bluuebunny/crossref_metadata_2025_split huggingface dataset:
1234 Optimising Vitamin D and Calcium Management in Thyroidectomy Patients
Authors: Yussuf B , Tharakaran N , Roderick M , Thomas L 
Published: July 2024

Abstract

Aim
The study aimed to investigate the causes of temporary postoperative hypocalcemia and strategies for correction. Objectives included assessing the impact of preoperative trust guidelines on detecting and managing Vitamin D deficiency in thyroidectomy patients and analyzing its correlation with postoperative hypocalcemia at Northampton General Hospital.

Method
A three-cycle audit analyzed 16, 12, and 8 cases, respectively, encompassing total and completion thyroidectomies at NGH. Collaborative development of standardized trust guidelines involved the ENT Team, Endocrinology, and Pharmacists. Data collection covered various parameters, and departmental teachings were conducted to educate the team on the new guidelines.

Results
Thyroidectomy indications included Graves's disease, large Multinodular Goitre, and malignancy. In the third cycle, all patients underwent preoperative Vitamin D checks, aligning postoperative hypocalcemia with the national range. Our interventions increased preoperative Vitamin D checks from 56% to 100%, reducing deficiency from 25% to 0%. Postoperative hypocalcemia decreased from 56% in Cycle 1 to 8.3% in Cycle 2 and 12.5% in Cycle 3. Long-term hypoparathyroidism dropped to 0% in Cycle 3, with no correlation between surgeon technique or indication and postoperative hypocalcemia.

Conclusions
The introduction of preoperative guidelines significantly enhanced Vitamin D deficiency detection, substantially reducing postoperative hypocalcemia. This underscores the positive impact of standardized protocols on patient care. Future efforts involve re-auditing with the involvement of junior doctors to ensure continuous enhancement in clinical practice.
166 A Retrospective Observational Study on Laparoscopic and Open Hernia Repairs at a Single Centre
Authors: Madhusudanan Pillai G , Girijavallabhan Nair P 
Published: July 2024

Abstract

Aim
To compare Laparoscopic and open hernia repairs in terms of patient management and post operative complications was collected and compared against the existing standards regarding management of hernias.

Method
A retrospective observational study of all emergency and elective, laparoscopic and open inguinal hernia repairs that were performed during the years 2020-2021 was conducted. Demographic and outcome data were collected from electronic patient records including patient demographics, laterality, type of repair, conversion rate, peri- and postoperative complications, rates of recurrence, chronic groin pain and mortality. These were then analyzed using MS Excel and SPSS.

Results
108 patients were studied in total. In the post operative period, there was zero mortality in both groups, and only one patient developed recurrence as a complication. None of the other patients had any major complications. 1 patient complained of paraesthesia in the groin, 5 had scrotal edema, 5 developed seromas. Other minor complications were inguinodynia, post operative pain, bruising and haematoma in 1 percent of patients. The single incidence of recurrence occurred in a case where open repair was done and a greater proportion of minor complications were observed in people who underwent laparoscopic repair (19% of all laparoscopic repairs), while it was lower in patients who underwent open repair (14.7% of all open repairs). These differences were of no statistical significance as Chi-square test.

Conclusions
The data obtained reveal that there is no significant difference between the outcomes of laparoscopic and open hernia repairs at a single Centre.
450 Outcomes of Groin Hernia Surgery in ELHT: A Comparative Retrospective Study with NICE, BHS, and EHS Statistics
Authors: Sallam A , Butt M , Yasin M , Hassan A , Abudeeb H , Obeidallah R , Atluri L Mm 
Published: July 2024

Abstract

Aim
The aim of this study was to evaluate the results of groin hernia surgery, at East Lancashire Hospitals Trust (ELHT) by comparing the severity of pain and recurrence rates with established standards set by the National Institute for Health and Care Excellence (NICE) British Hernia Society (BHS) and European Hernia Society (EHS).

Method
This retrospective analysis involved patients who underwent groin hernia repair between 2019 and 2021 at ELHT trust hospitals. The selection criteria were based on guidelines provided by the BHSs Hernia Commission Guide. Data was collected from records during the specified time frame.

Results
Out of all cases chronic pain occurred in 2.90% which's notably lower compared to the 10 12% range reported by the European Hernia Society. Furthermore, the recurrence rate at ELHT was found to be 2.51% below the rate of 15% mentioned by the European Hernia Society.

Conclusions
Based on these findings it can be concluded that ELHT has achieved outcomes in groin hernia surgery when compared to benchmarks set by the European Hernia Society. Notably ELHT demonstrated rates of chronic pain and recurrence highlighting successful surgical interventions and providing valuable insights for best practices in hernia surgery. These results have implications for optimizing outcomes. May influence future guidelines and practices, in groin hernia surgery.
1047 Umbilical Hernia Emergency Care: A Scoping Review
Authors: Kuligowska A , Walshaw J , Smart N , Blencowe N , Lee M 
Published: July 2024

Abstract

Aim
Umbilical hernias may become acutely symptomatic, strangulated, or obstructed, requiring emergency treatment. Robust evidence is required for high-quality care in this field. This study presents a scoping review on emergency care of umbilical hernias.

Method
The study is reported in line with PRISMA-ScR guidance. EMBASE, MEDLINE & CENTRAL databases were searched using a predefined strategy. A secondary hand-search was also performed. Eligible studies were primary research, reporting any aspect of emergency umbilical hernia care, published in the English language. Where emergency umbilical hernia care was not the primary focus, subsets of relevant data should be extractable. Two authors screened s and full texts, disagreement resolved by discussion and third author. Data were charted according to core concepts addressed by each study. A narrative synthesis was performed.

Results
The search generated 299 s, with 32 full texts for assessment and 15 included for final review. This encompassed 52,089 patients undergoing emergency umbilical hernia care. Most were retrospective cohort designs (11/15), equally split between single (7/15) and multi-centre (8/15) studies with only one RCT. Most multi-centre studies were from national databases (7/8). Themes arising included risk profile (n=4), timing of surgery (n=5), investigations (n=2), repair method (n=9, 5 mesh vs suture; 4 laparoscopic vs open), and outcomes (n=12). Most common outcomes reported were mortality (n=10), morbidity (n=8), and length of hospital stay (n=6).

Conclusions
This scoping review demonstrates paucity of high-quality data for this condition. There is a need for randomised trials addressing timing and technical aspects of repair, with umbilical hernia-specific patient reported outcomes measures.
163 Laparoscopic Surgery: Good for the Patient, Bad for the Surgeon. A Systematic Narrative Review
Authors: Abimbola A , Quiney G , Colucci G 
Published: July 2024

Abstract

Background
Musculoskeletal (MSK) injuries are very common among laparoscopic surgeons. These injuries can result in physician burnout, early retirement, and medical/surgical treatment. The aims of this study are to identify the causes of MSK injuries in laparoscopic surgeons, the most common injuries, and strategies to prevent them.

Method
Following the PRISMA guidelines, Medline, Embase and PubMed databases were systematically searched for relevant articles using the predefined inclusion/exclusion criteria. Data was extracted by two independent reviewers.

Results
A total of 321 papers were found, after screening 41 papers were selected for inclusion. Many study designs involved the use of biomechanical methods, surveys, and quality of life questionnaires. Studies varied drastically in their sample sizes. Results show that long periods of static postures held in non-ergonomic positions are a significant contributing factor to MSK injuries. This is more likely in laparoscopic surgery, as surgeons hold more fixed positions with more physical demand when compared with open surgery. Studies show that the most common sites for injury are the neck, back and shoulder.

Conclusions
MSK injuries are an ongoing problem which is often underestimated and poorly reported. There was clear evidence in the literature that microbreaks and strength training is beneficial, and that ergonomic training should be a standard element of surgical training.
728 Laparoscopic Fundoplication as a Day Case Procedure - Patient Comprehension for a Successful Model
Authors: Jayasankar B , Abdelsaid K , Hamouda A 
Published: July 2024

Abstract

Aim
The British Association of Day Surgery states that elective laparoscopic Nissen’s fundoplication procedures should be performed as a day case in 40% of patients. The purpose of the study was to design a model for laparoscopic fundoplication to increase the numbers done as a day case procedure.

Method
This was a retrospective study of all patients who underwent laparoscopic fundoplication from 2014 - 2019. We introduced patient information leaflets and awareness amongst the patients regarding the procedure following our initial audit in 2014. Further intervention in terms of the surgical team and theatre staff awareness to reach our goal by distributing surgery-oriented pamphlets and information. We re-audited to see if there were any improvements in 2016 and 2019 when compared to our previous cohort. A total of 104 patients were audited through the years.

Results
In 2019, 34.4 % patients regardless of hiatus hernia size were discharged on the same day; 48.2 % patients were discharged on the next day; 24.1% patients had a large hiatus hernia or gastric volvulus; 40.9% patients excluding large and complicated hiatus hernia were discharged on the same day; 75.8 % patients had intraoperative local anaesthetic inject at the operative field.

Conclusions
The main two factors which contributed to improvement of our results were Intraoperative injection of local anaesthetic medications to operative field and Patient information pamphlets. Also, when a patient is made aware of the procedure being a day case in advance, they are more prepared to return home the same day following the procedure.
1297 Factors Influencing Lymph Node Retrieval and Staging in Colorectal Cancer Resections: A Single-Centre Study
Authors: Khalid S Y , Bokhari M H T , Akhtar M A B , Zeeshan S 
Published: July 2024

Abstract

Aim
The American Joint Committee on Cancer (AJCC) recommends examination of a minimum of 12 total dissected lymph nodes to stage rectal cancer accurately. This study aimed to explore the factors influencing lymph node (LN) retrieval and their impact on nodal positivity and N category in colorectal cancer (CRC) staging.

Method
This retrospective single-centre study included patients with CRC who underwent laparoscopic excision by a single colorectal surgeon between July 2021 and July 2023. Data were extracted from the hospital's electronic database, with exclusion criteria for benign conditions.

Results
The average number of LNs in this cohort was 17.95±6.55. At least 12 LNs were recovered in 90.91% of the cases. The right colon was the most common tumour site. Right hemicolectomy, transverse colon resection, and sigmoid colectomy achieved 100% compliance with the adequate retrieval criteria. An increase in LN retrieval was observed with higher T stages. A positive linear correlation was observed between the number of harvested LNs and the length of the resected bowel. No significant difference in LN yield was observed between node-positive and node-negative cases.

Conclusions
Tumour site emerged as a significant factor influencing LN retrieval in CRC resections. While age and sex showed no substantial impact, tumour size and extent of resected bowel positively correlated with LN counts. The overall lymph node yield had no effect on node positivity, indicating that, following a careful inspection of the specimen, a lower lymph node yield may be deemed sufficient.
162 Outcomes Following Surgical Management of Temporomandibular Disorder in a Specialist Setting
Authors: Amin A , Pirmorad S , Dennis J , Zar Rab K , Komath D 
Published: July 2024

Abstract

Introduction
Temporomandibular joint (TMJ) dysfunction is an increasingly prevalent condition affecting 31% of adults and 11% of children/adolescents. Initial management is usually conservative with physiotherapy, diet modification, analgesics, and education. 5-10% of patients require surgical treatment. TMJ arthroscopies allows minimally invasive surgery for joints with early degenerative changes. The purpose is to provide symptomatic relief and improve function.

Aim
To evaluate clinical outcomes 3 months post TMJ surgery.

Method
Retrospective data was collected from the notes of all patients who underwent procedures between February 2019 and August 2023. Data collected included pain/diet scores, mouth opening, Wilkes staging, clinical diagnosis and the use of intra-articular Platelet Rich Plasma or steroid injections.

Results
147 procedures were undertaken. The average age was 43 with an 83.0% female predominance. Overall, 1 arthroplasty, 1 eminectomy, 11 total joint replacements and 134 arthroscopies with/without arthrocentesis were performed with positive results. Mouth opening scores increasing from an average of 27.4mm to 29.5mm, diet scores from 5.8 to 7.5 and pain scores reducing from 7.1 to 4.4. At the 3 month follow up, 53 patients were planned for further monitoring, 32 discharged, 9 listed for a further arthroscopy and 15 for a TMJ replacement.

Conclusions
Surgical management provides good outcomes and Level 2 arthroscopy is an essential tool in the armamentarium. Development of an integrated physiotherapy pathway as well as educational leaflets has been vital. Educational Leaflets improved patient experience with re-audit results showing positive outcomes. Involvement of clinical psychologists is required for a multidisciplinary approach.
435 Post ERCP Pancreatitis at a Tertiary Centre - a Retrospective Incidence and Causal Analysis
Authors: Jain S , Orabi A , Davis G , Anderson S , Mekhail P 
Published: July 2024

Abstract

Background
Post Endoscopic Retrograde Cholangio Pancreatography (ERCP) pancreatitis (PEP) is a serious and potentially life-threatening complication of ERCP. The overall incidence of PEP varies between 3.5% and 9.7% as per the recent meta-analyses in 2014. We aim to evaluate the incidence of PEP, conduct a causal analysis and financial implications at our hospital for general surgical patients.

Method
All General Surgical patients who had ERCP done between 01/10/2022 and 31/03/2023 were included in the analysis. The patient records on TrakCare® were analysed for demographic details, admission records, ERCP details, pre-procedural laboratory values and length of stay. The successful ERCPs defined as cannulation of the common bile duct were divided into the PEP and the non-PEP groups.

Results
A total of 155 patients had ERCP attempted but only 131 were successful. Of these 131, 13 (9.92%) developed PEP. Females in their 60s were predominantly affected. Three out of six patients undergoing ERCP for malignant biliary obstructions were affected (50%). Patients with grossly deranged Liver Function Tests (mean bilirubin levels &gt;=134.92µmol/L) had a higher risk of developing PEP (p-value=0.021). The mean overall hospital stay was 3.5 days longer (2-49 days) for patients who developed PEP costing an extra £20,475 - £35,763 over 6 months to the NHS. There were no mortalities recorded.

Conclusions
Patients with gallstone disease should receive prompt cholecystectomy adhering to NICE guidelines to reduce the risk of developing gallstone-related complications. This in turn would lead to a reduction in PEP and positively affect the financial implications for the NHS.
798 Improving the Use of Ultrasound Imaging in the Diagnosis and Assessment of Paediatric Patients Admitted with Suspected Appendicitis
Authors: Renney O , Duhoky R ,   ALSGBI Academy research group, Morrison T E M 
Published: July 2024

Abstract

Aim
To investigate the barriers to and rate of ultrasonography use to facilitate the diagnosis of suspected appendicitis and assess its effect on negative appendicectomy rates in concordance with GIRFT guidelines for children with abdominal pain.

Method
Retrospective single-site data on paediatric patients presenting with suspected appendicitis was collected over 6 months, using operative and admission records, imaging requests and histology results. An anonymous survey was distributed amongst Surgical clinicians to determine the perceived impact of access to and influencers of ultrasonography use for children.

Results
Of 91 patients, 35 underwent a diagnostic laparoscopy. The operation findings were: 23% (8) not acute appendicitis, 23% (8) perforated or complex appendicitis and 54% (19) “other” acute appendicitis. 85% (30) of patients who were surgically managed did not have an ultrasound before theatre.
23% (21) of the total cohort underwent an ultrasound and none of the scans suggested acute appendicitis. Of these, 76% (16) of patients were managed non-operatively. Of the 5 patients who underwent an ultrasound and proceeded to laparoscopy; none had intraoperative findings of appendicitis. Further analysis aims to investigate why ultrasound was utilised for only 23% of patients and to clarify the decision-making processes behind a “straight to theatre” versus an “imaging-first” approach.

Conclusions
The negative paediatric appendicectomy rate in this District General Hospital was 23%. According to this data, ultrasonography is a reliable rule-out tool for suspected appendicitis and more frequent use could reduce unnecessary operations.
584 A Systematic Review of Generative Adversarial Networks (GANs) in Plastic Surgery
Authors: Zargaran A , Sousi S , Glynou S P , Zargaran D , Mosahebi A 
Published: July 2024

Abstract

Aim
Generative Adversarial Networks (GANs), based on zero-sum game theory, involve two neural networks—the generator and discriminator—to create realistic synthetic data. They're becoming increasingly significant in medicine and plastic surgery. This review assesses GANs' impact in Plastic Surgery, offering a framework for their application and evaluation in various subspecialties, highlighting their potential in research and patient care advancements.

Method
Following PRISMA guidelines, a systematic review was performed of all applications of GANs within Plastic Surgery and its subspecialties published from 2014 to 2022. Three independent reviewers screened studies using COVIDENCE review management software, from databases including PubMed, Embase, PsychInfo, Scopus and Google Scholar.

Results
A total of 70 studies were captured by the search, of which seven studies were included in the final analysis. The Kappa score for interrater reliability was 0.97. The most common subspecialty represented was craniofacial (n=4). Proposed uses of GANs ranged from facial recognition, burn estimation, scar prediction and post-breast cancer reconstruction anomaly scoring. All proposed GANs were conditional, with four of the studies using primarily collected training datasets, and the remainder using public datasets. Average dataset training size was 54,593 (range: 300,575-6). All of the studies had different reporting structures, and only four studies had a form of cross-evaluation qualitatively (n=1) or quantitatively (n=3)

Conclusions
GANs can transform research and patient care. Standardised reporting and diverse dataset transparency are essential. Despite their creation needing computational expertise, it's vital for plastic surgeons to understand GAN development to fully leverage their potential in plastic surgery and related fields.
725 Delphi Consensus to Improve Patient Safety in the Aesthetic Injectables Market: Consensus, Controversies and the 5Ps Framework
Authors: Zargaran D , Zargaran A , Sousi S , Knight D , Woollard A , Terranova T , Sines D , Weyrich T , Mosahebi A 
Published: July 2024

Abstract

Aim
The rapid growth of the aesthetic injectables sector presents a public health challenge given limited regulations to date. This study aimed to establish agreed proposals from industry experts and practitioners to uphold and safeguard patient safety.

Method
A Delphi consensus design was adopted comprising three survey rounds. Industry practitioners and experts were invited to suggest proposals to improve patient safety. We used the MoSCoW prioritization technique to aid practitioners in attributing importance and significance to proposals. Consensus was defined a priori as 75%.

Results
One-hundred-and-twenty-two practitioners completed Round 1, 100 completed Round 2 and 51 completed Round 3. A total of 38 proposals were identified after consolidation and removal of duplicates from Round 1. Round 2 established consensus on 16 items, and 18 items went to Round 3 but consensus was not achieved on all these items. Of the 38 proposals initially made, a series of five overarching themes emerged as fundamental for stakeholders. Issues relating to patients, practitioner skills or competence, product type and storage, place of practice and promotion techniques were the key themes. From these we propose and evaluate the five Ps framework: Patient, Practitioner, Product, Place and Promotion.

Conclusions
Our Delphi consensus study establishes consensus for 16 key proposals to improve patient safety. The study also highlights areas of controversy and proposes the novel 5Ps framework to help appraise the aesthetics industry.
655 Aching for Change: Musculoskeletal Pain in the Operating Room Amongst KSS Trainees
Authors: Bickerton R , Goatly G , Bowbrick Gi 
Published: July 2024

Abstract

Aim
Work-related injuries are common among surgeons, with some studies finding up to 70% report difficulties. Given the increasing career longevity expected from today's surgical trainees, injury prevention is more important than ever. However, ergonomics education for surgical trainees in the UK is deficient. We aimed to gauge whether current trainees in Kent, Surrey, and Sussex (KSS) experience pain whilst operating and what strategies, if any, they utilise.

Method
A questionnaire was distributed to trainees in the KSS School of Surgery collecting data on basic demographics, pain related to operating and pain management strategies.

Results
75 trainees across the KSS region responded. Mean age was 32 years (range 26-42) and median training level was ST4. General surgery (n=22), orthopaedics (n=19) and urology (n=13) were the most prevalent specialties. All trainees reported musculoskeletal pain attributed to operating, with 36% (n=27) experiencing pain “frequently” or “always”. 69% (n=52) found this pain “sometimes”, “frequently” or “always” distracted them whilst operating. The most common sites for pain were the lower back (73%), neck (49.3%), upper back (38.7%) and shoulders (37.3%). No participants had received formal ergonomics training and the majority (86.7%) had not discussed pain with their supervisors.

Conclusions
Musculoskeletal pain from operating was found to be a common issue in this cohort, with the majority reporting distraction while operating. Ergonomics is not currently addressed by any formal training programmes. We have recommended a regional training initiative for trainees in KSS to address and prevent musculoskeletal injuries.