bluuebunny/crossref_metadata_2025_split huggingface dataset:
O224: Patient Services Not Fit for Purpose: Analysis of Skin Cancer Pathway
Authors: Lau Jessica , Marla Ananya , Borra Poojit , Parthiban Sunil , Butler Peter , Ponniah Allan 
Published: March 2024

Abstract

Background
NHS public satisfaction fell to 29% in 2022; a record low in NatCen’s British Social Attitudes report since its debut in 1983. Exacerbated by COVID-19, services have redesigned to having an almost 3-fold increase in percentage of telehealth appointments. Now &gt;40% of initial skin cancer appointments in our service are delivered remotely, an approach prioritising efficiency over patient-centred care. This study attempts to gain a comprehensive understanding of patient perceptions and attitudes in our skin cancer pathway.

Method
A snapshot survey of 103 consecutive patients, aged 22-96, 58% female, was conducted over one year at the Royal Free Hospital's skin cancer service. Data was analysed using thematic analysis, allowing for identification of recurring themes and patterns, following the American Association for Public Opinion Research’s guidelines for population analysis. Statistical analysis of frequency data was also applied.

Results
Key findings include a clear preference towards face-to-face as opposed to tele-dermatology in 62% of patients. Tele-dermatology’s primary drawback is only allowing for the assessment of one lesion in a clinic appointment, leaving 54% of patients with multiple unassessed lesions. Patients expressed satisfaction (72%) with waiting times for their initial appointment, however, 68% of patients were dissatisfied with the waiting time for their biopsy results.

Conclusions
The present configuration of services is not fit for patient needs. This study identifies key themes addressing appointment scheduling, telehealth limitations and communication preferences, offering guidance to healthcare providers to improve the quality of care for skin cancer patients, enhancing patient satisfaction and overall healthcare quality.
O244: Patients’ priorities in Vulval lichen sclerosus – results of a patient and public involvement for a study investigating autologous lipotransfer and platelet-rich plasma in Vulval lichen sclerosus
Authors: Jasionowska Sara , Almadori Aurora , Langridge Benjamin , Hansen Esther , Butler Peter 
Published: March 2024

Abstract

Background
Vulval lichen sclerosus (VLS) is a high-burden, under-researched chronic skin disease. It is characterised by itching, pain, sexual dysfunction and poor quality of life. Up to 70% of patients develop fibrosis and vulval architectural changes. The only evidence-based treatment includes topical steroids. New potential surgical treatments include autologous fat transfer (AFG) and platelet-rich plasma (PRP) injections but high-level evidence supporting these treatments is sparse.

Aims
To identify patients’ research priorities and evaluate the acceptability of AFG and PRP as treatments for VLS and design a trial co-produced by patients.

Methods
One-to-one interviews, focus groups and online questionnaires were used to investigate patients’ research priorities, acceptability of treatments, preferred outcome assessment tools, views on a sham procedure and trial design.

Results
A focus group (n=18) and an online patient survey (n=809) identified the top research priorities: changes to vulval anatomy, emotional impact on intimate relationships, inability to have penetrative intercourse and pain during intercourse. Patients reported poor quality of life and said that addressing these would be life-changing. Ninety-nine percent of patients agreed that this trial should be performed and 73% were willing to take part if a sham procedure was used. A patient advisory group (n=5) has been created to co-produce the trial.

Conclusion
VLS is a complex disease with no core outcome set. Patient co-production is a keystone to a successful trial design and ensures that research is aligned with patients’ priorities. This research defines the key priorities of research into current surgical interventions for VLS.
O152: Prognostic value of receptor positivity loss following neoadjuvant chemotherapy in breast cancer patients: a systematic review and meta-analysis
Authors: Dowling Gavin , Alrawashdeh Maen , Daly Gordon , Hembrecht Sandra , Hill Arnold 
Published: March 2024

Abstract

Introduction
Receptor status of breast cancer (BC) has been reported to change after neoadjuvant treatment leading to discordance between diagnostic biopsy and surgical specimens. This meta-analysis aims to investigate the prognostic significance of a loss of human epidermal growth factor receptor 2 (HER2) and hormone receptor positivity in residual disease after neoadjuvant therapy.

Methods
A systematic search of electronic databases was conducted to identify studies that investigated the impact loss of receptor status had on prognosis. Studies reporting disease free survival (DFS) and/or overall survival (OS) hazard ratios (HRs) for loss of HER2 or hormone receptor positivity following neoadjuvant treatment for BC were included. A meta-analysis was undertaken for relevant studies. Pooled hazard ratios were calculated using 95% confidence intervals (CIs).

Results
Eight studies with a total of 2673 patients were included in the meta-analysis. Patients who lost HER2 positivity had significantly worse OS (pooled HR 1.80, 95% CI 1.01-3.22, p=0.05) and DFS (pooled HR 2.03, 95% CI 1.47-2.82, p&lt;0.001), compared to those who maintained positivity. Similarly, patients with a loss of hormone receptor positivity had significantly worse OS (pooled HR 2.49, 95% CI 1.65-3.77, p&lt;0.001) and DFS (pooled HR 3.71, 95% CI 1.79-7.69, p&lt;0.001) than those who remained hormone receptor positive after neoadjuvant therapy.

Conclusion
This meta-analysis found that a loss of either HER2 or hormone receptor positivity following neoadjuvant therapy negatively impacted survival outcomes. These findings suggest that retesting of receptor status may offer prognostic information, in addition to potentially altering adjuvant treatment regimens.
O22: Postoperative Telemedicine is feasible and sustainable; a prospective life-cycle assessment approach to carbon footprint analysis
Authors: Lathan Ross , Walshaw Josephine , Hitchman Louise , Ravindhran Bharadhwaj , Carradice Daniel , Smith George , Chetter Ian , Lockwood Sonia , Yiasemido Marina 
Published: March 2024

Abstract

Introduction
The NHS must provide a net zero service by 2045. Innovative strategies are required to quantify, evaluate and implement environmentally friendly interventions into practice. The study evaluates the feasibility and sustainability of remote post-operative follow-up using novel methodology.

Methods
Patients were reviewed remotely and face-to-face at 30 days post-operatively. A prospective life-cycle assessment(LCA) approach to carbon footprint analysis was used to calculate carbon emissions kgCO2e. Patient postcodes were applied to conversion factors to calculate travel emissions. Median(IQR) kgCO2e saved were presented. Carbon offsetting values are based on kgCO2e sequestered by a standardised UK variety tree.

Results
31 participants(M:F 2.4, 66.7±11.7 years) were included. The median return distance for patient travel was 42.5km(7.2-58.7). Median reduction using remote follow-up was 41.2 kgCO2e(24.5-80.3) per patient(P&lt;0.001). Using remote follow-up is equivalent to planting 1 tree for every 6.9 patients reviewed. Every readmission with SSI results in an additional 1219.93 kgCO2e.

Discussion
This model shows that the prospective LCA approach is achievable. Implementation of an asynchronous follow-up model is effective in substantially reducing the carbon footprint of a tertiary vascular surgical centre. Further work is needed to corroborate these findings on a larger scale and incorporate kgCO2e into cost analysis of SSI monitoring strategies.
O2: The development of anti-bullying, discrimination, and harassment guidance: A survey among the association of surgeons in training (ASiT) council members
Authors: El Boghdady Michael 
Published: March 2024

Abstract

Introduction
Surgical trainees have a reasonable expectation to feel safe and valued in their workplace. Previous reports proved that poor behaviour and misconduct existed in national health system. We aimed to conduct a survey among ASiT council members to identify the need of guidance to report bullying, discrimination, and harassment for trainees who experienced any type of poor behaviour at workplace.

Methods
Data among executive and council members was collected. Questions were related to trainee demographics, level of training, specialities, experienced, witnessed, or reported poor behaviours including bullying, discrimination and harassment. We asked if participants lacked direction when experienced poor behaviours, if support strategies were needed such as a standardised guidance for reports.

Results
A total of 58 survey responses were received, 55.17% of participants experienced bullying, 77.58% witnessed it and 67.25% did not report. While 37.93% experienced discrimination, 62.07% witnessed it and 68.97% did not report. A total of 24.14% experienced sexual harassment, was witnessed in 29.69%, 72.41% did not report. Over eighty percent mentioned they need more guidance to support trainees. Almost all participants (98%) agreed that surgical trainees should be made aware of routes for reporting, and 88% agreed that ASiT should develop the guidance to support trainees against poor behaviours.

Conclusion
Most of the trainees who experienced or witnessed poor behaviours did not report the incidents. A new standardised anti-bullying, anti-discrimination, and anti-harassment guidance was developed based on our study results. We envisage that its use may play a role in eliminating misconducts in surgical training.
O262: Evaluating the role and efficacy of virtual reality and simulation in teaching acute and trauma scenarios – a systematic review
Authors: Kavallieros Konstantinos , Tran Mi-Tra , Ahmad Manal , Ahmad Basma , Shalhoub Joseph , Davies Alun 
Published: March 2024

Abstract

Introduction
Simulation allows trainees to practice skills safely and is the current gold standard method of teaching. More recently, novel methods such as virtual reality (VR) and augmented reality are being explored as possible methods of teaching.

Aims
To evaluate the current evidence pertaining to simulation and VR as methods of teaching in teaching acute and trauma management.

Methods
A systematic review was conducted using the PRISMA guidelines. Medline and Embase (via Ovid interface) were used to search for articles up to March 2023. The following MeSH terms were used: ‘(virtual reality OR VR) AND (acute surgical OR surgery OR trauma OR trauma management) AND (medical education OR education OR surgical training OR training) AND simulation’.

Results
A total of 3815 articles were identified. 2648 were screened upon de-duplication. 40 articles underwent full-text review; 14 were extracted. Prospective cohort studies were the most common, 43.8%. Experimental studies included a total of 436 participants, with a median sample size of 23 (IQR:14–32). 6 studies compared VR to simulation methods. Half of these articles indicated favourable conclusions towards VR training compared to standard training. A further 8 studies evaluated feasibility of VR training only – all had favourable outcomes for VR.

Conclusion
This review identified a range of evidence indicating that VR can be useful for training of acute surgical scenarios. VR was generally a well-received training modality although unlikely to replace simulation entirely. More robust statistical analysis in further studies is required, with investigation into the longer-term impact of VR training.
O69: Exploring clinical study outcomes for pelvic venous disorders: An in-depth 10-year review of the literature
Authors: Kavallieros Konstantinos , Pope Tasneem , Tan Matthew , Sekhon Harmeena , Gianesini Sergio , Lazarashvili Zaza , Jaworucka-Kaczorowska Aleksandra , Narayanan Sriram , Gwozdz Adam , Davies Alun 
Published: March 2024

Abstract

Objective
There is increasing recognition that health systems need to improve the value of patient care by measuring outcomes. Pelvic Venous disorders (PeVD) can have a significant impact on the quality of life of women affected and despite growing recognition, remain underdiagnosed. Developing a core outcome set (COS) for benchmarking care delivery enhances the standardisation of care. We aimed to generate a list of outcomes reported in previous PeVD treatment studies to lay the foundation for developing a COS for PeVD.

Methods
This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping reviews (PRISMA-ScR). Closely related outcomes were classified into domains, and domains into three core areas: disease-specific, treatment-related, quality of life (QOL)-related outcomes.

Results
Of the 951 records identified, 43 publications were included. From these studies, 96 different outcomes were identified. Closely related outcomes were organised into 37 outcome domains, which were then categorised into 3 core outcome areas; 16 (43%) were disease-specific, 15 (41%) treatment-related, and 6 (16%) were QOL related. Of the 43 studies included, disease-specific outcomes were identified in 41 (95%) studies, treatment-related outcomes in 41 (95%) studies, and quality of life outcomes in only 6 (14%) studies.

Conclusions
There was significant heterogeneity in outcomes reported in PeVD studies. Most PeVD treatment studies evaluated disease-specific and treatment-related outcomes features of PeVD, but few reported outcomes that measured the impact of quality of life. These findings will inform the next steps in developing a core outcome set for PeVD.
O70: A Novel Screening Tool for Pelvic Venous disorders
Authors: Kavallieros Konstantinos , Pope Tasneem , Tan Matthew , Narayanan Sriram , Gwozdz Adam , Davies Alun 
Published: March 2024

Abstract

Objective
Pelvic venous disease (PeVD) remains a common yet under-diagnosed condition, and there remains no standardised diagnostic work-up. A self-assessment questionnaire was developed to aid the identification of women with PeVD. The study aimed to assess the performance of the questionnaire score in identifying patients with PeVD.

Methods
Retrospective data analysis from consecutive referrals to a vascular surgery clinic in Singapore between 2018-2022. Before diagnostic evaluation, patients completed a novel, 6-item questionnaire, resulting in a Basic Score. From 2022, patients completed an additional 4-item questionnaire developed as an adjunct, resulting in a Specific Score - adding Basic and Specific Scores yields the Combined Score. Duplex US was used as the reference standard.

Results
A total of 94 women were assessed. Of these, 73 (77.8%) met DUS criteria for PeVD. All completed the Basic questionnaire, which demonstrated high discriminatory ability (area under the receiver-operating curve (AUC) of 0.878 [95% CI:0.779-0.977]). A Basic Score ≥3 had high sensitivity and moderately high specificity of 93.2% [95% CI: 84.7 -97.7] and 81.0% [95% CI:58.1 – 94.6], respectively. 36.2% (34/94) of patients answered both questionnaires. There was insufficient evidence that the Specific questionnaire improved performance (AUC 0.979 [95% CI: 0.937 – 1.00] vs 0.966 [95% CI:0.903 -1.00], for Basic Score vs Combined Score).

Conclusions
Our findings suggest that the Basic questionnaire may be useful in the diagnostic workup of PeVD, potentially increasing referral to vascular specialists for appropriate management. However, diagnostic accuracy may be over-estimated due to high disease prevalence in the cohort, prohibiting generalisation of results.
O159: Designed to Respect and Repair the Abdominal Aorta: A 9-year International Experience with the Fenestrated Anaconda Endograft
Authors: Jubouri Matti , Surkhi Abdelaziz , Tan Sven , Bailey Damian , Williams Ian , Bashir Mohamad 
Published: March 2024

Abstract

Background
Endovascular aortic repair (EVAR) has become the mainstay treatment for abdominal aortic aneurysms and is associated with optimal clinical outcomes. However, there remains a risk of complications requiring reintervention. Several EVAR devices exist commercially, yet, the Terumo Aortic Fenestrated Anaconda™ (FA) has demonstrated outstanding results.

Methods
The current study represents a 9-year cross-sectional international analysis of custom-made FA. Data was collected prospectively in 27 countries and stored in a registry. This was later retrieved and analysed retrospectively.

Results
A total of 5058 patients received the FA endograft. This was indicated either due to complex anatomy for competitor devices (n = 3891, 76.9%) or based on surgeon preference (n = 1167, 23.1%). Overall, the FA was utilised to rescue 3466 (68.5%) failed previous EVARs using competitor devices. The predominant device category and proximal ring stent configuration were bifurcate (83.6%) and standard (64.5%). Most were delivered within 6-8 weeks (55.4%) of diagnosis and 95% came with a prototype. As for clinical outcomes, both survival and TVP were 100% during the first 6 postoperative years but dropped to 77.1% and 81% thereafter. A sac regression of 0-30% was observed in 4772 (94.3%) over the first 4 years, whilst all patients had 20-45% sac regression afterwards. No cases of endograft migration or reintervention were recorded. All clinical outcomes were further stratified by indication group.

Conclusion
The custom-made FA endograft features a highly unique and innovative design which enables it to treat highly complex aortic anatomy while achieving favourable results.
O130: Apoptosis Post Microwave Ablation of the Liver: Does it Change with Power?
Authors: Alzaraa Ahmed , Zayyan Kassim , West Kevin , Morgan Bruno 
Published: March 2024

Abstract

Summary
Apoptosis helps eradicate the remained cancer cells after microwave ablation. The extent of its expression is yet to be defined.

Aims
To investigate whether the ablation power made any difference to the expression of apoptosis in the ablated and normal areas.

Methods
Ablations with 50W, 70W, and 90W powers were created in three ex vivo perfused porcine livers. Biopsies from the lesions were assessed with Hematoxylin-Eosin and immunohistochemistry (Caspase 3 and M30) looking for apoptosis in each zone (central necrotic zone [CNZ], transitional zone [TZ], and normal surrounding zone [NZ]). Statistical analysis was performed using ANOVA and t-test.

Results
None of the CNZ showed expression of Caspase-3. In the TZ, there was significant difference between 50W and 90W (P = 0.009), but not between 50W and 70W (P = 0.8), or between 70W and 90W (P = 0.4). In the NZ, a highly significant difference was noted between 50W and 90W (P = 0.003), a significant difference between 50W and 70W (P = 0.01), but not between 70W and 90W (P = 0.06). For M30, no expression of M30 was noted in all necrotic zones. A significant difference was noted between 50W and 90W (P = 0.02). There were no significant differences between 50W and 70W (P = 0.4) or between 70W and 90W (P = 0.07).

Conclusion
Increasing power enhances apoptosis in the ablated areas. This response can be an adjunct for eradicating cancer cells that might escape the heat in the ablated zones.
O80: Intensive pre-operative information course (IPIC) and pre-operative weight loss results in long-term sustained weight loss following bariatric surgery: 11year results from a Tertiary Referral Centre
Authors: Lucocq James , Andrew de Beaux , Tulloh Bruce , Lamb Peter , Robertson Andrew 
Published: March 2024

Abstract

Introduction
Outcomes of long-term (5-10 year) weight loss have not been investigated thoroughly and the role of pre-operative weight loss on long-term weight loss, among other factors, are unknown. Our regional bariatric service introduced a 12-week intensive pre-operative information course (IPIC) to optimise pre-operative weight loss and provide education prior to bariatric surgery. The present study determines the effect of pre-operative weight loss and an intense pre-operative information course (IPIC), on long-term weight outcomes and sustained weight loss post-bariatric surgery.

Methods
Data were collected prospectively from a bariatric center (2008-2022). Excess weight loss (EWL) ≥50% and ≥70% were considered outcome measures. Survival analysis and logistic regression identified variables associated with overall and sustained EWL≥50% and ≥70%.

Results
339 patients (median age, 49 years; median follow-up, 7 years [0.5-11years]; median EWL%, 49.6%.) were evaluated, including 158 gastric sleeve and 161 gastric bypass. During follow-up 273 patients (80.5%) and 196 patients (53.1%) achieved EWL≥50% and ≥70%, respectively. In multivariate survival analyses, pre-operative weight loss through IPIC, both &lt;10.5% and &gt;10.5%EWL, were positively associated with EWL≥50% (HR2.23,p&lt;0.001) and EWL≥70% (HR 3.24,p&lt;0.001), respectively. After a median of 6.5years after achieving EWL50% or EWL70%, 56.8% (154/271) had sustained EWL50% and 50.6% (85/168) sustained EWL70%. Higher pre-operative weight loss through IPIC increased the likelihood of sustained EWL≥50% (OR,2.36;p=0.013) and EWL≥70% (OR,2.03;p=0.011) at the end of follow up.

Conclusions
IPIC and higher pre-operative weight loss improve weight loss post-bariatric surgery and reduce the likelihood of weight regain during long-term follow-up.
O119: Investigating the Secretome of Adipose Derived Stem Cells on Extracellular Matrix Remodelling in Radiation-Induced Fibrosis
Authors: Wai Jasmine May Yen , Cui Xiang Mei , Langridge Benjamin James , Frommer Marvin , Butler Peter E M 
Published: March 2024

Abstract

Background
Radiation-induced fibrosis (RIF) is a debilitating complication following radiotherapy, characterised by fibroblast proliferation and excessive extracellular matrix (ECM) deposition, leading to functional and aesthetic impairments. Although autologous fat grafting (AFG) has shown promise in reversing RIF, the mechanisms, largely attributed to adipose-derived stem cells (ADSCs), remain elusive. This study aimed to investigate ADSCs’ and their secretome on ECM remodelling in RIF management.

Methods
The anti-fibrotic potential of the ADSC secretome on HDFs subjected to ionising radiation was assessed via a series of in vitro experiments. Control HDFs were compared with irradiated HDFs to assess any phenotypical changes. Irradiated HDFs were treated with ADSC pre-conditioned media (CM) or ADSC co-culture (CC). Gene expression (COL1A1, TGF-β, CCN-2, MMP-1, MMP-3, TIMP-1, ACTA2, TNC) was assessed via real-time quantitative PCR (RT-qPCR). ProCollagen1a1 and CCN2 protein concentrations were assessed by ELISA.

Results
Irradiated HDFs demonstrated changes in fibrotic gene expression. ADSC-CM treatment significantly reduced COL1A1 expression, although protein levels remained unchanged. TGF-β1, CCN2, MMP-3, TIMP-1 and ACTA-2 exhibited reduced expression post-ADSC-CM treatment whereas TNC expression was found to be significantly increased. Co-culture with ADSCs led to a general, but not statistically significant, decrease in pro-fibrotic gene expression. Notably, CCN-2 protein expression significantly increased.

Conclusion
This study demonstrates that ionising radiation results in a pathological pro-fibrotic phenotype in HDFs. The ADSC secretome potentially mitigates this, reducing pro-fibrotic gene expression. Unexpectedly, co-culture experiments highlighted a complex interaction with upregulation of fibrosis-associated genes. Further research is needed to clarify these interactions to improve therapeutic interventions for RIF.