bluuebunny/crossref_metadata_2025_split huggingface dataset:
812 Audit on Chest Drain Clinic: Are We Utilising the Service Effectively?
Authors: Binti Yusri N A , Abdelrahman R , Pimprikar S 
Published: August 2024

Abstract

Aim
The chest drain clinic service, under the Department of Thoracic Surgery, designed to provide follow-ups for patients discharged with ambulatory chest drains. This audit assessed the clinic's effectiveness in ensuring safety, regular reviews, and its impact on costs and bed utilization.

Method
A retrospective analysis of a one-year period identified 97 patients discharged home with ambulatory chest drains. Patients progress and complications assessed throughout their follow-ups. In addition, number of bed days saved along with service costs from the day of discharge to the day of chest drain removal were calculated and analysed.

Results
The study found that 64% of these patients required only one clinic visit before their drains were removed. This led to 60% reduction in inpatient admissions, resulting in a remarkable total of 1,038 saved bed days. There was substantial cost savings, totalling approximately £361,200 over the study period. These savings allowed the service to care for an additional 173 inpatients, generating potential income of £1,038,000 for the trust.
Furthermore, minimal number of 7.2% patients required re-admission due to complications such as pain, infection, or worsening surgical emphysema. These patients could re-enter care directly from the chest drain clinic, bypassing emergency department, thereby saving time and resources.

Conclusions
In summary, the chest drain follow-up clinic has demonstrated its effectiveness not only in patient safety and regular reviews but also in substantial cost savings, increased bed availability, and efficient re-admission procedures. This study highlights the significance of expanding and optimizing such services within healthcare institutions, benefiting both patients and healthcare providers.
852 Total Endovascular Aortic Arch Repair: Is It for Everyone and Where Is Its Evidence?
Authors: Hussain M , Jubouri M , Al-Tawil M , Tan S Z , Bashir M , Georgotellis A , Velayudhan B , Mohammed I 
Published: August 2024

Abstract

Background
Open total arch replacement (TAR) remains the mainstay management strategy for thoracic aortic arch pathologies. TAR evolved from the 2-stage conventional elephant trunk (CET) technique to the hybrid frozen elephant trunk (FET) which combined open surgical repair (OSR) with thoracic endovascular aortic repair (TEVAR) into a 1-stage procedure. Although FET has been able to achieve better outcomes than CET, it is still associated with complications requiring secondary reintervention. Consequently, FET is being overtaken by new generations of TEVAR devices for endoarch repair. Total endoarch repair (TER) is currently indicated in patients deemed high-risk for open surgery; however, it has shown strong potential for becoming the gold standard treatment for aortic arch pathologies. Therefore, this review aimed to highlight the evolution of aortic arch repair, focusing on TER device development, intervention criteria, and clinical outcomes.

Method
A comprehensive literature search of various databases (PubMed, Google Scholar, EMBASE, Scopus, and ResearchGate) was conducted and papers published as of July 2023 were included.

Results
Upon comprehensively searching the literature, the technical success of TER ranged from 91%-100%, mortality 0%-19%, stroke 0%-16.7%, and reintervention 0%-30.3%, using different commercially available endografts.

Conclusions
TER represents the future of aortic arch repair with comparable clinical outcomes to FET. Given its novelty, further studies with larger cohorts and longer follow-up periods are necessary. Additionally, studies directly comparing arch OSR to TER are warranted to determine superiority.
1189 Agenesis of Gallbladder - a Rare Condition with Common Symptoms
Authors: Feyang Limbu D , Shrestha K , Pal S , Shrestha A 
Published: August 2024

Abstract

Introduction
Agenesis of the gallbladder is a rare abnormality with an incidence of 0.01-0.06%. Although patients are asymptomatic, half of them can present with abdominal pain, particularly biliary colic. Women are affected more than men with a likelihood ratio of 3:1.

Case
This is a case of a 50-year-old lady who presented with recurrent symptoms and signs of biliary colic type pain. All her routine bloods including inflammatory markers, Liver Function Test and amylase were within normal limits. A combination of Transabdominal ultrasound (USG), CT scan, MRCP, HIDA scans concluded gallbladder agenesis without extrahepatic biliary atresia. Currently, she is being managed conservatively with analgesia and antispasmodics. She is undergoing investigations like gastroscopy to rule out other causes of her symptoms. She has been referred to tertiary centre for Endoscopic USG and Sphincter of Oddi (SOD) Manometry.

Discussion
It is interesting to see how such a rare condition presents with a typical biliary symptom. However, diagnosis begins by ruling out any structural causes for the pain with radiological investigations as mentioned above including endoscopic USG, ERCP and analysis of bile for crystals. Finally, SOD manometry performed to rule out any SOD dysfunction which also can present with similar symptoms. A combination of antispasmodic and simple analgesia is effective for management of symptoms.

Conclusions
Biliary colic symptoms are common with gallbladder agenesis. MRCP is effective investigation for diagnosis. Antispasmodic medication and simple analgesia are the treatment of choice.
8 IgG4-Related Sclerosing Disease of the Temporal Bone: A Systematic Review
Authors: Oochit K , Wong Y Y , Mihuna A , Oliwa A , Kontorinis G 
Published: August 2024

Abstract

Aim
IgG4-related disease (IgG4-RD) involving the temporal bone is an uncommon and underrecognized pathology often mistaken for malignancy. This systematic review is the first that aims to thoroughly analyse IgG4-RD of the temporal bone.

Method
The following databases (Ovid MEDLINE, EMBASE, Cochrane Library, and Google Scholar) were searched using the following keywords: "lgG4-RD," "skull," "skull base," "cranial," "temporal bone," "inner ear." The bibliographies of relevant articles were additionally manually searched. The JBI Critical Appraisal Checklist for Case Reports and Case Series was used to assess the risk of bias; because of the scarcity of the reports, data were available through limited case series and reports; thus, data synthesis was not possible.

Results
Seventeen studies with 22 cases of temporal bone involvement were included. The most common presenting symptoms were hearing loss, otalgia, and headache. The mastoid and petrous bone were the most affected anatomical areas. Both computed tomography and magnetic resonance imaging were used. Biopsies showed the characteristic lymphoplasmacytic infiltrate in all cases, with histopathology being the diagnostic modality that set the diagnosis. Most patients were treated with corticosteroids ± surgery or a combination of corticosteroids and immunosuppressants with 95.5% symptomatic response and disease control.

Conclusions
IgG4-RD of the temporal bone radiologically manifests as space-occupying, lytic lesions; clinically, it presents with vague otological symptoms. Diagnosis involves a thorough workup, with histopathology being crucial in setting a definite diagnosis. IgG4-RD tends to respond well to systemic corticosteroids, whereas surgery is mostly required for diagnostic purposes.
1140 Antibiotic Stewardship in Treating Glandular Fever Tonsillitis
Authors: Sood M , Elmarghani M , Misirovs R , Ganesh V 
Published: August 2024

Abstract

Introduction
Glandular fever is caused by Epstein-Barr virus. Antibiotics are not indicated in viral infections. A large number of patients who are hospitalised with sore throat will have Glandular fever with positive IM serology and be incorrectly treated with antibiotics without evidence of superimposed bacterial infection.

Aim
To assess the use of antibiotics in EBV positive patients with no signs of bacterial infection in NHS Lothian.

Method
A retrospective audit of 75 adult patients hospitalised with tonsillitis between August 2020 and July 2021. Data on diagnosis, inflammatory markers, EBV serology, and antibiotic use were collected and analysed. This was compared to previously reported NHS Tayside 4-year data between 2017 and 2020.

Results
Of the 75 tonsillitis admissions, 28% were IM Positive. Of these, 86% were discharged on antibiotics despite no evidence of concomitant bacterial infection. Similar figures were noted in NHS Tayside.

Conclusions
Glandular fever seems to be managed with antibiotics which goes against current best practice. Local and national ENT guidelines need to be updated and created, respectively.
1280 The Role of Antibiotics in Diverticular Bleeding
Authors: Al-Hashemi S , Davis C , Heneghan H , Fearon N 
Published: August 2024

Abstract

Aim
Diverticular disease is a leading cause of lower gastrointestinal bleeding. The management of diverticular bleeding varies between surgeons. Evidence has shown that omission of antibiotics for the first presentation of uncomplicated acute diverticulitis is sometimes safe. We sought to identify trends that may suggest the same is true in patients presenting with diverticular bleeding.

Method
This was a retrospective cohort study. The Hospital Inpatient Enquiry coding system was used to identify patients presenting to our hospital with diverticular bleeding without colonic perforation requiring hospitalisation between the period. Data were then collected regarding demographics, initial blood results, inclusion or omission of antibiotic therapy, need for inpatient endoscopy, length of stay, need for surgery and readmission within 30 days with re-bleeding.

Results
34 patients were identified, roughly 3/4 of whom were female. The average age was 75 years old (Standard Deviation +/- 13) and the median duration of bleeding before presentation was 24 hours. The mean haemoglobin was 11.5 grams/decilitre (SD +/-2) and mean white cell count was 10.4 (SD +/- 4). Median C reactive protein was 8.2 (range 1 - 209) 18/34 patients were prescribed antibiotics and had a mean length of stay of 4.8 days. Those in whom antibiotics were omitted had a mean length of stay of 3.7 days. There were 19 inpatient endoscopies undertaken, none of which resulted in any endoscopic intervention. Only 1 patient was readmitted within 30 days with rebleeding.

Conclusions
This study suggests omission of antibiotics in patients presenting with diverticular bleeding may be safe in select circumstances.
422 Does Surgeon Age Influence the Outcome of Emergency Laparotomies? a Single Centre Retrospective Study
Authors: Behera K , Hargest R 
Published: August 2024

Abstract

Aim
In the United Kingdom, over 20000 emergency laparotomies are performed annually and reported in the National Emergency Laparotomy Audit (NELA). Although the mortality rate after emergency laparotomy has fallen recently, it is still significantly higher than elective surgery. Many studies have assessed the correlation between patient factors and institutional provisions against emergency laparotomy outcomes. However, there is limited evidence for the influence of surgeon related factors. To assess the influence of surgeon age on mortality rate for patients undergoing emergency laparotomy.

Method
Data was collected from NELA (2014–2018). Operations performed by surgeons who were locums, non-consultants or from a speciality outside of general, vascular or transplant surgery, and those with missing data were excluded. Surgeon age &lt;50 or &gt;50 years were compared to 30-day, 60-day, 90-day and 1-year mortality.

Results
In total, 1147 patients were included and 264 (19%) excluded for the reasons listed above. There was no significant difference in the mean 30-day, 60-day, 90-day and 1-year mortality between the groups. The mean mortality rates for &lt;50 years (&gt;50 years) were 11.60% (11.80%), 14.70% (14.60%), 15.00% (14.80%) and 15.20% (15.00%) respectively (p=0.44). Surgeons aged &gt;50 years had a 10% decrease in overall mortality rate compared to 4% for the &lt;50 group. There was a significant difference in patient demographics between the two groups as the &gt;50 group had a higher risk caseload (p=0.02).

Conclusions
Overall mortality after emergency laparotomy was not related to surgeon age but older surgeons undertook higher risk cases.
383 Assessing Knee Pain Following Intramedullary Nailing for Tibial Shaft Fractures: Retrospective Analysis of Patient Outcomes at Single High Volume Major Trauma Centre
Authors: Dangata K , Murphy L , Rooney B 
Published: August 2024

Abstract

Aim
The primary objective of this study is to use proven patient reported outcome measurement (PROM) tools to compare knee pain and function between the two approaches.

Method
This single centre retrospective study identified all patients who underwent IM nailing of the tibia between January 2020 – February 2023 in the Queen Elizabeth University Hospital Glasgow. The patient cohort was divided into those who received an SPN versus an IPN. The outcomes were assessed using the Oxford Knee Score and Kujala scores.

Results
After applying exclusion criteria, our study comprised 93 patients, from whom we obtained 50 responses (23 IPN vs 27 SPN) and the mean patient age was 47. No statistically significant disparities in patient demographics were observed between the 2 groups. The mean Oxford Knee score in the SPN group was 34.5 compared to 38.3 the IPN group. The mean Kujala score was 67.6 in the SPN group versus 73.3 in the IPN group. Using a two-tailed student’s T test we concluded that the pain scores from both Oxford knee score and Kujala Knee were not significantly different between the SPN and IPN group.

Conclusions
Based on our analysis the outcomes in anterior knee pain between the IPN and SPN group are comparable. It is recommended to continue using suprapatellar tibial nailing technique for treating tibial shaft fractures at our institution. A larger scale powered study is required assess its superiority over the IPN procedure for anterior knee pain.
652 Inspiring Future Surgeons - Exploring Influences on Year 3 UK Medical Students' Interest in Surgical Specialties: A Thematic Analysis
Authors: Kaur H K , Alakus C A , Elsherbiney S , Khera G 
Published: August 2024

Abstract

Aim
UK surgical training is recognised for its demanding nature, extensive working hours, stressful environment, and prolonged training. We aimed to identify positive factors influencing medical students in considering a surgical career, to shape surgical educational placements.

Method
An optional, anonymous, single-question, open-text survey was administered to 190, year 3 UK medical students, after completing a 11-week surgical clinical placement, comprising Breast, Emergency Department, Interventional Radiology, Orthopaedics, Peri-op anaesthetics, Plastics, Vascular, Upper/Lower GI and Urology. The specific question asked was, 'Would you contemplate pursuing a career in surgery?' Subsequently, a qualitative analysis focused on responses from participants expressing interest in a surgical career, utilizing a thematic approach to categorize and identify common patterns.

Results
102 responses were received of which 35 were not suitable for analysis. Among the remaining 67 students, 37 (55.2%) demonstrated a positive inclination towards a surgical career. Following thematic analysis four main themes were identified:Encountering positive role models within field of surgeryHands-on practical nature of surgeryPositive influence of recent surgical placementPre-existing surgical interest
There was also evidence that some student’s had changed their minds, reporting they were ‘inspired and pleasantly surprised, despite being apprehensive about surgery before starting placement’.

Conclusions
To increase recruitment to surgical specialities and improving surgical placement satisfaction requires positive engagement with diverse surgical specialties, gaining hands-on experience in a supportive environment, with inspiring surgical role models. Our study sheds light on the areas where medical schools and surgeons should tailor educational strategies to inspire future surgeons.
1070 Intraoperative Identification of Glioblastoma Multiforme Using Label-Free Optical Biosensors and Refractive Index Sensing
Authors: Balaji A , Suvarna R , Ovalekar R , Musa M , Chauhan M 
Published: August 2024

Abstract

Aim
Glioblastoma multiforme is the most prevalent brain tumour, with a high recurrence rate due to the lack of quality and cost-effective imaging techniques. Thus, our study aims to explore application of biosensors as a potential non-invasive, low-cost and highly specific means of identifying GBM cells intraoperatively utilising differences in refractive indices of tissue imprints obtained.

Method
A literature search was performed on Medline OVID, PubMed and Google Scholar with keywords including ‘glioblastoma’, ‘biosensor’, ‘refractive index’ and ‘glutamate’.

Conclusions
Splicing pattern alterations and downregulation of canonical isoforms of Glial Fibrillary Acidic Protein (GFAP) are pivotal in glioma progression. Glutamate dysregulation in glioblastoma (GBM) is emphasised by GLAST (glutamate aspartate transporter) activity. GLAST, vital for extracellular glutamate homeostasis, is dependent on the Na+/K+-ATPase electrochemical gradient. GBM cells exhibit compromised glutamate uptake due to GLT-1 absence, influenced by oncogenes such as AEG-16, and aberrant GLAST localization in the nucleus. Neurophotonics and spectroscopy methods show promise in distinguishing between GBM and healthy brain parenchyma, however they are limited by cost. A prospective study revealed high specificity with gold imprinting biosensors in identifying GBM tissue with refractive index 1.350, warranting investigation into the differences in the interaction of GFAP and GLAST proteins with light via spectroscopic techniques which could provide better intraoperative guidance. A potential methodology could involve refractive index sensing with “label-free optical sensors to detect biomolecular interactions” with GFAP and GLAST proteins using transmitted diffraction patterns.
716 Analysis of Routine Endoscopy Referrals in NHS Greater Glasgow and Clyde
Authors: McElvaney J , Irving A , Lawton A , Sabir S , Glen P 
Published: August 2024

Abstract

Aim
Routine (category 3/4) upper gastrointestinal endoscopies (UGIE) constitute a significant proportion of endoscopy workload in NHS Greater Glasgow and Clyde (GGC). Referrals are varied and there are opportunities for service improvement to reduce clinician burden and patient outcomes. This is with particular relevance to early detection and prevention of cancer. This work aimed to analyse routine UGIE referrals and subsequent scopes within GGC to identify quality improvement opportunities, potentially including endoscopy-saving alternatives such as Cytosponge.

Method
Referral indications for 299 males over 50 years awaiting routine UGIE in GGC on 02/03/2023 were reviewed. Referrals were categorised into 6 groups based on primary presentation. Data on findings, biopsy and follow-up were gathered where UGIE was subsequently performed.

Results
299 patients were analysed; 197 received UGIE (4 had no available scope report), 77 remained waiting, 25 had died/not attended/declined UGIE. Primary referral presentations were 13% Oesophageal; 29% Gastric; 10% Anaemia; 28% Liver/variceal; 14% Dysphagia; 6% other (n=299). At UGIE, 10% (n=193) identified pre-/malignancy across all groups; there were 3 cases of new malignancy. 75% (n=193) received medical/conservative management following their scope and 22 cases could have been reassured using Cytosponge.

Conclusions
There are opportunities for improved routine UGIE delivery in GGC which may reflect nationally. These include altered vetting practices and potential UGIE-saving procedures. Notably, there was no Barrett’s oesophagus rich group within this cohort.
36 The Duration of Postoperative Antibiotics in Autologous Breast Reconstruction: A Systematic Review and Meta-Analysis
Authors: Aldarragi A , Farah N , Warner C , Ghasemi A , Ekakitie O , Jabr Y , Rahman S 
Published: August 2024

Abstract
Although prophylactic antibiotic use following autologous breast reconstruction post-mastectomy is a common practice, there is no consensus in the literature regarding its duration. Antibiotic stewardship is important to minimise multi-resistant organisms as well as mitigate the associated side effects. Currently, there are no published guidelines regarding the duration of prophylactic antibiotics in autologous breast reconstruction surgery following mastectomy. The authors searched the online literature regarding the administration of antibiotics for autologous breast reconstruction surgery post-mastectomy. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. The primary outcome measure was the incidence of surgical site infections (SSIs). Three studies met the inclusion criteria and included a total of 1,400 patients. Overall, 101 (7.2%) SSIs were observed. There was no significant difference in the rate of SSIs when comparing the use of antibiotics for less than or longer than 24 hours postoperatively (odds ratio = 1.434, p = 0.124). There is no significant difference between SSIs with the use of antibiotics for longer than 24 hours when compared to less than 24 hours. Further studies in the form of randomised controlled trials are required to assess the effects of prophylactic antibiotic duration in autologous breast reconstruction following mastectomy.
335 Investigating of the Utilisation of Botulinum Toxin Type-a in of Breast Reconstructive Surgery: A Literature Review
Authors: Cui X M , Lim J S , Wai J , Mosahebi A 
Published: August 2024

Abstract

Aim
Breast malignancy remains a serious and debilitating disease, with numbers increasing every year. Previous research found that botulinum toxin type A (BoNT-A) can be used in various aspects in plastic and reconstructive surgery, and that BoNT-A can be applied in many non-aesthetic surgeries. This review aims to investigate the efficacy of BoNT-A on improving outcomes for flap reconstruction of the breast in women in the past 5 years.

Method
A systematic review approach of Medline, Embase, PubMed and Cochrane Register of Controlled Trials (CENTRAL) identified 5 publications after the application of selection criteria.

Results
The literature was assessed based on pain attenuation, scar prevention, muscular contracture and muscle spasms. Only scar reduction was clinically relevant, with mean total POSAS scores between the intervention (15.17±7.6, p=0.034) and control (13.04±5.44, p=0.034) at the 9-month follow-up.

Conclusions
There is evidence supporting the use of BoNT-A in scar reduction for breast reconstruction, however, no additional benefits were identified.