bluuebunny/crossref_metadata_2025_split huggingface dataset:
789 Alternative Operative Procedures in Repeat Mitral Valve Surgery: A Systematic Review and Meta-Analysis
Authors: Shirke M , Soh V , Wee A , Harky A 
Published: July 2024

Abstract

Aim
Median sternotomy remains the gold standard redo mitral valve surgery. However, this can be physically demanding for patients and affect mortality and morbidity. Alternative procedures such as the right anterolateral mini thoracotomy have been explored to mitigate the risks of a re-sternotomy. This review aims to compare the clinical outcomes of re-sternotomy (MS) versus right mini thoracotomy (MT) in mitral valve surgery.

Method
A systematic, electronic search was performed according to PRISMA guidelines to identify relevant articles that compared outcomes of the MS versus MT procedures in patients who have had cardiac surgery via an MS approach.

Results
Twelve studies were identified, enrolling 4,514 patients. Length of hospital stay (MD= -3.71, 95% CI[-4.92, -2.49]), 30-day mortality(OR = 0.59, 95% CI [0.39, 0.90]), and new-onset renal failure(OR=0.38, 95% CI [0.22, 0.65]) were statistically significant in favour of the MT approach. Infection rates(OR=0.56, 95% CI[0.25, 1.21]) and length of ICU stay (MD= -0.55, 95% CI[-1.16, 0.06]) was lower in the MT group; however, the difference was not significant. No significant differences were observed in the CPB time(MD=-2.33, 95% CI [-8.15, 3.50]), aortic cross-clamp time MD= -1.67, 95% CI[-17.07, 13.76]), and rates of stroke(OR=1.03, 95% CI[0.55, 1.92]).

Conclusions
Right MT offers a reduced length of hospital stay, ICU stay, and a lower risk of new-onset renal failure requiring dialysis and hence, can be considered a safe alternative. This review calls for robust trials in the field to further strengthen the evidence.
888 Incidence Rates of Penn Classes and Class-Specific Mortality in Acute Type an Aortic Dissection Patients: An Epidemiological Systematic Review and Meta-Analysis
Authors: Chandiramani A , Al-Tawil M , Rajasekar T , Elleithy A , Kakar S , Haneya A , Harky A , Zeinah M 
Published: July 2024

Abstract

Background
Acute type A aortic dissection (ATAAD) is a life-threatening emergency which is associated with high morbidity and mortality. One of the complications is end-organ ischemia, a known predictor of mortality. The primary aim of this meta-analysis is to summarise the findings of observational studies investigating the utility of the Penn classification system as well as analyse the incidence rates and mortality patterns within each class.

Method
Electronic databases PubMed, MEDLINE, and Embase were searched through to April 2023. These were then filtered by multiple reviewers to meet the inclusion criteria. The extracted data included patient characteristics and primary outcomes included incidence rates of different Penn classes, along with the corresponding mortality for each class.

Results
Out of 1512 studies identified during the initial search, ten studies met the inclusion criteria. Pooled incidence of Penn A was the highest at 0.55 [0.52, 0.58] followed by Penn B at 0.21 [0.17, 0.25], and Penn C at 0.14 [0.11, 0.17]. Patients with both Penn B+C were found to be at the highest risk of death as their mortality rates were 0.36 [0.31, 0.41]. Within those populations, the subtype with the highest individual mortality was Penn C at 0.21 [0.15, 0.27] followed by Penn B at 0.19 [0.15, 0.23] and Penn A at 0.07 [0.05, 0.10].

Conclusions
In conclusion, amongst patients presenting with ATAAD, Penn class A was the most frequently observed, followed by classes B, C, and BC. Our findings indicate an incremental increase in mortality rates with the progression of Penn classification.
327 Impact of Adjuvant Chemotherapy/Radiotherapy on the 5 Year Overall Survival of Patients with Non-Metastatic Rectal Cancer in Bulgaria - a Retrospective Population-Wide Observational Study
Authors: Ravendran K , Balagumar K , Raja A 
Published: July 2024

Abstract

Introduction
Survival rates of patients with non-metastatic rectal cancer (RC) have increased, due the use of adjuvant chemotherapy/radiotherapy post-surgery, recommended by the National Comprehensive Cancer Network (NCCN) [1–3]. The aim of the study was to analyse the impact of adjuvant chemotherapy/radiotherapy on the 5-year overall survival (OS) of patients diagnosed with non-metastatic RC patients in Bulgaria.

Method
This is a retrospective population wide observational study of 8968 cases registered with Colorectal cancer in the Bulgarian National Cancer Registry (BNCR) between 2015 and 2016. The mean and median age of patients with left colon (LCC) and right colon (RCC) along with rectal cancer (RC) was analysed. The impact of adjuvant chemotherapy and radiotherapy on the 5-Year OS for non-metastatic RC was analysed. Kaplan-Meier curve with log rank, ANOVA and chi-squared tests were used to estimate the statistical significance.

Results
The mean age at diagnosis for RCC, LCC and RC was 68.9, 67.41 and 66.4 respectively (p-Value=&lt;0.001). The median age at diagnosis was 69, 68 and 67 for RCC, LCC and RC respectively.
Our study showed that patients with non-metastatic RC that received both adjuvant chemotherapy and radiotherapy had a higher 5-year OS compared to patients who received either chemotherapy, radiotherapy or neither therapy (61.4%, 59.5%, 56.2%, 51.8%), p-Value=0.007. Less than 40% of patients received either adjuvant chemotherapy or radiotherapy.

Conclusions
Adjuvant chemotherapy/radiotherapy improves the 5-Year OS for patients with non-metastatic RC. NCCN guidelines should be implemented in Bulgaria [1–3]. Bulgaria will benefit by implementing an organised screening programme [4].
825 Still FIT for Purpose? Learning From False Negative Faecal Immunochemical Tests in Symptomatic Colorectal Cancer Patients
Authors: Louden E , Rao P , Oo K 
Published: July 2024

Abstract

Aim
Faecal immunochemical testing (FIT) is a non-invasive screening tool used to aid the detection of colorectal cancers (CRC) by measuring microscopic levels of blood in the stool. The symptomatic threshold is recommended as ≥10μg Hb/g. The use of FIT alongside red flag symptoms provides a higher positive predictive value for diagnosing CRC. We aim to identify delays in the diagnosis and treatment in false negative FIT patients and to improve the pathways of urgent suspected CRCs.

Method
A prospective cohort of CRC 439 patients under Hywel Dda University Health Board multidisciplinary team (MDT) was reviewed. Exclusion criteria consisted of patients with anorectal mass, anal ulceration or emergency presentation. Data were collected and analysed to appraise the referral process, FIT timing and results, clinical, pathological and oncological outcomes.

Results
A total of 366 patients (175F:191M) were analysed. There was a false negative rate of 3.8% (n=14). The mean time taken from FIT to diagnosis for these patients was 53.9 days. The main subsequent diagnostic modality was CT (n=10). The average times taken from referral to the first diagnostic modalities (CT colonography and Endoscopy) were 51.6 days and 106 days respectively.

Conclusions
This study examined the clinical and oncological consequences of false-negative FIT results in CRC patients. It highlighted the need for expert clinical judgment through MDT input and complementary diagnostic modalities to minimize diagnostic delays and improve patient outcomes. This analysis has helped improve referral pathways in a single centre MDT for urgent suspected CRCs.
370 Do Prolonged Surgery Waiting List Times Affect the Incidence of Post-Tonsillectomy Haemorrhage, in the Context of the COVID-19 Pandemic?
Authors: Kieu P L , Izzat S 
Published: July 2024

Abstract

Aim
The United Kingdom was affected by the COVID-19 pandemic with the reduction of many services within the NHS, including suspension of elective surgical procedures from March 2020. We hypothesised that delayed surgery caused by the pandemic may increase the risk of post-tonsillectomy haemorrhage due to increased episodes of tonsillitis. The aims of this review were to investigate the relationship between prolonged waiting times and post-tonsillectomy haemorrhage.

Method
We performed a single-site, retrospective review from March 2019 to August 2023, with data collected from electronic hospital records. Both adults and children were included in the analysis and only procedures performed for recurrent tonsillitis were included.

Results
We identified 234 cases: 184 adeno/tonsillectomies in the pre-COVID (March 2019-20) and 50 in the post-COVID (August 2020-21) cohort. In the pre-COVID cohort, 7.6% (n=14) experienced a post-tonsillectomy haemorrhage, with 1.1% (n=2) experiencing a primary haemorrhage and 6.5% (n=12) experiencing secondary haemorrhage. The return to theatre rate was 2.2% (n=4). Median waiting time for surgery was 78 days. In the post-COVID cohort, secondary haemorrhage occurred in 6.0% (n=3). No patients experienced a primary haemorrhage and return to theatre rate was 0%. Median waiting time was 345 days. Simple logistic regression was performed which showed no significant association between waiting times and post-tonsillectomy haemorrhage across the whole (p = 0.90, 95% CI [-0.0002, 0.0002]) cohort.

Conclusions
Our cohort demonstrated no significant relationship between prolonged waiting times and post-tonsillectomy haemorrhage. Small sample size was a significant limitation; we recommend a larger scale, multi-centre study to investigate this further.
1114 Evaluation of the Ethical Controversies in Separation Surgery of Conjoined Twins: A Critical Review of the Literature
Authors: Woo Y T 
Published: July 2024

Abstract

Aim
To further examine the ethical concerns involved in separation surgery of conjoined twins, through analysing the relevant discussions in the published literature.

Method
A critical review on the ethical issues surrounding separation surgery of conjoined twins was conducted. A literature search on PubMed and Embase was carried out using three terms - ‘ethics’, ‘conjoined twins’ and ‘separation’. Relevant papers published in the past ten years (2013-2023) were included based on the PRISMA standard.

Results
Seven papers were included in this review. Most papers approached the ethical issues in separation surgery of conjoined twins from the four pillars of ethics. There are contradicting arguments with regards to beneficence and non-maleficence, depending on the perspective of the twins taken. All papers looked into autonomy and some into consent, specifically regarding decision-making. Most papers agree that the parents should be making the decision due to the patients lacking capacity. However, some argue that the patients should be making their own decisions where there is no urgency. Equality has been explored around the distribution of shared organs and survival opportunities. Other ethical principles, including the act-omission and double effect doctrines which support separation, have also been discussed.

Conclusions
There does not seem to be a definite answer to whether separation surgery is justified. Every case’s unique situation should be scrutinised differently, with guidance from the four pillars of ethics, and involvement of the families and ethical committees. Decisions should not be based on ethical considerations alone, but to take into account other factors.
1179 Navigating the AI Landscape: Surveying the Use of AI Language Tools for Medical Portfolios
Authors: Harris M , Majchrzak J , Baig F 
Published: July 2024

Abstract

Aim
Recent advances in artificial intelligence (AI) driven natural language processing have made it possible to use tools such as ChatGPT to generate pieces of text which are realistic, eloquent, and challenging to distinguish from human-generated content. This work aims to answer the question: could the use of these tools for medical portfolios represent a positive opportunity to enhance learning, or would it detract from the purpose of reflective practice?

Method
In total, 98 post-graduate doctors from across the UK were surveyed to gather data on their awareness of, previous use of, disclosure of use and experience with these tools for their professional portfolios. Their opinions on the need for future guidance in this area were also explored.

Results
From 90 respondents who currently maintain a professional portfolio, 18 (20%) had used AI-driven tools in some form to generate content for it and none disclosed this use. Regarding disclosing the use of AI-driven tools, 67.3% advocate for this whereas 32.7% believe disclosure is unnecessary. There was slightly stronger consensus regarding how useful guidance from regulatory bodies on this practice would be, with 73.5% in support of guidance and 26.5% in opposition.

Conclusions
Clearly, there is an urgent need for larger studies, discussion, and consensus from regulatory bodies so that guidance can be put in place. Without this, maintaining the integrity of CPD will become challenging for both trainee doctors and assessors of medical portfolios.
198 Overcoming Developing-World Challenges in Cochlear Implantation: A Nigerian Perspective
Authors: Jesuyajolu D , Obuh O , Zubair A 
Published: July 2024

Abstract

Introduction
The emergence of cochlear implantation (CI) in the mid-20th century was a transformation to the field of restorative otology. The advance in this field has not been felt in lower-income countries where a huge burden of profound hearing loss lies. We sought to review the literature on the practice of cochlea implantation in Nigeria.

Method
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews, we conducted a study of the literature on CI in Nigeria. All observational studies with information on cochlear implants and/or implantation in Nigeria were included with no limitations on outcomes. We extracted the following data: age, sample size, sex, aetiology, outcome, type of devices, complications, challenges, and the location of the surgery. The results were pooled and reported as frequencies and percentages. Three studies were utilised in this review.

Results
The study included 25 patients. The age of the identified patients ranged from 1.2 months to 63 years. There were slightly more males than females (52% males). The most common aetiology of deafness in the participants was following a febrile illness (40%), followed by deafness post-meningitis (24%). The challenges identified included high cost, lack of full rehabilitative facilities and staff, scepticism, and lack of funding.

Conclusions
CI remains the most effective for those who are profoundly deaf. Although successful CI programmes exist in Nigeria, the number of implant programmes and the affordability are not yet commensurate to the needs of the entire Nigerian population.
260 Barriers to the Delivery of Obstetric Care Within Primary Health Centres (PHC) in India- a Scoping Review
Authors: Veerappan V , Kundu S , Arora H , Virk S , Goshal R , Gadgil A , Raykar M 
Published: July 2024

Abstract

Aim
This scoping review aimed aims to identify challenges in delivering obstetrics care within PHCs in India, using the 6 WHO healthcare building blocks.

Method
A literature search covered PubMed, MEDLINE databases, and Google Scholar. Studies published from 2012 to 2022, discussing PHC-based obstetrics care in India, were included based on predefined criteria. Title, and full-text screenings were conducted using Covidence, involving 2 reviewers for screening and 1-2 reviewers for conflict resolution. Data extraction on the 6 WHO building blocks was performed by 4 reviewers.

Results
Twenty-two studies were included for final review, mostly cross-sectional (59%), mainly from the state of Bihar (23%). Service delivery (77%) and health workforce (73%) were the most extensively discussed building blocks. Leadership and governance were the least discussed (14%). Challenges in service delivery encompassed limited antenatal care uptake, inadequate emergency obstetrics care and adjunct services, inadequate infrastructure, equipment and space and poor transport, and onward referral services. Health workforce issues included staffing levels and competency and training deficiencies in existing staff.

Conclusions
This review highlights significant challenges in obstetrics care delivery within Indian PHCs in India, primarily related to service delivery and health workforce. Our scoping review identified literature gaps within the four building blocks outside service delivery and health workforce, and geographical literature gaps from the Northeast of India. PHCs play a crucial role in the equitable delivery of obstetrics services that can reach the most underserved population across India. It is imperative that surgical and obstetrics plan strategies include primary care within them.
282 Emergency Laparoscopic Parastomal Hernia Repair Around Ileal Coduit in a Morbidly Obese Patient - a Surgical Challenge Managed Successfully
Authors: Pal S , Basu S , Shrestha A 
Published: July 2024

Abstract

Aim
Management of a strangulated parastomal hernia (PH) around the ileal conduit can be a surgical challenge. We demonstrate here a safe and effective laparoscopic repair of a strangulated PH in the emergency setting for a 53year-old morbidly obese woman (BMI: 40).

Method
Entry to abdominal-cavity was by Veress-needle technique. PH defect was identified – containing strangulated part of ascending-colon that reduced spontaneously during creation of pneumoperitoneum. Adhesiolysis around stomal defect up to lateral attachment of ileal conduit was completed. 3cm defect was opposed using transfascial nonabsorbable sutures. 15cm circular-composite-mesh was fashioned U-shaped and introduced in medial to lateral direction with the U lips overlapped and fixed snug laterally around the ideal conduit. Mesh was further fixed through double-crown fixation.

Results
Patient had an uneventful recovery and discharged on the second post-operative day. A 10-month CT as a part of bladder cancer follow up showed no PH recurrence.

Conclusions
This case shows that strangulated PH around an ileal conduit, an uncommon presentation, can be successfully managed laparoscopically even in the emergency setting especially for patients of high BMI with proper assessment and appropriate expertise. Successful management of this challenging presentation of strangulated PH around ileal conduit demonstrates the safe and effective use of laparoscopic surgery especially in the emergency setting for patients of high BMI.
732 Does Intraoperative Urinary Catheterisation Decrease Postoperative Urinary Retention After Laparoscopic Inguinal Hernia Repair? a Systematic Review and Meta-Analysis
Authors: Romman S , Fagbemi O , Hajibandeh S , Ghessemi N , Evans D , Athwal T 
Published: July 2024

Abstract

Aim
To evaluate comparative outcomes of laparoscopic inguinal hernia repair with and without use of intraoperative urinary catheterisation.

Method
A systematic search of MEDLINE, CENTRAL and Web of Science and bibliographic reference lists were conducted. All comparative studies evaluating outcomes of laparoscopic inguinal hernia repair with and without use of intraoperative urinary catheterisation were included and their risk of bias were assessed using their risk of bias were assessed using ROBINS-I tool. Postoperative urinary retention was analysed as the primary outcome parameter and an odds ratio (OR) was determined using Random-effects modelling.

Results
We included 6 comparative studies reporting a total of 8,675 patients who underwent laparoscopic inguinal hernia repair with (n=3,318) and without (n=5,357) use of intraoperative urinary catheterisation. There was no significant difference in postoperative urinary retention between the two groups (4.3% versus 3.7%, OR 0.93; 95% CI 0.55-1.58, p=0.80). There was significant heterogeneity among the included studies (I2: 75%, p=0.001). Results of sensitivity analyses were consistent with the results of the main analysis.

Conclusions
Meta-analysis of best available evidence (level 2a) demonstrated that use of intraoperative urinary catheter has no advantage in prevention of postoperative urinary retention following laparoscopic inguinal hernia repair. Future randomised controlled trials are required to control for confounding factors that increases the risk of urinary retention.
30 Does the Use of Antibiotics Prophylaxis Affect the Rate of Postoperative Fistula Rates in Cleft Palate Patients?
Authors: Singh S , Narayan N , Cobb A , Chummun S 
Published: July 2024

Abstract

Aim
Assess whether post-operative antibiotic prophylaxis affected the incidence of oronasal fistula formation in cleft palate patients. Design and setting: Institutional retrospective study using data from patients undergoing primary palatoplasty.

Gold standard
Fistula rate of no more than 8-10%.

Method
In the first cycle, there were two groups (A and B). In group A, the patients had antibiotics on induction and 24 hours after, in group B, the patients had further antibiotics for a week. Our work from the cleft collective showed no evidence of change in fistula rates in relation to the antibiotic regime. Therefore, group A surgeon changed practice had antibiotics only on induction and group B remained the same from the first cycle.

Results
In cycle 1, we found little evidence to suggest a difference in fistula rate between the use of an antibiotic regimen as binary variables: Grp A(P=0.171) and Grp B (P=0.69). Cycle 2 also demonstrated the following: Grp A (P=0.557) and Grp B(P=0.443).

Conclusions
The use of antibiotics and differing regimes, postoperatively do not influence the incidence of postoperative fistulae in cleft palate.
1088 The Quality of Information Recorded in Neurosurgical Operation Notes: A Closed Loop Audit
Authors: Chaudhry D , Konakanchi J , Ratnayaka R , Momin S 
Published: July 2024

Abstract

Introduction
Operation notes are critically important documents which serve as record for significant events in the lives of patients. They serve multiple functions, but chiefly to help guide peri-operative management. Surgeons must keep records that are accurate, thorough, and readable. This is fundamental part of the GMC’s Good Medical Practice as well as the Royal College of Surgeons of England Good Surgical Practice guidelines which lays out 18 various parameters for what should be included in an operation note.

Aim
This retrospective audit aimed to evaluate the compliance of neurosurgical operation notes with the Royal College of Surgeons guidelines, identifying areas for improvement.

Method
All neurosurgical procedures between October 1 and October 31, 2023, at a Major Trauma Centre in the West Midlands were retrospectively audited. Two independent reviewers used a standardized proforma in Microsoft Excel for data extraction, comparing compliance.

Results
91 operation records were examined and found high compliance (100%) in key fields: date, surgeon's name, assistant's name, operative procedure, operative diagnosis, and signature. Negligible compliance was found in identification of prosthesis (0%), estimated blood loss (1%), extra procedures (1%), elective/emergency classification (1%), time (4%), and problems/complications (19.8%). Notably, detailed post-op instructions were lacking in over 1 in 3 operation notes, with 19.7% omitting DVT prophylaxis, and 20% neglecting clip/suture removal instructions.

Conclusions
While certain aspects showed exemplary compliance, critical deficiencies were identified, particularly in post-operative instructions. A template proforma for post op instructions is required in addition to more targeted guidelines for operation notes within neurosurgery.