bluuebunny/crossref_metadata_2025_split huggingface dataset:
757 Does Increased Sampling of Cerebrospinal Fluid from External Ventricular Drains Lead to Increased Rates of Infection?
Authors: Edwards B , Zolnourian A , Bulters D 
Published: May 2021

Abstract

Introduction
External ventricular drains (EVDs) are commonly used in the management of acute hydrocephalus after subarachnoid haemorrhage (SAH). Infection is the most common complication. There remains controversy over whether frequent sampling is associated with increased risk of infection.

Method
Two cohorts of patients requiring EVD after SAH were retrospectively analysed for suspected and proven CSF infection. The first clinical cohort was of 50 consecutive patients with twice weekly sampling. The second group had alternate daily sampling as part of a prospective research study.

Results
Female to male ratio were (32:18) and (29:15) in clinical vs research group respectively. Average age of both groups was 59. Average length of treatment with EVD in both groups was 10 days. 16/50 (32%) patients had a suspected infection vs 13/44 (30%) and 8/50 (16%) had a proven infection compared to 6/44 (14%) in clinical and research groups, respectively. There was no statistically significant difference between the two groups (suspected infections p = 0.7 and proven infections p = 0.7)

Conclusions
Increased rates in CSF sampling in the research cohort did not result in higher rates of CSF infection. This suggests that rate of sampling, if done following a strict protocol, is not associated with increased risk of infection.
809 Evaluation of the Two Week Wait Colorectal Cancer Pathway in a District General Hospital
Authors: Karadakhy O , Poynton-Smith E , Le G , Mohamed E , Singh R G , Miles-Marsh R , Kulkarni N 
Published: May 2021

Abstract

Introduction
Updated guidelines published by the National Institute for Health and Care Excellence in 2015 widened the referral criteria for the two week wait (2WW) pathway for suspected lower gastrointestinal cancer, in an attempt to increase early diagnosis. The aim of this study was to evaluate the compliance of referrals received via the (2WW) pathway for suspected lower gastrointestinal cancer.

Method
We conducted a retrospective study which utilised a local cancer registry to identify all patients who had been referred to United Lincolnshire Hospitals Trust over a two-month period. Electronic patient records were checked to establish whether patients fulfilled the 2015 referral criteria.

Results
Out of 615 patients referred, 51 (8%) had colorectal cancer. 92 (15%) referrals did not meet the criteria for the 2WW pathway. Whether or not the referral was ‘appropriate’ had no significant effect on the diagnoses of bowel cancer (X2 = .003, p&gt;.05).

Conclusions
16% of all referrals did not meet criteria. This may appear as an inefficient use of resources, however there was no difference in rates of cancer between appropriate and inappropriate referrals. The referral criteria are likely to evolve over the course of time, and perhaps clinicians’ judgement should be taken into account.
932 A Systematic Review and Meta-Analysis of Subxiphoid Versus Unilateral Intercostal Video-Assisted Thoracoscopic Surgery
Authors: Patel D , Almukhtar A , Caruana E 
Published: May 2021

Abstract

Introduction
Subxiphoid approach is emerging as an alternative to intercostal video-assisted thoracoscopic surgery (VATS). We sought to compare the clinical efficacy of both approaches.

Method
A protocol was registered at PROSPERO [CRD42020155686]. Studies were retrieved from literature in July 2020.
The Main outcomes were operative duration, intraoperative complications and postoperative length of hospital stay (LoS). Subgroup analysis was performed by procedure type.

Results
1469 patients (51% male) were included from 12 observational studies, with 620 (42%) having undergone sVATS. There was a high-moderate risk of bias across included papers.
There was no difference in operative duration (MD 13.1 minutes, 95% CI -11.3 to + 37.6; p = 0.29), intraoperative complications (OR 0.17, 95% CI -0.28 to + 0.61; p = 0.47), or LoS (MD -0.8 days, 95% CI -1.8 to + 0.2; p = 0.08). LoS was lower for sVATS thymectomy (MD -1.7 days, 95% CI -2.9 to -0.3; p = 0.01).
Acute pain (10-point numerical rating scale) was lower for sVATS (MD -2.2, 95% CI -3.2 to -1.2; p &lt; 0.001). There was insufficient data to report on chronic pain, quality of life, or surgeon workload.

Conclusions
There is a potential benefit for sVATS in selected procedures. Well-designed randomised trials with consistent outcome reporting are required.
950 Experience of Inguinal Mesh Hernioplasty Under Local Anaesthesia: A 3-Year Experience in A Teaching Hospital
Authors: Hashmi Z , Ahmed R , Zafar T , Ahmed M , Yousaf N , Chaudhary K , Islam R , Aljarad F , Madanur M 
Published: May 2021

Abstract

Objective
To prove Inguinal mesh hernioplasty under L/A is safe and acceptable. Helps with post-operative pain and enables rapid recovery as a day case.

Method
All patients who underwent inguinal hernia repair under local anaesthesia were retrospectively analysed in our hospital between July 2014- July 2017. Clinical judgement was used for inclusion and exclusion parameters.

Results
From July 2014- July 2017, 260 patients were included in study who underwent Inguinal mesh hernioplasty under L/A. ASA grade for all patients ranged between I-III. The mean age was 37 (20-65). Intraoperatively (9.1) 3.5% patients had problems such as pain, hypotension or sweating. About (86.3%) 224 patients were discharged home the same day and remaining stayed overnight for less than 24 hours. Hematoma was seen in 5 (1.92%) patients, Urinary retention in 2 (0.7%) patients, Wound infection seen in 24(9.2%) patients, Readmission in 10 (3.8%) patients. Chronic groin pain was seen in 10 (3.9%) patients and no recurrence on 6 months follow up.

Conclusions
Our results showed that this procedure is feasible under L/A and can be performed safely. It showed satisfactory acceptance by the operating surgeon and patient, without significant perioperative issues. It is reliable and showed shorter hospital stay.
994 The Cost of Testicular Torsion Care in Ireland 2009-2018: A Novel Cost Estimation Model Using a National Database
Authors: Sugrue D , Driessen A 
Published: May 2021

Abstract

Introduction
Activity-Based Funding (ABF) is a new reimbursement model for public hospitals in Ireland. Little data exists regarding cost estimates for acute surgical admissions in Ireland. This study presents a novel method of direct-cost estimation for Testicular Torsion (TT) care in Ireland.

Method
Hospital In-Patient Enquiry (HIPE) data, covering all public hospital admissions in Ireland, were analysed to derive annual incidence rates for TT between 2009-2018. The monetary cost of each case was calculated by cross-referencing the Diagnosis-Related Group (DRG) with reference prices for inpatients and day-cases in public hospitals in 2019. Annual cost was adjusted using the Consumer Price Index for Health (Ireland)

Results
N = 1,746 patients under 25 years underwent orchidectomy or orchidopexy for TT between 2009 and 2018. The direct cost of TT care in public hospitals between 2009 and 2018 was €6,331,402. Costs increased 54% over 10 years, from €513,232 in 2009 to €788,700 in 2018 (2019 Euros). Just over two-thirds of cases (70%, n = 1,230) were reimbursed with public funding

Conclusions
This novel cost-estimation model may serve as a template for future direct-cost estimates for surgical interventions in Ireland. This will improve the accuracy of future economic evaluation for healthcare interventions in Ireland.
851 SMILE: Sustaining Medical Education in A Lockdown Environment. Student Perceptions of a Free Online Access Medical Education Platform as An Adjunct to The Traditional Undergraduate Curriculum During Lockdown
Authors: Pascoe J , Foster P , Quddus M , Kosti A , Guest F , Stevens S , Bamford R , Coulston J 
Published: May 2021

Abstract

Introduction
The coronavirus outbreak has had significant impact on medical students worldwide. SMILE is a free online access medical education (FOAMEd) platform. SMILE delivered 200 lectures during lockdown with up to 1400 students per session from UK medical schools and 33 abroad. Here we discuss student perceptions to SMILE during lockdown

Method
A survey was used to collect information from students who had utilised the platform during lockdown. This examined access to learning, impact on mental health during lockdown and the differences between FOAMed and more traditional based campus lecture-based learning.

Results
1306 students responded to the survey. The majority of students were concerned regarding their training during lockdown, with 71% reporting an impact on their stress levels and 44% reporting a negative impact on mental health.
On average students attended 4.3hours of teaching put on by their university per week, vs 7.9hours by SMILE.
Positives included anonymity, making 80% more likely to both ask and answer questions, the informal approach, ease of access and enthusiastic teachers. Negatives included time differences and technical issues.

Conclusions
Lockdown provided challenges in medical education, which platforms like SMILE addressed. Our experiences highlighted many positive outcomes of online medical education that may be applicable to other educators.
135 Direct and Combined Revascularization Versus Indirect Revascularization in the Treatment of Moyamoya Disease: A Systematic Review and Meta-Analysis
Authors: Lee K S , Teo M , Zhang Zhang J J Y , Steinberg G K 
Published: May 2021

Abstract

Introduction
The goal of surgical revascularization of moyamoya disease (MMD) is to augment cerebral blood flow and prevent intracranial haemorrhage. This study aimed to compare direct and combined versus indirect bypasses with regard to perioperative complications in paediatric and adult patients with MMD, using a systematic review and meta-analysis of published observational studies.

Method
Primary outcome measures analysed included perioperative (30 days) complications.

Results
20 studies reporting 2982 patients were eventually included. Pooled mean age was 37.5 years (95%CI: 33.5–41.5) and 7.4 years (95%CI: 4.1–10.7) in adult and paediatric patients, respectively. For adult patients, perioperative stroke rate was comparable between direct/combined and indirect bypass (OR = 1.26 [95%CI: 0.81–1.96], p = 0.300 for indirect). For paediatric patients, perioperative stroke rate was comparable between direct/combined and indirect bypass (OR = 2.43 [95%CI:0.74–7.94], p = 0.143 for indirect). No difference found in perioperative mortality between direct/combined and indirect bypass for adult patients (OR = 1.16 [95%CI:0.07–19.00], p = 0.915 for indirect). There was no difference in perioperative mortality between direct/combined and indirect bypass (OR = 1.39 [95%CI:0–Inf], p = 1.00 for indirect) in paediatric patients.

Conclusions
Both direct and indirect bypasses can be equally effective in preventing stroke, with similar rates of perioperative complications in paediatric and adult MMD patients.
166 Dual Mobility for Total Hip Arthroplasty Revision Surgery: A Systematic Review and Metanalysis
Authors: Antinolfi P , Pace V , Placella G , Bettinelli G , Salini V 
Published: May 2021

Abstract
Dual Mobility (DM) implants provide greater stability especially in Revision Total Hip Arthroplasty (R-THA) when compared to primary THA. Aim: to identify the current evidence regarding outcomes of DM in R-THA when compared to fixed-bearing (FB) implants.
Review in accordance with PRISMA guidelines. Structured electronic searches. Primary outcome measure: dislocation rate following R-THA. Secondary outcome measures: implant survival, aseptic loosening, infection rate. Studies' methodology quality assessed using MINORS criteria.
All articles published from 2016 to December 2019 included. 1777 R-THAs were reported (49.9% with DM acetabular component, 50.1% with FB component). Sample size: 67-426 patients. Mean age: 57-73. Mean follow-up period: 12-60 months. Significant risk ratio of 1.08 [1.05, 1.12] (95% CI, I2 = 37%, P &lt; 0.00001) with statistically significant difference between the two groups in favour of DM implant. Statistically significant difference in favour of DM group with respect to dislocation rate (risk ratio 0.22, 95% CI; P &lt; 0.00001) and aseptic loosening (risk ratio 0.51, 95% CI; P &lt; 0.05). No statistical difference between the groups on risk ratio for infection 0.94 (95% CI; P = 0.85).
DM implants are beneficial in R-THA when compared to FB implants. However, one needs to balance the benefits of using DM implant considering the patient’s clinical conditions and the costs involved.
794 A Systematic Review Measuring and Reporting the Surgical Learning Curve in Early Phase Studies of Surgical Innovation
Authors: Alford N , Shah M , Hudson E , Mutanga I , Macefield R 
Published: May 2021

Abstract

Introduction
Community learning is a key component for the progression of surgical innovation, which is itself crucial to advancing surgical practice. Assessment of learning curve’s (LCs) allow rigorous evaluation of new surgical procedures/devices and their introduction into clinical practice. The Idea–Development–Exploration–Assessment–Long-term (IDEAL) framework provides recommendations for the evaluation of new surgical procedures and devices throughout the stages of innovation. This study aimed to identify the current reporting practice of LCs in IDEAL studies.

Method
A systematic review was conducted to identify author-reported IDEAL/IDEAL-D studies of any IDEAL stage and surgical specialty. LC outcomes were extracted including information relating to surgeons’ experience and training, and methods for measuring and assessing the LC.

Results
Searches yielded 1411 publications, of which 59 studies met the eligibility criteria. Of these, 31 (53%) reported information on the LC, with only 3 (5%) studies measuring or reporting on LC in detail. 21 (36%) studies reported training for surgeons and 16 (27%) reported support or performance monitoring.

Conclusions
Despite IDEAL recommendations, reporting the LC was found to be rare in the included studies. Reporting of the LC in future studies is recommended to facilitate robust evaluation of new surgical procedures and devices.
475 Acute Type A Aortic Dissection In-Hours Vs Out-Of-Hours: A Systematic Review and Meta-Analysis
Authors: Toh S , Yew D C M , Choong J J , Chong T L , Harky A 
Published: May 2021

Abstract

Introduction
Acute type A aortic dissection (ATAAD) is a life-threatening medical emergency requiring immediate surgical intervention. We sought to compare clinical outcomes in patients with ATAAD that undergone surgical repair during in-hours (IH) versus out-of-hours (OOH).

Method
Electronic database search at PubMed, Ovid, Scopus, Cochrane and Embase was performed from inception till March 2020. Primary outcomes were 30-day mortality, stroke, and re-operation for bleeding; secondary outcomes were previous cardiac surgery and total arch replacement.

Results
Six articles with a total of 3,744 patients met the inclusion criteria. Re-operation for bleeding and stroke rate were similar, with 18% in IH vs 23% in OOH (RR 0.89, 95% CI [0.73, 1.08], p = 0.24), and 12% in IH vs 13% in OOH (RR 0.83, 95% CI [0.66, 1.03], p = 0.09) respectively. 30-day mortality was significantly lower in IH (26%) vs 24% in OOH (RR 0.81, 95% CI [0.72, 0.90], p = 0.0001). Previous cardiac surgery was higher in IH (5%) vs 4% in OOH patients (p = 0.005). Total arch replacement were similar in both cohorts, 29% in IH vs 32% in OOH (RR 0.96, 95% CI [0.89, 1.04], p = 0.37).

Conclusions
ATAAD operation during IH and OOH have comparable clinical outcomes. Therefore, operating on such cases should be decided on clinical priority without delay.
688 Rapid Implementation of Virtual Fracture Clinic During COVID 19 Reduces Both Face-To-Face Appointments and Facilitates Rapid Feedback and Education to Be Delivered to The Emergency Department
Authors: Havenhand T , Hoggett L , Bhutta A 
Published: May 2021

Abstract

Introduction
COVID-19 has dictated a shift towards virtual clinics. Pennine Acute Hospitals NHS Trust serves over a million patients with a significant number of face-to-face fracture clinics. Introduction of a Virtual Fracture Clinic (VFC) reduces hospital return rates and improves patient experience. The referral data can be used to give immediate monthly feedback to the referring department to further improving patient flow.

Method
Prospective data was collected for all referrals to VFC during March 2020. Data included referral diagnosis, actual diagnosis, referrers grade, and final outcome.

Results
630 referrals were made to VFC. 347 (55%) of those referrals were directly discharged without the need for physical consultation. Of these 114 (32%) were injuries which can be discharged by the Emergency Department with an advice leaflet using existing pathways. Of the remaining discharges 102 (29%) were query fractures or sprains; and 135 (39%) were minor fractures; which needed only advice via a letter and no face to face follow up.

Conclusions
Implementation of VFC leads to a decrease in physical appointments by 55% saving 347 face to face appointments. The new system has also facilitated effective audit of referrals in order to further improve patient flow from the Emergency Department via feedback mechanisms and education.
719 The Routine Use of Opioid Medication for Post-Operative Pain Relief Can Risk Long Term Dependence, In Patients Previously Opiate Naive
Authors: McGurk S , Majeed T , Magee C 
Published: May 2021

Abstract

Introduction
Post-operative pain relief commonly involves opiates. Rising concerns about misuse has increased scrutiny of prescribing practices. In the UK, 12.5% of prescriptions are for opiates. In the US, the Department of Health and Human Services has declared an epidemic of opiate misuse. We aimed to evaluate opiate prescribing practices post-operatively, within a UK teaching hospital, and establish the risk of prolonged opiate use.

Method
A pan-speciality retrospective observational cohort study was performed. Patients who underwent surgery in the year 2018 were included. Patients were opiate naïve if their admission Medicine reconciliation and GP record described no opiates for the previous year. Endpoints: the proportion of patients discharged with opiates and the proportion of patients remaining on opiates at 1- and 2-years post admission.

Results
20526 operations were performed on 17524 patients, across pan-specialities. 8772 patients were discharged on opiates. 673 required further opiates from their GP after discharge, of which 331 were previously opiate naive. At 1 year post op, 180 previously naive patients remained on opiates.

Conclusions
Attention needs to be given to the risk of developing opiate dependence post-operatively. An evidence-based approach should support clinicians in preventing an opiate crisis in the UK.
458 Patient Willingness to Undergo Elective Orthopaedic Surgery in Relation to the COVID-19 Outbreak
Authors: Erotocritou M , Prasad A , Burns S , Haddo O , Bartlett W , Mavroveli S , Hanna S , Berber O 
Published: May 2021

Abstract

Objective
To determine patients’ willingness to undergo elective orthopaedic surgery during the COVID-19 pandemic.

Method
4 groups of patients were chosen based on type of surgery. A telephone survey was conducted, including questions on diagnosis, symptom duration, pain severity, co-morbidities, anxiety levels for COVID-19 and surgery. Patients were given the conditions for surgery and asked whether they would undergo surgery, have the operation carried out by another consultant and any factors that would increase their confidence.

Results
Of 200 patients, 156 participated (78%). 78.2% were willing to undergo surgery. There was a statistically significant difference in willingness between age groups 40-49 (100%) and 80 + (58.3%). Differences in willingness between surgery types, BOA risk class, sex, symptom duration and pain scores, were not statistically significant.
Patients unwilling to undergo surgery reported statistically higher anxiety scores for health (4.39) and surgery (4.62) compared to the willing group (2.89 and 2.71 respectively). Patients’ main concern was contracting COVID (35.2%).

Conclusions
Our study demonstrated that the majority of patients were willing to undergo surgery. This can be used to inform strategies for resuming elective surgeries. It has also highlighted several areas in patient perception that warrant further investigation and the importance of enhanced consent on the specific risks.
209 Breast Lymphoma Treatment Outcomes in a Pakistani Population: 20 Years of Experience at a Single Centre
Authors: Abid M , Bano R , Khan A I , Fiaz S A , Chaudry M Z , Khan H M 
Published: May 2021

Abstract

Background
Breast lymphomas constitute a rare disease entity. To date, limited relevant data have been reported. We therefore here present a review of breast lymphoma patients treated at a single centre over 20-year period, focusing on histological types, treatment modalities and outcomes.

Method
We identified patients who were diagnosed and treated for breast lymphoma at a single centre from January 1995 to January 2014 and extracted data regarding patient demographics and clinical data.

Results
Twenty-seven patients with breast lymphoma were identified, of which 3 were males. Median age at diagnosis was 37 years (range:22-76 years). Chemotherapy was main stay of treatment and 55.6% patients also received radiation to affected breast. At our institute, only 3 patients, all with progressive disease, had surgery performed to achieve local palliation. Complete response after chemotherapy was seen in 63% patients and partial response in 7.4%, while 26% patients demonstrated disease progression. The mean follow up was 46.8 months. Seven patients (33.3%) who were alive at last follow up, as well as 1 patient who died, survived more than 5 years after diagnosis.

Conclusions
Patients with breast lymphoma should receive aggressive treatment, with combination of chemotherapy and radiation therapy. Surgery should be limited for diagnosis and palliation of local symptoms in cases of progressive disease.
479 Climate Change and Environmental Sustainability: A Survey of The Behaviours, Attitudes and Current Practice of Surgeons in The UK And Ireland
Authors: Harris H , Rizan C , Bhutta M 
Published: May 2021

Abstract

Background
The operating theatre is resource intensive and surgery is a major contributor to the environmental impact of healthcare. Our survey aims to explore the behaviours and attitudes of surgeons towards climate change and understand the barriers towards sustainable practice.

Method
We invited surgeons and surgical trainees to take part in a voluntary online survey between June- October 2020 and disseminated this via the Royal College of Surgeons of England, Edinburgh, and Ireland, ASIT, and to surgeons locally.

Results
We received 116 responses from 14 different surgical specialties, across all grades. The majority (107/116 respondees) said that they were concerned about climate change. This concern had led to change in surgeons’ personal lives (98/116) and professional lives (63/116). Most respondees agreed that surgeons have a responsibility to be aware of the environmental impact of surgical services (101/116). Surgeons were generally not aware of any environmental training or education in the workplace and felt efforts towards improving surgical sustainability in their workplace were minimal. Surgeons would welcome more national guidance (103/116) and would welcome more regulation and monitoring (93/116).

Conclusions
Our results indicate that surgeons are concerned about climate change and they are willing to engage in efforts to transition to more sustainable practice.