bluuebunny/crossref_metadata_2025_split huggingface dataset:
384 Use of A Dry Swab During ACL Hamstring Tendon Graft Preparation May Lead to Decreased Graft Diameter at Implantation with Subsequent Rebound in Graft Diameter When Exposed to Haemarthrosis – A Porcine Tendon Study
Authors: Havenhand T , Jain N 
Published: May 2021

Abstract

Introduction
ACL reconstruction surgery commonly utilises a hamstring tendon graft. Grafts are normally covered with a wet swab prior to implantation. The aim of this study was to determine the variance in graft diameter when comparing the traditional wet swab to a dry swab.

Method
Flexor tendons from a selection of fresh pig trotters were isolated and prepared with a standard ACL graft preparation technique. Half of the grafts were covered with a wet swab; the other half were covered with a dry swab. Graft diameters were measured at 10-minute intervals. After 30 minutes the grafts were submerged in Hartmann’s solution to simulate the post-operative haemarthrosis, diameters were checked again after 1 hour in the solution.

Results
Use of a dry swab resulted in a 0.5mm greater reduction in diameter than the wet swab group. The dry swab group also showed an increase in diameter by 0.5mm when soaked in Hartmann’s solution, this was not seen in the wet swab group.

Conclusions
Using a dry swab produces a smaller graft diameter, this would allow smaller bone tunnels, retaining bone stock. The subsequent rebound in diameter when in solution may increase the press fit mechanism and facilitate improved integration into the bone tunnel.
472 Addressing the Quality of Hospital Care of Colorectal Cancer Patients Undergoing Surgery: What Did We Learn from the National Bowel Cancer Audit?
Authors: Li C , Ooi S Z Y , Woo T , Chan P H M 
Published: May 2021

Abstract

Aim
To identify the most relevant clinical factors in the National Bowel Cancer Audit (NBOCA) that contribute to the variation in the quality of care provided in different hospitals for colorectal cancer patients undergoing surgery.

Method
Data from 36,116 patients with colorectal cancer who had undergone surgery were retrospectively collected from the NBOCA and analysed from 145 and 146 hospitals over two years. A validated multiple linear regression was performed to compare the identified clinical factors with various quality outcomes. The quality outcomes defined in this study were the length of hospitalisation, 2-year mortality, readmission rate, 90-day mortality, and 18-month stoma rate.

Results
Four clinical factors (laparoscopy rate, abdominal-perineal-resection-of-rectum (APER), pre-operative radiotherapy and patients with distant metastases) were shown to have a significant (p &lt; 0.05) impact on the length of hospitalisation and 18-month stoma rate. 18-month stoma rate was also significantly associated with 2-year mortality. External validation of the regression model demonstrated the Root-Mean-Square-Error of 0.811 and 4.62 for 18-month stoma rate and 2-year mortality respectively.

Conclusions
Hospitals should monitor the four clinical factors for patients with colorectal cancer during perioperative care. Clinicians should consider these factors along with the individual patients’ history when formulating a management plan for patients with colorectal cancer.
542 The Attune Total Knee Replacement: Early Clinical Performance Versus an Established Implant At 3 Years Post-Surgery
Authors: Gunn F , Walmsley P 
Published: May 2021

Abstract

Introduction
In 2013, the Attune® knee implant system was released as an updated prosthesis design, superseding the PFC Sigma®. Limited data exists regarding the early-to-midterm survival, functional and clinical benefits of the Attune®. The primary aim of this study was to compare functional outcome between the Attune® and PFC Sigma® at 3 years post-op.

Method
A single-centre, prospective cohort study of 110 patients, selected by propensity score matching, was conducted. Patient demographics, peri-operative care, clinical outcomes and functional scores were analysed to determine which prosthesis conferred a superior functional outcome.

Results
Median and mean increases in American Knee Society Score for the Attune® and Sigma® knees were 53 (26.9) and 43.6 (± 15.4) respectively (p = 0.307). Mean increase in Oxford Knee Scores were 21.8 (± 8.8) and 18.7 (± 8.8) for the Attune® and Sigma® respectively (p = 0.27, 95% CI -2.56 to 8.7). Mean and median increased range of movement was 11.8o (± 28) and 1.7o (± 13.5o) for the Attune® and Sigma® respectively (p = 0.05, 95% CI -0.015 to 20.2).

Conclusions
The Attune® knee system displays a significantly improved range of motion and a trend towards higher knee scores over a conventional implant at 3 years post-surgery, which may support use in future clinical practice.
644 Validation of The Prostate Imaging Reporting and Data System (PIRADS) Tool for Prostate Cancer Detection in A Contemporary British Cohort
Authors: Desai C , Ehsanullah S A , Bhojwani A , Dhanasekaran A 
Published: May 2021

Abstract

Introduction
The European Association of Urology (EAU) recommends multiparametric MRI (mpMRI) prior to prostate biopsy for investigation of prostate cancer (CaP). Specifically, the mpMRI should be reported using the Prostate Imaging Reporting and Data System (PIRADS) tool. Our study aims to externally validate the PIRADS tool over a multi-centre district general hospital.

Method
Retrospective review was performed on 104 consecutive patients who underwent mpMRI and subsequent cognitive transrectal ultrasound biopsy of prostate (CTRUSB) over an 18-month period. Collected mpMRI data was correlated with Gleason grading obtained through CTRUSB histology.

Results
On histology findings, a total of 64.4% patients (n = 67) were found to have prostate cancer with a mean PSA density (PSAD) of 0.48. Extremes of the PIRADS scoring tool showed a clear correlation. PIRADS 2 correlated to a 0% prostate cancer detection rate (PSAD 0.16), whereas PIRADS 5 correlated to 93.1% detection rate (PSAD 0.49). However, for PIRADS 3 and 4, prostate cancer detection rates were 49.8% (PSAD 0.25) and 50.9% (PSAD 0.18) respectively.

Conclusions
Our study substantiates the association of lesions scored as PIRADS 5 with prostate cancer detection. CTRUSB in PIRADS 2 lesions can be safely avoided. For PIRADS 3 and 4 lesions, PSAD should be considered before performing a biopsy.
648 External Validation of The European Randomized Study of Screening for Prostate Cancer Risk Calculator 3 (ERSPC-RC3) In the Detection of Prostate Cancer and Avoiding Unnecessary Prostate Biopsies
Authors: Desai C , Ehsanullah S A , Bhojwani A , Dhanasekaran A 
Published: May 2021

Abstract

Introduction
The Prostate Cancer Research Foundation – Stichting Wetenschappelijk Onderzoek Prostaatkanker group has devised the European Randomized Study of Screening for Prostate Cancer (CaP) Risk Calculator 3 (ERSPC-RC3) tool which aims to increase prostate cancer detection rates and avoid unnecessary prostate biopsies. We report the external validation and accuracy of the ERSPC-RC3 in our UK cohort.

Method
Retrospective data was collected for patients who had prostate biopsy at a multi-centre district general hospital over an 18-month period. The ERSPC-RC3 was applied to identify the probability of a positive biopsy for CaP (Gleason score ≥7).

Results
Out of 121 TRUS biopsies, 78 patients met the ERSPC-RC3 inclusion criteria. Patients were stratified as low-risk (detectable CaP risk &lt;12.5%) n = 10, intermediate-risk (detectable CaP risk 12.5-20%) n = 8, and high-risk (detectable CaP risk &gt;20%) n = 60 groups. All low-risk patients had a benign histology. Gleason 7 CaP was found in 37.5% from the intermediate-risk group and 41.7% in the high-risk group respectively.

Conclusions
Our results demonstrate that using ERSPC-RC3 could have prevented 44% (n = 34) of patients from having unnecessary biopsies. We recommend the use of ERSPC-RC3 to risk stratify patients being investigated for suspected CaP.
795 Trends in Cerebrospinal Fluid Leak Rates Following the Extended Endoscopic Endonasal Approach for Anterior Skull Base Meningioma: A Meta-Analysis Over the Last 20 Years
Authors: Zamanipoor Najafabadi A H , Khan D Z , Muskens I S , Broekman M L D , Dorward N L , van Furth W R , Marcus H J 
Published: May 2021

Abstract

Introduction
The extended endoscopic approach (EEA) provides direct access for resection of tuberculum sellae (TSM) and olfactory groove meningiomas (OGM) but is associated with cerebrospinal fluid (CSF) leak in up to 25% of patients. To evaluate the impact of improved skull base reconstructive techniques, we assessed published CSF leak percentages in EEA over the last two decades.

Method
Random-effects meta-analyses were performed for studies published between 2004-2020. Outcomes assessed were CSF leak, gross total resection, visual improvement, intraoperative arterial injury and 30-day mortality. For the main analyses, publications were pragmatically grouped based on publication year in three categories: 2004-2010, 2011-2015, and 2016-2020.

Results
We included 29 studies describing 540 TSM and 115 OGM patients. CSF leak incidence dropped over time from 22% (95% CI: 6-43%) in studies published between 2004 and 2010, to 16% (95% CI: 11-23%) between 2011 and 2015, and 4% (95% CI: 1-9%) between 2016 and 2020. Outcomes of gross total resection, visual improvement, intraoperative arterial injury, and 30-day mortality remained stable over time

Conclusions
We report a noticeable decrease in CSF leak over time, which might be attributed to the development of reconstructive techniques (e.g., hadad bassagasteguy flap, and gasket seal), refined multilayer repair protocols, and selected lumbar drain usage.
836 Presentation, Clinical Outcomes and Prognosis of Primary Appendiceal Adenocarcinoma; Single Centre Experience
Authors: Abounozha S , Waqas A , Kelly S 
Published: May 2021

Abstract

Background
Appendiceal adenocarcinoma is a rare condition. The aim of the study is to determine the pattern of clinical picture, histological diagnosis and prognosis of the disease on patients in our area.

Method
A retrospective data analysis of patients who underwent appendicectomies from January 2011 to December 2019 in Northumbria NHS Trust.
Records of patients with histologically diagnosed appendiceal adenocarcinoma were studied for their demographics, clinical features, laboratory, radiological results, operative notes and histological types.

Results
13 out of 3138 appendicectomies (0.41%: 6 Males, 7 Females with mean age of 69.84 years) were found to have primary appendiceal adenocarcinoma. Almost all the patients presented with clinical picture in keeping of acute appendicitis.
9 patients underwent emergency appendicectomies. 4 patients were treated conservatively.
Appendiceal adenocarcinoma was diagnosed based on colonoscopy in 1 patient, CT scan in 1, post-appendicectomy histology in 9 patients, 2 post RHC histologies.
Survival rate was 71.4% after 1 year, 64.3% after 2 years and 42.9% after 3 years.
Overall median survival time for all TNM stages was 39.0 (95% CI, 15.72 to 62.27) months. Mean survival time was best in stage II 56.33 (95% CI, 48.86 to 63.80) months.

Conclusions
Preoperative diagnosis is very difficult. Overall prognosis is poor.
877 The Transobturator Male Sling: Does It Stand the Test of Time?
Authors: Sohawon R , Rizvi I G , Ravindra P , Pipe M , King T , Belal M 
Published: May 2021

Abstract

Introduction
The commonest cause of stress urinary incontinence in men is radical prostatectomy. We aimed to determine the efficacy, complication rate and need for salvage surgery in the medium-long term for male sling insertion.

Method
Retrospective review of all patients undergoing male sling insertion at one centre between 2009-2018. Data was collected on complications, patient satisfaction and need for further surgery. Preoperative severity was categorized as mild, moderate, or severe. We assessed ICIQ score, 24h-pad usage, patient satisfaction and identified risk factors for treatment success/failure.

Results
91 men had slings inserted (median age- 67.3). Three months success rates in mild, moderate and severe SUI groups were 96%, 86% and 80% respectively which dropped to 65%, 62% and 47% in the medium term. The rate of AUS implantation was 6%, 15% and 33% respectively. Complications included pain, infection, retention and OAB. Patient satisfaction at 5-years was 57%. Only factor predicting success or failure was pre-operative ICIQ-UI(SF) score.

Conclusions
Male sling success rates deteriorate over time. 15% will have an AUS. The risk of complications is low and transient. A pre-operative ICIQ-UI(SF) score of &gt; 18 is a predictor of failure. Sling insertion remains a reasonable treatment option for male patients suffering with SUI.
912 Comparison of Magnetic Resonance Imaging Cognitive Prostate Biopsy Versus Magnetic Resonance Imaging-Ultrasound Fusion Prostate Biopsy in The Detection of Prostate Cancer
Authors: Bhojwani A , Desai C , Ehsanullah S A , Shahzad S A 
Published: May 2021

Abstract

Introduction
Prostate biopsy is performed to obtain tissue specimens to diagnose prostate cancer (CaP). Superimposing magnetic resonance imaging (MRI) on the prostate biopsy machine can improve the targeting of abnormal prostate lesions found on MRI scans. We compare the results of MRI cognitive prostate biopsy to MRI-US fusion biopsy in the detection of prostate cancer.

Method
Data was collected retrospectively for all patient that had an MRI and prostate biopsy from 01/01/2019 to 31/12/2019. Electronic patient records and radiology imaging software were used to collate data.

Results
319 patients with at least PIRADS 3 on MRI prostate were identified. CaP was detected in 70% (26/37) of the cognitive biopsy cohort and 66% (186/282) of the fusion biopsy cohort. None of the patients required additional biopsies. Only the fusion biopsy cohort had complications which were Urosepsis - 7, Haematuria - 3, Urinary retention - 1 and Rectal bleeding- 1.

Conclusions
Our study suggests the CaP detection rates were similar in both cohorts. However, similar patient numbers are required to avoid selection bias. 66.5% of all PIRADS 3 lesions were found to be ≥ Gleason 7. We recommend using magnetic resonance imaging-ultrasound fusion prostate biopsy to enhance prostate cancer detection rates.
945 Re-Audit of Incorrect Tcis; Are We Now Listing the Right Teeth
Authors: Matharu K , Shah A , Shorafa M 
Published: May 2021

Abstract

Introduction
In 2018 in our OMFS out-patients department there were two wrong tooth extraction (WTE) events- at a Clinical Governance meeting we identified that TCI (‘to come in’ forms) were being completed incorrectly; from December 2018 to February 2019 there were 6 separate forms where the teeth listed for extraction was different to the teeth that were planned for extraction. As a result, our first stage audit involved data collection and root cause analysis of the incorrectly completed forms.
As a result of the findings of the first stage audit, we decided to implement a change to TCI forms.

Aim
To assess whether TCI forms were being correctly completed following on change to TCI forms.

Data collection
Retrospective data collection from September 2019- January 2020 analysing any occurrences of incorrect TCI forms

Results
No further incidents of incorrect TCI forms since September 2019 and WTE since the last occurrence in 2018.

Conclusions
Although an incorrect TCI form was not listed as a potential cause for the two WTE events that occurred within the department, incorrect documentation is a known risk factor for WTEs. This completed audit cycle demonstrates successful learning from the WTEs and the implementation of beneficial changes.
518 New In Vitro Model of Traumatic Brain Injury to Assess Biomaterial Based Regenerative Strategies
Authors: Basit R H , Jenkins S I , Chari D M 
Published: May 2021

Abstract

Introduction
Penetrating traumatic brain injury (pTBI) management is largely supportive, with no clinically established regenerative therapies. Neurocompatible biomaterials offer a high potential to promote regenerative mechanisms but facile, high throughput, pathomimetic in vitro pTBI models for the developmental testing of neuro-materials is lacking.

Method
A mouse mixed glial culture system was utilised within which penetrating injuries could be induced. DuraGen PlusTM – an FDA approved neurosurgical grade biomaterial could be implanted into lesions to assess cell-biomaterial responses. Reactive gliosis (astrocytic morphological responses/GFAP expression) and microglial infiltration (Iba1 expression) were assessed/quantified.

Results
Key pathological features of pTBI were observed in the model, with the ability to (i) introduce reproducible lesions (diameter 949 ± 26 μm) and (ii) for DuraGen PlusTM to be implanted into lesions. Peri-lesional astrocytes displayed hypertrophic palisading morphologies and GFAP upregulation, analogous to gliosis in vivo. Significant microglial numbers infiltrated the DuraGen PlusTM implant at 7 days post-lesion (132.41 ± 15.83 cells/mm2) versus lesion only (82.04 ± 5.11 cells/mm2), p &lt; 0.05).

Conclusions
We have developed a novel, neuropathomimetic pTBI model, wherein biomaterial implantation enables investigation of neural cell-biomaterial responses. This model can facilitate early-stage evaluation of novel biomaterials as high throughput, inexpensive and facile screening tool.
11 A Sequential Simulation Experience for Interim Foundation Doctors and Analysis of Preparedness to Practice Early
Authors: Ashcroft J , Havers N , Seebacher-Tomas A , Plesci E , Goh S , Hudson V 
Published: May 2021

Abstract

Introduction
Covid-19 necessitated the early graduation of medical students to join the healthcare workforce as Foundation Interim Year 1 (FiY1) doctors. A sequential simulation session was implemented to improve and assess FiY1 preparedness towards approaching deteriorating patients.

Method
12 FiY1 doctors participated in the session containing three sequential major stations: complex new admission, ward-based management, and acute deterioration. Participants interpreted investigations, performed examinations, created management plans, and escalated using a pager.

Results
There was a significant improvement in preparedness for giving treatment (median(IQR): pre-simulation 3(3-4) vs. post-simulation 4(4-4.75); p = 0.04) and paperwork (2(2-3.75) vs. 4(3.25-4.75); p = 0.03). Following four weeks of FiY1 participants demonstrated significant improvement in preparedness for giving treatment (median(IQR): pre-simulation 3(3-4) vs. post-FiY1 4.5(4-5); p = 0.01), communication and teamworking (4(3.25-4.75) vs. 5(5-5.75); p = 0.01), and paperwork (2(2-3.75) vs. 5(5-5); p = 0.01). The FiY1 programme improved integration within teams and facilitated training whilst medical school placements left participants feeling apprehensive and unprepared to practice.

Conclusions
This session provided an engaging method of increasing preparedness towards common challenges new physicians face. This study suggests future senior medical student apprenticeships should give the same investment, opportunities, and responsibilities as that of the FiY1 programme.
988 The Prevalence and Incidence of Gender Bias and Sexual Discrimination in Orthopaedics, and Mitigating Strategies: A Systematic Review
Authors: Elbayouk A , Halim U , Ali A , Javed S , Cullen C 
Published: May 2021

Abstract

Background
The aim of this systematic review was to outline the prevalence and impact of Gender bias and sexual discrimination (GBSD) in orthopaedics, and to investigate interventions countering such behaviours.

Method
Original research papers pertaining to the prevalence and impact of gender bias or sexual discrimination, or mitigating strategies in orthopaedics, were suitable for inclusion. PRISMA guidelines were adhered to in this review.

Results
Of 570 papers, 27 were eligible for inclusion. A total of 13 papers discussed the prevalence of GBSD, whilst 13 related to the impact of these behaviours, and 6 discussed mitigating strategies. GBSD were found to be prevalent in the orthopaedic workplace, with all sources showing females to be the victims. The impact of GBSD includes poor workforce representation, lower salaries, barriers to career progression, and reduced academic output for females in orthopaedics. Mitigating strategies in the literature are focussed on encouraging females to apply for orthopaedic training programmes, by providing female role models, mentors, and educational interventions.

Conclusions
GBSD are highly prevalent in orthopaedic surgery, impacting females at all stages of their careers. Mitigating strategies have been tested but are limited in their scope. As such, the orthopaedic community as a whole is obliged to do more to tackle GBSD.
199 Use of A 3D Hand-Held Scanner to Capture Trochlear Groove Shape, A Proof-of-Concept Study
Authors: Mistry J , Hing C , Harris S 
Published: May 2021

Abstract

Introduction
Trochleoplasty is a surgical procedure used to treat patellar instability through modifying the trochlear groove. Analysis of the groove with a hand-held scanner would enable accurate real time planning and facilitate tailor made correction. We aimed to measure trochlear depth, sulcus angle, trochlear facet ratio, trochlear angle and lateral trochlear inclination angle and establish inter- and intra-rater reliability for each knee model.

Method
The trochlear groove of the knee models was scanned by two investigators and 3D reference models created. These were surface matched and custom software along with Excel was utilised to determine the desired parameters. Intraclass correlation coefficient (ICC) was used for test-retest reliability and to determine which parameter results, for each model, showed the best reproducibility.

Results
There was good inter-observer reliability - trochlear depth (1.0 mm), sulcus angle (2.7°), trochlear angle (4.0°) and lateral trochlear inclination angle (4.0°), except in the trochlear facet ratio (32.0%) of one knee model. With outliers removed ICC was good-excellent in (46.7%) of measurements, with trochlear depth showing the best reproducibility.

Conclusions
This feasibility study showed that the hand-held scanner in conjunction with supporting software can measure trochlear parameters in a controlled environment and justifies extending research into its use in trochleoplasty.
3 Peer-Produced Induction Material for Foundation Year One Doctors in Plastic Surgery – A Quality Improvement Project
Authors: Dwyer-Hemmings L , Salfity L 
Published: May 2021

Abstract

Introduction
Induction programmes are recommended for all junior doctors starting new posts and are mandatory for foundation year one doctors (FY1s). Constraints on time and staff mean these guidelines are not always met. This project aimed to improve the efficiency, effectiveness, and timeliness of care by designing and distributing peer-produced induction material to FY1s starting placements in plastic surgery.

Method
A quality-improvement methodology was utilised. Online questionnaires assessed FY1 experiences in several domains using five-point Likert scales and free-text answers. This information was used to design induction material. Material was distributed to incoming FY1 cohorts, the questionnaire was repeated, and material updated and redistributed.

Results
Three quality improvement cycles were performed over a one-year period. Four FY1s were surveyed pre-intervention, and four post-intervention. Post-intervention, there was a statistically significant improvement in understanding of responsibilities (+2.2, p &lt; 0.01) and departmental structure (+2.0, p = 0.018). FY1s felt confident in starting (4.75±0.5), prepared for on-calls (4.75±0.5), and satisfaction was high (4.75±0.5)

Conclusions
Peer-produced induction material for FY1s can improve understanding of responsibilities and structure within a plastic surgery department. This will increase confidence of new starters and facilitate smooth transition of staff, enabling the provision of high-quality care by enhancing its efficiency, effectiveness, and timeliness.