bluuebunny/crossref_metadata_2025_split huggingface dataset:
19 An Evaluation of the Quality and Readability of Online Information Regarding Foreign Bodies of the Ear, Nose and Throat
Authors: Ko T K , Tan D J Y , Fan K S 
Published: August 2024

Abstract

Aim
Foreign body (FB) inhalation, ingestion and insertion account for 11% of ENT emergency hospital admissions. Children are disproportionately affected, and urgent intervention may be needed to maintain open airways. High-quality, readable online information could help reduce poor outcomes from foreign bodies. The aim is to determine the quality and readability of online health information relating to FB.

Method
Google was used to conduct searches using 6 search phrases. For each search phrase, the first 30 results were captured for inclusion in the study. Eligibility criteria were applied to select only health information. The EQIP tool was used to assess information quality. Readability was assessed using the Flesch Reading Ease Score (FRES) and the Flesch-Kincaid Grade Level (FKGL).

Results
Of the information websites included (n=73), most (63%) were from the USA. The median EQIP score was 21 (IQR18-25, max29), suggesting moderate information quality. Precautionary measures were not mentioned on 40% of websites and 30% did not identify disc batteries as a risky FB. Red flags for urgent care were identified on 95% of websites, 89% advised patients to seek medical attention and only 38.4% of websites advised patients on safe foreign body removal. Readability scores (FRES:12.4 years; FKGL:6.2) showed most websites (56%) were below the recommended 6th-grade level.

Conclusions
The EQIP score suggests that information quality should be improved to provide patients and parents with clear information to help identify high-risk foreign bodies such as disc batteries and magnets, while providing guidance for removal of low-risk foreign bodies.
188 Assessing the Quality and Readability of Online Patient Information: ENT UK Patient E-Leaflets Versus ChatGPT Responses
Authors: Ko T K , Shamil E , Fan K S , Schuster-Bruce J , Jaafar N , Khwaja S , Eynon-Lewis N , D’Souza A , Andrews P 
Published: August 2024

Abstract

Introduction
The evolution of artificial intelligence has introduced new ways to disseminate health information, including natural language processing models like ChatGPT. However, the quality and readability of such digitally generated information remains understudied. This study is the first to compare the quality and readability of digitally generated health information against leaflets produced by professionals.

Method
Patient information leaflets for five ENT UK leaflets, and their corresponding ChatGPT responses, were evaluated using the Ensuring Quality Information for Patients (EQIP) tool and readability tools including the Flesch Reading Ease Score (FRES) and Flesch-Kincaid Grade Level (FKGL). Statistical analysis was performed to identify differences between leaflets, assessors, and sources of information.

Results
ENT UK leaflets were of moderate quality, scoring a median EQIP of 23. Statistically significant differences in overall EQIP score were identified between ENT UK leaflets but ChatGPT responses were of uniform quality. Non-specialist doctors rated the highest EQIP scores while medical students scored the lowest. The mean readability of ENT UK leaflets was higher than ChatGPT responses. The overall EQIP scores negatively correlated with readability metrics of ChatGPT responses. In short, the information quality of ENT UK leaflets was moderate and varied between topics. Equivalent ChatGPT information provided comparable content quality but with reduced readability.

Conclusions
ChatGPT patient information leaflets had comparable content, but were less readable, and required a higher reading age than ENT UK leaflets. With the increasing use of online health resources, this study underscores the need for a balanced approach that optimises both the quality and readability of patient education material.
331 Regional Anaesthesia Does Not Reduce Length of Stay, or Mortality Outcomes in Traumatic Rib Fractures
Authors: Bradley R , Manoharan G , Hodson A , Marsden M 
Published: August 2024

Abstract

Aim
Length of stay (LOS) and mortality for patients with traumatic rib fractures is influenced by multiple factors. We aimed to identify 1) factors correlated with LOS and 2) assess the impact of regional analgesia on outcomes.

Method
Consecutive adult patients admitted to two TUs with traumatic rib fractures were included. Data were collected on patients’ demographics, mechanism of injury, Battle score, in-hospital complications, regional anaesthesia (“nerve block”), LOS and mortality. Multivariable regression analysis (MVR) was performed to identify factors associated with LOS and mortality.

Results
We included 228 patients. Most were male (62%), median age 75 years (IQR 59-86). Most sustained a fall &lt;2m (67%). Median LOS was 6 days (IQR 3-11), mortality was 7%. On univariate analysis only Battle Score was associated with increased LOS (p =&lt;0.01). On MVR, with Battle score and nerve block in the model, nerve blocks did not affect either LOS (p=0.21, CI -4.5-1.0) or mortality (p=0.45, CI 1.1-1.3).

Conclusions
After traumatic rib fracture, once accounting for the Battle Score, nerve block did not reduce LOS or mortality. Further work is required to assess the impact of confounders in this observational study.
424 Damage Control Laparotomy – a Single Centre Experience
Authors: Terry C , Hawezi J , Phelan L , Bowley D , Dilworth M , Bedford M 
Published: August 2024

Abstract

Background
Damage control laparotomy (DCL) delivers life-saving primary surgery, and optimisation of physiology status with deferral of definitive anatomical reconstruction. Developed for major trauma, DCL may be used for non-traumatic abdominal emergencies. We aimed to assess our unit’s utilisation and outcomes of patients undergoing non-traumatic DCL.

Method
Observational study of consecutive adult patients (2014-2022) undergoing DCL within our National Emergency Laparotomy Audit (NELA) database.

Results
109 patients, median age: 61 years (range 21-92); 52% (57/109) were male. Of 109 patients, indications for DCL were post-procedural complications in 29%, bowel obstruction 22%, mesenteric ischaemia 23%, perforation 21%, and other 5%. Median number of relook laparotomies: 1 (range 0-5), median time to closure: two days (range 1-15). 30-day mortality: 27/109 (25%). 23/109 (21%) died before definitive surgery could be completed. 74/86 survivors (86%) had primary fascial repair at final relook surgery, the remainder undergoing laparostomy therapy. 1-year mortality was 38/109 (37%). 94/109 (86%) primary temporary closures used negative pressure therapy; the remainder used passive dressings (e.g., Bogotá bag, skin-only closure). Median ICU stay was 7 days (range 0-130). 42/86 (49%) had stoma formation at final surgery, enterocutaneous fistula occurred in 10/86 (12%) survivors. Incisional hernia was detected in 7/71 (10%) at follow-up.

Conclusions
Outcomes after DCL for non-traumatic abdominal emergencies demonstrate acceptable outcomes for this most critically ill cohort. Selection for DCL is currently individualised by surgeon and no national guidelines exist to support decision making. A national comparative trial would help define the place of DCL in non-traumatic abdominal emergencies.
762 Post-Operative Outcomes After Emergency Stoma Surgery in Frail Older Adults
Authors: Kulasekaran A , Yadala Venkata S , Bayne F , Macdonald S 
Published: August 2024

Abstract

Aim
To describe the post-operative outcomes of frail older adults who undergo emergency stoma surgery in the West of Scotland.

Method
A retrospective review of a prospectively maintained emergency laparotomy database (ELLSA) from 3 hospitals across 3 years (Dec ’19-’22) was performed in Dec ’23. Older adults (&gt;65years old) who were frail (i.e., Rockwood frailty score &gt;4) under-going emergency stoma formation per NELA criteria were included and clinical notes were reviewed, including prospectively maintained follow-up from stoma practitioners. Factors such as pre-morbid independence level, mortality within a year/as in patient, frailty score 1-year post-operation/at death, ability to manage stoma independently, and long term care were investigated. All patients had minimum 1 year follow-up.

Results
A total of 234 older adults underwent emergency stoma surgery and 23% were frail. Median age of frail patients was 77(IQR - 13.5) and 48% were male. 70.4% of patients were frailer by discharge or death and 2/3 were unable to manage their stoma independently. The 30-day mortality rate was 29.6%, and half of patients had died by 1 year follow-up.

Conclusions
Outcomes are poor for frail older adults undergoing emergency stoma surgery. A majority of patients get significantly frailer post-operatively. Mortality rates are high and very few independently manage their stoma. Therefore, patients within this cohort may benefit from an anastomosis rather than a stoma, in carefully selected cases. This data may help to further research to identify these patients and guide peri-operative shared decision making.
122 Monkeypox Correlations: Genital Symptoms, Immunocompromised Status and MSM
Authors: El Boghdady M , Youssef M , Marianne Ewalds-Kvist B , Nada H 
Published: August 2024

Abstract

Aim
The outbreak of the virus infection Monkeypox (Mpox) in England was on transmission level 2. Mpox and HIV infections may occur simultaneously among the MSM population, exacerbating the symptoms along with treating problems. We aimed to study if Mpox painful genital symptoms correlated with immunocompromised status, sexuality and length of hospital stay.

Method
A retrospective data analysis was conducted. The admissions were divided into four groups named: perianal, penile, rectal, and other symptoms. Correlations between patients’ pain groups, sexuality, or immunocompromised status as well as length of hospital stay were studied. Significances were computed by Spearman’s rho correlation and Kruskal-Wallis H analyses of variance.

Results
Sixty-nine patients were included, 65 males (mean age=38,5, SD 8.29; Md=39) and females mean age=35.5 (SD 9.04; Md= 39.5) years (n.s). The two gender’s Mpox pain areas differed from each other (p=0.014). A total of 38% of the men presented painful perianal or rectal lesions and 22 men displayed general symptoms and 17 acknowledged MSM. A total of 40% of the men were sexually active with multiple partners; an inverse correlation between men with MSM and men with HIV (rho [25]= -.385*, p= .029, 1-tailed) was revealed. Altogether 23% of men presented HIV and 8% suffered from additional STI. Those with rectal pain had the longest hospital stay with a mean of 6.0 (SD 7.63) days (p=0.017) compared to other groups.

Conclusions
Correlations between patients diagnosed with Mpox and genital symptoms were revealed as opposed to inverse correlations between immunocompromised status/HIV and MSM.
461 The Reality of Virtual Reality for Rural Surgeon Augmented Reality Training
Authors: Khera G , Gnanaraj J , Mishra A , Vohra R , Dhanda J 
Published: August 2024

Abstract

Aim
Virtual-reality (VR) and augmented-reality (AR) training workshops were undertaken in New Delhi and new surgical training content generated. This study aimed to gauge the perspective of medical students and rural Indian surgeons regarding VR and AR training.

Method
An online survey was administered to both workshop participants and rural surgeons not attending the workshop. We created surgical training 360-degree AR videos enriched with close-up and monitor views as well as conventional YouTube videos. Respondents were asked to compare their experiences whilst viewing videos on VR headsets or standard screen view.

Results
186 responses received and 41 were from workshop attendees. An overwhelming 82% of all respondents believed that 360-degree AR videos offered superior learning opportunities, with 83% reporting an improved learning curve. However, only 49% respondents had access to VR headsets and 84% respondents found it unnecessary to use them to watch videos. Non-availability of VR headsets (53%) and cost of VR headsets (19%) were limiting factors for not using VR headsets. Self-reported side effects with VR headsets were minimal, affecting less than 9% of respondents.

Conclusions
The consensus among respondents was that 360-degree AR videos were highly effective for learning. The flexibility to choose between VR headsets or standard viewing was crucial, underscoring the adaptability of the medium. However, the availability of VR headsets emerged as a challenge, particularly in rural areas. A small percentage encountered issues with VR headsets.
The results strongly suggest that virtual training, has the potential to transform the rural surgical education learning landscape.
847 Conflict Resolution in Surgery
Authors: Castelhano R , Riding D 
Published: August 2024

Abstract

Aim
Evidence from academic and public inquiries suggest that patient safety is threatened when interpersonal communication and professional behaviour breaks down within surgical multidisciplinary teams. Despite this available evidence, undergraduate and postgraduate curricula place a strong emphasis on the development of surgical knowledge and skill, with limited focus on optimal team working and the management of interpersonal conflict. The increasingly diverse surgical workforce will induce a commensurate diversity of personality types, and so an assessment of the evidence base defining the effects of interpersonal conflict and evaluating mitigating interventions, may inform future curricula.

Method
A systematic interrogation of relevant databases was undertaken. Keywords included “conflict resolution”, “surgery”, “healthcare professionals” and further related terms. The authors analysed the identified studies in line with PRISMA guidelines to assess relevance. Inconsistencies were resolved through discussion between the reviewers.

Results
Sixty-three studies emerged from the analysis. Interpersonal conflict negatively impacted healthcare professionals (HCPs), inducing stress, burnout, and job dissatisfaction, and threatened team effectiveness and patient safety. Common causes of conflict were categorised into systemic and interpersonal factors. Conflict resolution interventions focussed on communication skills training, team-building workshops, and debriefing sessions. Although studies recognised the value of conflict resolution, strategies varied across surgical specialties.

Conclusions
This systematic review defines conflict within surgical teams as a threat to patient safety and HCP wellbeing. There is strategic heterogeneity within the educational interventions reported in the literature. We argue that formalised teamworking and conflict resolution training is a neglected component of surgical curricula.
79 Neurovascular Status Documentation in Complex Limb Fractures: First Cycle Audit
Authors: Eisner A , Bradshaw F , Wakefield E , Zhang J , MacGregor M , Capburn E , Krkovic M 
Published: August 2024

Abstract

Aim
Assessing neurovascular status post-fracture is vital to detect complications and guide medical actions. Fractures can cause neurovascular problems and timely recognition prevents long-term damage. Neurovascular status should be recorded on admission to establish a baseline and identify those that need urgent surgery, and the findings should be well documented.

Method
Neurovascular documentation for patients with fractures of the tibia or femur was audited over the period of one year at a major trauma centre according to NICE guidelines. 885 patients met the inclusion criteria, giving a total of 959 fractures.

Results
Poor compliance was defined as &lt;75% of guidelines followed. 911/959 (95%) of all fractures had a basic mention of neurovascular status in patient notes. 492/959 (51%) had gross sensation documented, 143/959 (15%) had a named nerve assessment, 71/959 (7%) had motility assessed using the MRC scale and 367/959 (38%) had a pulse assessment, with the pulses assessed documented. We recommend a pre-written template for clinicians detailing the different aspects of the neurovascular examination and documentation. This template will remind clinicians of examination and documentation, enabling ongoing monitoring, facilitating prompt detection of issues, thus improving outcomes, and reducing long-term complications.

Conclusions
Inadequate documentation of neurovascular status in patient records poses a risk to those requiring urgent surgery or experiencing neurovascular compromise, potentially leading to long-term complications. Ensuring an error-free documentation process is crucial and a primary goal for the trauma and orthopaedic department.
89 Can Poller Screws Decrease Pain Relief in Tibial Fractures?
Authors: Bradshaw F , Wakefield E , Tandon A , Zhang J , Krkovic M 
Published: August 2024

Abstract

Aim
Poller screws optimise fracture alignment in those fractures managed with intramedullary (IM) nails. They enhance stability, control nail insertion, and prevent translation. Indications encompass acute fractures, delayed unions/non-unions, and deformity. Classified into four generations, they've shown positive outcomes: improved alignment, reduced complications, and shorter healing. However, their pain management impact is understudied. This retrospective cohort study aimed to compare opioid medication needs in tibial fractures managed with IM nails with and without poller screws.

Method
Between January 2015 and December 2022, a retrospective analysis was conducted on tibial fractures treated at a major trauma centre. Patients primarily treated with IM nails were included. Patient and operation notes as well as radiographs, were reviewed to identify poller screw utilisation. Opioid medication data was collected and converted to “coverage” (days) and “strength” (morphine milligrams equivalent or MME). Two-tailed independent samples T-tests were performed to determine differences between patients treated with (n =205) and without poller screws (n=745).

Results
Patients with poller screws had fewer days with opioid prescriptions in the second post-operative month (6.8 vs.8.9 days, p=0.038) and significantly lower opioid strength requirements across the first post-operative year (688.4 vs.1295.4 MME, p=0.001), except the first month.

Conclusions
There is limited research on the connection between poller screws and pain. This study discusses their potential to reduce post-operative pain in tibial fractures. The results highlight the importance of using poller screws alongside IM. This combination appears to be effective in improving post-operative pain management and enhancing overall patient outcomes.
159 Online Information Regarding Lymphoedema: A Systematic Review Assessing the Quality of Websites’ Content
Authors: Kok C , Karamitros G , Gokani V 
Published: August 2024

Abstract

Aim
In the 21st century, the internet is a major source for patients searching for answers regarding health-related issues. However, the quality of information online is not regulated, creating the potential for poor-quality, or incomplete information which could lead to confusion and distress for patients. The aim of this study is to assess the quality of patient information on lymphoedema, available online.

Method
An internet search for the term ”lymphoedema”, was performed, and the first 100 relevant websites were identified from the three most popular search engines (Google, Yahoo and Bing). The websites were evaluated using the validated modified Ensuring Quality Information for Patients (EQIP) instrument.

Results
Of the 300 websites identified via our search strategy, 105 (35%) were included in our final analysis after removal of duplicates, non-English or irrelevant websites, and websites targeting the scientific community. The median EQIP score of the assessed websites was 22. Most websites (62.9%) failed to mention surgical treatment as a potential option for lymphoedema, did not provide any description of the risks of treatment options (75.2%), and did not report any quantitative risks (98.1%).

Conclusions
Our comparative qualitative analysis contributes to the broader understanding that the overall low quality, structure, and readability of available online information on lymphoedema are potential levers that promote disparities in patient access to care for this population group. The content of the websites should be updated to include surgical treatment options and risks associated with treatment options.
392 Artificial Intelligence Approach in Hip Prosthesis Identification and Assessing Radiographic Outcome Measures
Authors: Soteriou I , Hadjixenophontos S , Musbahi O , Jones G , Pouris K , Cobb J 
Published: August 2024

Abstract

Aim
Radiographic assessment is crucial for the success of a hip replacement procedure as an accurately positioned prosthesis indicates favourable long-term outcomes. This project aims to develop a novel artificial intelligence (AI)-based method that can: (1) automatically identify the presence of a hip resurfacing prosthesis in radiographs and (2) calculate the radiographic neck-shaft angle (NSA) of the prosthesis from two-dimensional plane images using both anterior-posterior (AP) and lateral x-rays with high accuracy.

Method
Using a computer vision and pattern recognition algorithm, the femur shaft and prosthesis regions were identified, and their respective angles were extracted for NSA calculation. A neural network (NN) was then trained using clinician-generated AP radiograph NSAs as ground truths and AI-generated AP and lateral NSAs as features. Spearman's correlation and Kruskal-Wallis tests were calculated to explore any significant association between the final AI-generated and clinician-generated AP x-ray NSAs. Mean absolute error (MAE) and R-squared values were calculated with and without the NN model to identify the model's accuracy and variability.

Results
There was a statistically significant correlation between the final AI-generated AP x-ray NSAs and the clinician-generated AP x-ray NSAs (rs=0.83,p=0.00). MAE and R2 without the NN were 3.09 and 0.37 respectively. MAE and R2 with the NN were 1.94 and 0.53 respectively.

Conclusions
The results of this study demonstrate that the identification of hip resurfacing prostheses using artificial intelligence is feasible. By incorporating additional features such as the lateral NSA, the model can provide an accurate prediction of the AP radiographic NSA, closely approximating the ground truth.