bluuebunny/crossref_metadata_2025_split huggingface dataset:
20 An Evaluation of the Quality and Readability of Online Information Regarding TMJ Dysfunction
Authors: Tan D J Y , Ko T K , Fan K S 
Published: July 2024

Abstract

Aim
The accessibility and availability of the internet has allowed people to increasingly seek health information online, and therefore it plays an essential role in the decision-making process of the patient. The study aimed to assess the quality and readability of online health information on TMJ dysfunction.

Method
The search was conducted on Google using keywords: jaw pain, jaw locking, jaw discomfort, jaw clicking, jaw popping, temporomandibular joint, TMJ dysfunction, TMD and temporomandibular disorder. Ensuring Quality Information for Patient (EQIP) tool was used to assess quality of information and the application of readability score reflected through Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level(FKGL), Gunning-Fog Index(GFI) and Simple Measure of Gobbledygook(SMOG).

Results
134 websites were eligible for assessment. The overall median EQIP score was 23, with an IQR of 7 and maximum score of 30. The most common source of information was healthcare industry (n=60; 45%), followed by news services (n=19; 14%), with a median EQIP score of 20 and 25 respectively. Statistically significant differences in overall EQIP scores were found between different sources of information (p=0.004). Only 31(23%) websites achieved the recommended 6th grade or below readability level, and only 14 (10%) discussed complication rates with none mentioning mortality rates at all.

Conclusions
Most online information on TMJ dysfunction is of suboptimal quality and readability. This study identified areas for improvements when producing patient material regarding TMJ dysfunction. To improve patient education and awareness, content creators should strive to be informative, accurate, and patient-centric.
173 Pressure Sores in Spinal Patients Admitted to Intensive Care - a Retrospective Observational Study
Authors: Glossop S , Upadhyay A , Abdallah M , McCarthy M 
Published: July 2024

Abstract

Aim
Spinal patients in the intensive care unit (ICU) have a high risk of developing pressure sores due to factors such as immobilisation and collar use. In a collaboration between the spinal surgery department and the ICU at a tertiary care hospital, this study aimed to assess the prevalence of pressure sores in spinal patients in the ICU as well as potential risk factors, to establish any required changes to patient care.

Method
NHS-mandated DATIX reports for all pressure sores in ICU were cross-referenced with a list of all spinal patients admitted to ICU between January 2018 and August 2022 (4-and-a-half years). We included pressure sores such as occipital, sacral, clavicular, hips. Exclusions were sores categorised below Grade 2 and those caused by intubation such as lips or mouth.

Results
97 patients were included and fifteen (15.5%) developed grade 2 or above pressure sores in ICU. Admission age, days spent in hospital and days in ICU were significantly greater in those who developed pressure sores compared to those who did not (all P &lt; 0.05). Advanced respiratory support time was also greater in those who developed pressure sores (P &lt; 0.05).

Conclusions
Just over 1 in 7 spinal patients in the ICU developed pressure sores and clinicians should be aware of the potential risks for mutual benefits of patient comfort and the NHS cost burden. However, in comparison to other studies reporting percentages of 19.1% and 37.5%, the department appears to be doing comparatively well in preventing pressure sores.
624 A Retrospective Review of Blood Pressure Variability (BPV) and Abdominal Aortic Aneurysm (AAA)
Authors: Ramirez Piriz C , Charles E , Martin G , Bicknell C 
Published: July 2024

Abstract

Background
Abdominal aortic aneurysms (AAA) rupture risk increases with expansion. Understanding of factors influencing AAA growth are crucial to reduce the risk of rupture. Blood pressure (BP) is considered a contributor to AAA formation, but the association with AAA growth remains unclear. Blood pressure variability (BPV) has emerged as an important cardiovascular risk factor, yet its relationship with AAA growth has not been investigated.

Method
A retrospective review of 90 patients participating in a multi-centre AAA growth study (NCT05376514) was conducted. Mean growth (mm/yr) was calculated from first and most recent duplex ultrasound scans. Outpatient BP readings between scans were used to calculate BPV defined as the standard deviation (SD) of systolic and diastolic values. Patients were stratified into high and low BPV groups and again into tertiles. Mann-whitney U and unpaired T-tests were used for group comparisons, Kruskall-Wallis to assess for a dose-response relationship between tertiles of BPV. Multiple regression analysis examined variable impact on growth.

Results
High diastolic BPV was associated with a faster growth rate (2.05 mm/yr [IQR= 1.00 – 3.00]) vs low diastolic BPV (1.44 mm/ yr ([IQR= 0.475-2.00]p=0.036) with a significant dose-response relationship between the lowest and highest BPV tertiles (p= 0.019). DBPV was a significant predictor of AAA growth in the multiple regression model for tertile classification (p=0.016). There was no association between systolic BPV and faster AAA growth rates.

Conclusions
There was a significant association between higher diastolic blood pressure variability and AAA growth. DBPV may be an important risk stratification tool.
946 Soft Tissue Sarcoma Survival Analysis and Evaluation of Management Options in Wales: A 3-Year Retrospective Single-Centre Analysis
Authors: Li C Y , Young H , Vass J , Bragg T 
Published: July 2024

Abstract

Aim
Soft tissue sarcomas (STS) are a rare group of mesenchymal neoplasm with great heterogeneity in their histologic subtype, anatomy, natural biological behaviour, and prognosis. The aim of this project is to evaluate the need of early detection and review the prognostic factors contributing to the overall STS survival outcome among patients who were under the care of the Welsh Sarcoma Service over a three-year period.

Method
Patients are selected from the Morriston Hospital sarcoma database from March 2019 to March 2022. Demographic data, tumour grade, histological subtype, performance status, treatment type, operative details and outcomes were recorded.

Results
159 patients with a diagnosis of STS were selected from the database. The median overall survival was 2.19 years; with a 23.9% of mortality rate in the first-year post diagnosis and 10.8% in the third-year post diagnosis. Of all factors evaluated, grading (p = 0.008), performance status (p &lt;0.001), treatment types (p= &lt;0.001) and site of cancer recurrence (p = 0.024) resulted statistically significant. Metastatic development has a significant increased risk of death by 2.5-fold compared to those without recurrence.

Conclusions
This study evaluates the management of STS at a single centre over three years and summarises the significant prognostic factors contributing to the overall survival rate. Analysis further highlights development of metastasis carry a poorer prognosis. Hence, the importance of early detection and treatment within the first year of diagnosis should not be overlooked.
589 Survivorship After Radical Gastrectomy with Adjuvant Chemoradiotherapy for Locally Advanced Gastric and Junctional Adenocarcinoma
Authors: Moran P , Elliott J A , Ravi N , Donohoe C L , Cunningham M , Reynolds J V 
Published: July 2024

Abstract

Introduction
In the US Intergroup-0116 trial adjuvant chemoradiotherapy (aCRT) significantly improved overall survival (OS) compared with surgery alone for locally advanced gastric adenocarcinoma. Subsequently, the CRITICS and ARTIST-2 trials demonstrated no additional benefit to aCRT compared with chemotherapy alone. The aim of this study was to evaluate long-term outcomes in survivorship among patients previously treated with radical D2 gastrectomy and aCRT (MacDonald Regimen).

Method
Consecutive patients who underwent aCRT following radical D2 gastrectomy between 2002-2018 were identified from a prospectively maintained database. Among patients without evidence of recurrence at 1 year postoperatively, long-term radiotherapy complications were coded using the framework of the Common Toxicity Criteria for Adverse Events (CTCAE) V5, and use of nutritional adjuncts and micronutrient supplementation recorded.

Results
Some 49 patients were included (pT3-4, 88%; pN2-3, 61%; diffuse type, 45%). Median, 1-, 3- and 5-year OS were 29.8 months, 90%, 45% and 41%. Late effects data were available for 18 patients. Gastrointestinal late effects were evident in 81% (most commonly dysphagia, subacute obstructive symptoms, food intolerance and diarrhoea). Small bowel obstruction occurred in 2 patients, small intestinal bacterial overgrowth in 2 patients and pancreatic exocrine insufficiency in 2 patients. 3 patients required long-term oral nutritional supplementation, and 2 required home enteral nutrition.

Conclusions
Despite adverse pathological features, long-term survival was achieved in a significant proportion of patients. However, these data highlight that adjuvant chemoradiotherapy following radical gastrectomy with D2 lymphadenectomy may be associated with considerable late effects in survivorship, and management within specialist multidisciplinary teams is advocated.
969 Assessment of Diagnostic Criteria and Treatment Approaches for Biliary Dyskinesia: A Retrospective Analysis in NHS Grampian
Authors: Luangboriboon J , Yousif M , Ghazanfar M 
Published: July 2024

Abstract

Aim
Biliary dyskinesia is a motility disorder of the gallbladder and sphincter of Oddi which presents with biliary-type pain without a structural pathology. Diagnosis relies on the ROME IV criteria for Functional Gallbladder Disorder, but its clinical utilisation remains limited. This retrospective study evaluates the diagnostic criteria, investigations, treatment, and surgical outcomes in patients with suspected biliary dyskinesia.

Method
Data from 185 patients who underwent cholecystokinin cholescintigraphy between 2017 and 2022 in NHS Grampian were analysed. Information on patient demographics, Rome IV criteria, supportive investigations, treatments, complications, hospital admissions, and medication use was collected from Trakcare.

Results
The average patient age was 46 years, with 21.1% male and 78.9% female participants. The Rome IV Criteria was used in only 12.4% of cases. Cholecystectomy was performed in 40.5% of cases, with complications occurring in 10.6% of these surgeries. On average, patients were admitted to the hospital 1.07 times, staying for approximately 3.92 days before surgery. Notably, 30.6% of cholecystectomy patients needed readmission for unresolved symptoms, and 40.5% relied on analgesics.

Conclusions
Rome IV criteria was underutilised in diagnosing biliary dyskinesia. Cholecystectomy did not reliably relieve symptoms in all patients, resulting in repeat admissions. Better adherence to diagnostic criteria and clear treatment guidelines are needed.
68 The Emerging Role of Stem Cell Enriched Fat Grafts for Breast Reconstruction: A Systematic Review and Meta-Analysis
Authors: Hayre A 
Published: July 2024

Abstract

Aim
Recent trials involving adipose derived stem cell (ADSC) enriched fat grafts have shown promising results when compared to routine autologous fat transfer (AFT) in breast reconstruction surgeries. The current systematic review and meta-analysis aimed to compare outcomes of ADSC-enriched fat grafts versus routine AFT for breast reconstruction purposes.

Method
A search of electronic information was conducted identifying all case control and cohort studies comparing the outcomes of ADSC-enriched fat grafts versus routine AFT for breast reconstruction. Primary outcomes included volume retention, fat necrosis and cancer recurrence. Secondary outcome measures were patient satisfaction post-surgery, cyst development, redness and swelling, infection and operation time. Fixed and random effects modelling were used for the analysis. Six studies enrolling 381 subjects were selected.

Results
There was a significant difference between the ADSC-enriched fat grafts and routine AFT groups in terms of mean volume retention (standardised mean difference [MD]= 2.52, P= 0.05). There were no significant differences between the two groups in terms of fat necrosis (Odds Ratio [OR]= 3.81, P =0.13) and cancer recurrence (OR= 1.39, P= 0.58). For secondary outcomes, the intervention group had similar results compared with the control group in terms of patient satisfaction, redness and swelling as well as infection and cyst development. Operation time was shorter for the latter group.

Conclusions
ADSC-enriched fat grafting is a superior option compared to the routine AFT for breast reconstruction surgery as it improves the mean volume retention and does not worsen patient satisfaction and surgical complications.
804 Exploring the Characteristics of ENT Senior House Officers: Insights for Workforce Planning
Authors: D’Souza F , Springford L , Seymour K , Ahmed J , Nogueira C 
Published: July 2024

Abstract

Aim
The current healthcare climate has adversely impacted the recruitment and retention of healthcare professionals, particularly Senior House Officers (SHOs), who play an important role in the provision of ENT services. Consequently, there has been a shift in the characteristics of applicants for SHO positions. We examined applicant characteristics for a Trust Grade ENT SHO position at The Royal London Hospital.

Method
Data was collected from all applications made for the position, evaluating qualifications, experience, academic achievements, skills, and fitness to practice. Essential characteristics included a medical degree, surgical experience, &lt;2 years' ENT experience, foundation program completion, and English proficiency. Desirable features encompassed MRCS exam success, NHS experience, peer-reviewed publications, teaching and research qualifications, and participation in audits and quality improvement projects.

Results
There were 110 applicants; 94% qualified outside the UK. Whilst 74% met all essential criteria, significantly fewer satisfied desirable criteria such as passing surgical membership examinations (0-5%) and prior NHS experience (7%). 2% to 4% reported experience of performing basic ENT procedures under supervision, and only 4% reported previously assisting in theatre. 1 applicant satisfied all desirable characteristics.

Conclusions
The current healthcare climate has significantly impacted the characteristics of the ENT SHO workforce. A lack of NHS experience and limited ENT exposure necessitates intensive support for new SHOs. Departments must consider how to balance the provision of support, for example with the implementation of registrar hot weeks or funding for additional staffing, with key economic and educational interests.
814 If You Want to Go Far, Go Together: Student Perception of Joint Medical and Surgical Education Programmes
Authors: Kerdegari N , Sunder Bala Sundaram D , Kirby R , Leng G 
Published: July 2024

Abstract

Aim
Medical students have varied specialty interests which acts as a barrier to undergraduate engagement at specialty-specific conferences. The Tomorrow's Doctors 2023 conference, hosted at The Royal Society of Medicine, aimed to improve students’ understanding of current innovations across multiple medical and surgical specialties. The aim of this study is to determine student perception of a combined medical and surgical conference.

Method
The two-day conference consisted of 8 talks and 8 workshops. Feedback was collected following each day using online questionnaires. Each questionnaire was specific to the agenda of that day. Quantitative and qualitative feedback was collected on students’ perception of combined medical and surgical conferences for undergraduate students. Free-text responses underwent thematic analysis.

Results
There were 90 delegates on day one and 85 delegates on day two from 16 medical schools. Post-conference feedback was completed by 45 (50.0%) and 42 (49.4%) attendees for days one and two respectively. 82.2% of day one and 88.1% of day two respondents agreed that joint medical and surgical conferences were beneficial for medical students. Thematic analysis of post-conference free-text responses revealed the commonest themes for favouring joint medical and surgical conferences were ability to explore both medical and surgical interests (52.5%), supports career progression (27.5%) and practical application of knowledge gained (17.5%).

Conclusions
Our feedback demonstrates that joint medical and surgical conferences are perceived as beneficial by current medical students. Future undergraduate conferences should adopt a combined approach to allow students to explore their varied interests and subsequently facilitate informed specialty selection.
416 The Impact of Pancreas Transplantation on Secondary Diabetic Complications: A Systematic Review
Authors: Giri G , Doherty D , Azmi S , Khambalia H , Van Dellen D 
Published: July 2024

Abstract

Aim
Pancreas transplantation (PT) provides diabetic cure for patients with complicated Type 1 Diabetes Mellitus (T1DM). We aimed to examine the impact of PT on secondary diabetic complications, including retinopathy, neuropathy, and cardiovascular disease.

Method
A database search using MedLINE for publications up to April 2023 was conducted employing MeSH terms ‘Pancreas Transplantation’ AND ‘Diabetes Mellitus, Type 1’ AND ‘Diabetic Retinopathy’ OR ‘Heart Disease’ OR ‘Cardiovascular Diseases’ OR ‘Peripheral Vascular Disease’ OR “Amputation’ OR ‘Neuropathy.”

Results
223 articles were screened, with 172 excluded as per study design (total included 51). 64.7% (n=33) of studies were retrospective case control studies, 35.3% (n=18) of studies were retrospective cohort studies. A total of 5616 patients with a mean of 99.1 (SD± 262.4) simultaneous kidney transplant (SPK) patients and 48.2 (SD± 262.4) pancreas transplant alone (PTA) patients per article were studied. All articles examining diabetic retinopathy concluded that retinopathy improved or stabilized. 69% (n=11) of papers demonstrated no significant change to visual acuity. An equal number of articles (n=4) demonstrated increased peripheral nerve conduction velocity after SPK and PTA. 40% (n=2) of articles examining vibration perception studies demonstrated an increase post-transplantation. Improvements in cardiac events incidence, metabolic factors, and heart structure were seen in 79% (n=15) of cardiovascular articles.

Conclusions
Despite significant heterogeneity in outcome measures observed, PT provides benefits in mitigating the complication profile of T1DM. Standardised outcome measurement should be adopted to allow assessment of the impact of beta-cell replacement with the potential for objective evidence reversibility of secondary complications.
632 Hepatitis C Positive Organ Donation and Direct Acting Antivirals in Pancreas Transplantation: A Systematic Review
Authors: Siran L S , Doherty D , Moinuddin Z , Khambalia H , van Dellen D 
Published: July 2024

Abstract

Background
Pancreas transplantation (PT) provides diabetic cure for patients with complicated diabetes mellitus. However, there is a paucity of suitable donor organs to fulfil requirements resulting in deaths on the waiting list. Organs from otherwise suitable hepatitis C virus positive (HCV+) donors alongside direct-acting antiviral agents (DAAs) have been used in kidney and liver transplants in small trials. We aimed to review this strategy in PT.

Method
A literature search was conducted on OVID MedLINE, PubMed and EMBASE to evaluate evidence on the use of HCV+ organ donors for PT in HCV- recipients alongside DAA therapy.

Results
Database analysis produced 5 articles (4 single centre retrospective, 1 case report). This included a total of 65 patients, 15 of which received PT. Two studies examined multiple organ transplants whilst 3 evaluated PT alone. Three studies employed prophylactic perioperative therapy, while 2 examined treatment post-transplantation. 100% of patients achieved a sustained virological response (SVR) at 12 weeks across all 5 studies. There were no episodes of acute rejection or complications directly associated with DAA therapy or HCV infection. HCV transmission occurred in only 1 of 15 patients, which was successfully treated. Pancreatic graft function and outcome after 7-12 months was good.

Conclusions
The use of DAA therapy is safe and effective for HCV+ donors to HCV- transplant in early reported studies. This approach could facilitate the successful utilisation of HCV+ organs for transplantation thereby minimising impact on supply and demand disparities. Pancreas transplantation specific studies are required to further analyse outcomes.
292 Predictive Factors for Post-Operative Hypotension Following Carotid Endarterectomy
Authors: Musa A M , Gaba K , Nash T , Patterson B , Pemberton M 
Published: July 2024

Abstract

Background
Post-operative hypotension is a recognised complication following carotid endarterectomy (CEA). This study aimed to examine the incidence of post-operative hypotension requiring vasopressors and to identify variables associated with this phenomenon following CEA.

Method
A retrospective cohort study of 73 consecutive patients undergoing CEA between June 2022 and June 2023 was conducted. Patient data, including degree of carotid stenosis, and comorbidities such as myocardial infarction, diabetes, hypertension, and chronic kidney disease (CKD), were extracted from medical records. Fisher’s exact test was used to evaluate the difference in prevalence of co-morbidities between groups, and Mann-Whitney U test to assess for difference in degree of carotid stenosis.

Results
71 symptomatic and 2 asymptomatic CEAs were performed, with 12.3% (n=9) experiencing post-operative hypotension requiring vasopressors. In the post-CEA hypotension group, 33.3% (n=3) had a history of myocardial infarction, 77.8% (n=7) had hypertension, and none had diabetes or CKD. In comparison, the non-hypotensive group had a prevalence of 17.2% (n=11) for myocardial infarction, 18.8% (n=12) for diabetes, 71.9% (n=46) for hypertension, and 6.3% (n=4) for CKD. There was no significant difference in prevalence of these co-morbidities between the two groups. The degree of carotid stenosis was similar in the post-CEA hypotension and the non-hypotension group, 75% (IQR 60% – 90%), and 70% (IQR 65% - 90%), respectively.

Conclusions
Approximately 1 in 8 CEA patients require vasopressor support for post-operative hypotension. However, no specific variable emerged as a significant predictor for vasopressor requirement. Consequently, emphasis should be placed on post-operative monitoring to facilitate timely and appropriate intervention.