bluuebunny/crossref_metadata_2025_split huggingface dataset:
854 Bridging the Communication Gap in Surgery: A Quality Improvement Initiative to Improve Surgical Juniors’ Confidence in Navigating Difficult Conversations and Documentation
Authors: Kamal T 
Published: July 2024

Abstract

Aim
In response to the challenges faced by surgical juniors in communicating with critically ill patients and their families, particularly after emergency surgery, we initiated a comprehensive two-pronged QIP. Our aims were 1) to enhance skills and confidence of surgical juniors in navigating difficult conversations, and 2) to improve documentation of post-operative patient and NOK discussions after ITU step-down to ward, in-line with NICE guidelines (CG83-1.13).

Method
A retrospective analysis of 14 laparotomy patients in September 2023, revealed that only 36% had documented NOK discussions 3-5 days post-operatively, falling short of best practice guidelines recommending documentation within 12 hours. Only 33% of the 10 patients requiring ITU admission, received documented NOK updates post-step-down to the ward. Interventions to address this included developing a communication skills workshop and implementing colored cards in notes folders to visually identify patients needing NOK discussions.

Results
Pre- and post-workshop surveys, utilizing a 1-to-5 scale, measured confidence levels of junior doctors for difficult discussions, with 13 and 9 respondents, respectively. High confidence scores (4 or 5) for different discussion types showed substantial improvement post-workshop: DNACPR (31% vs. 89%), end-of-life (31% vs. 55%), emotionally charged (31% vs. 78%). Furthermore, 100% of participants post-workshop were highly likely (4 or 5) to utilizing communication frameworks e.g., SPIES.

Conclusions
Our interventions have demonstrated a significant improvement in the confidence of surgical juniors when navigating challenging conversations. Our ongoing efforts include expanding our ‘communication in surgery’ workshop series, which we hope to present, and a re-audit of NOK discussion documentation to objectively measure positive changes post-intervention.
145 Arthroscopy Combined with Platelet-Rich Plasma Injections in Temporomandibular Joint Disorders: Impact on Patients' Quality of Life
Authors: Zar Rab K , Komath D 
Published: July 2024

Abstract

Aim
Temporomandibular joint disorders are associated with pain, dysfunction, and reduced quality of life. Emerging treatments, such as arthroscopy combined with platelet-rich plasma (PRP) injections, offer promise in managing these conditions. This study aims to assess the impact of this combined approach on patients' quality of life. The study outlines a detailed surgical procedure for level 2 arthroscopy, as well as the specialized method for preparing PRP, step by step.

Method
This retrospective cohort study included 80 patients who underwent unilateral or bilateral TMJ arthroscopy with PRP injection between 2019 and 2023. Inclusion criteria involved radiological and clinical evidence of TMJ disorders and failed non-operative treatments. Patients completed the TMJ-S-QoL questionnaire, evaluating pain, diet, speech, and psychosocial aspects postoperatively.

Results
Arthroscopy with PRP injection led to significant improvements in patients' quality of life. The TMJ-S-QoL questionnaire revealed positive outcomes in pain relief, functional improvement, and psychosocial well-being. Statistical analysis confirmed the significance of these improvements (p &lt; 0.05).

Conclusions
Arthroscopy combined with PRP injections represents a promising therapeutic approach for TMJ disorders. This study demonstrates its positive impact on patients' quality of life, encompassing pain reduction, improved function, and enhanced psychosocial well-being. These findings contribute to a comprehensive understanding of treatment efficacy, paving the way for improved patient care and outcomes in TMJ disorder management.
208 Head and Neck Surgical Oncology Handover Audit Using ‘RAAAIDDSS’ Method
Authors: Jamalludin A , Elegio G , Abu Shamat H , Haxhiaj E 
Published: July 2024

Abstract

Background
Patient handover is vital in ensuring patient safety and quality of patient care, in line with Royal College of Surgeons Guidance of Safe Handover (2007). ‘RAAAIDDSSS’ method stands for resection (surgery), airway, anticoagulant, antibiotics, intake, drain, Doppler, serology, scans, structure (plans). It shows comprehensive clinical updates for planning best management, ensuring smooth flow of activity and reducing morbidity. This method is ideal as our surgical patients often have altered airway anatomy and airway plans and consequently variable feeding routes.

Aim
To audit the compliance of RAAAIDDSSS method.

Method
This is a prospective audit in Head and Neck Surgery Department of University College London Hospital (UCLH), done within 4 weeks across June-July 2023, with sample (n=100) for first cycle and (n=81) for second cycle. The format was implemented in handover sheet and case presentation was run according to this method.

Results
First cycle showed good compliance to RAAAIDDSSS handover method. The least compliant component is ‘structure’ which showed only 62%. Results were presented in grand ward round. Second cycle showed significant improvement. Almost all components showed 100% compliance, except for the ‘intake’, which was 90%. Overall shows positive compliance to this handover method.

Conclusions
UCLH Head and Neck Surgery has strict compliance with the RAAIDDSSS method. This audit brings significant positive impacts and changes to clinical practice in terms of patient safety, service efficiency and quality of patient care. This audit also holds valuable clinical value and opens doors for further audits as well as project expansion regionally and nationally.
540 Outcomes of Laparoscopic Common Bile Duct Exploration and Laparoscopic Cholecystectomy; a Single Centre Review from a District General Hospital in Northern Ireland
Authors: Winter J , Ainley P , McGuinness E , Gudyma J , Eltayeb O 
Published: July 2024

Abstract

Aim
Laparoscopic cholecystectomy and common bile duct exploration is a one-stage therapeutic option for patients presenting with choledocholithiasis. This is a review of outcomes for patients who underwent this procedure in a district general hospital setting in Northern Ireland over a two-year period.

Method
This is a retrospective review of prospectively collected data concerning all patients who underwent laparoscopic cholecystectomy and common bile duct exploration between October 2021 and October 2023. Data were reviewed to include pre-operative liver function, pre-operative imaging, rate of conversion to open procedure, length of stay, and readmission rate due to complications.

Results
106 patients were included in the review. The average length of stay was 2.7 days (with a median of 1 day). 87.7% of patients had deranged liver function tests on the morning of surgery, and 100% had proven choledocholithiasis on cross-sectional imaging prior to proceeding to theatre. Only two patients required conversion to open cholecystectomy. No patients developed post-operative pancreatitis. The complication rate was 11.3%, with most complications being of Clavien-Dindo Grade I or II. The readmission rate was 7.5%.

Conclusions
Common bile duct exploration at the time of laparoscopic cholecystectomy represents a safe and effective method for management of choledocholithiasis. It can be considered as an alternative to endoscopic retrograde cholangiopancreatography as a therapeutic option in an appropriately selected patient group.
1195 The Outcomes of Liver Resection for Metastatic Liver Disease from Melanoma: A Systematic Review and Meta-Analysis
Authors: Ravulapalli K , Tijare C , Al-Mukhtar A 
Published: July 2024

Abstract

Aim
There remains controversy in the literature regarding the choice of treatment of melanoma metastases to the liver. This systematic review aims to compare the survival and morbidity rates of patients undergoing liver metastasectomy with patients undergoing medical treatment.

Method
A literature search was conducted from inception until June 2022 using Ovid, Medline, Embase and the Cochrane library. Snowball and hand searches were also carried out. Included studies compared survival outcomes between patients undergoing metastasectomy to those undergoing medical management. Meta-analyses were performed comparing the survival at 6 months, 1, 3 and 5 years as well as overall survival. A sub-analysis was performed comparing the overall survival between surgically and medically treated patients which exclusively uveal melanoma hepatic metastases.

Results
25 studies with a total of 2990 participants were included in our study. All studies were found to have some degree of risk of bias. Mean Overall survival was 44.31 (SD 46.25) and 21.59 (SD 24.31) in surgically and medically treated patients respectively. Meta-analysis showed a statistically significant benefit overall in favour of surgically treated patients (OR = 1.33, 95% CI 0.29 to 2.3, p =0.01, I²=0). This was also the case at 6 months, 1, 3 and 5 years. Meta-analysis showed no significant differences in survival between surgically and medically treated patients which exclusively uveal melanoma metastases.

Conclusions
This review demonstrates improved survival in patients undergoing hepatic metastatectomy for melanoma metastases compared to those undergoing medical treatment, but this may not be the case for those with uveal metastases.
294 Does the Initial Antibiotic Choice Affect the Incidence of Post-Operative Collections in Paediatric Appendicitis?
Authors: Manoharan M , Alrasad R , Chatterjee-Woolman S , Peeraully R , Shepherd G , Shenoy M 
Published: July 2024

Abstract

Introduction
In appendicitis, antibiotics are routinely commenced prior to consideration of operative management. The choice of initial regimen depends on local antimicrobial guidelines. The presence of resistant organisms risks development of post-operative collections.
In our tertiary paediatric surgery unit, antimicrobial guidelines were changed in September 2022 to recommend co-amoxiclav instead of cefuroxime/metronidazole. This study compares incidence of post-operative collections before and after the policy change.

Method
Patients who underwent appendicectomy between September 2021 and October 2023 were identified and contemporaneous data collected. Patients who had initial surgery elsewhere, interval/incidental appendicectomies or penicillin allergy were excluded. Comparison was made between patients receiving cefuroxime/metronidazole (Group 1) or co-amoxiclav (Group 2).

Results
Over the 26-month period, there were 104 patients in Group 1 (after excluding 47) and 104 in Group 2 (after excluding 46). 4 (3.8%) developed collections in Group 1 versus 13 (12.5%) in Group 2. In Group 1, 2 (50%) were treated with antibiotics alone, 1 (25%) required drain insertion and 1 (25%) had a laparotomy. In Group 2, 7 (54%) were treated with antibiotics alone, 5 (38%) required drain insertion and 1 (8%) had a laparotomy. The relative risk of developing a post-operative collection was 3.3 (p=0.023) in Group 2 versus Group 1.

Conclusions
The change in antimicrobial policy resulted in a significant increase in post-operative collections in our unit. This provides evidence that a regimen of cefuroxime/metronidazole is more effective at preventing collections and we are liaising with our Microbiology department with a view to amend the guidelines.
71 Stereotactic Ablative Radiotherapy Is a Safe and Feasible Treatment Option for Patients with Hepatocellular Carcinoma
Authors: Wagner B , Falk S , Callaway M , Abbadi R , Appanna G , Rees J , Skipworth J , van Laarhoven S 
Published: July 2024

Abstract

Aim
Stereotactic ablative body radiotherapy (SABR) is a highly focused radiation treatment that delivers an intense dose of radiation to a tumour whilst limiting exposure of surrounding tissues. SABR has been associated with improvement in survival and good rates of local control in non-surgical candidates with hepatocellular carcinoma (HCC). The aim of this study was to evaluate the outcomes of HCC patients treated with SABR after its introduction in a tertiary referral hepatobiliary centre.

Method
A total of 32 patients (median age 73 years {47 to 85}, 78% male) who received SABR for HCC liver lesions between July 2020 and August 2022 were retrospectively analysed. Patient, treatment, and follow-up details were obtained from online patient records and imaging.

Results
Overall Survival rate was 78% at a median follow-up of 12 months (range 4 to 30). Local control was achieved in 72%, while progression occurred in 31%. Median time to progression was 6 months (range 3 to 31). The rate of progression-free survival at 12 months was 62.5%. Only 31% reported toxicities. No patients in the study group experienced any Grade ³ 3 toxicities.

Conclusions
Our experience following the introduction of SABR for patients with HCC is that SABR is a viable, well-tolerated and effective treatment option in this patient group. Further research is warranted to examine the clinical benefits of combination treatment with SABR and other treatment modalities to maximise disease control in patients with both early and advanced HCC.
399 Cancer Recurrence in Positive Margin Partial Nephrectomies: 5-Year Results from the West of Scotland
Authors: Wrobel A , Durai P , Qureshi K , Umez-Eronini N , Hendry J , Oades G 
Published: July 2024

Abstract

Aim
Provide insight into the incidence of disease recurrence following a positive margin partial nephrectomy in Renal cancer patients. Allowing the analysis of the current surveillance protocols for early detection of disease recurrence.

Method
A retrospective review of all patients undergoing Partial Nephrectomies (PN) within a single centre between 2016 and 2021 was performed. Demographic data including age and sex, as well as tumour-specific data of histology, RENAL score, tumour margin, surveillance, and disease recurrence was recorded. Follow-up was performed as per WOSCAN guidance.

Results
255 patients underwent PN: 79 (31%) open (OPN) and 176 (69%) robotic-assisted procedures (RALPN). OPN was performed in higher risk cancers with a higher risk of positive margin compared to RALPN (10.1% vs 6.25%). The median follow-up time was 35 months. 3 patients with positive margins had recurrence; all were pT3 cancer following OPN of which 2 had metastatic and 1 patient had local recurrence. 18 positive margin patients (95%) were compliant with WOSCAN surveillance guidelines.

Conclusions
OPN was performed for more complex tumours which had a higher risk of positive margins and thus recurrence. Regional data can be used to better counsel patients, however further work should assess any evolving change in RALPN positive margin rates as more complex tumours are attempted robotically.
Political Partisanship and Economic Outcomes: Canada, 1870–2020
Authors: Voia Marcel-Cristian , Ferris J Stephen 
Published: July 2024

Abstract
This paper examines the role of partisanship at the provincial and federal levels in relation to the functioning of the Canadian economy. At the provincial level (1976–2019), we find no evidence of a traditional partisan effect but do find evidence weakly consistent with a rational partisan cycle a′ la Alesina. At the federal level (1870–2020), we also find no evidence consistent with a distinctive expansion in output arising when the government is controlled by the left-leaning (Liberal) political party although we again find evidence of a weak rational partisan effect. The former result is reinforced by finding the absence of evidence of partisan changes in federal spending and/or taxation. But while the data do not support a theory of left-right partisan policy over the entire post-Confederation (1867) period of Canada’s history, the data do support distinctive periods of partisan influence on aggregate output. The first is consistent with Sir John A. MacDonald’s post-Confederation conservative government’s adoption of a policy of nation-building based on the railway, immigration, and tariffs. The second is the period between 1885 and 1933 where traditional left-right partisanship is evident and the third is the period following the Great Depression where a distinction between the outcomes arising under left- versus right-leaning parties is no longer apparent.
2024 Clinical Practice Guideline Update by the Infectious Diseases Society of America on Complicated Intra-abdominal Infections: Diagnostic Imaging of Suspected Acute Diverticulitis in Adults and Pregnant People
Authors: Bonomo Robert A , Tamma Pranita D , Abrahamian Fredrick M , Bessesen Mary , Chow Anthony W , Dellinger E Patchen , Edwards Morven S , Goldstein Ellie , Hayden Mary K , Humphries Romney , Kaye Keith S , Potoski Brian A , Rodríguez-Baño Jesús , Sawyer Robert , Skalweit Marion , Snydman David R , Donnelly Katelyn , Loveless Jennifer 
Published: July 2024

Abstract
This paper is part of a clinical practice guideline update on the risk assessment, diagnostic imaging, and microbiological evaluation of complicated intra-abdominal infections in adults, children, and pregnant people, developed by the Infectious Diseases Society of America. In this paper, the panel provides recommendations for diagnostic imaging of suspected acute diverticulitis. The panel's recommendations are based on evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.
Prosapia bicincta (Hemiptera: Cercopidae) abundance, plant associations, and impacts on groundcover in Hawaiʻi Island rangelands
Authors: Wilson Shannon , Thorne Mark S , Johnson Melissa A , Peck Daniel C , Wright Mark G 
Published: July 2024

Abstract
The twolined spittlebug, Prosapia bicincta (Say), is a major economic pest of forage grass and turfgrass. Prosapia bicincta was first detected in rangelands on Hawaiʻi Island in 2016 and has since spread to an estimated 72,000 ha in the North and South Kona districts. This study aimed to quantify P. bicincta abundance, plant associations, and impacts on groundcover over time. Monthly surveys of P. bicincta nymphs and adults were conducted from February 2018 to September 2022 along 17 established 100-m transects at 4 ranches located in Kona, Hawaiʻi Island, spanning an elevation gradient from 519 to 1,874 m above sea level (a.s.l.). Monitoring revealed P. bicincta occurs from 519 to 1,679 m a.s.l., primarily in Kikuyu grass (Cenchrus clandestinus (Hochst. ex Chiov.)) Morrone (Poales: Poaceae) pastures. Peaks in P. bicincta abundance coincided with the wet season, with most activity occurring from April to October and little to no activity between November and March. Mid elevation (1,000–1,300 m) transects had significantly higher mean P. bicincta abundance (126 nymphs/m2) relative to low (500–999 m) (64 nymphs/m2) and high elevations (&gt;1,300 m) (20 nymphs/m2). Sites with the highest abundance of P. bicincta were also associated with the greatest decrease in mean grass cover (30%) and were replaced by forbs, bare ground, and shrubs. Grasses accounted for 72% of the total P. bicincta detections, with the remaining plants comprised of legumes (16%), sedges (6%), and forbs (6%). Twenty new P. bicincta plant associations were found. This information will help improve the effectiveness of management to suppress populations below economic thresholds.
Field longevity of methyl eugenol and cue-lure plugs and associated insecticidal strips: captures of Bactrocera dorsalis and Zeugodacus cucurbitae (Diptera: Tephritidae) in Hawaii
Authors: Shelly Todd E , Fezza Thomas J , Martin Rodolfo Mesa 
Published: July 2024

Abstract
Certain species of true fruit flies (Diptera: Tephritidae) cause tremendous damage to commercially important fruits and vegetables, and many countries operate continuous trapping programs which rely on male-specific lures such as trimedlure (TML), methyl eugenol (ME), and cue-lure (CL). Traditionally, these attractants have been applied as liquids to cotton wicks inside traps, although this results in high evaporative loss of the lure. Slow-release, polymeric plugs have been widely adopted for TML, but such devices are not widely used for ME or CL. Recent data, however, suggest that ME and CL plugs may be attractive for as long as 12 wk in the field. The present study investigates whether ME and CL plugs weathered for 18 or 24 wk are effective in capturing males of Bactrocera dorsalis (Hendel) and Zeugodacus cucurbitae (Coquillett), respectively. For B. dorsalis, 6 g ME plugs were as effective as the control treatment (fresh liquid on a wick) after 12 wk of weathering but not after 18 or 24 wk. For Z. cucurbitae, 3 g CL plugs were as effective as the control treatment (fresh CL plugs) after 12 and 18 wk of weathering but not after 24 wk. The residual content and release rate of the 2 lures were also measured over time, but, with the exception of the residual content of ME, we did not find a direct correlation between these parameters and numbers of flies captured.
Gut microbiome in two high-altitude bird populations showed heterogeneity in sex and life stage
Authors: Sun Mingwan , Halimubieke Naerhulan , Fang Baozhu , Valdebenito José O , Xu Xieyang , Sheppard Samuel K , Székely Tamás , Zhang Tongzuo , He Shunfu , Lu Rong , Ward Stephen , Urrutia Araxi O , Liu Yang 
Published: July 2024

Abstract
Gut microbiotas have important impacts on host health, reproductive success, and survival. While extensive research in mammals has identified the exogenous (e.g. environment) and endogenous (e.g. phylogeny, sex, and age) factors that shape the gut microbiota composition and functionality, yet avian systems remain comparatively less understood. Shorebirds, characterized by a well-resolved phylogeny and diverse life-history traits, present an ideal model for dissecting the factors modulating gut microbiota dynamics. Here, we provide an insight into the composition of gut microbiota in two high-altitude (ca. 3200 m above sea level) breeding populations of Kentish plover (Charadrius alexandrinus) and Tibetan sand plover (Charadrius altrifrons) in the Qinghai–Tibetan Plateau, China. By analysing faecal bacterial communities using 16S rRNA sequencing technology, we find a convergence in gut microbial communities between the two species, dominated by Firmicutes, Proteobacteria, and Bacteroidetes. This suggests that the shared breeding environment potentially acts as a significant determinant shaping their gut microbiota. We also show sex- and age-specific patterns of gut microbiota: female adults maintain a higher diversity than males, and juveniles are enriched in Rhizobiaceae and Exiguobacterium due to their vegetative food resource. Our study not only provides a comprehensive descriptive information for future investigations on the diversity, functionality, and determinants of avian microbiomes, but also underscores the importance of microbial communities in broader ecological contexts.