bluuebunny/crossref_metadata_2025_split huggingface dataset:
776 Retrospective Audit of CPIP and Hip Surveillance Compliance in a District General Hospital
Authors: Hunter C , Rawlins E , Rapson R , Winfield C 
Published: August 2024

Abstract

Aim
CPIP (Cerebral Palsy Integrated Pathway) is a national pathway used to assess whether children with cerebral palsy show signs of hip migration based on regular pelvic x-rays. This allows Clinicians to determine if early surgical intervention is required. The aim of this audit is to determine if we are adhering to the CPIP at Torbay Hospital.

Method
Data was collected on the children who are under CPIP in the Devon area. Adherence to this pathway was assessed based on whether children were receiving their hip x-rays at the appropriate time based on their Gross Motor Function Classification System Score (GMFCS). Furthermore, we will be distributing a questionnaire to determine patient satisfaction with CPIP.

Results
Based on our analysis 64 children were identified, with 83% having a recent CPIP assessment and 68% of patients receiving their x-rays in an appropriate timeframe. Additionally, it was found that 72% of hip x-rays requested were reported.

Conclusions
It can be concluded that the Trust is adherent to CPIP, however some improvements could be made to increase adherence. To increase adherence, actions such as monthly meetings between the radiography and physiotherapy department will take place. Following these improvements, a repeat analysis will be carried out to determine adherence to CPIP.
994 Enhancing Compliance with BOAST Guidelines: A Closed-Loop Audit on Cervical Clearance in Head Injury Patients
Authors: Kondi S , Soliman A 
Published: August 2024

Abstract

Aim
This audit aimed to evaluate the compliance of cervical spine clearance in head injury patients according to BOAST guidelines following the implementation of a novel intervention, a single request tab, suggested after the previous audits.

Method
BOAST guidelines state that if brain CT is necessary for a head injury, this should include the CT cervical spine. Previous audits (June/Nov 2021 and Aug/Sept 2022) highlighted a persistent lack of adequate cervical spine clearance in head injury patients at Queen Alexandra Hospital. In response, a solution was proposed and implemented on May 5, 2023, introducing a single request tab within the Imaging requesting software (ICE) for CT Brain and CT C-spine. Data collected from July/Aug 2023 assessed the adherence to BOAST guidelines for all admitted head injury patients.

Results
The data encompassed 36 head injury patients, primarily diagnosed with subdural hematoma (55%), followed by skull fractures (14%). The audits in 2021 and 2022 revealed suboptimal compliance (23% and 37% respectively) despite interventions. The new implementation showcased a significant improvement, with a 53% compliance rate. This contrasts with the previous audits, suggesting enhanced adherence to BOAST guidelines.

Conclusions
Ensuring cervical spine clearance in head injury patients aligns with BOAST guidelines, emphasizing patient safety. Our audit demonstrated substantial progress in compliance, signifying improved adherence to guidelines and elevated patient care standards. The implementation of the single request tab streamlined the workflow, enhancing efficiency for clinicians to request scans promptly. We recommend widespread education initiatives for Emergency Department staff and the adoption of the single request tab across all trusts to optimize patient care.
53 The Diagnostic Performance of Uromonitor in the Evaluation of Patients at Risk for Urothelial Carcinoma
Authors: Wombwell A , Lobo N , Nair R , Khan S , Thurairaja R 
Published: August 2024

Abstract

Aim
Uromonitor is a urinary biomarker test that detects hotspot mutations in three genes (TERT, FGFR3 and KRAS) and has been shown to detect non-muscle-invasive bladder cancer with 100% sensitivity. We compared the performance of Uromonitor with urine cytology for the detection urothelial carcinoma in patients presenting with haematuria in our unit.

Method
Between September 2021 and January 2023, voided urine samples were obtained prior to cystoscopy from 56 patients presenting with haematuria. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of Uromonitor for the detection of urothelial carcinoma were calculated and compared to histology.

Results
Uromonitor demonstrated a sensitivity of 40.0%, specificity of 90.3%, a PPV of 76.9% and a NPV of 65.1%. In contrast, urine cytology demonstrated a sensitivity of 40.9%, a specificity of 85.3%, PPV of 64.3% and NPV of 69.0%.

Conclusions
Our ‘real world’ evaluation, Uromonitor showed improved specificity but lower sensitivity for the detection of urothelial carcinoma compared to cytology.
252 Analysis of the High Readmission Rate Following Elective Ureteroscopy – the Need for Improved Patient Information on Stent-Related Symptoms
Authors: Krum T , Frackleton R , Garrod H 
Published: August 2024

Abstract

Aim
To understand the high emergency readmission rate following elective ureteroscopy at Wirral University Teaching Hospital (WUTH) and to develop strategies to reduce readmissions to the national average.

Method
Comparison and retrospective chart review of Model Hospital and equivalent WUTH records and analysis of the nature and duration of readmission.

Results
Between October 2021 and March 2023, 212 elective ureteroscopies were performed at WUTH, 76.9% (n=163) involved insertion or exchange of a ureteric stent. The 30-day readmission rate following ureteroscopy was found to be 13.7% (n=29), which is higher than the median 8.6% Model Hospital national rate. Notably, it was found that 86% (n=25) of readmissions had a ureteric stent inserted or exchanged in their primary procedure. Most patients (75.9%, n=22) were readmitted within a week of their procedure and those that stayed overnight (55.2%, n=16) had a median length of stay of 2.5 days. Of these, 31.3% (n=5) were readmitted due to stent-related symptoms, including loin pain upon voiding, mild haematuria, frequency, and urgency. In contrast, for readmissions not requiring an overnight stay (44.8 %, n=13), stent-related symptoms accounted for 69.2% (n=9) of presentations.

Conclusions
Stent related symptoms are well understood, frequently reported, and do not necessarily require readmission. The high number of emergency presentations at WUTH with stent related symptoms suggests that most patients were unaware of this. ‘Stent passports’ detailing common symptoms, red-flags and when to seek urgent medical advice may be an effective tool to improve patient’s experience and reduce readmissions following ureteroscopy.
368 Single Shot Instillation Intra-Vesical Chemotherapy Administration: A Global Audit of Guideline Compliance – Results From the BURST-RESECT Study
Authors: Simpson K , Gallagher K , Bhatt N , Maclennan S , Hina S , James J , Gartner T , El-Koubani O , Mariappan P , Kasivisvanathan V 
Published: August 2024

Abstract

Aim
Auditing administration of Single instillation intra-vesical chemotherapy (SI-IVC) which has level 1 evidence in reducing cancer recurrence rate after Trans-Urethral Resection (TURBT) for non-muscle invasive bladder cancer (NMIBC).

Method
Using RESECT study (NCT05154084) data, a retrospective observational study was performed. Patients included underwent primary curative TURBT for bladder cancer. Cases were excluded if SI-IVC administration data was missing. The primary outcome was the rate of administration of SI-IVC.

Results
Data from 232 hospitals globally were included. After exclusions, there were 7933 (87.5%) cases analysed (44% low grade, 56% high grade NMIBC).
SI-IVC was administered in 3075 (39%) of cases (Low grade + SI-IVC: 48%, high grade + SI-IVC: 32%).
Considering low grade cases (3390), where SI-IVC is most beneficial, reasons listed for non-administration were “Surgeon did not request it” (68%), “Surgeon requested it, but it was not given” (7%) and “SI-IVC is never given at our hospital” (25%). Of 3566 cases where the surgeon did not request SI-IVC, 1497 (42%) the surgeon thought it was not indicated, 512 (14.4%) were because of potential contra-indications, no reason documented in 1210 (34%). Of these 2707 cases with no documented contraindication, 837 (31%) had low grade disease and likely would have benefitted.

Conclusions
The most common reason for non-administration of guideline recommended SI-IVC was that the surgeon did not request it, in almost one third of these cases the patient is likely to have benefitted. The RESECT study will test whether providing feedback and education to surgeons about their guideline compliance can improve compliance and outcomes.
984 Evaluation of Calcium and Urate Level Testing on Patients for the Acute Stone List Surgery
Authors: Tayo O , Karanjia R 
Published: August 2024

Abstract

Aim
Is to assess compliance with the newly implemented protocol for requesting calcium and urate levels at the initial patient presentation in an Accident & Emergency / Urgent Treatment Centre setting, who were managed either conservatively or with ureteric stent insertion, prior to undergoing laser fragmentation of renal stones in preparation for the acute stone list.

Background
Ensuring comprehensive pre-operative assessments, including calcium and urate level checks, is vital in the management of patients with renal colic symptoms or infective obstructed urinary systems. Following the initiation of the acute stone list, a standard protocol was introduced in the urology department to standardize this process.

Method
This single-cycle audit reviewed the records of 51 patients listed on the acute stone list from the commencement of the initiative. The focus was on determining whether these patients had their calcium and urate levels checked at the time of their surgery.

Results
Calcium Testing: Of the 51 patients, 27 (52.94%) had undergone calcium testing at presentation, while 24 (47.06%) had not. Urate Testing: 23 patients (45.10%) had their urate levels tested, compared to 28 patients (54.90%) who did not receive this test. The target is 100% compliance in all patients on the acute stone list, should have had these test by time of procedure

Conclusions
This audit underscores the importance of strict adherence to pre-operative testing protocols for patients on the acute stone list. Improved compliance, especially in urate level testing, is essential for optimizing patient outcomes and the overall success of surgical interventions.
1063 Establishment of Pneumoperitoneum for Renal Surgery Using the Kii Fios First Entry System: Early Experience and Case Series
Authors: Collins P , O’Gorman L , Hairdaran I , Hennessey D 
Published: August 2024

Abstract

Introduction
The ideal technique for establishing pneumoperitoneum for renal laparoscopic surgery is unknown. Veress and Hasson methods have been commonly employed, but the use of a direct vision entry port is less widely described. The aim of this study was to assess the success, safety, and efficiency of this technique in our first fifty cases.

Method
The Kii Fios First Entry system was used in all cases. The camera is placed in the trocar and this was advanced under vision, with simultaneous insufflation. Patient BMI, time to pneumoperitoneum, complications, and subsequent hernia rates were recorded.

Results
Fifty patients were included with mean body mass index 30.5kg/m2. All patients were placed in the lateral position for surgery. The entry port was placed between umbilicus and costal margin. A 10mm port was used for the first 10 cases, with a 5mm port and smaller calibre camera used for the remaining 40. Twenty-two (44%) patients underwent pyeloplasty, 19 (38%) underwent nephrectomy, and 9 (18%) other surgeries. Mean time to establishment of pneumoperitonem was 31 seconds, with the shortest recorded time being 12 seconds. No patient suffered a visceral or vascular injury. The 10mm port sites were closed formally, but 5mm sites were not. No patient has developed a port-site hernia. The First Entry port costs €39 per item.

Conclusions
The Kii Fios First Entry system represents a safe, easy, and inexpensive alternative for establishing pneumoperitoneum in laparoscopic renal surgery, with very short entry times in this series.
318 Unmasking Unusual Penile Complications in External Iliac Artery Stenting
Authors: Iossifidis E , Bennett P 
Published: August 2024

Abstract

Introduction
Distal embolisation following percutaneous transluminal angioplasty (PTA) is a recognised complication, occurring in 7.9%-23.7% of procedures. Whilst ischaemic complications have been reported following internal iliac artery embolisation, most commonly causing buttock claudication and erectile dysfunction, distal embolisation into the internal pudendal artery has been scarcely reported.

Case Report
A 65-year-old diabetic smoker attended for elective bilateral external iliac artery (EIA) stenting for chronic limb threatening ischaemia via retrograde left femoral approach. Pre-procedural CT demonstrated lining thrombus at the aortic bifurcation and the left common iliac artery (CIA). Following discharge, they attended the emergency department with a painful necrotic lesion on the left posterior side of the scrotum, which was excised by the urology team with sections showing necrotic and acutely inflamed tissue. A painful, necrotic lesion had also developed on the left side of the glans penis which was treated conservatively.

Discussion
The posterior scrotum and penis are supplied by the internal pudendal artery, a terminal branch of the anterior division of the internal iliac artery (IIA). This patient embolised from their left CIA and aortic bifurcation lining thrombus into the left internal pudendal artery resulting in ischaemic ulceration of the penis and scrotum. The scrotal tissue has healed completely, whereas the penile wound is still healing 6 months later.

Conclusions
Internal pudendal artery embolus following iliac PTA is a rare, but important, complication which can lead to significant distress for patients. Education and councelling of these risks to patients could lead to earlier recognition, treatment, and better desired outcomes.
507 Assessing the Standard of Referral Letter Documentation and Outcomes of Claudicants in the Vascular Outpatient Clinic
Authors: Iossifidis E , Shehata M , Bennett P 
Published: August 2024

Abstract

Aim
Referrals to the vascular outpatient clinic are made by GPs and Allied Health Professionals (AHPs), who may not have prior vascular training. We assessed standards of referral letters with associated clinic outcomes.

Method
Referral letters for new patients attending clinic 01/01/2023-31/08/2023 were reviewed for intermittent claudication (IC) diagnosis along with referral urgency and referring clinician grade. Documentation of IC distance, pulses, cardiovascular risk factors (CVSRF), antiplatelet and statin prescriptions were assessed as minimum standard.

Results
141 (GP:111,AHP:30) new IC patients were reviewed in clinic: 72.3% male, mean age 71.2(SD:10.5) years. 100 were referred as routine, 33 urgent and 8 not specified. 86(61%) referral letters recorded claudication distance (47(54.7%) &lt;100m, 39(45.3%) &gt;100m). GPs and AHPs had no differences in documentation for ≥1 CVSRF (71(64%) vs 19(63.3%), p=0.949), antiplatelet prescription (43(38.7%) vs 10(33.3%), p=0.588) and statin prescription (60(54.1%) vs 16(63.3%), p=0.944). 100(70.9%) referrals had documented pulses, with no difference between GPs and AHPs (81(73.6%) vs 19(63.3%), p=0.302). No differences in referral urgency were found related to pulse assessment in community. Patients with IC distance &lt;100m were more likely to be referred for further investigations than &gt;100m (21(45.6%) vs 7(17.9%), p=0.008).

Conclusions
Walking distance &lt;100m on referrals was the only factor associated with further clinic investigations. Therefore, we are developing an IC management flowchart for the integrated care board with distance &gt;100m to be managed in the community with best medical therapy/exercise, and &lt;100m to be referred for clinic assessment.
563 Graft Failure After Revascularization of CLTI Patients: Graft Surveillance
Authors: Miah M , Avabde D , Ghahramani I , Hemanth R , Abbas R , Maha Q , Beech A , Salem M 
Published: August 2024

Abstract

Background
Failure of infrainguinal bypass grafts remains, despite expert surgeons and meticulous surgical technique, a matter of concern for both patient and surgeon. Anastomotic intimal hyperplasia is commonly greater at the downstream or at the outflow anastomosis. All infrainguinal bypasses should go under routine surveillance to pick the grafts at risk for the prevention of graft failure.

Aim
The aim was to find out if we are following the standard guidelines in the management of CLTI patients, including postoperative follow up. Also, to monitor whether the patients were having postoperative Duplex surveillance scan to pick any graft at risk.

Method
All patients were included who underwent infra-inguinal bypass procedure for CLTI during last 8months (from mid-January to Mid-September 2023) in our Vascular unit. Retrospective data were collected.

Results
Total 38 patients had lower limb bypass procedure over last 8 months (from 15th January till 14th September 2023). However, two Fem- Fem crossover, one Ilio-popliteal and one Pedal bypass were excluded. Thus, total 36 patients were included for the study (n=34). The vast majority (n=27, 79.4%) had Femoro Popliteal Bypass (AK/BK) and the rest (n=7, 20.5%) had Distal bypass (Fem-distal or Pop-distal bypass). 18% patients had amputation and 15% patients died. 61% of the remaining patients were on surveillance. Those, who were not on surveillance, 44% of them had graft occlusion.

Conclusions
Surveillance can predict graft at risk and the graft occlusion can be prevented by appropriate intervention. Every vascular unit should have their own post procedural follow up strategies.
722 A Rapid Review on Paediatric Arteriovenous Malformation Intervention Modalities, Associated Symptomatic Outcomes, and Complication Rates
Authors: Lee R , Wang J 
Published: August 2024

Abstract

Aim
Symptomatic congenital extracranial paediatric arteriovenous malformations (AVM) carry disproportionate risks of massive haemorrhage or heart failure. Treatment of these rare AVMs is complex due to patient presentation heterogeneity. We aim to elucidate interventional approaches resulting in optimal patient outcomes through analysis of previous case literature.

Method
Using PRISMA guidelines, Medline and PubMed were searched systematically. Inclusion criteria was limited to full-text, English language case reports focusing on paediatric patients (≤18 years) with surgically and/or endovascularly treated symptomatic, extracranial, congenital AVMs within connective tissue. Data regarding case characteristics, Schobinger classification, treatment modalities, symptom resolution, complications, and presence of interventions past the initial treatment plan, were extracted.

Results
38 studies were included out of 959 records. 66 patients were identified. Patients were treated either with endovascular embolisation (n=38), open (n=10), or combined approaches (n=18). 65% (43/66) of all patients reported resolution of symptoms with no complications. This rate was 83% (15/18) in the patient group which underwent interventions through a combined approach. 80% (12/15) of the patient group requiring additional intervention past the initial treatment plan, experienced worse symptom relief and complications. This rate was 4.2% (2/47) in the patient group not requiring additional intervention past the initial treatment plan. 4 patients had incomplete follow-up.

Conclusions
Combining open surgical and endovascular modalities in management of AVMs appear most effective in achieving symptom resolution with lower complication rates. If lesions are not effectively occluded after the initial intervention plan, surgeons should proceed cautiously to avoid iatrogenic harm, weighing the risk-benefit ratio of performing additional interventions.
Resuscitation of Asphyxiated Newborn Infants With Room Air or Oxygen
Authors: Davis Peter G. , Baker Elizabeth 
Published: August 2024

Abstract
The Resair 2 trial challenged the long-standing practice of resuscitating newborn infants with 100% oxygen. This quasi-randomized trial enrolled 703 infants with birth weight &gt;999 g and compared 100% with 21% oxygen (room air). Resuscitation with 21% oxygen did not reduce the rate of the primary composite outcome of mortality or moderate/severe encephalopathy (23.7% versus 21.2%; odds ratio 0.94, 95% confidence interval 0.63 to 1.40), or its components. However, important secondary outcomes were improved with resuscitation with 21% oxygen, including time to breathing and 5-minute Apgar score. Resair 2 paved the way for further studies, leading to 21% oxygen becoming standard therapy for term infants requiring resuscitation.
Association of Umbilical Cord Milking vs Delayed Umbilical Cord Clamping With Death or Severe Intraventricular Hemorrhage Among Preterm Infants
Authors: Kim Seh Hyun , Kim Han-Suk 
Published: August 2024

Abstract
Umbilical cord milking (UCM) may serve as an alternative to delayed umbilical cord clamping (DCC) in preterm infants. This study was planned as a non-inferiority randomized trial to compare the rates of death or severe intraventricular hemorrhage (IVH) in preterm infants receiving UCM versus those receiving DCC. The trial was terminated early for safety, precluding a non-inferiority analysis. A post hoc analysis of 474 infants &lt;32 weeks’ gestation showed no difference in the preplanned composite primary outcome (12% versus 8%; 95% confidence interval [CI] –0.02 to 0.09, p = 0.16), but the UCM group had a higher incidence of severe IVH than the DCC group (8% versus 3%; 95% CI 0.01 to 0.09, p = 0.02), which prompted early stopping.
Valganciclovir for Symptomatic Congenital Cytomegalovirus Disease
Authors: Ma Li 
Published: August 2024

Abstract
A 6-week course of ganciclovir improves audiologic outcomes at 6 months for infants with symptomatic congenital cytomegalovirus (CMV) disease, but effects wane over time. This international trial investigated prolonged valganciclovir therapy (6 months). Ninety-six infants with symptomatic congenital CMV were randomized to receive valganciclovir for either 6 months or 6 weeks. Despite no improvement in the primary end point of change in “best-ear” hearing at 6 months (p = 0.41), secondary endpoints at 2 years demonstrated benefit (maintained “total-ear” hearing (p = 0.04) and better neurodevelopmental scores in language (p = 0.004) and receptive-communication scale (p = 0.003). There was no significant difference in the occurrence of adverse events between the two groups.
Supplemental Therapeutic Oxygen for Prethreshold Retinopathy of Prematurity
Authors: Mitra Souvik 
Published: August 2024

Abstract
Retinopathy of prematurity (ROP) is a neovascular retinal disorder of preterm infants. Its progression may be exacerbated by hypoxic stimuli leading to release of angiogenic growth factors. STOP-ROP, a multicenter randomized controlled trial of 649 preterm infants with prethreshold ROP, investigated if supplemental oxygen therapy to achieve an oxygen saturation target of 96%–99%, compared with a target of 89%–94%, reduced progression to threshold ROP. There were no statistically significant differences in the primary ophthalmic outcomes or secondary pulmonary outcomes between the 2 groups. However, harms of hospitalization and need for supplemental oxygen were significantly higher in the supplemental oxygen arm at 3 months’ corrected age.