneumonia ( 2.1% vs 10.4 %, p &lt; 0.05).

Conclusions
UMS AVR are more commonly used in females and high BMI patients. Our results show that UMS AVR is a safe alternative approach for aortic valve surgery revealing comparable early and midterm results to conventional FS AVR.
780 Rapid Deployment or Sutureless Valves as An Alternative to Conventional Bioprosthetic Aortic Valve Replacement
Authors: Aljanadi F , Moawad N , Jones M 
Published: October 2021

Abstract

Aim
Rapid deployment valves are being used widely. We wanted to compare outcomes for rapid-deployment valves and conventional bioprosthetic aortic valve replacements in order to assess if their use is justifiable.

Method
Outcomes of the last 120 patients who received a rapid-deployment AVR (RDAVR) between Sept 2014-Sept 2019 were compared to the last 120 patients who had conventional bioprosthetic aortic valve replacement (Conv AVR).

Results
Age of RDAVR 77.5±4.93 was compared to Conv AVR 67.9±11.9 years (p &gt; 0.05). Other baseline characteristics were similar. RDAVR group included more elderly (&gt;80 years; 40 vs 11, p &lt; 0.05) and females (83 vs 36, p &lt; 0.05). RDAVR group had shorter cross clamp time (68 vs 89 min, p &lt; 0.05) and cardiopulmonary bypass time (97 vs 110 min, p &lt; 0.05) for isolated AVR. Mortality was equal in both groups (1.7%). Post-operative pressure gradients were similar (mean gradient 10.4±4.44 vs 11±5.31 mmHg and peak gradient 20.32±8.64 vs 22.95±9.72 mmHg). Additionally, patients were divided into size matched subgroups and post-operative pressure gradients were comparable. Hospital length of stay and early post-operative results were similar between the two groups. Early permanent pacemaker rate was similar in both groups (9 vs 5, p &gt; 0.05). Survival rates in group 1 and 2 were 97.5% vs 99.2% at 1 year, 95.8% vs 96.7% at 2 years. and 95% vs 96.7% at 3 years, respectively.

Conclusions
RDAVR had similar haemodynamic outcomes and survival. Where shorter cross clamp and pump times may be desirable RDAVR may be preferred in older high-risk patients.
838 Pulmonary Embolectomy: Techniques and Outcomes from The Literature
Authors: Kwan L Y A , Lee J , Cheung A , Chan J 
Published: October 2021

Abstract

Aim
Pulmonary embolectomy involves the surgical removal of a thrombus from the pulmonary tree, with the most popular approaches being surgical embolectomy (SE), percutaneous pulmonary embolectomy (PPE) and minimally invasive thoracotomy (MIT). The latter two new techniques are gradually increasing in popularity in the treatment of acute pulmonary embolism (PE) due to reduced recovery times. This study aims to evaluate and compare the clinical outcomes of the three aforementioned techniques in the treatment of acute PE.

Method
A literature review was performed with PUBMED to identify studies reporting these interventions. 79 papers were included, involving a total of 2445 patients. Patients’ baseline characteristics and perioperative status, inpatient mortality rates and complication rates of each intervention group were individually assessed and compared.

Results
Among all three interventions, SE studies demonstrated the highest in-patient mortality rate (20.8%). Patients receiving SE are also more likely to have pulmonary (2.8%) and other postoperative bleeding (7.4%). PPE patients are more likely to develop gastrointestinal bleeding and surgical site complications (4%). Scatter graph of the SE studies showed a declining trend of mortality rate over time (R²=0.50).

Conclusions
All three methods are effective in treating acute PE, while SE showed a trend of decreasing mortality over time. Further research on PPE and MIT is needed to define its place in the treatment of acute PE.
1011 The Implications of The Use of Left Ventricular Assist Devices (Lvads) Or Extra-Corporeal Membrane Oxygenation (ECMO) In Patients with Severe Heart Failure
Authors: Kumar A 
Published: October 2021

Abstract

Introduction
Heart failure (HF) is a chronic, debilitating and progressive disease(1). Consequently, guidelines recommend heart transplants for patients suffering from end-stage HF, termed destination therapy(2). However, with increasing disparity between the number of donor hearts available and people on the waiting list, identifying the most suitable interim intervention (bridge-to-transplant) therapy is paramount(3,4).

Method
A scoping search identified controversy surrounding LVAD versus ECMO in end-stage HF. Discussions with an expert in the field at a tertiary centre in the UK (Queen Elizabeth Hospital Birmingham) enabled refinement of the topic. A literature review was conducted, followed by a title and abstract screen. Subsequently, remaining literature was critically appraised.

Results
First generation LVADs may decrease mortality by 48% in comparison to optimal medical management, although have been associated with disabling stroke. Second and third generation LVADs demonstrate impressive survival at 30 days (&gt;95%), a strong favourable long-term prognostic indicator. Additionally, improvement in HF severity and QoL have been demonstrated. Unlike ECMO, LVAD appears to be feasible as a DT, lasting as long as 8 years. However, the cost of LVADs may be prohibitive, higher than transplantation2. However, ECMO may facilitate multi-organ and right ventricular recovery, enabling transplantation to occur with increased stability. Neither option has conclusive evidence for cost-effectiveness.

Conclusions
Both LVADs and ECMO can be considered as effective BTT options, suitable in different clinical scenarios. The decision for BTT intervention should be undertaken on a case-by-case basis, in accordance with NICE guidelines, aiming for optimal outcomes in terms of survival, functionality and QoL.
1269 Five Year Propensity Matched Outcomes of Minimally Invasive vs Conventional Isolated Aortic Valve Surgery
Authors: Oo S , Khan A , Chan J , Vohra H 
Published: October 2021

Abstract

Aim
To analyse the early and mid-term outcomes of the patients undergoing conventional isolated aortic valve replacement (CAVR) versus minimally invasive isolated aortic valve replacement (MIAVR).

Method
This is a single centre retrospective study involving 653 patients who underwent isolated aortic valve replacement either via CAVR (n = 516) or MIAVR (n = 137) between August 2015 and March 2020. Using pre-operative characteristics, patients were propensity matched (PM) to produce 114 matched pairs. Assessment of peri-operative outcomes, early and mid-term survival and echocardiographic parameters was performed.

Results
PM analysis showed the larger sized aortic valve prosthesis were inserted in the MIAVR group (22.8±2.5mm) compared to CAVR group (22.0±2.2mm)(p = 0.010). CPB time was longer with MIAVR (94.4±19.5mins) compared to CAVR (83.1 + 33.3; p = 0.003). There were no differences in the early post-operative complications and mortality between the two groups. Follow-up echocardiographic data showed significant difference in mean aortic valve gradients between CAVR and MIAVR groups (17.3±8.2mmHg and13.0±5.1mmHg, respectively; p = 0.001). There was no significant difference between CAVR and MIAVR in the mid-term survival at 3 years. (log-rank test p = 0.314).

Conclusions
This study found that larger aortic valve sizes with lower mean gradients are being implanted in the MIAVR group. Despite the longer CPB time in the MIAVR group, there was no significant difference in the early complications, mortality, and mid-term survival between MIAVR and CAVR. Further studies will be required to analyse the long-term survival.