bluuebunny/crossref_metadata_2025_split huggingface dataset:
738 Lessons from the National Patient Safety Agency Alerts
Authors: Lee Rachel , Hatt Jacob , Mahawar Kamal , Bansal Mohit , Goyal Amit , Madhok Brijesh 
Published: October 2021

Abstract

Aim
The National Patient Safety Agency (NPSA) reviews incident reports from all NHS trusts, and reports deemed critical are issued as NPSA alerts. We aim to highlight important learning points from NPSA alerts to facilitate wider dissemination and prevent similar incidents, and overall improve patient safety.

Method
All patient safety alerts obtained from NPSA since inception (2008) till June 2020 were screened. We identified safety alerts that could be relevant to surgical practice, and further details of each alert were obtained from the Central Alerting System (CAS) website. Information obtained from CAS website was reviewed by consultant surgeons to identify specific learning points.

Results
1857 alerts were reported by NPSA of which 94 were relevant to surgical practice. Alerts were grouped into four themes: pre-operative(N = 4), intra-operative(N = 34), post-operative(N = 29), others(N = 8), and no specific learning point identified(N = 19). Pre-operative alerts focused on safety checks to avoid errors and improve patient safety e.g., WHO checklist. Majority of the intra-operative alerts were due to difficulty with use of specific equipment(n = 22) e.g., advanced haemostatic devices. Post-operative alerts highlighted specific issues with implants especially in breast and orthopaedic surgery(N = 23), and patient review following procedures(N = 6).

Conclusions
In spite of alerts occurring in a specific speciality, there is wider applicability to all surgical specialities e.g., pre-operative risk assessment in elderly patients requiring urgent surgery or confirming pregnancy status in immediate pre-operative period. Emphasis should be laid on staff training on using specialist equipment including troubleshooting. Raising awareness of these NPSA alerts may help prevent similar incidents.
828 STITCH And B**** - A Novel Programme Combining Pastoral Support and Surgical Skills
Authors: Lochab S , Stanier P , Rooker J 
Published: October 2021

Abstract

Aim
Foundation training can be a challenging time for Junior doctors; though help and support is offered, it is not always taken up. This programme aims to create a safe environment to facilitate discussion and provide pastoral support alongside teaching them new surgical skills.

Method
Four different sessions were organised over the period of four months (August 2020 – November 2020) and FY1/FY2 doctors working in the Orthopaedic department at the GWH, Swindon were invited to attend. Each session focussed on assorted suturing techniques and knot tying. In addition, the facilitator directed conversation towards opportunities to discuss frustrations, challenges, queries as well as positive occurrences. A questionnaire was distributed at the final session to evaluate participant experience.

Results
100% of attendees agreed or strongly agreed that they found their FY1 rotation challenging so far. 100% also scored 9/10 when asked how comfortable they were talking about concerns, worries or issues at these sessions. All the participants recorded ‘yes’ when asked if the session provided them with a listening ear, helpful advice, feeling supported, understanding/empathy and reassurance. 100% of the attendees scored that their confidence at suturing had improved (average: 4 points on a scale of 1-10).

Conclusions
Through these sessions, practical changes and improvements were achieved in the running of the Trauma and Orthopaedic department. Placement feedback was obtained, suggestions on things to improve or change and key issues were escalated to supervisors. There do not appear to be any similar programmes run that combine directed pastoral support and surgical skills teaching.
913 Near-Peer Teaching for Surgical Foundation Year Doctors During COVID-19 Pandemic
Authors: Olabisi O , Choi S , Hughes A , Torkington J 
Published: October 2021

Abstract

Introduction
Literature has shown near-peer teaching to be an effective method of improving learning. There is little data on surgical teaching initiatives of this kind. Nationally and locally, teaching sessions and courses have been cancelled due to the pandemic. A new surgical lunch-time virtual course was created to fill this gap.

Method
FY1 doctors from University Hospital Wales were invited to participate in a survey exploring the need and topics for surgical teaching. Results were used to create a surgical teaching course. Near-peer, core surgical trainees were recruited to teach. A post-course questionnaire was distributed to FY1 doctors who attended the teaching to assess the success of the course.

Results
15 FY1 doctors completed the initial questionnaire. 33% (5) were currently on a surgical placement. 60% (9) had an upcoming surgical placement. 73% (11) felt they did not have sufficient teaching on surgical specialties during medical school. 93% (14) felt they did not have sufficient teaching on how to manage surgical patients as a FY1. 100% (15) responded they would be interested in surgical teaching delivered by core surgical trainees. Eight topics were suggested, and lunchtime sessions were created. Post-course feedback was completed by 12 FY1 doctors. 88% (10) of respondents found the course ‘extremely useful’ and relevant to their surgical jobs.

Conclusions
There is a demand for surgical teaching for FY1s. Near-peer education designed by FY1s and delivered by CSTs is an effective way for teaching relevant surgical knowledge. Lunch-time virtual teaching is a good way to continue teaching sessions through the pandemic.
1644 Trainee Perspective in Sarcoma Care
Authors: Leong S , Clancy R , Jessop Z , Bragg T 
Published: October 2021

Abstract

Aim
Soft tissue sarcomas (STS) are rare and aggressive tumours. Appropriate multidisciplinary management requires robust knowledge of best practice and understanding of current guidelines. Plastic surgery trainees must therefore be proficient in the assessment, investigation, and treatment of patients with STS. We aimed to evaluate trainee education, confidence, and competence in managing patients with STS.

Method
All plastic surgery trainees in Wales completed an online questionnaire and written assessment. This was designed by the lead for STS and TPD. Formal training, knowledge of national guidelines and excision margins for different types of STS and skin cancer was assessed using short answer questions. A five-point Likert scale was used to assess trainee confidence in STS and skin cancer management and follow-up. Volume and type of teaching in sarcoma and skin cancer was also quantified.

Results
Trainees received less sarcoma training and were less confident in STS assessment and follow-up, in comparison to skin cancer. More senior trainees or those with formal sarcoma training were more confident in skin cancer management (mean confidence rating 4.4 vs 2.2) and performed better in the written assessment of excision margins (mean score 100% vs 61.45%)

Conclusions
Trainees receive less training in sarcoma with a significant impact on their competence and confidence in sarcoma care. We believe this is consistent across the United Kingdom as evidenced by just two sarcoma webinars held during the COVID-19 pandemic. Formal national evaluation of sarcoma teaching should be carried out to inform ongoing efforts to improve educational resources on this important topic for trainees.
1041 A Systematic Review of the Reporting Quality of Surgical Randomised Controlled Trials in Head and Neck Cancer using the CONSORT Statement
Authors: Canagarajah N A , Porter G J , Mitra K , Chu T S M 
Published: October 2021

Abstract

Introduction
Randomised controlled trials (RCTs) are considered the gold standard for evaluating the efficacy of an intervention. However, previous research has shown that surgical specialities poorly report RCTs, making it difficult to ascertain if various biases have been appropriately minimised. This systematic review assesses the reporting quality of surgical head and neck cancer RCTs.

Method
A literature search of PubMed and Embase was performed. Papers were included if they reported RCTs which assessed a surgical technique used to treat or diagnose head and neck cancer published during or after 2011. Therefore, the CONSORT 2010 checklist was used to evaluate the reporting quality of these trials.

Results
41 papers were included. The mean CONSORT score was 16.5/25 (66% adherence) and the scores ranged from 7.5 (30%) to 25. The most common omissions were full trial protocol (found in 14.6%), participant recruitment method (22%) and effect size with precision estimate for all outcome measures (29.3%). The full design and implementation of the randomisation method was reported in 6 (14.6%). Papers published in journals which endorsed CONSORT had significantly higher scores (p = 0.02) and journal impact factor was significantly correlated with CONSORT score (p = 0.01).

Conclusions
We have identified several pieces of information that are underreported in surgical head and neck cancer RCTs. These omissions make understanding and comparing the methodologies and conclusions of RCTs more difficult. The endorsement of CONSORT by journals improved adherence, suggesting that wider adoption of the checklist may improve reporting.
1109 Artificial Intelligence in Urological Oncology
Authors: Brodie A , Dai N , Teoh J Y C , Decaestecker K , Dasgupta P , Vasdev N 
Published: October 2021

Abstract

Aim
A comprehensive review of the literature on the current and future applications of artificial intelligence (AI) in the context of urological oncology.

Method
Four key areas of urological oncology were identified, and a comprehensive literature review was carried out in each area looking at the current and future applications of AI. These four areas included: Prostate cancer, Renal cancer, Bladder cancer, Robotic Surgery.

Results
In total, 63 primary research articles were reviewed across these four areas. For prostate, renal and bladder cancer, AI has already shown great promise in the areas of imaging and histopathology interpretation, predicting tumour grade, reducing inter-observer variability and identification of genomic biomarkers. For robotic surgery, AI has already demonstrated value in the assessment of operator skill and using this to predict surgical outcomes. However, some common limitations to the applicability of AI into clinical practice include an overwhelming predominance of small retrospective studies, concerns over the datasets and methodology of AI training, the complexity of AI algorithms being such that they become un-interpretable and the technological requirements and ethical considerations with so much confidential “big data.”

Conclusions
The potential for AI to improve clinical care is clearly unparalleled but there remain significant challenges to adoption into clinical practice. Future research will need to focus on the establishment of multi-institute open access databases and improved data collection and integration for improved training of AI algorithms and ultimately, for clinical applicability to be realised, there needs to be high-quality prospective randomised multi-institute studies.
1363 Oesophago-Pleural Fistula After Pneumonectomy; A Systematic Review
Authors: Phelan L , Layton G R , Lee E H , Liampas E , Bishay E , Griffiths E A 
Published: October 2021

Abstract

Introduction
Oesophago-pleural fistula (OPF) is an infrequent but highly complex complication of pneumonectomy with a mortality of up to 63%. There is a paucity of data on the optimal treatment strategy.

Method
Systematic review was conducted in line with PRISMA guidance concerning OPF following pneumonectomy. Demographic, operative and management data were analysed.

Results
30 full manuscripts of the 76 abstracts were included in the analysis. Data was limited to case reports or small series. In total, information for 58 patients was included. Median age was 59 years, with a median follow up time was 18 months. Most authors adopted sepsis control with chest drainage and pleural lavage and the mean number of interventions was 1.6. Overall mortality was 31% (18/58). There was no significant difference between the time to presentation following left (29.2+/-39.28 months) and right pneumonectomy (66.24+/-110.62) (p = 0.2271) nor any significant difference between successful outcomes following intervention for OPF after left (11/14) compared to right pneumonectomy (31/41) (p = 0.8219) or 90-day mortality (p = 0.4571). However, 26% of patients had synchronous broncho-pleural fistula and 90-day mortality was significantly higher in these patients (6/15 vs 6/43. p = 0.0395). 25 patients who underwent additional pericardial, oesophageal or a nodal resection or intervention at the time of pneumonectomy had a significantly reduced mean time to presentation with OPF (21.49+/-60.15 vs. 84.99+/-114.31. p = 0.0148) and a higher 90-day mortality (8/25 vs 3/32. P = 0.0414).

Conclusions
Major heterogeneity of management hinders the introduction of standardised guidance of post-pnuemonectomy OPF. An MDT approach involving Oesophago-gastric and Cardio-Thoracic Surgery is vital.
1459 Intravesical Chemohyperthermia Versus Bacillus Calmette-Guerin Instillation for Intermediate- And High-Risk Non-Muscle Invasive Bladder Cancer: A Systematic Review and Meta-Analysis
Authors: Zhao H , Chan V W S , Castellani D , Chan E O T , Ong W L K , Peng Q , Moschini M , Krajewski W , Pradere B , Ng C F , Enikeev D , Vasdev N , Ekin G , Sousa A , Leon J , Guerrero-Ramos F , Tan W S , Kelly J , Shariat S F , Witjes J A , Teoh J Y C 
Published: October 2021

Abstract

Introduction
Traditional intravesical chemotherapy instillations under room temperature post trans-urethral resection (TUR) of non-muscle invasive bladder cancer (NMIBC) have lower efficacies than maintenance BCG installations. Intravesical chemo-hyperthermia (CHT) at higher temperatures is developed to improve the efficacy of chemotherapy instillation. This systematic review aims to compare the use of CHT and BCG instillation post-TUR.

Method
The protocol of this review is registered on PROSPERO(CRD42020223277). A comprehensive literature search was performed on Medline, EMBASE, and Cochrane CENTRAL to identify studies comparing CHT and BCG post-TUR for intermediate- or high-risk NMIBC. Primary outcomes include recurrence-free survival (RFS) and progression-free survival (PFS). Secondary outcomes include adverse events (AE).

Results
From 2,375 identified records, four randomised control trials incorporating 327 patients were included for meta-analysis. The use of CHT was found to be non-inferior to BCG in RFS, PFS and AEs (Grades 1-3) (p &gt; 0.05). Sensitivity analysis, excluding patients with BCG failures, show 24-36 months recurrence rate to be significantly lower in CHT group (RR 0.64, 95% CI 0.42-0.98, p = 0.04) compared to the BCG group. In patients without carcinoma in situ (CIS), RFS is also significantly better in CHT patients (HR 0.52, 95% CI 0.32- 0.85, p &lt; 0.01). Safety profile remains non-inferior to the BCG group in sensitivity analyses. Quality of evidence across all outcomes ranged from moderate to low.

Conclusions
In well-selected patients, intravesical CHT has superior oncological outcomes and non-inferior safety profile when compared to BCG maintenance therapy for patients with intermediate- and high-risk NMIBC. CHT is a possible alternative treatment during BCG shortage.
Implantable brain–computer interface for neuroprosthetic-enabled volitional hand grasp restoration in spinal cord injury
Authors: Cajigas Iahn , Davis Kevin C , Meschede-Krasa Benyamin , Prins Noeline W , Gallo Sebastian , Naeem Jasim Ahmad , Palermo Anne , Wilson Audrey , Guerra Santiago , Parks Brandon A , Zimmerman Lauren , Gant Katie , Levi Allan D , Dietrich W Dalton , Fisher Letitia , Vanni Steven , Tauber John Michael , Garwood Indie C , Abel John H , Brown Emery N , Ivan Michael E , Prasad Abhishek , Jagid Jonathan 
Published: October 2021

AbstractLoss of hand function after cervical spinal cord injury severely impairs functional independence. We describe a method for restoring volitional control of hand grasp in one 21-year-old male subject with complete cervical quadriplegia (C5 American Spinal Injury Association Impairment Scale A) using a portable fully implanted brain–computer interface within the home environment. The brain–computer interface consists of subdural surface electrodes placed over the dominant-hand motor cortex and connects to a transmitter implanted subcutaneously below the clavicle, which allows continuous reading of the electrocorticographic activity. Movement-intent was used to trigger functional electrical stimulation of the dominant hand during an initial 29-weeks laboratory study and subsequently via a mechanical hand orthosis during in-home use. Movement-intent information could be decoded consistently throughout the 29-weeks in-laboratory study with a mean accuracy of 89.0% (range 78–93.3%). Improvements were observed in both the speed and accuracy of various upper extremity tasks, including lifting small objects and transferring objects to specific targets. At-home decoding accuracy during open-loop trials reached an accuracy of 91.3% (range 80–98.95%) and an accuracy of 88.3% (range 77.6–95.5%) during closed-loop trials. Importantly, the temporal stability of both the functional outcomes and decoder metrics were not explored in this study. A fully implanted brain–computer interface can be safely used to reliably decode movement-intent from motor cortex, allowing for accurate volitional control of hand grasp.
Conduction disorders as the first hallmark of isolated cardiac sarcoidosis in a highly active individual: a case report
Authors: Muccioli Silvia , Albani Stefano , Mabritto Barbara , Musumeci Giuseppe 
Published: October 2021

Abstract

Background
Cardiac sarcoidosis (CS) is an inflammatory disease with various clinical presentations depending on the extension of cardiac involvement. The disease is often clinically silent, therefore diagnosis is challenging.

Case summary
We discuss the case of a middle-aged highly active individual presenting with an occasional finding of low heart rate during self-monitoring. The electrocardiogram shows a Mobitz 2 heart block; thanks to multimodality imaging CS was diagnosed and corticosteroid therapy improved cardiac conduction.

Discussion
To our knowledge, this is one of the first documented cases of occasional, early findings of CS in a middle-aged highly active individual who presented with cardiac conduction involvement. Despite the very early diagnosis, multimodality imaging suggested an advanced disease with no oedema detection at the cardiac magnetic resonance. Nevertheless, prompt corticosteroid therapy was able to improve clinical conduction. Although non-sustained ventricular arrhythmias were detected, electrophysiological study allowed to discharge the patient safely without implantable cardioverter-defibrillator implantation. Light-to-moderate physical activity was allowed at mid-term follow-up. A multidisciplinary evaluation should be considered to resume a high-intensity training.
Intergenerational Educational Mobility and Life Course Economic Trajectories in a Social Democratic Welfare State
Authors: Hällsten Martin , Yaish Meir 
Published: October 2021

AbstractWe test a prediction of cumulative advantage theory about enduring life cycle effects of educational mobility on earnings. We identify four mobility groups by cross-classifying parental education (degree/no degree) by their offspring (degree/no degree) and study the long-term economic consequences of intergenerational educational mobility. Data for this study come from Swedish population registers covering birth cohorts between 1953 and 1955. We analyse earnings trajectories of Swedish men and women, in each educational mobility category, over most of their working-age life course. We find that the earnings trajectories cluster in two groups that reflect each’s educational destination, not their educational origin. These results suggest that mobility trajectories in the Swedish labour market do not follow any strong advantage pattern but instead are explained by the attainment of human capital. By contrast, complementary analyses of mid-life wealth, not necessarily derived in the labour market, suggest more support for cumulative advantage since those with high-educated parents have much higher levels of wealth. We argue that these contrasting results, between earnings and wealth, highlight the Swedish welfare regime’s effectiveness, particularly in regulating and suppressing inequality in the labour market.
Global longitudinal strain as a predictor of cardiovascular events and mortality in patients with ischemic heart disease and heart failure with preserved/mid-range ejection fraction
Authors: Santos J , Pires I , Neto V , Goncalves L , Correia J , Almeida I , Correia E 
Published: October 2021

Abstract

Introduction
Global longitudinal strain (GLS) is considered a more sensitive marker of systolic dysfunction than other measures commonly used in clinical practice, such as left ventricle ejection fraction (EF). Our objective was to evaluate the impact of reduced GLS in death and cardiovascular events in patients hospitalized due to heart failure with mid-range or preserved ejection fraction, with previous history of acute myocardial infarction.

Methods
A retrospective analysis of 170 patients admitted to a Cardiology ward due to acute heart failure (AHF) was performed. Patients with reduced EF (Simpson biplane method - EF&lt;40%) were excluded based on echocardiographic evaluation after AHF stabilization. GLS measured by “speckle tracking” technique was calculated for each patient. Measurements were made by the same operator to minimize interoperator variability. Mann-Whitney U test was used for univariate analysis. Kaplan-Meier survival plots and Cox-regression analysis were performed to assess differences in 12-month mortality (12MM) and in the composite endpoint of cardiovascular event or death (12CVM) at 12 months.

Results
A total of 127 patients were included. Mean patient age was 64 (±14) years; 72% were men. 48% of patients had history of ST elevation AMI. Mean EF was 54% (±8) and mean GLS was −14.3 (±3.8). Rates of 12MM and 12CV M were 14.2% and 19.3%, respectively. A statistically significant association between 12MM and 12MCV was found in univariate analysis for GLS (p&lt;0.001). Kaplan-Meyer survival plots revealed that a compromised GLS (&lt;−16) was associated with significantly increased 12MM (23% vs 2.5%, X2: 7.999, p=0.005) and 12CVM (26.6% vs 10%, X2: 4.139, p=0.042). When stratified by mid-range vs preserved EF, GLS &lt;−16 was associated with worse outcomes, although the results did not reach statistical significance (p&gt;0.05). However, when considering a severely compromised GLS (&lt;−13), GLS was significantly associated with increased 12MM (52% vs 8.3%, X2: 5.533, p=0.019) and 12CVM (50% vs 8.3%, X2: 4.970, p=0.026), in the subgroup of patients with heart failure with mid-range EF. Cox-regression analysis demonstrated that GLS was independently associated with 12MM (HR: 0.668p, &lt;0.001) and the 12CVM composite endpoint (HR: 0.819, p=0.008), even after adjustment for other important prognostic markers such as chronic kidney disease, pulmonary disease and diabetes, with significant hazard ratio reduction for each positive point increase in GLS.

Conclusion
GLS is an independent predictor of 12MM and 12CVM in patients hospitalized due to AHF, with an EF ≥40% and previous history of acute myocardial infarction. In the subgroup of patients with heart failure with mid-range EF, a severely compromised GLS (&lt;−13) is a strong predictor of 12MM and 12CVM.

Funding Acknowledgement
Type of funding sources: None.