bluuebunny/crossref_metadata_2025_split huggingface dataset:
295 Exploring Gemcitabine and Zoledronic Acid Effects on Tumour Cell Markers: Implications for Immune Response Enhancement
Authors: Atapaka S , Bodman-Smith M 
Published: August 2024

Abstract

Aim
This study aims to investigate the influence of Gemcitabine (GEM) and Zoledronic Acid (ZA) on critical tumour cell markers—ULBP-1, ULBP-2, ULBP-3, MICA/B, and HLA-1—in order to enhance susceptibility to gamma-delta T cells. The research focuses on understanding how these drugs affect marker expression using Raji, Daudi, and Thp-1 cell lines.

Method
GEM and ZA were administered at varying concentrations to the cell lines, employing flow cytometry for detailed marker expression analysis. The experiment aimed to observe alterations in the expression levels of ULBP-1, ULBP-2, ULBP-3, MICA/B, and HLA-1 markers following drug exposure.

Results
ULBP-1 consistently exhibited increased expression across all cell lines, suggesting potential vulnerability of tumour cells to gamma-delta T cell attacks. However, ULBP-2 responses were inconsistent, and ULBP-3 displayed variable patterns based on the specific cell line and treatment regimen. MICA/B expression showed an increase with higher ZA concentrations, though this observation was limited. HLA-1 markers remained relatively stable across cell lines, indicating a consistent population of live cells.

Conclusions
The findings suggest that GEM and ZA may alter specific tumour cell markers, potentially enhancing vulnerability to immune responses. However, drawing definitive conclusions requires extensive experimentation and statistical analysis due to limitations such as low repetitions. Future research should involve increased repetitions and rigorous statistical tests to determine the significance of these observed marker expression changes. Ultimately, this study sets the groundwork for exploring GEM and ZA as adjuncts to conventional cancer treatments, potentially unlocking their therapeutic potential in enhancing immune responses against tumours.
307 The Impact of Bone Quality on Surgical Decision-Making in Elective Primary Total Hip Arthroplasty: A Qualitative Analysis
Authors: Abouharb A , Karia M , Sabharwal S 
Published: August 2024

Abstract

Aim
This inductive/deductive qualitative hybrid study aims to explore the impact of bone quality on decision-making amongst surgeons performing elective primary Total Hip Arthroplasty (THA).

Method
Purposive and snowball sampling were used to recruit Consultant Orthopaedic Surgeons specialised in elective lower limb arthroplasty. Semi-structured interviews were conducted virtually and on Hospital premises, and audio was transcribed. An iterative inductive/deductive strategy was used to code interview transcripts, and thematic analysis was undertaken using NVivo software (Version 14.23.0), in accordance with Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.

Results
There were 10 surgeons from eight centres in the United Kingdom interviewed. Thematic saturation was achieved after eight interviews. Five main themes, and 13 sub-themes were identified. Bone quality impacted decisions around preoperative planning, surgical procedure, implant choice, iatrogenic injury prevention, and hip biomechanics. Many surgeons (7/10) described changing surgical procedure based on their intraoperative assessment of bone quality. There was consensus on the superiority of cemented femoral fixation in osteoporosis, and the importance of assessing X-rays preoperatively, though attitudes differed on acetabular fixation method, the utility of radiographs to measure bone quality, and current surgical guidelines.

Conclusions
Bone quality has a significant impact on the decision-making of experienced arthroplasty surgeons, though there are significant limitations in current methods of assessing it. The divergence identified amongst surgeons on the utility of X-rays to assess bone quality, and towards surgical guidelines merit further investigation.
436 Infra-Inguinal Angiogplasty Outcomes Audit Through the Lens of GRIFT and Sustainable Delivery
Authors: Saw Y C , Small E , Lumsden M 
Published: August 2024

Abstract

Aim
To evaluate the clinical outcomes in patients with Critical Limb Ischaemia (CLI) six months after lower limb arterial angioplasty. To quantify the risk of index limb loss within our cohort and develop a dataset for further audit and quality improvement. Assess surgical resource usage and reconcile with national Getting It Right First Time (GIRFT) strategy and sustainable service delivery. Post-pandemic challenges including increased waiting lists have elevated the risk of angioplasty failure since the 2018 GIRFT Vascular Surgery Report.

Method
A Health Intelligence dataset was obtained for all lower limb angiograms for a thirteen-month period beginning in January 2022 for a single tertiary centre. Morbidity and mortality data were collected.

Results
The cohort included 129 patients with a mean age of 71.9 years (range: 39-96 years). Limb salvage was successful in 53% of patients (n=69) with 15% of patients requiring a subsequent amputation (n=19). Of patients who underwent BKA, 50% would receive the BKA within 60 days (n=9). However, the rate of debridement excluding amputation at 6 months post-angioplasty was 18% (n=23). Mortality at 6 months was 25% (n=32).

Conclusions
Lower limb angioplasty remains crucial for limb salvage and symptom control. Utilisation of pre-angioplasty prognostic scores aid in assessing procedure risk and supporting collaborative decision-making. Review of the CLI patients who required early amputation will allow for development of a stratification/scoring system to predict successful angioplasty, aligning with principles of GIRFT and promoting sustainable medical practice.
674 Patient Services Not Fit for Purpose: Analysis of Skin Cancer Pathway
Authors: Lau J , Marla A , Borra P , Parthiban S , Butler P , Ponniah A 
Published: August 2024

Abstract

Background
NHS public satisfaction fell to 29% in 2022; a record low in NatCen’s British Social Attitudes report since its debut in 1983. Exacerbated by COVID-19, services have redesigned to having an almost 3-fold increase in percentage of telehealth appointments. Now &gt;40% of initial skin cancer appointments in our service are delivered remotely, an approach prioritising efficiency over patient-centred care. This study attempts to gain a comprehensive understanding of patient perceptions and attitudes in our skin cancer pathway.

Method
A snapshot survey of 103 consecutive patients, aged 22-96, 58% female, was conducted over one year at the Royal Free Hospital's skin cancer service. Data was analysed using thematic analysis, allowing for identification of recurring themes and patterns, following the American Association for Public Opinion Research’s guidelines for population analysis. Statistical analysis of frequency data was also applied.

Results
Key findings include a clear preference towards face-to-face as opposed to tele-dermatology in 62% of patients. Tele-dermatology’s primary drawback is only allowing for the assessment of one lesion in a clinic appointment, leaving 54% of patients with multiple unassessed lesions. Patients expressed satisfaction (72%) with waiting times for their initial appointment, however, 68% of patients were dissatisfied with the waiting time for their biopsy results.

Conclusions
The present configuration of services is not fit for patient needs. This study identifies key themes addressing appointment scheduling, telehealth limitations and communication preferences, offering guidance to healthcare providers to improve the quality of care for skin cancer patients, enhancing patient satisfaction and overall healthcare quality.
955 Is Non-Operative Management Equal to or Superior to Operative Management of Distal Radius Fractures for Patients Over 60?
Authors: Kim E , Walmsley P 
Published: August 2024

Abstract

Aim
Distal radius fractures are managed operatively with the implantation of a fixation device or conservatively with casting. However, most studies on distal radius fracture management focus on younger populations, and there is inconclusive evidence regarding the optimal management of elderly populations. This study evaluates current evidence to determine whether operative or non-operative management is superior for elderly distal radius fractures.

Method
A literature search was performed on Medline and EMBASE for papers from the year 2000 onwards. Level I-III studies that compared operative to non-operative management of distal radius fractures in patients aged 60 and above were included in this study. Data was analyzed using the Cochrane ROBINS-I and RoB 2 risk of bias tools and then formulated into forest plots and a double bar graph.

Results
13 heterogeneous studies involving 1,371 elderly patients with distal radius fractures were included. Significant bias was present in these studies, mainly with the non-comparability of treatment groups. At one year follow-up, operative management demonstrated significantly superior results in grip strength, radiographic outcome, and patient-reported outcome measures. Non-operative management demonstrated significantly lower complication rates and costs. Pain and time to union demonstrated a negligible difference between managements.

Conclusions
There is some evidence suggesting operative management provides better functional outcomes to elderly patients with distal radius fractures. Therefore, treatment should be guided by whether the patient’s functional needs outweigh the risk of complications with surgery. Additionally, intra-articular fractures were associated with osteoarthritis and high redisplacement when managed nonoperatively, potentially making operative management preferred with these patients.
966 Managing Infection Risk in Flexible Cystoscopy: An Audit and Service evaluation
Authors: Hicks O 
Published: August 2024

Abstract

Aim
The aim of this audit and service evaluation was to investigate the way in which the infection risk associated with diagnostic and therapeutic flexible cystoscopy was managed in one NHS trust, and to consider the impact that positive urinalysis rates prior to flexible cystoscopy had on service delivery.

Method
All appointments for both diagnostic and therapeutic flexible cystoscopy across the trust were audited prospectively for a two-month period.

Results
276 appointments were booked across this time period, of which 237 were attended and documented. Of these appointments, flexible cystoscopies went ahead in 219 patients and were completed in 215 patients, terminated early in 4 patients. Urinalysis was performed and recorded in 227 appointments. 18 asymptomatic patients tested positive for nitrites, indicating bacteriuria. 3 patients were symptomatic for urinary tract infection, including 1 patient who also underwent urinalysis and tested positive for nitrites. None of the patients who were symptomatic for urinary tract infection underwent flexible cystoscopy. Of the 18 asymptomatic patients who tested positive for nitrites, 9 were cancelled due to infection risk. Infection was the most common reason that a flexible cystoscopy did not go ahead. 72 appointments had no safety netting for infection risk documented.

Conclusions
There was an excellent rate of performing and recording urinalysis in this trust. There is room for improvement for the documentation of infection related safety netting. The decision to cancel appointments on the basis of infection risk in asymptomatic patients was taken on a case-by-case basis, though no symptomatic patients underwent flexible cystoscopy.
671 Neurosurgical Education and Training for Medical Students in the United Kingdom
Authors: Singh A , Baskaran R 
Published: August 2024

Abstract

Aim
Neurosurgical education in British medical schools varies due to the lack of a specialized curriculum. This study aims to evaluate the effectiveness of current practices for neurosurgical education among medical students. Acknowledging the perceived complexity for students, the primary goal is to identify obstacles to optimal learning and propose curriculum adjustments to address these challenges.

Method
A literature search was performed on Embase, Medline and Global Health using the search terms: medical student* OR medical school* AND teaching AND neurosurgery AND (United Kingdom OR UK OR England), including data from 1947 to 2023. The inclusion criteria were: (i) Neurosurgical education (ii) Medical-student (iii) United Kingdom. 8 studies were included and appraised by 2 blinded individuals. The results and conclusions were constructed into a narrative synthesis.

Results
Exposure to clinical settings such as neurosurgical operating theatres and wards plays a crucial role in augmenting students' learning and demonstrates favourable educational outcomes. While the effectiveness of neurosurgery-specific lecture series is discernible, disparities arise in the coverage of topics among medical schools due to variations in delivery methods and lecturer biases. Cumulative evidence indicates the requirement for a standardized curriculum to establish consistency and efficacy in the pedagogy of neurosurgical education.

Conclusions
The implementation of standardized guidelines is indispensable for the harmonization of neurosurgical pedagogy throughout medical schools. Augmented and structured exposure within clinical settings, alongside well-organized lecture series, constitutes an effective strategy for fostering interest and competence. This approach facilitates enhanced understanding and serves to incentivise medical students to contemplate neurosurgery as a prospective career.
131 Acute Injury of The Ulnar Collateral Ligament: Does Ultrasound Get a Thumbs Up?
Authors: Burton H , Goodarzi M , Chalmers R 
Published: August 2024

Abstract
Ulnar collateral ligament (UCL) injuries of the thumb constitute frequent trauma presentations. While clinical assessment proves valuable, instances arise in equivocal cases where imaging aids in determining optimal management. This project aims to assess the diagnostic efficacy of ultrasound in identifying UCL injuries.
A retrospective analysis was conducted utilizing online medical records system. Patients from the last five years who underwent thumb ultrasounds were identified and inclusion criteria encompassed: acute thumb injuries accompanied by ultrasounds indicative of full-thickness UCL tears and/or Stener lesions.
Fifty patients who underwent ultrasounds for acute thumb injuries with UCL concerns were identified. 31 were excluded with normal results or incomplete data. The remaining 19 patients had ultrasound reported complete UCL tears and/or Stener lesions and subsequently underwent operative intervention. The average age was 38.7 years; 58% were female. The median duration from presentation to ultrasound scan was 2 days, and from presentation to surgery was 4.5 days. Eleven patients (63%) exhibited a confirmed complete UCL tear during surgery; 6 patients (37%) had a normal intact UCL. Consequently, the positive predictive value of ultrasound in detecting acute UCL tears within this cohort was 63%.
It is known that accuracy of US is operator dependent and with over a third of patients in our cohort being identified as having false positive result following surgery, relying on US findings to proceed to surgery must be cautioned. It remains a valuable non-invasive investigation. For cases where the clinical picture is indeterminate, MRI is now our modality of choice.
248 Exploring Early Practice and Application of NovoSorbⓇ Biodegradable Temporising Matrix in the United Kingdom: A Case Series on Wound Reconstruction
Authors: Tam S S C , Taylor K , Patel P , Goon P , Khatib M 
Published: August 2024

Abstract

Aim
To identify patients treated with NovoSorbⓇ Biodegradable Temporising Matrix (BTM). To examine defect aetiology, indications of BTM and operation details. To investigate treatment outcomes and possible complications.

Method
From October 2021 to February 2023, 12 patients were treated with BTM for wound reconstruction at Lister Hospital, Stevenage. Patient information, defect size, the reason for BTM use, operation details, and complications were recorded from medical records. The length of initial hospital stays, the time from BTM application to integration, and the length of inpatient stay for post-secondary reconstruction were noted. Indications for BTM were grouped into four categories: covering wounds with exposed bone, covering wounds with exposed tendon, burn wound temporisation and aesthetic reconstruction. Complications were grouped into infection and non-adherence.

Results
This case series comprises defects from head to ankle caused by burns, surgical wounds, post-oncological resection, dermal infections, or traumatic loss. The median time for inpatient stay was 3.5 days, and patients who required skin grafts after full BTM integration were treated as day cases. One case had the post-operative complication of infection.

Conclusions
The team found that the BTM is a versatile dermal substitute that can be used to treat various defects in different parts of the body. Most patients showed no signs of infection or excessive scarring supporting the use of BTM. However, some cases were complicated, possibly due to other medical conditions. Therefore, careful patient selection, close monitoring, and appropriate wound care are recommended.
797 Outcomes From Head-and-Neck Defect Reconstruction with Double Simultaneous Free-Flaps – a Comprehensive Analysis and Showcase of Virtual Surgical Planning Experience
Authors: Chung N , Aslam F , Friebel T , Shahzad F , Khurshid A P , Tarar M M , Peat C , Ahmed O A , Berner J 
Published: August 2024

Abstract

Aim
Extensive composite head-and-neck-defects pose significant reconstructive challenges. This study describes experiences and outcomes associated with double simultaneous free-flap (DSFF) reconstruction for malignant and traumatic head-and-neck indications.

Method
Retrospective study spanning consecutive DSFFs from 2013 to 2023 at Freeman Hospital (FRH), UK, and Jinnah Burn and Reconstructive Surgery Center Lahore (JSC), Pakistan.

Results
Nine patients (18 free-flaps) were included. All patients underwent an osteocutaneous free fibula flap commonest in combination with an anterolateral thigh (n = 3) or free radial forearm flap (n = 2).
In the FRH and JSC groups respectively: mean ages were 53 years versus 27 years, cardiovascular/diabetic comorbidity rates were 60% versus 0%, surgical indications were malignancy (100%) versus trauma (100%), mean operative times were 13.7 (SD 2.8) hours versus 13.0 (SD 3.6) hours and significant complication rates were 60% versus 0%. The commonest complications were anaemia requiring transfusion (n = 3), seroma (n = 2) and wound infection or dehiscence (n = 2). All flaps survived.
Virtual Surgical Plans (VSPs) derived from CT imaging were utilised in all FRH operations. Plans guided construction of custom cutting jigs for precision osteotomy, implantation of osteointegrated teeth and pre-bending of reconstructive plates. 3D-printed end-reconstructive models were employed intra-operatively to enhance surgeon visualization.

Conclusions
This study emphasizes the risks associated with head-and-neck DSFF reconstruction in older, comorbid patients undergoing malignancy treatment compared to the younger, less-comorbid post-traumatic reconstruction group. There were no flap losses. VSP harbours potential in improving intra-operative planning efficiency, contributing to precise reconstruction and augmenting surgeon and patient understanding.
1180 A Cross-Sectional Analysis of Facial Aesthetic Botulinum Toxin Injection Education in the United Arab Emirates (UAE)
Authors: Zargaran A , Mansour H R Khademi , Mohamed F , Sousi S , Zargaran D , Davies J , Woollard A , Mosahebi A 
Published: August 2024

Abstract

Aim
The increasing demand for aesthetic facial botulinum toxin injections have resulted in a significant public health challenge internationally. There is variation in international practice pertaining to accreditation and licensing of practitioners to perform such procedures. The Keogh Review of 2013 identified education as a key area for improvement, however subsequent Health Education England recommendations for Level 7 accreditation were never formally adopted into UK law. This study explores educational practice in UAE, methodology, and compliance with national standards.

Method
A systematic online, social media and local database search was performed in English and Arabic using Boolean operators. Providers were contacted and data triangulated with benchmarking against national guidance including the Dubai Health Authority (DHA), which was broken down into three parts (i) theoretical ii) practical iii) assessments.) Descriptive statistical analysis was performed.

Results
Eighteen courses were identified, of which sixteen were included in the study. All courses had entry requirements, with 50% only allowing Doctors to participate, the remainder extending to other healthcare professionals such as dentists. 62.5% had assessments, including both practical and written, and all courses were accredited. 75% were compliant with national guidance for theory, 87.5% for practical, and 56.3% for assessments. Mean course price was AED13,624 (£2,888), whilst mean duration was 2.8 days.

Conclusions
Aesthetic Botulinum Toxin education in UAE is governed by clear criteria which in many instances are not being adhered to. All courses have specific entry requirements pertaining to professional background. The highest area for improvement in compliance was for assessments.
1244 Bridging the Gap: Enhancing Wound Management and Burn Skills in Junior Doctors
Authors: Khan R , Krzak A 
Published: August 2024

Abstract

Aim
This study aimed to improve Foundation Year 1 (FY1) doctors' understanding and confidence in wound and burn management through incorporation of wound and burn management teaching into the Thames Valley Deanery Foundation Training teaching curriculum.

Method
We employed a comprehensive pedagogical approach, integrating both theoretical knowledge and practical application. Initial assessment was conducted via a structured questionnaire, assessing participants' objective knowledge and perceived confidence in managing wounds and burns. The questionnaire was completed by 16 out of 46 and 10 out of 46 participating FY1 doctors pre- and post-teaching, respectively.

Results
Our analysis revealed a 48% (p&lt;0.001) rise in self-reported confidence in managing burns, wounds, dressing choice, and knowledge of potential reconstructive options. A 13% rise in objectively assessed knowledge was noted, though did not reach statistical significance (p=0.6). Qualitative feedback indicated a gap in the medical curriculum, with doctors reporting that essential aspects of wound and burn management had not been adequately addressed during their prior medical training.

Conclusions
Our findings emphasise the benefit of continuous medical education to address knowledge gaps not met by traditional medical curricula. The incorporation of burns and wound management teaching into the curriculum increased the level of confidence but did not objectively assess knowledge. It may therefore be beneficial to incorporate such frequently encountered Plastic Surgery topics at an earlier stage in medical education. Further research should assess the impact of such teaching sessions on patient outcomes and the broader implications of delivering this specialised education.