bluuebunny/crossref_metadata_2025_split huggingface dataset:
1090 A UK-Wide Audit on Peri-Operative Practices During Deceased Donor Kidney Transplantation: Results from a Prospective National Transplant Access to Theatre (NTACT) Audit
Authors: Borbas B , Mujeeb M , Tanase A , Aroori S 
Published: August 2024

Abstract

Aim
The outcomes of deceased donor kidney transplants are mainly affected by donor and recipient factors. There is little data on whether variations in perioperative practices could also affect the outcomes and there is also little data on the standard perioperative practices across the UK. This study aims to identify current perioperative practices from a prospective National Transplant Access to Theatre (NTACT) audit.

Method
A multicentre, prospective audit of adult deceased donor kidney-only transplants was conducted across 14 UK transplant centres from February to September 2022. Data collected via RedCap focused on pre-operative antibiotic use, surgeon's grade, post-operative destination, crossmatch, and advanced haemodynamic monitoring. Descriptive statistics were used for analysis.

Results
Among 476 kidney-only transplants, 29 were excluded, leaving 446 transplants for analysis. Pre-operatively, 98.4% received antibiotics, with co-amoxiclav (n=147), ciprofloxacin (n=92), and amikacin (n=69) being most common. Consultant surgeons led 91.7% (n=409) of operations, while consultant anaesthetists led 61.4%. Notably, central lines (67.7% n=302), arterial lines (44.2% n=197), and advanced hemodynamic monitoring (27.6% n=123) were employed. Goal-directed fluid therapy was administered in 71.7% (n=320) of cases, with 71.6% (n=229) using static parameters. Post-operatively, 76.9% (n=343) were sent to a transplant ward, while 9.4% (n=42) and 10.8% (n=48) were directed to the intensive care unit and high dependency unit, respectively.

Conclusions
This audit highlights significant variations in perioperative practices, prompting further exploration into their potential impact on postoperative outcomes such as graft function and mortality.
672 The Management of Distal Radius Buckle Fractures
Authors: Ferns J , Yan A , Blong J , Hodhody G 
Published: August 2024

Abstract

Aim
To evaluate the management of distal radius buckle fractures in children and improve out-patient clinic utilisation.

Method
From April to June 2023, data was retrospectively collected across 4 emergency departments, including a specialist Children’s hospital, 2 DGH Emergency Departments and an Urgent Care Centre on all children aged 4-15 who had the code of distal radius fracture. Data was collected on the initial treatment comparing casts and splints, the number of out-patient appointments and the complications. These were analysed and the significance calculated using the chi-square test.

Results
416 fractures were screened of which 216 fractures were buckle fractures. Of these, 153 (71%) were splinted and 63 (29%) were casted. No patients or carers expressed concern about deformities. 108 patients were directly discharged from the emergency department with 33 patients discharged from the Virtual fracture clinic and other 75 patients generating 124 clinic appointments. Complications included 10 re-attendances to the emergency department for pain/swelling/cast problems/to arrange follow up, 1 re-fracture and 1 pressure sore from a cast. The rate of complications was significantly greater in the cast group (9.5%) vs the splint group (3.3%) (p value = 0.008).

Conclusions
Casts have a higher rate of re-attendance and complications than splints. Splints should be first line and local ED protocols should be altered to reflect this. Direct discharge from the emergency department is safe and can result in better utilisation of outpatient services. This will be improved locally through a series of education events.
778 Predicting Flexor Tendon Complications Following Volar Plate Fixation of Distal Radius Fractures
Authors: Yang J , Parkes R , Yip C R , Chojnowski A 
Published: August 2024

Abstract

Introduction
For distal radius fractures which are complex or unstable, volar locking plates are an effective means of fracture stabilisation, however patients may later develop flexor tendon complications. The Soong grading system was devised to determine which patients are most at risk of these by grading them between 0 (least likely) and 2 (most likely). Presently, however, this classification does not form part of our national guidelines.

Aim
We wanted to assess our current practice against the Soong classification, including testing its predictive value in identifying patients who developed flexor tendon issues.

Method
We performed a search of digital records for all patients who underwent volar plating following distal radius fractures in Norfolk and Norwich University Hospital between September 2022 and February 2023. Each fracture was graded using the post-operative X-rays and clinical outcomes were determined through review of clinic letters.

Results
102 patients were initially identified although 3 were excluded due to the inadequacy of available imaging. Of the remaining 99 patients, the most common grade was grade 1 (47.5%), followed by grade 0 (44.4%) then grade 2 (8.1%). Flexor tendon complications occurred in 25% (2/8) of grade 2 patients and 2% (1/47) of grade 1 patients but never in grade 0 (0/44).

Conclusions
The Soong classification effectively identified patients at higher risk of flexor tendon complications. It remains unclear, however, what follow-up these patients should receive to mitigate this risk. This will require prospective studies, although close follow-up and early plate removal should be considered in the interim.
1073 Optimising the Acute Management of Distal Radius Fractures: Re-Audit
Authors: Hopkinson-Woolley D , Khatri C , Carlos J , Ramoutar D 
Published: August 2024

Abstract

Aim
Distal radius fractures are a common presentation and early management is often in the emergency department (ED). Good, early management in the ED has been shown to reduce the number of people requiring operative treatment. We aimed to evaluate the impact of a staff training programme intervention on the number of patients requiring theatre.

Method
Three training sessions were held, training ED staff on fracture management standards according to BOAST guidelines. These included manipulation with finger traps (instead of in-line traction) and application of effective three-point moulded plaster. We assessed reduction from radiographs pre- and post-reduction. Data on patients’ requirement for further management were collected and compared to previous years.

Results
Satisfactory reduction in ED was achieved in 42.8% of patients. Requirement for eventual operative reduction in theatre was reduced to 17.3% from 45% and 24.1% in 2018 and 2020 respectively. This may be attributable to adoption of reduction with finger traps after training sessions, although no patients received a three-point moulded plaster in the ED.

Conclusions
This study found that the staff training sessions improved the quality of reduction of distal radius fractures. This lowered the operative intervention rate (17.3%), which is still higher than seen in the literature (10%). This could be improved by further interventions to standardise application of appropriately moulded plaster.
1077 Surgical vs Non-Surgical Interventions for Distal Radius Fractures: A Quantitative Analysis of Patient-Rated Wrist Evaluation Measures
Authors: Namireddy S , Gill S 
Published: August 2024

Abstract

Aim
Trials to assess differences in PRWE (Patient Related Wrist Evaluation) over time, for both surgical and non-surgical interventions post DRFs (distal radius fractures) are rare. The DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire has been shown to be improved by a greater margin in the medium term for surgical interventions, than non-surgical interventions. However, a study found that PRWE can be considered superior to the DASH questionnaire for DRFs, due to greater specificity to wrist pain and function. This study aims to determine surgical vs non-surgical superiority for DRF’s over time with PRWE as a recovery metric.

Method
PubMed and Cochrane were searched for randomised controlled trials up to 31.8.23, reporting PRWE over 3, and 12 months. Data was extracted by 2 researchers. The differences in PRWE over time post-surgical and non-surgical interventions was assessed using unpaired T testing.

Results
1226 records were screened. 4 studies enrolling 817 participants met the eligibility criteria and were analysed. Significantly lower PRWE in surgical intervention has been identified at the 3-month mark (p&lt;0.001). There was greater significant change in non-surgical intervention between months 3 and 12 (p&lt;0.001).

Conclusions
Change in PRWE over time may be a good indicator of functional outcomes in DRFs post-surgical or non-surgical interventions. This could inform future clinical trial design and surgical decision-making. Further work is required to design even more user-friendly and digital patient-reported outcomes specifically for DRFs.
1093 Risk Factors for Spinal Cord Monitoring Alerts in Paediatric Patients Undergoing Spinal Deformity Surgery
Authors: Lee M , James S , McCarthy M , Kefalas D , Jones A , Ahuja S , Moideen N , Howes J 
Published: August 2024

Abstract

Aim
Intraoperative neurophysiological monitoring (IONM) is used during spinal deformity surgery to detect potential neurological insult. This study aims to determine clinical factors that increase the risk of IONM changes in this patient population.

Method
All patients ≤ 18 years old who underwent scoliosis correction surgery in a single institute between 2017 and 2022 were reviewed. Patients with IONM alerts were identified and demographic, clinical, operative and radiological details were obtained.

Results
There were 206 cases during which there were 9 significant neuromonitoring alerts. Compared to the non-alert group, the alert group had a significantly greater EBL (P &lt; 0.001), operative time (P &lt; 0.001), preoperative major Cobb angle (P = 0.022) and postoperative major Cobb angle (P = 0.015). There were no significant differences in age (P = 0.618), sex (P = 0.255), mean corrective rate (P = 0.401) and type of scoliosis (P = 0.185) between the two groups. IONM alerts were found to be triggered by the insertion of screws in 4 patients (44.4%), rod application and curve correction manoeuvres in 4 patients (44.4%) and corpectomy procedure in 1 patient (11.1%). In the alert group, no patients experienced postoperative neurological deficits and only 1 operation (11.1%) was aborted due to repeated IONM alerts.

Conclusions
Our study reaffirms the previously described risk factors in the literature. Greater operative time, EBL and preoperative and postoperative major Cobb angle are associated with an increased risk of potential spinal cord insult. IONM alerts commonly occur during and after the insertion of instrumentation and curve correction manoeuvres.
1165 The Effect of Stem Length on Stem Alignment: A Comparison of the 125mm and 150mm Exeter V40 Stems
Authors: Reece A , Clarke J 
Published: August 2024

Abstract

Aim
The Exeter V40 hip replacement stem is available in two lengths – 125mm and 150mm. The 150mm stem has been the standard for decades, however, the 125mm stem is a new option which may be more suited to certain femoral shapes. The aim of this study was to assess whether inserting a shorter stem (125mm) would affect stem alignment.

Method
This was a prospective cohort of 70 patients undergoing cemented total hip replacement at the Golden Jubilee National Hospital, a high-volume national arthroplasty centre. Patients were randomly assigned either the 125mm or the 150mm stem. The post-operative pelvic radiographs were evaluated for stem position. The angle between the midline of the stem and the anatomical axis of the femur was measured. Patient demographics were evaluated for any effect on stem alignment.

Results
Stems were positioned in significantly increased relative varus in the 125mm group (3.53° varus) compared to the 150mm group (2.21° varus) (p=0.009). Other factors such as BMI, surgeon, sex, and side of operation had no correlation to the stem position in either group.

Conclusions
There was a greater incidence of varus malalignment observed in the group undergoing THR using the shorter 125mm Exeter stem. This was statistically significant, but the clinical significance was not evaluated as part of this study, which will be investigated in future research.
555 Do Patients Want a Day Case BOO Procedure?
Authors: Blackburn J , Nitkunan T , Akiboye D 
Published: August 2024

Abstract

Aim
According to Getting It Right First Time (GIRFT) guidance, 25% of all Bladder Outflow Obstruction (BOO) surgery should be performed as a day-case procedure. The common practice amongst NHS trusts that achieve this target is to discharge patients home with a catheter, to return at a later date for trial without catheter (TWOC). The aim of this study was to determine if patients want to be discharged with a catheter.

Method
Data was collected at a single trust from 31 patients attending a Urology CNS clinic following their BOO surgery. All patients underwent either a TURP, HoLEP or BNI between 29/12/2022 to 13/06/2023. All patients were asked ‘If you were to go home on the day of your surgery with your catheter and come back in the following day to have your catheter removed, would you be agreeable to this?’. Patient responses were documented in clinic notes.

Results
84% of patients did not want to go home with a catheter following their surgery. Specific reasons included concerns if something were to go wrong with the catheter (4), catheter size (2) and catheter management (1). 13% of patients would be happy to go home with a catheter and one patient was ambivalent.

Conclusions
Over 80% of patients that underwent BOO surgery did not want to go home with a catheter. We suggest a solution to this would be removal of the catheter on the day of surgery. To date, 9 patients have undergone successful, same day catheter removal without complications.
878 The Outcome of Prophylactic Antibiotics Use in Local Anaesthetic Trans-Perineal Ultrasound-Guided Prostate Biopsy (LATP) - a District General Hospital Review
Authors: Balasubaramaniam V , Kailasa A , Donev K 
Published: August 2024

Abstract

Aim
Over the past few years, LATP has been gaining popularity over transrectal ultrasound guided (TRUS) as the modality of choice for prostate biopsy given the reduced risk of infection and hospital admission. LATP was implemented in our district general hospital in North Wales in November 2021. The benefit of prophylactic antibiotics for LATP remains uncertain. This study aims to investigate the benefits of prophylactic antibiotic use.

Method
A retrospective audit of patients who underwent LATP under one urologist over a 10-month period (11/02/2022-27/11/2022) were included in the study. All patients received a single dose of Gentamicin 240mg intravenously before the procedure. Pre-and post-procedure urine dipstick and mid-stream urine (MSU) found in patient notes and online record system was recorded. General practitioner and medical records were checked to identify if patients presented with urinary tract infections.

Results
A total of 53 male patients were included in the study. The mean age was 71.6 years old. 2 patients were admitted immediately after the procedure for urinary retention, however, MSU was negative. No patients (0%) developed urinary tract infection (UTI) post-operation.

Conclusions
The use of prophylactic Gentamicin pre-LATP minimises the chances of developing UTI post-procedure. Studies with large sample sizes and that investigate patients without prophylactic antibiotics should be carried out to determine if it is a safe alternative.
1036 Does Nephroureterectomy Decision Necessitates Prior Ureteric Biopsy in Cases with Upper Urothelial Tract Cancer?
Authors: Farag A , Sali G , Radnaeva I , Subramonian K 
Published: August 2024

Abstract

Introduction
Objective of study: assess need for ureteroscopic biopsy prior to nephroureterectomy (NU) for upper urothelial tract cancer (UTUC).

Method
Patients referred during 2015-2022 with suspected UTUC were included. Clinicopathological characteristics included presentation, CT results, urine cytology, ureteric biopsy and final histopathology. Analysis done using SPSS.

Results
Mode of presentation for 161 patients: 48% hematuria, 54 % CT filling defect, 8% ureteric thickening, 11% locally advanced and 17% inconclusive. Urine cytology was positive in 13% (n=21).
89 patients underwent nephroureterectomy. This cohort was subdivided into: Group1 with prior ureteric biopsy (n=39) and Group 2 without prior biopsy (n=50).
Histopathological analysis comparison of NU specimen of two groups is shown in Table1. 4 patients in Group 1 and 10 in group 2 had histological diagnosis of disease other than UTUC suggesting that 10% of group 1 avoided NU while 20% of Group2 could have had alternative treatment than NU if they had prior biopsy.
Amongst patients with prior biopsy, 5 had upstaging of histological grade on nephroureterectomy specimen. There was significant association (p=0.04) between histological grade on biopsy and NU specimen, especially in high grade disease.

Conclusions
Initial diagnostic ureteroscopy is useful in identifying UTUC requiring radical surgery and ruling out conditions which could be managed by alternative treatments. Prior Ureteroscopy may be avoided in patients with clear CT scan findings suggestive of UTUC associated with previous bladder cancer and/or abnormal urine cytology.
1069 What Is the Diagnostic Test Accuracy of Urinary Biomarkers for Prostate Cancer? A Systematic Review
Authors: Smith S , Manley K , Mills R 
Published: August 2024

Abstract

Aim
To conduct an up-to-date systematic review to evaluate the diagnostic accuracy of urinary biomarkers in isolation for prostate adenocarcinoma diagnosis in biopsy-naïve men presenting with suspected prostate cancer.

Method
Eligibility criteria: prospective cohort studies or randomised clinical trials including adult men with their first presentation of elevated PSA and/or abnormal DRE findings and evaluating urinary biomarkers for prostate adenocarcinoma diagnosis as compared to the reference standard of prostate biopsy with histological diagnosis. Studies of urinary biomarkers were included where the index test was applied in isolation (not in combination with additional serum biomarkers and/or risk scores). MEDLINE, Embase, Cochrane Library and Scopus were searched for studies published from 1st January 2000 to July 2023. Assessment of bias and applicability were performed using the QUADAS-2 tool. PROSPERO registration: CRD42023445178.

Results
2828 studies were identified, of which 7 prospective cohort studies were included (1688 patients). The studies evaluated exosome assay EXO106, 25 gene panel, Alpha-methylacyl-CoA racemase (AMACR) score, ExoDxÔ Prostate Intelliscore (EPI), prostate cancer gene 3 (PCA3), Hyaluronic acid (HA), Hyaluronidase (HAase) and exosomal prostate specific membrane antigen (PSMA).

Conclusions
The 25 gene panel (D score) biomarker had the highest AUC value of 0.901, followed by exosomal PSMA (AUC 0.854) and then PCA3 (AUC 0.83). In all but one study, the reference standard was based upon 10-12 core transrectal ultrasound-guided prostate biopsy without MRI. Future studies employing pre-biopsy mpMRI and transperineal biopsy in larger cohorts are needed to ascertain diagnostic accuracy and cost-effectiveness in the current NHS prostate cancer pathway.
382 Introduction of a New Diabetic Foot Treatment Protocol Using an Antibiotic Carrying Biocomposite
Authors: Shaw C , Vaidya A , Vig S , Kelleher D 
Published: August 2024

Abstract

Aim
Incidence of diabetes is increasing in the UK. This risks diabetic foot infections which are hard to treat and increase burden on the NHS with recurrent admissions for wound management and antibiotics. Stimulan is an absorbable calcium sulfate antibiotic carrier designed to mix with antibiotics and be applied to open wounds to treat infection including osteomyelitis; this delivers targeted local antibiotics at a higher concentration with ability to disregard renal function. This treats infection and ultimately stops recurrent hospital admissions. This quality improvement project looks at the use of Stimulan in a new protocol for the management of diabetic foot infections at a District General Hospital.

Method
All diabetic foot infections received a protocolled standard of care pathway aimed at grading severity of diabetic foot infection and treating appropriately. When there was a need for debridement of necrotic/infected tissue or drainage of collections, we introduced an intra-operative protocol to debride back to healthy bone, obtain tissue for micro analysis and pack with Stimulan for antibiotic cover.

Results
12 patients received a new standard of care including use of Stimulan intra-operatively combined with antibiotics to treat swab proven infections including Proteus Mirabilis, Enterococcous Faecalis/Coli, Staph Aureus/Epidermidis and Klebsiella. 6–12-month follow-up of these patients showed that they had a downgrading of their foot ulcer severity on the Wagner diabetic foot ulcer classification.

Conclusions
A new protocolled standard of care with the introduction of topical Stimulan mixed with appropriate antibiotics proved effective at treating diabetic foot ulcers complicated by infection.
517 Treatment of Steal Syndrome from a Brachioaxillary Haemodialysis Graft
Authors: Arumuga Jothi A , Mouhsen M I M M , Kordzadeh A , Thapar A , Dindyal S 
Published: August 2024

Abstract

Aim
High flow steal syndrome is a rare complication of arteriovenous (AV) prosthetic grafts used for haemodialysis access. It can be classified as high flow (due to flow diversion away from the hand) or low flow (due to forearm arterial occlusion) The conventional method of treatment is ligation of the graft and use of a tunnelled line. However, dialysis via a graft reduces mortality and hospitalisation for sepsis and reduces central vein stenosis. The aim of this case was to establish the feasibility of flow restriction of a brachioaxillary graft that was causing high flow steal syndrome.

Method
A 70-year-old lady with a new left brachioaxillary graft developed early hand pain at rest (Tordoir 3 class ischaemic steal). Duplex demonstrated patent radial and ulnar arteries with flow reversal in the radial artery. There was high volume flow through the graft. Waveforms at the radial artery improved with external compression of the graft. A multi-disciplinary decision was made to attempt to salvage the graft rather than ligate it. Under local anaesthesia the GORE® ACUSEAL graft was exposed at the arterial anastomosis and 3 large metal Ligaclips were applied 1cm apart to flow restrict the AV graft.

Results
There was return of triphasic radial signal after the 3rd Ligaclip with preserved graft flow. 2 weeks following the procedure the patient resumed dialysis and had resolution of ischaemic rest pain.

Conclusions
Flow restriction through the application of Ligaclips is a new way of treating high flow steal syndrome in AV grafts.