bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Healthy User Effect in Pharmacoepidemiology
Authors: Olawore Oluwasolape , Stϋrmer Til , Glynn Robert J , Lund Jennifer L 
Published: September 2024

Abstract
The healthy user effect is a well-recognized bias in the field of pharmacoepidemiology and can be expected to overstate the effect of a preventive intervention when comparing long term users or “adherers” to non-users. Similar to the healthy worker effect observed in occupational epidemiology, the healthy user effect can be separated into a healthy initiator effect (baseline confounding) and a healthy adherer effect (selection bias). Restriction approaches and new user designs that implicitly condition on the indication and, similar healthy behaviors or health status can often mitigate the healthy initiator effect (confounding) or healthy adherer effect (selection bias) at the start of a study. Addressing the healthy adherer effect due to continued conditioning on adherence over the duration of a study is more challenging as methods to mitigate it require the ability to predict adherence, which is often difficult using databases common in pharmacoepidemiologic research. Here, we describe the healthy user effect, with supporting examples, and describe study design approaches available to pharmacoepidemiologists to mitigate the potential for bias.
The Clinical Implication of Nocturia in Predicting Hypertension Among Working-Aged Koreans
Authors: Park Sung Keun , Oh Chang-Mo , Ryoo Jae-Hong , Jo Hyun chul , Kim Eugene , Jung Ju Young 
Published: September 2024

Abstract

BACKGROUND
Evidence has indicated that nocturia is a clinical manifestation of adverse health conditions, including cardiovascular diseases and metabolic disorders. However, previous studies are less available for the clinical implication of nocturia on the development of hypertension.

METHODS
Study participants were 32,420 working-aged Koreans (21,355 men and 11,065 women) who periodically received health checkups. They were categorized into 4 groups by the frequency of nocturia (never, &lt;1, 1–2, and ≥3/week). We used Cox proportional hazards models to analyze the multivariable-adjusted hazard ratio (HR) and 95% confidence intervals (CIs) for incident hypertension (multivariable-adjusted HR [95% CI]) in relation to the frequency of nocturia. Subgroup analysis was conducted by gender and sleep quality (good and poor sleep quality).

RESULTS
In women, nocturia was associated with an increased risk of hypertension, compared with never nocturia (HR [95% CI]; never: reference, &lt;1/week: 1.33 [1.10–1.60], 1–2/week: 1.26 [1.00–1.58], and ≥3/week: 1.34 [1.05–1.72]). This association was not observed in men (HR [95% CI]; never: reference, &lt;1/week: 1.00 [0.93–1.08], 1–2/week: 1.00 [0.88–1.12], and ≥3/week: 1.06 [0.94–1.23]). In subgroup analysis by sleep quality, only women with good sleep quality showed an association between nocturia and the risk of hypertension. However, women with poor sleep quality and men did not show an association between the frequency of nocturia and the risk of hypertension.

CONCLUSIONS
Nocturia is a potential risk factor for incident hypertension in working-aged women with good sleep quality.
XII—The Ethical Problem of Evil
Authors: Watts Daniel 
Published: September 2024

Abstract
I introduce a distinct challenge to religious belief: the Ethical Argument from evil. By this argument, paradigmatic forms of religious practice constitutively involve failures of ethical acknowledgement with respect to the reality of evil. I show how standard discussions of the problem of evil, as a purely logical or epistemic issue, abstract away from its fundamentally ethical dimensions. Drawing on an analogy with Moore’s paradox, I argue that the Ethical Argument presents a genuine theoretical problem, not merely a practical or pastoral one: the problem of how religious devotion can be compossible with properly acknowledging the reality of evil. I further argue that, in order properly to address this problem, the philosophy of religion needs to take a phenomenological turn. To illustrate this approach, I focus on the case of thankful prayer and draw out from Kierkegaard’s writings a religious ideal of unconditional gratitude. Developing the relevant notion of a failure of ethical acknowledgement in terms of two vices—wishful self-deception and spiritualized self-absorption—I show how Kierkegaard’s account can help us to assess whether expressions of religious devotion are objectionable on these grounds.
The Use of Tranexamic Acid in Breast Reduction and Abdominoplasty: A Review of a Multicenter Federated Electronic Health Record Database
Authors: Habarth-Morales Theodore E , Isch Emily , Zavitsanos Alexander P , Wride Wesley M , Davis Harrison D , Rios-Diaz Arturo J , Broach Robyn B , Fischer John P , Serletti Joseph M , Azoury Said C , Jenkins Matthew 
Published: September 2024

Abstract

Background
Tranexamic acid (TXA), a fibrinolysis inhibitor, is widely used in various surgical fields to minimize blood loss. However, its efficacy and safety in plastic surgery, especially in reduction mammaplasty and abdominoplasty, remain underexplored. This study investigates the utility of intravenous (IV) TXA in these procedures, focusing on reducing postoperative complications and evaluating its safety in the context of venous thromboembolism (VTE).

Objectives
To evaluate the efficacy and safety of TXA in reduction mammaplasty and abdominoplasty.

Methods
Using data from the TriNetX LLC (Cambridge, MA) National Health Research Network database, this retrospective study compared adult patients undergoing reduction mammaplasty or abdominoplasty who received intraoperative IV TXA against those who did not. Primary outcomes included postoperative seroma and hematoma incidences, whereas secondary outcomes assessed the necessity for procedural drainage and the occurrence of VTE within 1-year postsurgery.

Results
No significant differences in the rates or risks of hematoma, seroma, or the need for procedural drainage between patients administered IV TXA and those who were not, for both reduction mammaplasty and abdominoplasty. Additionally, IV TXA did not increase the risk of VTE in either patient group.

Conclusions
IV TXA application in reduction mammaplasty and abdominoplasty does not provide added benefits in reducing postoperative complications such as seroma, hematoma, or the necessity for procedural drainage. Furthermore, it does not alter the risk of thromboembolic events. These findings highlight the need for further research, particularly through randomized control trials, to understand TXA's efficacy in plastic surgery.

Level of Evidence: 3 (Therapeutic)
SP2.10 - Early outcomes with the Insides Chyme Reinfusor (ICR) device in the management of parenteral nutrition dependent high output stomas (PN-HOS)
Authors: Mohammed Rifat , Travers Angela , Slater Colette , Cotgrave Amy , Wilson Jeremy , Magee Conor 
Published: September 2024

Abstract

Aims
PN-HOS represent a complex challenge, requiring input from surgical, gastroenterology and nutritional teams. Length of stay (LOS) is prolonged with difficulties in achieving output control and adequate nutrition with other associated risks.
ICR is a modified stoma bag/mechanical pump and catheter device, reinfusing chyme into the distal limb, maintaining gut continuity, preserving enteral nutrient absorption and preventing distal limb atrophy. ICR may accelerate establishment of nutritional autonomy and reduce costs associated with PN/LOS.
We report the largest study of ICR outcomes

Methods
Prospective study of ICR outcomes in patients with PN-HOS. Analysis included LOS, duration of PN, establishment of nutritional autonomy, nutritional markers, adverse ICR effects.

Results
Sixteen patients were trained to use the ICR (6M:10F). Median age 60yr.
75% achieved independent use (median 5.6 days). Overall usage was 395 days (median 32 days). Nutritional autonomy achieved in nine patients (pre-reversal). ICR increased median albumin 10.5 g/l.
Adverse events included changing difficulties, spillage, noise, and discomfort.
Two patients discontinued ICR because of pain/reflux. One patient died from unrelated post-operative complications.
One patient with multiple loop stomas was successfully established on dual ICR.
Nursing experience with ICR demonstrated ease of use and straightforward patient education.
Cost analysis PN £5000/mth v ICR 1800/mth.
Anecdotally at the time of reversal, surgical opinion was of much favourable bowel for anastomosis and return to function.

Conclusions
The ICR device is safe and contributes to restoration of nutritional autonomy. It reduces PN dependence with cost-benefits and acceptable adverse effects. At time of initial surgery distal limb should be fashioned to allow potential use of ICR.
SP3.12 - Effect of Anticoagulants on Faecal Immunochemical Tests (FITs) in Bowel Cancer Screening
Authors: Maleki Aryan , Iacob George , Chandran Palanichamy 
Published: September 2024

Abstract

Background
Bowel cancer screening in the United Kingdom is based on the faecal immunochemical test (FIT). Eligible participants sometimes use anticoagulants which may stimulate bleeding from benign lesions affecting the screening performance of FITs for colorectal cancer. We aimed to evaluate the effectiveness of FITs in screening for colorectal cancer for patients taking anticoagulants.

Methods
This was a retrospective study of FIT positive patients on anticoagulation who underwent colonoscopy or CT colonoscopy between October 2022 and June 2023. The threshold for a FIT positive result was 150µg Hb/g of faeces for asymptomatic patients and 10µg Hb/g of faeces for symptomatic patients. Histology reports were reviewed for the presence of colorectal neoplasms and advanced adenomas (defined as adenomas with high-grade dysplasia, villous histology, or ≥10mm in size).

Results
A total of 57 patients were included- 38 used a direct oral anticoagulant (DOAC), 3 used warfarin, 15 used clopidogrel or ticagrelor, and 1 used dabigatran. Colorectal cancer was identified in 8.8% of individuals (5 out of 57) and advanced adenoma in 17.5% of individuals (10 out of 57). Use of anticoagulants was associated with a positive predictive value for advanced neoplasia (PPVAN) of 26.3%.

Conclusion
FIT accuracy as a surrogate marker for advanced neoplasia was not affected by the use of anticoagulants when compared with the current literature. Suspension of anticoagulation prior to FIT screening is not recommended. Further studies investigating the dosage and class of anticoagulation on FIT accuracy for bowel cancer screening may be warranted.
SP4.12 - A single centre experience of managing patients admitted for elective Nissen’s Fundoplication as a day case procedure
Authors: Carey Charles , James Stuart , Richardson Gemma , Jaunoo Shameen 
Published: September 2024

Abstract

Aims
Laparoscopic Nissen’s fundoplication (LNF) is an elective procedure used to treat gastro-oesophgeal reflux which cannot be managed effectively with medical and conservative methods. LNF is the most common surgical procedure used to treat reflux in the UK and optimising the discharge process for these patients can therefore prevent excessive admission times for many patients. This study aimed to analyse the success of LNF as a day case procedure in a tertiary centre.

Methods
The notes from patients who underwent LNF between January 2020 and December 2023 were retrospectively reviewed. The demographics, co-morbidities and the rates of readmission and complications of the patients included were noted. All patients were managed following local and national surgical, anaesthetic and nursing guidelines.

Results
67 patients underwent LNF within the time frame studied, each of which were initially planned to be kept in hospital overnight. 41 (61.2%) cases however, were considered to be medically safe for discharge as a day case operation. None of the patients studied required readmission or suffered any complications despite this change in their care plan.

Conclusions
This single centre experience showed that patient safety was not compromised by encouraging LNF as a day case procedure in selected patients. Day-case protocols should therefore be considered for patients undergoing LNF who have no/few major co-morbidities and can be looked after at home post-operatively in order to reduce healthcare costs and maximise bed space availability.
SP6.5 - The NHS's value-based funding model for organ transplantation achieves superior equity and outcomes vs global peers
Authors: Sharma Hemant , Millward Alex , Mehra Sanjay , Sharma Abhishek 
Published: September 2024

Abstract

Introduction
Value-based practice is gaining traction as a way to control costs, improve patient satisfaction, and increase provider accountability. The rising prevalence of end-stage organ disease contrasts with limited donor organs, necessitating maximising equitable access, clinical outcomes, and appropriate cost control. We compare key kidney transplant metrics across the UK, US, and Canada.

Methods
Parameters analysed from the 2010–2022 national registries include: (1) Policy-components, (2) Transplant rates per million population; (3) 1-5 year survival, (4) Median waiting times, (5) Average cost per patient. Inequality was assessed using the Gini-index and concentration-curves.

Results
The UK NHS funded &gt;1000 kidney-transplants in 2021 under standardised pricing and coordinated care. This enabled 98% one-year patient survival, 7 percentage points higher than in the US and Canada. The median kidney waiting time is 54% lower than in Canada. The UK transplantation rate per million increased by 25% over the decade, versus a 3% rise in the US and Canada. The Gini index is 0.03 in the UK, indicating highly equitable access, versus 0.11 in the US. Average transplant costs per patient are nearly 85% lower in the UK ($130,000) than in the US ($830,000).

Conclusions
The integrated funding and oversight model has facilitated access, survival, and sustainability gains on kidney transplantation for the UK NHS system versus lagging peer countries. Continued value optimisation remains necessary to tackle trade-offs.
High-Level Structural Comparison ParameterUnited-KingdomUnited-StatesCanadaKey Payer(s)Single: NHSMedicare, Medicaid, PrivateSingle: Provincial-plansUse of Quality-MetricsYesPartialIn ProgressPricing ModelNational-TariffFragmentedProvincialRegulatory-OversightCentralizedVariableProvincial
SP6.8 - Predicting Determinants of Successful Transplantation Using Supra-Marginal (DRI-Donor Risk Index &gt;1.5) Deceased Donor Kidneys
Authors: Sharma Hemant , Sharma Abshishek , Al-Amiedy Zaid , Devkaran Bhavesh , Mehra Sanjay 
Published: September 2024

Abstract

Objective
To develop machine-learning-models with national registry data to predict factors associated with favourable outcomes using supra-marginal ( DRI -Donor Risk Index &gt;1,5) deceased donor kidneys

Design
A retrospective cohort study using UK Transplant Registry data from 2000-2019

Setting
National registry administered by NHS Blood and Transplant in the United Kingdom.

Participants
Adult recipients (n = 6254) of first kidney-alone transplants from very supra-marginal deceased-donors (DRI≥1.5)

Main Outcome Measures
Death-censored graft failure and patient mortality

Predictors
Comprehensive recipient, donor, and transplant characteristics.

Statistical Analysis
Bayesian neural networks, gradient boosting machines, random forest, and SMOTE-balanced bagging classifiers tuned using Bayesian optimisation Cox regression, competing risk analysis, and calibration plots

Results
Overall 5-year graft survival was 81%. The random-forest-model had excellent predictive performance for graft failure (AUC 0.88, 95% CI 0.87-0.89; RMSE 0.29). recipient age &gt; 75-years (SHR 1.02, 95% CI 1.01-1.03), recipient-BMI &gt;30 (SHR 1.04, 95% CI 1.02-1.07), HLA mismatches &gt;4 (SHR 1.09, 95% CI 1.01-1.17), donor-creatinine &gt;120mmol/L (SHR 1.002, 95% CI 1.001-1.003), and rejection- within 3-months (SHR 1.56, 95% CI 1.32-1.85) were key determinants of poor survival. Prolonged cold-ischemia-time &gt;14hrs (SHR 1.01, 95% CI 1.007-1.015) was detrimental

Conclusions
Supra-marginal deceased-donor-kidneys can achieve excellent 5-year outcomes with careful recipient selection. Machine-learning accurately predicted factors associated with success.
Adjusted predictors of graft failureVariableSHR95% CIp-valueRecipient-age &gt; 75 years1.021.01-1.03&lt;0.001Recipient-BMI &gt;301.041.02-1.070.002HLA-mismatches &gt;41.091.01-1.170.03Creatinine at offer &gt;120 mmol/L/ 1.4 mg/dl1.0021.001-1.003&lt;0.001Rejection at 3 month1.561.32-1.85&lt;0.001Cold-ischemia-time &gt;14 hrs1.011.007-1.015&lt;0.001SHR: subdistribution hazard ratio;
SP6.12 - Do Pregnant Females Experiencing Physical Traumatic Injury have Different Mortality Outcomes Compared to Non-pregnant Females? A Systematic Review and Metanalysis
Authors: Thorne Elizabeth , Cole Elaine , Hess Emily , Rappoport Jacqueline , Thumbadoo Ruben , Shepherd Joanna 
Published: September 2024

Abstract

Aims
To collate and analyse literature capturing mortality rates in pregnant and non-pregnant individuals of childbearing age who experienced physical trauma. Additionally, to identify any statistically significant differences in interventions received.

Methods
Comprehensive searches of PubMed, MEDLINE, and grey literature were conducted using MeSH terms. Data extraction by two independent reviewers was followed by quality assessments using the Newcastle-Ottawa Scale. A random effects meta-analysis assessed the effect of pregnancy on mortality post-physical trauma, employing risk ratios (RR) and 95% confidence intervals. Publication bias was evaluated through linear regression, Eggers test, and funnel plots.

Results
Twelve studies met eligibility criteria, yielding 1,113,376 pregnant and 18,185,789 non-pregnant females of childbearing age who experienced physical trauma. Low publication bias was observed. Pregnant females demonstrated a 35% mortality reduction vs. non-pregnant females (pooled RR: 0.65 [0.47-0.89], p=0.008), though significant heterogeneity existed across studies (I2 = 77%). A subgroup analysis focusing on mechanism of injury found the mortality reduction in pregnancy increased to 59% in motor vehicle accidents (pooled RR = 0.41 [0.32-0.52], p&lt;0.001) with minimal study heterogeneity (I2 = 0%). Pregnant (vs. non-pregnant) females were less likely to be intubated (pooled RR = 0.69 [0.58, 0.81], p=&lt;0.001, I2 = 9), but there were no other significant differences in the types of intervention received.

Conclusions
Pregnant females have a lower mortality risk from physical trauma than non-pregnant counterparts, particularly where the mechanism of injury is a motor vehicle accident. Additional research is warranted to elucidate the underlying factors contributing to this observed difference.
SP7.10 - Awareness and Knowledge of Medical Coding Education Amongst Vascular Surgeons: A National Survey
Authors: Dhahri Adeel Abbas , Seabrook Max , Rao Ahsan , Darwish Nourelhuda , Essa Nazar , Rajagopalan Sriram 
Published: September 2024

Abstract

Aims
Accurate medical coding plays a critical role in optimising healthcare delivery, facilitating appropriate reimbursement, supporting research and data analysis, and providing a foundation for public healthcare databases and policies. This survey aims to explore the familiarity and comprehension of medical coding among vascular surgeons.

Methods
Ninety-five responses were gathered from participants across diverse levels of vascular surgery. A notable 77.7% (n=73) of respondents indicated a lack of formal training in medical coding. Additionally, 70.5% (n=67) of vascular surgeons advocated for including medical coding within surgical training programs. Regarding assessing medical coding proficiency, 61.1% (n=55) correctly identified ‘BSS’ as an example of non-medical coding classification. Moreover, 67.7% (n=63) accurately recognised ‘OPCS-4’ as the classification system employed by the NHS for coding surgical procedures.

Results
Ninety-five questionnaire responses were collected from participants working in vascular surgery of various levels. A notable 77.7% (n=73) of the participants reported receiving no formal training in medical coding. Additionally, 70.5% (n=67) of vascular surgeons expressed that medical coding should be included in surgical training. Regarding assessing medical coding knowledge, 61.1% (n=55) of respondents correctly identified ‘BSS’ as the non-example of medical coding classification. When asked about the classification system used by the NHS to code surgical procedures, 67.7% (n=63) correctly identified ‘OPCS-4.’

Conclusion
The study's findings reveal the need for more awareness, knowledge, and formal training in medical coding. Augmented education and training in medical coding, potentially through concise courses, are imperative for ensuring equitable reimbursement for healthcare services, facilitating data analysis for research and quality enhancement endeavours, and fostering effective inter-professional communication within the healthcare domain.
SP9.9 - Psychological recovery after emergency laparotomy; Giving patients Grief
Authors: Silva Louise , Smith Laurie , Watts Tessa , Bisson Jonathan , Jared Torkington , Cornish Julie Ann 
Published: September 2024

Abstract

Aims
Recent work demonstrated 8% of emergency laparotomy (EmLap) survivors were referred to mental health following surgery, suggesting it carries a significant psychological burden.
This exploratory work aims to describe patients’ psychological response 1 year after EmLap using a qualitative approach.

Methods
POLO is a prospective cohort multicentre, mixed methods study on EmLap patients. (IRAS 301310, ClinicalTrials.Gov NCT05281627). Purposive sampling identified a subgroup to undergo 2 semi-structured interviews at 6 and 12-months post-discharge, either in person/videoconferencing, using a pre-formulated topic guide. Interviews were recorded, transcribed verbatim, and analysed using Braun and Clark’s six-step approach.

Results
12 participants provided interviews at both time points. 75% were female; average age was 52 years. Patients underwent significant psychological adjustment following EmLap, similar to the Kuber-Ross Grief Reaction model; transitioning through shock, anger, bargaining, depression to eventual acceptance. Patients’ recollection of early response was disbelief, followed by anger towards their care. Bargaining centred around having restorative surgery. Depression was exacerbated by physical issues; fatigue, stoma stigma and ongoing medical treatment. Most patients reached acceptance stage by the 12-month interview.

Conclusion
This is the first study to describe the psychological response following EmLap. This work parallels the psychological response with other significant traumatic events, such as grief. These findings may suggest that the negative effect on patients’ mental health following surgery, observed by an increase in referral, are part of a “normal” trajectory, rather than pathological. More work is needed to understand how, and when, the response becomes problematic to functioning and long-term wellbeing.