bluuebunny/crossref_metadata_2025_split huggingface dataset:
466 Colo-Seminal Vesicle Fistula as a Complication of Low Anterior Resection
Authors: Ravichandran M , Karim S , Niaz O , Das P 
Published: August 2024

Abstract
A fistula between the colon and seminal vesicles following low anterior resection is an uncommon post-operative complication. This report details the case of a 68-year-old patient diagnosed with locally advanced mid-low rectal cancer (T3N2M0). He underwent short-course radiotherapy and consolidation chemotherapy (RAPIDO), followed by laparoscopic low anterior resection. With a background of diabetes and a BMI of 36, and being registered blind, it was decided not to give him a defunctioning stoma.
The immediate post-op period was uneventful; however, six weeks post-operatively, he returned with pneumaturia. A flexible cystoscopy ruled out bladder or urethral pathology. Further investigation, including CT and MRI, revealed a fistulous connection between the sigmoid colon and seminal vesicles. An anastomotic leak was suspected, and an initial flexible sigmoidoscopy was unable to identify this due to poor bowel preparation, prompting initial conservative management. However, a repeated flexible sigmoidoscopy eventually confirmed complete anastomotic dehiscence. Despite initially being clinically well, he eventually developed testicular swelling and elevated inflammatory markers, with CT suggestive of air tracking via the vas deferens and scrotal air. He underwent laparoscopic disconnection of the anastomosis, culminating in the formation of an end colostomy and perianal proctectomy with concurrent exploration of the left scrotum and bilateral ureteric stenting.
Post-operatively, he spent several days in the ITU before being transferred to the wards. Over the next 25 days, the patient clinically improved and was eventually discharged symptom-free.
The report captures the link between an anastomotic leak and a rare fistula formation between the colon and seminal vesicles after low anterior resection.
856 Malignant Melanoma of the Small Bowel Causing Multiple Simultaneous Intussusceptions; a Rare Presentation
Authors: Ponnuswamy K , Leong D , Mughal H , Abdelreheem M , Zeineldin A , Khawaja A 
Published: August 2024

Abstract

Background
The rare occurrence of primary melanoma in the small bowel, particularly leading to simultaneous multiple intussusceptions, presents intricate challenges in diagnosis and management. We detail a case of a male in his late 50s with multiple intussusceptions secondary to melanoma deposits in the proximal small bowel.

Case presentation
55-year-old patient presented with severe abdominal pain for 3 weeks, dark stools, unexplained anaemia, and unintentional weight loss. Imaging revealed small bowel obstruction due to intussusception caused by a polypoidal point, prompting surgical intervention. The initial laparotomy led to resecting a segment of the small bowel with the polyp, histopathology revealed malignant melanoma. Post-operatively the patient showed improvement but faced recurrent intussusceptions. Tertiary centre/multi-disciplinary team advise was sought and A PET-CT scan was done that identified 3 hotspots (likely polyps) in the proximal small bowel. Patient underwent a repeat laparotomy where 3 polyps were noted causing simultaneous intussusceptions and 68cm of proximal small bowel was resected with ileo-ileal anastomosis performed.

Discussion
This unique case highlights the rarity of simultaneous multiple intussusceptions due to small bowel melanoma deposits and emphasises the role of surgical intervention. While recognising the benefit of polyp resection during the initial surgery, the case suggests the importance of proactive management and multi-disciplinary approaches for optimal outcomes in such complex scenarios. Key takeaways include maintaining a high index of suspicion for malignancy in unusual presentations, advocating for timely expert consultation, emphasizing small bowel resection for intussusceptions, and considering resecting all identified polyps to prevent complications and improve patient outcomes.
623 Patient Reported Outcome Measures (PROMs) of Altemeier’s Procedure
Authors: O’Sullivan A , Manku B , Bleehen L , Abdelgalel K , Iqbal N , Murphy P , Ramcharan S , Singh S 
Published: August 2024

Abstract

Aim
Rectal prolapse (RP) is a debilitating condition that can be managed using Altemeier’s procedure (AP). We aimed to evaluate patient-reported long-term outcomes following AP focusing on symptoms, post-procedure pain and overall satisfaction.

Method
Patients who underwent AP in a District General Hospital between January 2015 and December 2022 were reviewed. Patients were contacted by telephone and interviewed using a standardised questionnaire. Likert scores and a Numeric Rating Scale (NRS) were used to assess functional outcome and pain respectively. Indication for surgery, recurrence, and data on further procedures were also collected.

Results
Out of 38 patients identified, 20 who underwent AP over the study period (mean age 78 years, s.d. 7.44, Female=20) were contactable and included in our study. In combination with RP, indications for surgery included faecal incontinence, obstructive defaecation symptoms, pain and rectal bleeding. At the time of follow up, 75% of patients reported their initial symptoms to be slightly or much better, 10% reported no change and 15% reported slightly worse symptoms. Prior to AP, 45% of patients reported no pain compared to 70% post-procedure. Severe pain was reported by 30% of patients pre-Altemeier’s compared to five percent post-procedure. Recurrence of RP occurred in 40% patients. 30% of patients required a second procedure. Overall, 80% of patients were satisfied with their outcome and 90% would recommend AP to friends and family.

Conclusions
Most patients reported better functional outcome and good overall satisfaction, despite 30% requiring a further procedure. Our study was limited by small sample size and subjectiveness of patient reporting.
1138 A Closed Loop Audit of Laparoscopic Appendicectomy Documentation with the Introduction of an Operation Note Template to Improve Adherence to the 2022 GIRFT Guidelines
Authors: Wright W 
Published: August 2024

Abstract

Aim
This audit aimed to assess documentation of laparoscopic appendicectomies and measure the effect of introducing an electronic operation note template. Operation documentation is of great importance to patient care, clinical communication, facilitating research and providing a legal record. In 2022, GIRFT, RCS and ASGBI produced the ‘Best practice for Laparoscopic Appendicectomy Documentation guideline (September 2022) which contained forty-four recommendations.

Method
Between 1st June 2022 and 30th September 2022, 99 laparoscopic appendicectomies were performed at Broomfield Hospital, Essex whose operation notes were appropriate to be audited against the GIRFT guideline. Subsequently, an operation note template was designed on Microsoft Word using the guideline and refined with feedback from stakeholders including the surgeons who would be using it. The template was rolled out across the general surgery department in November 2022. Laparoscopic appendicectomies carried out between 1st December 2022 and 31st March 2023 were then reaudited.

Results
Between June and September 2022, prior to the introduction of the template, the average adherence to the guideline was 35%. Between December 2022 and March 2023, the average adherence was 55%, but was 89% in operation notes which used the template. Positive feedback on the template included ease of use and reduced time to complete compared to typing on a blank document.

Conclusions
This audit has demonstrated the important role templates play in significantly improving documentation and adherence to guidelines which positively affects patient care. The improvement in adherence even when the template was not used is likely due to the heightened awareness of the guideline.
116 Comparing the Effect of Using Virtual Reality Versus Simulation, to Manage an Acute Surgical Scenario, on Academic Buoyancy
Authors: Tran M T , Ahmad M , Patel K , Argyriou O , Davies A , Shalhoub J 
Published: August 2024

Abstract

Background
Simulation is regularly used in surgical training to allow trainees to practice skills safely. Virtual reality (VR) is a recent simulation modality which offers immersive computer-generated medical and surgical training scenarios. Much of trainee performance can be hindered by stress, self-consciousness, performance anxiety, fear of criticism and self-perceived poor task execution. Academic buoyancy is a learner’s ability to successfully deal with short-term, minor academic setbacks, such as poor grades and exam pressures, and having academic buoyancy can translate into long-term academic resilience. We aimed to compare academic buoyancy between junior doctors after managing an acute surgical scenario using VR and mannequin-based simulation.

Method
Eighteen junior doctor volunteers (Foundation and Core Trainee Year 1) were recruited, with ten participants randomly allocated to VR and eight to mannequin-based Simulation. Participants assessed and managed a 15-minute pneumothorax scenario. The academic buoyancy scale (ABS), which consists of four questions on a self-rated 7-point Likert scale, was used to measure pre-session and post-session academic buoyancy.

Results
ABS scores increased for both study groups, although this was only statistically significant for VR participants (p≤0.01), suggesting that VR may provide a more comfortable environment for trainees to hone their clinical skills. VR participants also had higher overall simulation scores than mannequin-based simulation participants, however no correlation was found between ABS scores and overall simulation scores.

Conclusions
VR as a simulation modality benefits by improving short-term markers of confidence. Future research should establish whether spaced VR teaching sessions translate into improved long-term markers of resilience.
634 Biodegradable Temporising Dermal Matrix Graft for Open Foot Wounds, an Audit from a Tertiary Vascular Unit
Authors: Shah R , Hussain I , Dindyal S , Tiruveedhula M , Emmanuel A , Thapar A 
Published: August 2024

Abstract

Aim
Following diabetic foot attacks many patients are left with exposed bone, which can lead to osteomyelitis and failure to heal. These patients are currently treated with simple dressings or vacuum therapy and skin grafts. However, vacuum therapy is expensive, requires intensive follow-up and can be inconvenient to patients. An alternative is to apply a polyurethane-based, biodegradable temporising matrix – currently used in burns practice. The aim of this project was to audit the safety and preliminary efficacy of the matrix in healing open foot wounds in a tertiary vascular unit.

Method
Consecutive patients receiving matrix cover from January 2021 were retrieved from the theatre database. 10 patients met our inclusion criteria, 5 males and 5 female patients with a mean age of 69 years. Five (50%) were diabetic, 10% were smokers and 40% were ex-smokers. Two patients died prior to wound healing and one patient was lost to follow-up leaving 7 patients.

Results
Safety: One patient developed surgical site infection, managed with wound washout and dressing changes with no loss of matrix. No patient developed osteomyelitis. Efficacy: Wound healing occured in 5 patients, after a median of 51 days (IQR 12 days). One patient underwent an additional skin graft on top of the matrix and healed. One patient did not heal.

Conclusions
In this early report we found a low rate of matrix infection or requirement for skin grafting. Two-thirds of wounds healed following matrix application. A comparative study of matrix vs vacuum therapy would be valuable.
1182 Ethnic Diversity in Facial Image Databases – the State of Play for Aesthetic Plastic Surgery
Authors: Zargaran A , Silva K , Sousi S , Zargaran D , Mosahebi A 
Published: August 2024

Abstract

Aim
The rise of social media has resulted in heightened patient expectations of cosmetic outcomes. The increasing trend of selfies and image collection may promote higher-powered predictive analytics to inform research and pre-operative consultations supporting informed consent. However, given the scattered and siloed nature of such databases, little is known regarding their composition. This study evaluated published facial image databases for ethnic representation, image quality and labelling.

Method
Databases were identified via a systematic search on PubMed, Embase, PsychInfo and Google Scholar. Databases were evaluated by two independent reviewers for demographics alongside image characteristics and governance surrounding data availability and usage.

Results
6,544,444 images of 199,579 people from 54 databases were included in the study from 1988 – 2023. The USA (n=19, 33%) and UK (n=1, 18.2%) accounted for more than half of the databases. Gender distribution across the 20 databases that provided information on this showed an approximately equal split, with 216,331 images of males and 216,459 images of females. Of the data labelled for ethnicity, the most common was Black (40.1%, n=48,425) followed by White (38.7%, n=46,738) and Asian (8.3%, n=10,061). Only one database (FERET) had longitudinal coverage of age progression. 59% of databases were publicly available, whilst 87% did not permit commercial use.

Conclusions
Labelling of large datasets is limited without important information on ethnicity and gender. More work needs to be done to ensure that these databases are suitable for more widespread research purposes and to promote greater representation within such databases and aesthetic plastic surgery research.
57 Day-Case Laparoscopic Partial Gastrectomies in Adults: A Two-Year Study at a University Teaching Hospital
Authors: Dhanoya G 
Published: August 2024

Abstract

Background
Day-case surgeries allow patients to return home on the same day after undergoing their surgical procedure, allowing shorter inpatient stays, reduced hospital costs and reduced risk of hospital acquired infections amongst other benefits. Laparoscopic partial gastrectomy (LPG) is the most popular treatment option for small gastrointestinal stromal tutors (GISTS) and other benign stomach lesions. Little research, however, has been done to investigate the safety and efficacy of performing LPGs in ambulatory centres as day cases.

Aim
The aim of this study was to assess the efficacy and safety of day-case LPG procedures as a more desirable alternative to admitting patients to hospital &gt;24hrs post LPG surgery.

Method
We wanted to use the data collected over a two-year period in our university teaching hospital to investigate patient, or other factors which might facilitate a safe same-day discharge. This was done by comparing the post-op complications and 30-day readmission rates between patients who underwent day-case procedures, and those who were admitted to hospital &gt;24hrs post-surgery.

Results
Results showed no significant difference in complications or readmission rates between the two groups of patients.

Conclusions
Day-case LPG has the potential to become the primary treatment pathway for low-risk patients suffering from small GISTs and benign stomach lesions, as it will save valuable hospital resources and costs, with no added post-operative complications.
1 93 Exploring the Modulatory Effects of Adipose-Derived Stem Cells on Fibroblasts in Chronic Radiation-Induced Fibrosis
Authors: Onderkova A , Langridge B , Frommer M , McKenzie M , Abul A , Butler P 
Published: August 2024

Abstract

Background
Radiation-induced fibrosis (RIF) is a common and debilitating side effect of radiotherapy in head and neck cancer patients. Despite its prevalence, effective treatments are lacking. However, autologous fat grafting can not only restore volume in these patients but also help with local tissue regeneration. This has been attributed to adipose-derived stem cells (ADSCs)’s anti-inflammatory and pro-regenerative properties within the grafts. Yet, the precise cellular mechanisms underlying their effects on the chronic inflammatory response in RIF remain to be elucidated.

Method
This study involved collecting tissue from head and neck RIF patients, isolating and expanding ADSCs and fibroblasts in vitro, and examining their interactions through co-culture experiments. The anti-inflammatory effects of ADSCs on fibroblasts were evaluated by measuring the expression of nine genes (COL1A1, TGFB1, ACTA2, MMP1, MMP9, TNC, CCL19, CDKN2A, CDKN1A) and assessing procollagen production, key in extracellular matrix remodelling in fibrosis. Clinical outcomes were also preliminarily evaluated.

Results
ADSCs significantly altered COL1A1 expression in RIF fibroblasts, normalizing it and increasing procollagen production. However, no statistically significant variations were observed in the expression of genes related to fibroblast transformation, extracellular matrix degradation, remodelling, immune regulation, and cellular senescence.

Conclusions
This study provides insights into the cellular mechanisms by which ADSCs may affect the chronic inflammatory response in RIF, particularly through the modulation of extracellular matrix production. These findings suggest the potential therapeutic role of ADSCs in the treatment of RIF, highlighting the importance of further research to optimise therapeutic protocols, determine underlying molecular mechanisms, and assess long-term safety and efficacy.
52 Stop the Clot! Improving Extended VTE Prescriptions Following Major Abdominal Surgery
Authors: Virdee P K , Chang J 
Published: August 2024

Abstract

Aim
Extended VTE (eVTE) prophylaxis following major abdominal cancer surgery is well documented across national guidelines and associated with reduced VTE incidence. Following cases of VTE after major abdominal non-cancer surgery, eVTE prophylaxis is being increasingly favoured for both cancer and non-cancer patients in the General Surgery department at a district general hospital in Birmingham. To improve prescription rate of eVTE prophylaxis following major abdominal surgery where appropriate and improve the quality and consistency of eVTE prophylaxis documentation in operation notes, to reduce error and ensure safe mitigation against VTE risk following major abdominal surgery.

Method
Theatre and ward lists were reviewed across 4 weeks to identify suitable patients for inclusion. Data collected was on the indication, prescription, and documentation of eVTE prophylaxis. Following implementation of interventions, results were compared to previous audit cycles.

Results
Operation note documentation of eVTE prophylaxis was significantly improved, with documentation rate at 76.2% compared with 30.4% previously (p=0.024). Whilst overall prescription rate remained similar, 100% of cancer patients received eVTE prophylaxis when indicated, compared to only 72.7% previously.

Conclusions
The documentation rate of eVTE prophylaxis on operation notes was significantly improved following our interventions, alongside improved prescription rates of eVTE prophylaxis for cancer patients. Further cycles would benefit from data collection over a longer duration to achieve a larger sample size. Finally, a comparison of VTE incidence across cancer and non-cancer groups, before and after interventions, would be useful in determining whether eVTE prophylaxis in both subgroups should be incorporated in local guidelines.
106 Evaluation of Documentation on Patient Information Around Blood Transfusions, Against NICE Guidelines, in a District General Hospital: A Two-Cycle Review
Authors: Kieu P L , Asaad P 
Published: August 2024

Abstract

Aim
NHS Blood and Transplant state those who “have received blood, platelets, plasma or any blood products after 1 January 1980” cannot donate blood and NICE guidelines recommend to document discussions for any blood transfusions that are prescribed and given. A review of eight hospitals by Safety of Blood, Tissues and Organs (SaBTO) stated 43% of doctors documented that they explained the reason for transfusion to the patient highlighting documentation of these discussions is poor. We reviewed the documentation of blood transfusion discussions in a General Surgical department in a district general hospital and compared it to NICE guidelines [NG24], with the aim to improve documentation by over 20%.

Method
Two full PDSA cycles were performed. The first cycle consisted of a retrospective review of the electronic notes of patients who had been prescribed a blood transfusion by the General Surgical team between Jun-Dec 2021. Documents were compared against NICE recommendations on patient information on blood transfusions. Teaching was delivered in the local Surgical induction from Aug 2022. We subsequently performed a prospective review of documentation between Aug-Dec 2022.

Results
47 patients were prescribed blood transfusion between Jun-Dec 2021 and 23 patients were prescribed blood transfusion between Aug-Dec 2022. After Aug 2022, documentation had improved by 11.7-19.2% across the recommended domains by NICE.

Conclusions
Educating doctors on the importance of documenting these discussions and highlighting alternatives to transfusion is crucial as potential donors will not be able to donate blood if they receive a transfusion.
233 Introduction of the Head and Neck Same Day Emergency Care Service (HNSDEC)
Authors: Bhamra N , Butler J , Narang K , Barraclough J 
Published: August 2024

Abstract

Aim
The development of SDEC (Same Day Emergency Care) has been a priority for the National Health Service (NHS) in the UK, as part of its long-term plan to reduce demand on hospital resources. HNSDEC (Head and Neck Same Day Emergency Care) has been developed to aim to improve patient care and experience as well as reducing demand on emergency and urgent care services.

Method
An unused patient bay on the Head and Neck inpatient ward at The Royal Wolverhampton NHS Trust was transformed into HNSDEC after the procurement of additional equipment and recruitment and training of Advanced Clinical Practitioners (ACPs). Pathways were then developed for treatment of ENT and OMFS patients – both for either same day review or a scheduled review in ‘hot clinic’. Working with informatics, performance metrics have been analysed, and questionnaires were distributed to ascertain patient satisfaction.

Results
Within the first 6 months of opening, we have seen 796 patients with an admission rate of 8.6% across both ENT and OMFS. HNSDEC has been very well received by those within the emergency and urgent care services with positive feedback demonstrating its impact.

Conclusions
In order to continue building on the early success of HNSDEC, we propose that the service be moved to a different location to allow for expansion and to ensure sustainability for the future with a bigger waiting area to improve patient flow. An ongoing focus on inter-departmental collaboration and education to continue to provide the best possible patient care and experience.