bluuebunny/crossref_metadata_2025_split huggingface dataset:
725 Experience of Implementing Diversity Teaching into University of Oxford
Authors: Ali S , Nanda A , Turner M , Swales C 
Published: October 2021

Abstract

Background
Medical education should equip students with the necessary skills to support the diverse population they treat and work with and be confident to act as an ally for patients and colleagues. We found there to be a gap for a diversity module in the curriculum at Oxford University.

Method
We created a diversity training session for over 300 medical students aiming to;
The course consisted of a series of talks conducted by a senior lecturer on diversity, doctors, patients, and students, followed by small-group case-based teaching facilitated by a final-year medical student and a junior doctor. All facilitators underwent training by a senior lecturer on diversity. The cases encouraged students to reflect on their own personal biases and enact how they would confront discrimination on the wards. Students completed a survey before and after the session, rating self-confidence on six key learning points.

Results
91.4% students agreed the session was useful to their medical training. There was a significant increase in students who felt confident implementing all learning points: defining key terms (post-session: 95.4%, pre-session: 82.3%); understanding health inequalities (post-session: 93%, pre-session: 54.6%); awareness of personal bias (post-session: 87.9%, pre-session: 70%); partaking in allyship (post-session: 95%, pre-session: 89.5%); and being an active bystander (post-session: 91.4%, pre-session: 45.9%). 79.3% felt confident to challenge acts of discrimination (33.6% pre-session).

Conclusions
This session educates and empowers students to challenge acts of discrimination. We recommend the implementation of similar sessions at all medical schools.
692 A Machine Learning Approach to Predict the Postoperative Length of Stay After Coronary Artery Bypass Grafting Using Preoperative Characteristics
Authors: Bruno V D , Guida G , Jones C , Bates M , Di Tommaso E , Rajakaruna C 
Published: October 2021

Abstract

Aim
Lengthy hospital length of stay (LOS) has a direct impact on healthcare costs. We aimed to design predictive models of prolonged LOS after coronary artery bypass grafting (CABG) with only preoperative characteristics and machine learning (ML) strategies.

Method
In a single centre retrospective analysis, 2,082 consecutive patients underwent first-time elective/urgent CABG: 1,262 has a short postoperative LOS (≤ 6 days) while the remaining 820 had a long LOS (&gt; 6 days). 70/30 training/testing ratio and resampling methods were used, and cross-validation was conducted.

Results
The two groups differ significantly in terms of pre-operative variables: short LOS patients were younger (p &lt; 0.01), more frequently male (p &lt; 0.01) with lower BMI (p &lt; 0.01) and better angina class (p &lt; 0.01) and NYHA class (p &lt; 0.01). Moreover, they had lower incidence of hypertension (p = 0.04), COPD (p &lt; 0.01) and PVD (p &lt; 0.01). The Logistic Euroscore was also better in this group (median 0.02 vs 0.03, p &lt; 0.01). The predictive abilities of the ML models were as follows: logistic regression: Area under the Curve (AUC) = 0.71, accuracy = 0.69; Generalized additive model: AUC= 0.7, Accuracy = 0.68; Random Decision Forest: AUC = 0.7, Accuracy = 0.68; Naïve Bayes AUC = 0.63, Accuracy 0.58.

Conclusions
Developing a reliable predictive model with only pre-operative variables proved to be difficult, but several preoperative characteristics have a significant impact on the probability of prolonged LOS after CABG. Larger studies are needed to investigate the possibility of developing a reliable predictive model that would help to improve surgical planning.
1506 Theatre and The Environmental Impact: If You Don’t Measure It Can’t Be Managed
Authors: McCormack E E , Hopkins D , Nally D M 
Published: October 2021

Abstract

Introduction
The environmental impact of healthcare is estimated to be 5% of the total global impact and up to 10% in certain countries. The Green Healthcare programme in Ireland has published aims on its website to recycle 70% of the packaging waste and reduce waste sent to landfill by 10% by 2035. Currently the national average of recycled waste from hospitals is 11%

Method
We commenced a waste analysis project to assess the carbon footprint of our theatres. We measured the amount of waste which could potentially be recycled and preformed an economic analysis on this data to calculate projected cost benefit. Pilot analysis split waste into three categories – recyclable, landfill, and healthcare risk. Cases included ranged from minor to major complex including robotic procedures.

Results
Waste destined for the incinerator was excluded Pilot data showed that recyclable waste per case ranged from 400g to 2kg. which represents up to 50% of waste that would have otherwise been destined for landfill

Conclusions
Significant environmental and monetary savings are possible and recycling in theatre has been shown to be feasible in other hospitals. This does however require engagement from all staff and hospital administration. Further analysis is required to quantify the monetary cost to introduce a recycling programme and to determine optimum pathways for waste disposal in the theatre setting.
169 Clinical Outcomes of Radial Head Arthroplasty as Primary Treatment for Post-traumatic Mason Type 3 and 4 Fractures: A Long-term Follow-up
Authors: Aslam A , Pearson K , Waseem M 
Published: October 2021

Abstract

Aim
Radial head arthroplasty (RHA) is the favoured treatment for complex radial head fractures, enabling functional restoration of elbow kinematics. However, study of long-term outcomes associated with RHA is largely neglected. This study aimed to fill the gap in the literature by firstly, assessing functional outcomes, and secondly, determining complications and rates of revision and/or removal of prosthesis associated with RHA, at our district general hospital.

Method
We retrospectively reviewed a consecutive single-surgeon series of patients receiving RHA as primary treatment for radial head fractures graded either 3 or 4 according to the Mason-Johnston classification between 2004 and 2009. Function at final follow-up was assessed using Quick Disabilities of the Arm, Shoulder and Hand (q-DASH) score and Mayo Elbow Performance Score (MEPS).

Results
16 patients identified; 12 available for final follow-up. Mean follow-up time of 12.60 years (range: 10.67-16.08). Mean q-DASH score of 8.2 (range: 0-34.1). Mean MEPS of 85.83 (range: 50-100) with 11 (91.67%) reporting excellent/good results. All complications occurred within the first year post-operatively. Stiffness was the most common (50%) complication, but additional procedures improved objective range of movement in affected patients. Only one patient required implant revision throughout follow-up, which was due to prosthesis subluxation in the first month.

Conclusions
This study is amongst the first to examine clinical outcomes associated with RHA with an average follow-up &gt;12 years. Our results emphasise good functional restoration and low implant failure rate. Regular follow-up particularly in the early post-operative period is essential in detecting and resolving complications.
1540 Genome-Wide Association Analysis In 401,583 Individuals Identifies Novel Therapeutic Targets for Haemorrhoids
Authors: Ahmed W U l R , Wiberg A , Ng M , Smart N J , Zondervan K T , Furniss D 
Published: October 2021

Abstract

Aim
To elucidate the genetic architecture of haemorrhoids and identify genes and biological pathways central to their pathobiology.

Method
We report the first ever genome-wide association study of haemorrhoids in 31,652 cases and 369,931 controls from UK Biobank. Genes and biological pathways were prioritised using several bioinformatic approaches, and potential therapeutic targets were identified in the Open Targets Platform. A weighted genetic risk score (wGRS) for haemorrhoids was constructed to compare genetic susceptibility in surgical vs non-surgical haemorrhoids patients.

Results
Twelve novel genome-wide significant susceptibility loci were discovered to be associated with haemorrhoids. Seventeen genes were mapped to these loci, and gene sets in biological pathways relating to extracellular matrix regulation and TGF-β signalling were strongly implicated. Seven gene-products (41.2%) were predicted tractable to antibody and/or small molecule targeting, and three products (17.6%) have known pharmaceutical interactions (ACHE, ADRA2B, ELN). The wGRS analysis demonstrated that haemorrhoid patients requiring surgery have a higher inherent genetic susceptibility than those managed non-surgically (P = 4.58 × 10-27).

Conclusions
This study has advanced our understanding of haemorrhoids pathobiology with the identification of several biologically plausible genes and pathways, many of which demonstrate strong therapeutic potential. The wGRS correlated with disease severity, representing a first step in personalised medicine approaches to haemorrhoids.
1350 Wide-Awake Local Anaesthetic No Tourniquet (WALANT) Vs General/Regional Anaesthetic for Flexor Tendon Injuries: A Single-Centre, Retrospective Cohort Study
Authors: Greasley L , Patel P , Nolan G , Bamal R , Bell D 
Published: October 2021

Abstract

Aim
Flexor tendon repairs are commonly performed under general/regional anaesthesia. Wide-awake local anaesthetic no tourniquet (WALANT) has potential advantages including the ability to test the repair intra-operatively; removal of the risks of general anaesthesia; no aerosol generation, thus reducing COVID-19 transmission risk. An ongoing systematic review identified no comparative studies. This study aimed to compare the functional outcomes and complications of flexor tendon repairs under WALANT and general/regional anaesthetic.

Method
A single-centre, retrospective cohort study was undertaken (July 2019-August 2020). Consecutive adult patients undergoing flexor tendon repair were included. Exclusion criteria were ≥ 3 injured fingers; concurrent hand fracture; revascularisation; replantation. Data were collected on demographics, injuries, operative technique, and outcomes.

Results
Overall, 139 patients with 165 injured digits were included. Most (60%) were repaired under general anaesthesia. Local anaesthetic (was used for 46 patients (21 with tourniquet, 25 WALANT). Only 30% (42/139) patients had range of motion data at 6-weeks, dropping to 19% (26/139) at 12-weeks. WALANT patients had fewer ruptures (8% vs 14%), fewer adhesions requiring tenolysis (0% vs 4%) and less complications overall than the general/regional anaesthesia group. The results were not found to be statistically significant.

Conclusions
The lack of data due to patients not attending follow-up, makes meaningful research on flexor tendon injuries very challenging. This study suggests WALANT may reduce complications but is limited by the inherent bias of a retrospective, non-randomised study, and small numbers. Adequately designed and powered studies are recommended in future to further investigate the potential benefits of wide-awake surgery.
75 A Snapshot Audit on the Current Practice of Minimal Access Surgery in the UK During COVID-19 Pandemic
Authors: Barrow H , Patel R , Selvasekar C 
Published: October 2021

Abstract

Aim
COVID-19 is an ongoing global pandemic that poses potential increase in the risk of post-operative complications. Early guidelines placed an embargo on minimal access surgery, aiming to minimise risk to patients and the surgical team through aerolisation of the virus. We aimed to assess the practice of minimal access surgery during the peak of the pandemic and associated surgical outcomes.

Method
An email link to an online questionnaire was distributed to a variety of surgical specialties via the Royal College of Surgeons COVID group and ALSGBI members. Data collection was carried out over a 4-month period. Data assessed included screening methods, case volume, surgical approach and patient outcomes.

Results
A total of 118 responses from a variety of surgical specialties were collected over 59 units, ranging in grade from Consultant to SHO/Core Trainee. The volume of minimal access procedures decreased during the pandemic from 94.9% of units to 39.0% (P &lt; 0.001), with a greater percentage opting for an open approach (54.2% vs 39.0%, P &lt; 0.001). Combining screening methods was a favoured approach, and it was frequently used alongside a designated ‘Clean’ theatre. A small proportion of patients suffered from post-operative COVID-19 complications (15.3%), but COVID-19 mortality was low.

Conclusions
Whilst the risk of COVID-19 infection was not completely abolished perioperatively throughout the pandemic, it appears to be minimised by use of adequate screening with designated clean areas. It would therefore support guidelines advocating continued use of minimal access surgery during peaks of COVID-19 if prudent peri-operative measures are taken.
1628 Vaccination for Safe Surgery During The SARS-Cov-2 Pandemic: Modelling Study
Authors:   COVIDSurg Collaborative
Published: October 2021

Abstract

Introduction
Compared to the general population, in the postoperative period, surgical patients are both at increased risk of SARS-CoV-2 infection and increased mortality in the event of SARS-CoV-2 infection. This study modelled the impact of preoperative vaccination of patients aged ≥70 years having elective inpatient surgery.

Method
The primary outcome was the number needed to treat (NNT) to prevent one death over one year following SARS-CoV-2 vaccination. Postoperative SARS-CoV-2 incidence and adjusted mortality risk difference for SARS-CoV-2 infection were estimated from the prospective GlobalSurg-CovidSurg Week study (90,146 elective surgery patients across 1,595 hospitals in 115 countries), were used to estimate lives saved by vaccination in the first 30 postoperative days. SARS-CoV-2 case and death registration data from the Office for National Statistics was used to estimate NNTs for the general population. Best and worst-case scenarios were used to describe uncertainty around estimates.

Results
Among patients aged ≥70 years undergoing any type of surgery, NNT was estimated to be 332 (best case: 213; worst case: 690). NNT was lower in the cancer surgery subgroup (245 [150-545]). This was more favourable than the NNT for vaccination of the general population aged ≥70 (588 [403-1032]). Globally, vaccinating elective surgery patients aged ≥70 years preoperatively was projected to save 27,356 lives in one year compared to vaccinating the same patients after surgery.

Conclusions
Preoperative pathways should be set up for the vaccination of patients aged ≥70. In settings with limited vaccine availability, elective cancer surgery patients should be prioritised for vaccination.
921 Management of Acute Cholecystitis - the MACHO Study
Authors: Clarke R ,   Macho Steering Group
Published: October 2021

Abstract

Background
Acute cholecystitis is a common surgical condition. Gold standard treatment is index cholecystectomy, although there are reasons this might not be offered. The aim of this study was to explore treatments and outcomes in patients with acute cholecystitis.

Method
A multicentre retrospective study was carried out to identify a historic three-month cohort. Patients were identified through clinical coding. Demographics, clinical outcomes, comorbidities, Tokyo grade, and intervention descriptors were collected. Logistic regression was performed to identify characteristics of patients receiving a drain, and to propensity match for clinical outcomes.

Results
Seven centres reported on 1130 patients. Median age was 62 years, and 145 (12.8%) had grade III cholecystitis. Grade III cholecystitis was present in 19 (25.6%) of those who underwent cholecystostomy, 34 (9.3%) of those who underwent index cholecystectomy, and 92 (13.3%) of those who were conservatively managed. Overall complication rates were higher for those managed with cholecystostomy (36.5%) or conservatively (22.6%) vs index cholecystectomy (7.5%) (p &lt; 0.001). Logistic regression found CCI and grade III cholecystitis were associated with increased rates of any complication. Increased CCI and grade II/III cholecystitis were associated with increased rates of major complications.

Conclusions
'Hot' laparoscopic cholecystectomy seems to be offered to mild cases in fit patients. Patients with grade III disease and moderate comorbidities may not have cholecystectomy in a timely manner, leaving them at risk of repeated severe episodes.
1271 The Management of Acutely Symptomatic Hernia (MASH): A UK Wide Prospective Cohort Study
Authors: Burns F A ,   MASH Steering group
Published: October 2021

Abstract

Introduction
Acutely symptomatic abdominal wall and groin hernias (ASH) are a common presentation, accounting for approximately 25% of acute surgical admissions in the UK. There is limited data to guide the treatment of such presentations. This study aimed to assess outcomes of emergency hernia surgery, and identify common management strategies, to improve care for these high-risk patients.

Method
A 12 week, UK-based, multi-centre, collaborative, prospective cohort study (NCT04197271) recruited adults with ASH. Data on inpatient management, specific surgical intervention, in-hospital morbidity and mortality and quality of life (EQ-5D-5L) was measured. 30 and 90-day follow-up phone calls collected complications and quality of life. Descriptive analyses were performed to describe population and outcomes.

Results
Twenty-three acute trusts recruited 264 patients. Inguinal (37.9%) and umbilical (37.1%) hernias were most common. 17% were awaiting elective surgery and 17% had been previously declined intervention. 46% were incarcerated at presentation, and 31% symptomatic (painful/irreducible). 82% of patients had operations within 48 hours, with 95% performed open. Mesh was used in 55%, the majority (86%) being synthetic non-absorbable. Sutures used for suture repair varied widely. Complications were infrequent; 2% developed pneumonia or delirium. Surgical site infection occurred in 3% and mortality was 1.2%. Quality of life improved between baseline and 30-days following repair.

Conclusions
There is variation in the management of ASH in the UK, particularly with repair techniques, use of mesh and laparoscopy. One in five patients was awaiting repair; this might indicate a need for expedited pathways and reprioritising elective hernia repair.
57 A Closed Loop Audit of Post-Operative Driving Advice Documentation
Authors: Khan H , Tang C , Kamalakannan B , Bamford R 
Published: October 2021

Abstract

Aim
The Driving and Vehicle Licensing Agency state post-operatively it is between the patient and doctor to establish when would be safe to resume driving, providing recovery does not exceed three months. This audit aimed to assess and improve the documentation rate of driving advice in the discharge summaries given to patients post abdominal surgery.

Method
Retrospective data collection from electronic records over the months of August and September 2020. 132 discharge summaries were screened to assess the baseline rate of verbal/documented driving advice given on discharge. Following the 1st cycle, posters encouraging the inclusion of driving advice and demonstrating how to access driving advice to discharge summaries were developed and distributed across the surgical wards. A 2nd cycle re-audit was conducted in October 2020 to measure the effect of change, and a further 3rd cycle audit was conducted in November 2020.

Results
1st cycle included 132 patients. 62% had documented advice on their discharge summaries, while 38% had no proof of driving advice. After intervention, 2nd cycle included 30 patients. Results showed a significant increase in advice documentation (80%). A 3rd cycle was carried out with 47 patients. This showed a reduction in advice documentation (66%).

Conclusions
Driving advice on discharge in post-operative patients is crucial part of patient safety. Implementation of intervention has increased the documentation of driving advice showing enhancing patient safety. However, 3rd cycle after registrar’s changeover showed a decrease in the rate of documentation. A teaching session is planned for new doctors followed by 4th cycle.
33 Impact of Disruption of Tibio-Fibular Joints During Distraction Osteogenesis on Knee and Ankle Joint Function
Authors: Zhou A , Girish M , Lim J A , Thahir A , Krkovic M 
Published: October 2021

Abstract

Aim
The aim of this study is to investigate whether a disruption of proximal and/or distal tibio-fibular joint correlates to patient’s function and osteoarthritis.

Method
Retrospective analysis of 44 patients with lower limb bone defects treated by tibial corticotomy and distraction osteogenesis was conducted. Analysis of lower limb x-rays before surgery, immediately post-surgery and after frame removal permitted calculations of changes in tibial length and changes in fibula position relative to the tibia at the proximal and distal tibio-fibular joints. X-rays before and after treatment were also graded for osteoarthritis severity using Alhbäck's classification. Functional ability was scored using the American Orthopaedic Foot & Ankle Society (AOFAS) score and the Knee society score (KSS).

Results
15 patients showed a decrease in the distance between fibular tip and distal tibia, 5 showed no change and 12 showed an increase at the end of the treatment. No statistical significant association was noted with KSS or AOFAS score (p &gt; 0.05), however one patient with a large distance increase exhibited severe radiological exacerbation of knee osteoarthritis. The distal corticotomy group achieved significantly higher length of new bone (p &lt; 0.001) and were more likely to have exacerbation of knee osteoarthritis (p &lt; 0.05). Conversely, proximal corticotomy group were significantly more likely to show an exacerbation of ankle osteoarthritis (p &lt; 0.05).

Conclusions
Attempts should be made not to disrupt the tibio-fibular joints during bone transport, but disruption does not necessarily correlate to poorer outcomes. Our results show that lengthening index reduces with larger bone defects, suggesting that radical debridement/resection may not negatively affect the healing index.
159 The Need Of Six Monthly Follow Up X-Rays Post Total Knee Replacement(TKR)
Authors: Baig N , Ferrari M , Lukaszewicz A 
Published: October 2021

Abstract

Background
There is a longstanding culture of repeat x-rays after total knee replacement (TKR) as part of follow up, often combined with a clinic review. This is to check that the prosthesis is in a satisfactory position. There are inherently a number of issues with this historic approach including exposure of patients to further radiation who may be asymptomatic, time delays in busy clinics or x-ray departments and costs.

Objectives
The aim of this audit was to assess whether follow up plain films after TKR are methodically undertaken and of benefit to confirm satisfactory appearance if immediate post -operative x-rays were unremarkable. The findings of a six month follow up x-ray was specifically evaluated. The secondary aim was to establish the timing of further follow up x-rays within the department.

Method
200 patients were included within the analysis, they all received a TKR at a major trauma centre, over a one-year period between December 2017 and December 2018.

Results
It was found that 100% of those patients having a post-operative film had a satisfactory appearance. 78% of patients had at least one further follow op x-ray of which 99.4% were satisfactory. Up to five follow up x-rays were taken with 53.5% of patients having a follow up x-ray at 6 months.

Conclusions
From the above results there is minimal, if any, evidence within the data set to support routine, additional follow up imaging if initial post-operative films are satisfactory, and the patient is asymptomatic.