bluuebunny/crossref_metadata_2025_split huggingface dataset:
619 Is the Subdivision of Thy3 Nodules Needed? An Audit Reviewing the Management of Thy3 Nodules, and the Associated Malignancy Rates
Authors: Davies B , Sajjanshetty M , Thomas Z 
Published: October 2021

Abstract

Introduction
Following the 2014 update to the BAETS thyroid nodule cytology guidance, the management of Thy3 lesions was modified by subdivision into Thy3a and Thy3f categories. Both lesions remain indeterminate but are proposed to have differing risks of malignancy when counselling patents: these risks have been called into question by subsequent data.

Aim
This Audit aimed to review the management of Thy3 (Thy3a and Thy3f) cytological diagnoses, within an NHS Trust, and compare this to the BAET Guidance 2014. Further, malignancy rates for Thy3a and Thy3f cytology were made over the calculated over the time period.

Method
A retrospective Audit looking at 118 patients with a Thy3 cytology identified between 2014 and 2019. Data separated into data pre-2015 and 2015 onwards.

Results
In 2014, 29% of Thy3a nodules were managed in line with 2014 BAETS guidance. This improved to 34% from 2015. Meanwhile, Thy3f diagnoses were managed mostly in favour of the BAETS guidelines – 83% in 2014 and 92% 2015 onwards. The malignancy rates found, amongst all 118 patients, were 17.2% and 14.8% for Thy3f and Thy3a nodules respectively.

Conclusions
At this institution, Thy3 cytological diagnoses, regardless of classification into Thy3a or Thy3f, were largely treated in the same way (by a diagnostic hemi-thyroidectomy). The management of the nodules may reflect a variety of factors, including how comfortable patients and surgeons are when handling uncertainty. With malignancy rates for both Thy3a and Thy3f nodules being much the same, it is not surprising that they are managed in a similar way.
1481 Is Imaging for the Evaluation of Anosmia Really Necessary?
Authors: Boztepe S , Balakumar R 
Published: October 2021

Abstract

Aim
Although it is rare for anosmia to be caused by olfactory lesions, it is commonplace for some form of imaging to be undertaken to investigate olfactory loss in patients. This study aimed to identify the pick-up rate of pathology in patients who had an isolated complaint of anosmia.

Method
We undertook a retrospective study over a 2-year period between 2018 to 2020 in a teaching hospital. The cases were identified using the hospital radiology database for patients referred for CT or MRI of their head or sinuses due to anosmia. Patients referred with symptoms other than olfactory loss were excluded.

Results
Out of the 132 scans undertaken in this period, 52 were included with 47 being MRI scans. There were 5 (10%) patients who had intracranial pathology identified and these were all on MRI scans. Only 2 (4%) cases had actual olfactory tract-related abnormalities. This included absent olfactory bulbs and a soft tissue lesion within the region of the olfactory apparatus.

Conclusions
This study suggests a 4% pick up rate of olfactory tract-related pathology which demonstrates some value when investigating anosmia. However, with the large number of scans that do not alter management and the ever-increasing burden on our health system, large scale studies are needed to develop an evidence-based risk stratification approach.
1282 Evaluation of the Basket in Catheter Technique for Transcystic Bile Duct Exploration and Suspected Ductal Stones
Authors: Nassar A , Qandeel H , Khan K , Ng H , Hasanat S , Ashour H 
Published: October 2021

Abstract

Aim
The ‘Basket-in-catheter’ (BIC) technique facilitates laparoscopic transcystic ductal exploration (LTCE) and increases its success rate, being easier and safer than inserting the basket alone. This study evaluates the benefits in confirmed and suspected ductal stones.

Method
Prospective preoperative, operative and postoperative data on consecutive single session ductal explorations was collected over 28 years and analysed. BIC became our default technique for the transcystic approach to confirmed or suspected bile duct stones.

Results
741 of 1225 (60.5%) attempted LTCE were performed using retrieval baskets without dilating the cystic duct (CD). BIC was used in 646 (87.2%). Of 386 (52.1%) patients undergoing successful stone retrieval 62.7% had clinical and radiological risk factors for ductal stones and 92.0% had positive intraoperative cholangiography. 355 (47.9%) patients had preoperative or operative risk factors for CBD stones and equivocal cholangiography in 25%. Basket trawling was negative and repeat cholangiography confirmed resolution of abnormalities. Choledochoscopy was utilised in 484/1225 (39.5%), either primarily or when blind trawling failed to extract stones. Retained stones occurred in 7 patients, six requiring ERCP. Bile leakage occurred in 6 patients. There were two open conversions, no biliary injuries and no mortality. Post-operative pancreatitis occurred in 7 and recurrent stones in 8 patients.

Conclusions
The BIC technique achieves successful LTCE without CD dilatation in 40%, reducing the need for choledochoscopy and choledochotomy. It facilitates safe and speedy CBD trawling when stones are suspected due to preoperative or operative risk factors or equivocal cholangiography and helps surgeons acquire and consolidate ductal exploration skills.
442 COVID-19 And the Oral Surgery/Orthodontic Interface: Has A Delay in Treatment Complicated the Position of Unerupted And Ectopic Teeth Planned for Surgical Removal or Exposure?
Authors: Devine R , Holden A , Felstead A 
Published: October 2021

Abstract

Aim
To evaluate whether there has been a change in clinical or radiographic position and the resultant occurrence of complications of unerupted and ectopic teeth due to delayed treatment during the COVID-19 pandemic

Method
Data was collected over a three-month period at the Royal United Hospital, Bath, Oral and Maxillofacial Surgery Department. This was via a questionnaire distributed to clinicians and prospectively completed for each surgical procedure planned for the removal or exposure of ectopic canines, premolars, and supernumerary teeth.

Results
A total of 20 surgical extractions or exposures were performed during the three-month period, with 33% (n = 6) having a marked difference between their expected and final position. Complications occurred in 66.6% (n = 4) of cases that demonstrated a discrepancy in location. These were an increased surgical time, increased removal of bone or a cancellation of intended treatment. This cancellation occurred as the tooth had erupted enough for non-surgical management. In cases where there was no discrepancy (n = 14), no complications were reported.

Conclusions
These findings suggest the delay in treatment caused by the COVID-19 pandemic has resulted in a clinically significant change in the position of ectopic teeth planned for surgical removal or exposure. Given these findings, it is crucial that clinicians be aware that radiographic investigations are diagnostic and recent. The threshold for repeat imaging in all cases which have been delayed should be low to avoid unexpected surgical complications arising from inaccuracy in tooth localisation.
1110 The Cost of Fixing a Fractured Mandible: A Waste Reduction Project
Authors: Mitchell F , Parmar J 
Published: October 2021

Abstract

Introduction
Fractured mandibles are a frequent injury seen in the hospital and are commonly caused by interpersonal violence and accidental injury. The need to reduce expenditure in the NHS and redirect funds to where it is most needed is an important topic in recent times. The cost of open reduction internal fixation (ORIF) of mandible fractures can vary by the choice of equipment and technique used. Therefore, this waste reduction project aimed to identify any variation in treatment and minimise this.

Method
A data collection exercise was performed of isolated mandibular fractures which required surgical intervention. Operation notes were examined from April 2018 to March 2019, with 99 cases found. Information was collected about the number and type of drill bits, plates and screws that were used in the surgery. The expected cost for plating different mandibular fractures including simple, comminuted and multiple fractures was calculated which was compared to the actual average cost by type of injury and operating surgeon.

Results
The most common injury seen was Parasymphysis fractures, with the average ORIF cost across all surgeons being £239.07. The expected cost to fix this fracture was calculated at £237.95, or £325.31 if intra-operative intermaxillary fixation is used. It was demonstrated that the cost across all injuries was within the expected range and therefore no improvement could be made.

Conclusions
By limiting the available equipment, stocking the most cost-effective options, and teaching surgeons standardised treatments we are able to reduce the cost and waste in the hospital.
22 Motivations, Barriers, And Social Media: A Qualitative Study of Uptake of Women into Neurosurgery
Authors: Bandyopadhyay S , Moudgil-Joshi J , Norton E , Haq M , Saunders K 
Published: October 2021

Abstract

Objective
To explore how social media could be utilised to influence an individual’s motivation to pursue a neurosurgical career, an emerging topic area. The focus of this study was on women interested in neurosurgery.

Background
Women are significantly under-represented in neurosurgery. 18% of all neurosurgeons – including 8% of consultants – are women. Most previous studies have used quantitative methods that are not best suited to gaining an in-depth understanding of the barriers that women face in pursuing a career in neurosurgery, or what would enable more women to go into the speciality.

Method
In this qualitative study, individual semi-structured interviews were conducted until data saturation was achieved. Participants were women pre-neurosurgical trainees. The interview data was examined through a thematic analysis involving open and axial coding.

Results
Thirty women participated in the study. Four overarching themes were identified: (1) mentorship, (2) testimony from other women doing neurosurgery, (3) social media as a means of increasing interest in neurosurgery as a career choice, and (4) real-life exposure to the speciality.

Conclusions
There is scope to further improve uptake of women into neurosurgical training in the UK. Motivations and barriers to women pursuing neurosurgery should be addressed openly through early experience, role models and mentorship. Social media can help facilitate these opportunities, disseminate information and inspiration, and has the potential to undo societal biases.
1120 Clinical Applications of Local Field Potentials in Deep Brain Stimulation
Authors: Khan K 
Published: October 2021

Abstract

Aim
Local field potentials (LFP) are gathered when deep brain stimulation (DBS) electrodes are inserted into subcortical structures; however, the clinical application of these findings are unclear.

Method
A literature search was conducted using PRISMA guidelines, 231 papers were analysed for the literature review.

Results
The lack of dopamine in Parkinson’s disease (PD), is thought to increase the sensitivity of the basal ganglia-thalamo-cortical network to rhythmic oscillatory inputs causing pathological oscillations. Beta band frequency oscillations have been strongly linked to bradykinesia and rigidity in Parkinson’s disease patients. Whereas gamma oscillations were found to be prokinetic and possibly related to normal physiology. There has been varying views on LFP findings and tremor pathology, recent research has suggested a link between the ratio of slow and fast oscillations increasing resulting in a tremor. Studies found contradicting results with pathological oscillations, reasons for the variation include the time of the LFP recordings and the placement of the electrodes. The use of LFP presents a promising new technology namely adaptive deep brain stimulation (aDBS). aDBS has not been tested long-term in human patients, the safety and effectiveness long-term is unknown.

Conclusions
aDBS provide an exciting new technology however, the current evidence base provides a proof-of- principle, there are still many issues which need to be addressed before this can become an established treatment. With technological advances aDBS could revolutionise PD treatment and if perfected could potentially abolish patient’s symptoms completely.
973 Why Are Curative Treatment Rates So Low for Stage I/II Oesophago-Gastric Cancer in The West of Scotland?
Authors: Khan K , Gall L , Forshaw M 
Published: October 2021

Abstract

Aim
Over the last decade, quality performance indicators (QPIs) have been used to drive improvements in cancer care in Scotland. QPI-11 targets curative treatment rates for oesophago-gastric (OG) cancer and this target has been consistently missed. This study aimed to investigate why patients with potentially curable Stage I and II OG cancer did not receive curative treatment in the West of Scotland.

Method
The West of Scotland MCN database was interrogated for patients with newly diagnosed stage I and II OG cancer between January 2018 and December 2019 to identify those patients who did not have curative treatment. Electronic records were then analysed.

Results
81 patients (mean age of 79.3 ± 8.9 years; 41 (50.6%) female) were identified. Median Scottish Index of Multiple Deprivation was 3 (IQR 1-7). There were 46 (56.8%) oesophageal cancers, 49 (60.5%) adenocarcinomas and 63 (77.8%) were Stage II cancers. Formal CPEX fitness was assessed in only 6 patients (7.4%). Reasons for curative treatment not being received were as follows: not clinically fit (n = 69 (85.2%)); patient declined curative treatment (n = 7 (8.6%)); disease progression (n = 3 (3.7%)) and identification of synchronous cancers (n = 2 (2.5%)). 61 patients (75.3%) are deceased at the time of analysis, with a median time from MDT discussion to death of 6 (IQR 2-11.5) months.

Conclusions
Lack of fitness for radical treatment is the predominant reason for Stage I and II OG cancer patients in the West of Scotland not being treated with curative intent. This may be related to the previously described “West of Scotland” effect on health comorbidities.
471 C-Reactive Protein Accurately Predicts Severity of Acute Pancreatitis in Children
Authors: Walker H , Melling J , Jones M , Melling C 
Published: October 2021

Abstract

Introduction
Predicting severity of acute pancreatitis enables optimization of care, reducing morbidity and length of stay. Modified adult scoring systems have not yet been able to adequately predict severity in children. This study supports the use of CRP in children as a superior biomarker of acute pancreatitis severity compared with the modified Glasgow Pancreas score.

Method
This was a retrospective study of children presenting with a first episode of acute pancreatitis from 2002 - 2020 in a single tertiary paediatric surgical centre. Serum markers including CRP at 48 hours of admission were analysed. Statistical analysis included Receiver Operating Curve (ROC) analysis for promising biomarkers, and these were compared to the modified Glasgow Pancreas Score. A severe episode was defined by development of local complications and/or organ support. An Area Under Curve (AUC) &gt;0.90 was defined as an excellent predictor of severity.

Results
Data of 59 children were analysed, median age 13 years, 22 (37%) patients had a severe episode. ROC analysis demonstrated CRP as the best predictor of severity, giving an AUC of 0.92. Optimum cut off value for CRP was 107. 5mg/L (p &lt; 0.0001), producing 91% sensitivity and 84% specificity. This was significantly superior to the modified Glasgow Pancreas score, which gave an AUC of 0.66 (p &lt; 0.0424) producing 36% sensitivity and 100% specificity.

Conclusions
We have shown that a CRP &gt;107.5 within 48 hours of admission can be used to predict severity of acute pancreatitis in children with greater accuracy than current scoring systems.
468 Free Flap Breast Reconstruction in the UK: Are We Meeting the Demand?
Authors: Begaj A , Marlborough F , Allison K P 
Published: October 2021

Abstract
The demand for free flap breast reconstruction appears to be increasing. This study aims to evaluate the capacity for microsurgical breast reconstruction across the UK and compare this to the apparent demand to inform future workforce planning.
A questionnaire was sent to all the plastic surgery units in the UK to establish whether they performed reconstructive breast surgery, the number of free flaps they performed a year and what issues they were encountering in meeting the demand.
The response rate was 92.8% of 56 units. Current workforce planning figures show that there are 161 Consultant Plastic Surgeons who perform free tissue breast reconstruction. Across the UK, the total number of extra breast reconstructive surgeons felt to be needed was 78. The mean number of free flaps per year per surgeon was 20 [11-37]. Responders suggested that they felt 20 [12-30] free flaps were a suitable number to maintain their skills. 66% of the responders reported issues impairing delivery of their free flap service with access to theatre (41%) and inability to meet the demand (18%) as 2 of the key reasons.
Our results show that there is a demand for microsurgical breast reconstruction that is not being fully met at present. The authors hope that this survey may add to the evidence base that plastic surgeons remain an integral part of the care of many breast cancer patients and will encourage trainees to consider it as a subspecialty of choice.
600 Bilateral Upper Limb Compartment Syndrome After Massive Postpartum Haemorrhage
Authors: Payne A , Elahi S 
Published: October 2021

Abstract

Case Summary
Upper limb compartment syndrome (ULCS) is an uncommon limb-threatening emergency occurring as a result of increased interstitial pressure within osteofascial compartments. The overwhelming majority of causes occur in one limb, with frequent causes including fractures, reperfusion injury and burns. We report the unusual case of bilateral upper limb CS in a previously well 35-year-old female secondary to massive resuscitation following postpartum haemorrhage. The patient received 7 litres of blood products and 4 litres of crystalloid over a period of 8 hours. One hour postoperatively both hands became painful and swollen. Symptoms worsened over the following hour: both forearms were tense to palpate with demonstrable pain on passive extension of bilateral wrists and digits of the left hand, and capillary refill to all digits was brisk. Creatinine kinase was measured at 4,600U/L and bilateral forearm and left-hand fasciotomies were performed. The presence of bulging muscles in both forearms and the left hand confirmed the diagnosis of compartment syndrome, and perfusion was restored to all digits after release of the compartments. The patient later underwent split thickness skin grafting to both forearms and left-hand fasciotomy wounds. After 5 weeks of hand therapy, she regained good function of both hands. Bilateral ULCS is extremely uncommon but has been reported secondary to massive resuscitation, particularly in trauma patients, and we suspect that this was the cause in our patient.
1099 Financial Implications of Implementing MSLT-II Trial Findings for Treatment of Cutaneous Malignant Melanoma Patients in A Tertiary Referral Centre in The United Kingdom
Authors: Misky A T , Sadr A H , Nikkhah D 
Published: October 2021

Abstract

Aim
Cutaneous malignant melanoma is a significant public health challenge in the United Kingdom. Since the new American Joint Committee on Cancer (AJCC) version 8 definition of melanoma staging, more melanoma patients are eligible for sentinel lymph node biopsies (SLNB). Prior to the MSLT-II trial, SLNB positive patients were treated as a distinct group within cutaneous melanoma patients and in most centres would routinely undergo lymph node clearance (LNC) of the regional lymph node basin to control disease. Given the above developments in melanoma care, we compared the cost of SLNB and monitoring to the cost of LNC for patients with melanoma.

Method
We retrospectively reviewed all SLNB positive patients undergoing LNC or surveillance in 2019. We measured the cost of all clinical encounters for both groups and performed a cost analysis.

Results
Our study shows that the mean cost per patient of axillary LNC is £4731.64 and groin LNC is £5381.78 against a cost of £2896.67 for SLNBs. Mean inpatient stay was 2.8 nights following LNC and 0.11 nights following SLNB. 50% of LNCs and 11% of SLNBs were associated with post-operative complications.

Conclusions
Our data shows that treating uncomplicated SLNB positive patients with surveillance rather than immediate LNC results in reduced morbidity, lower complication rate and shorter inpatient stay for the patients, as well as lower financial burden to the unit. This is reflected by the UK Consensus statement on melanoma, suggesting that LNC should not be routinely offered for positive SLNB without high-risk features.
1334 Improving Patient Flow Through the Hand Trauma Pathway
Authors: Rela M , Clough E , Chu H , Hughes J 
Published: October 2021

Abstract

Aim
A full-cycle audit was conducted at our plastic surgery unit, assessing adherence to hand trauma standards by the British Society for Surgery of the Hand. These stipulate that time from referral to clinic for open injuries and closed fractures should be within 24 hours and 72 hours respectively and time to theatre from date of injury (DOI) within 4 and 7 days, respectively.

Method
Data for the initial audit was collected from Nov 2019-Feb 2020 and for the re-audit from Aug-Dec 2020. Lists were generated of 50 patients with open injuries including flexor tendon, extensor tendon and nerve injuries and 50 hand fractures in both cycles. Data was collected on DOI, date of referral, clinic review and surgery.

Results
The initial audit results showed poor DOI documentation (open injuries 30%, fractures 54%). For open injuries, 44% met standards for clinical review within 24 hours and 94% for time to theatre. For fractures, 94% met the standard for time to clinic and 90% for time to theatre. The interventions included adding the standards to the clinic booking form and creating a mandatory DOI field on the referral system. The re-audit showed improvement of DOI documentation (open injuries 95%, fractures 100%) and the proportion of open injuries seen within 24 hours to 60%.

Conclusions
The interventions had a positive impact on our hand trauma pathway. Areas for improvement include reducing the number of patient visits to the service and encouraging early decision-making, particularly for patients reviewed in the emergency department.