bluuebunny/crossref_metadata_2025_split huggingface dataset:
651 The Impact of Methylation Array Analysis on the Diagnosis of Central Nervous System Tumours: DNA Quality, Concordance and Cost Efficiency
Authors: Evans D , Walker L , Schlecht H , Burghel G , Roncaroli F 
Published: August 2023

Abstract

Aim
Genome-wide DNA methylation arrays are commonly used in diagnostic practice to classify central nervous system tumours; they are still regarded as a research tool and are not clinically validated. Epigenetic profiles may not match the pathology or return identities with low calibration scores (low confidence). We conducted a multi-centre audit on the impact of methylation arrays on brain tumour diagnosis, including DNA quality and cost efficiency.

Method
Seventy-six tumours were analysed between January 2020 and June 2022 using the v11b.4 Heidelberg classifier. Tumour pathology, methylome and calibration scores (high = ≥0.84, low = 0.30-0.83) were extracted and concordance assessed (histological versus epigenetic classification). Microscopic features of all cases were reviewed. Each methylation analysis cost £470.

Results
DNA quality of 22.37% of samples was inadequate for testing due to damage or low DNA concentration. Inadequate DNA depended on diathermic artefacts or size of viable tissue. There was no concordance between pathology and arrays in 30.51% of cases; 66.67% of these had low calibration scores. High calibration scores, low calibration scores and “unidentified tumours” occurred in 47.46%, 32.20% and 20.34% of samples, respectively. Of the total cost of methylation arrays (£35,72), £9,400 was spent on non-contributory tests.

Conclusions
Methylation arrays are helpful but are not free from limitations. Specimen size, extent of necrosis and coagulation artefacts affect DNA concentration. Interpretation of profiles with low calibration is challenging when methylation profiles and pathology are discordant. The 20% of unidentified tumours required further analysis including whole genome sequencing and gene fusion analysis.
1175 Management and Outcome of Intracranial Fungal Infections in Africa: A Scoping Review
Authors: Takoutsing B D , Ooi S Z Y , Egu C , Gillespie C S , Bandyopadhyay S , Dalle D U , Erhabor J , Ciuculete A C , Kesici Ö , Awad A K , Dokponou Y C H , Khan M , Ikwuegbuenyi C A , Dada O E , Bankole N D A 
Published: August 2023

Abstract

Aim
To detail the management, and outcome of intracranial fungal infections (IcFIs) across Africa.

Method
This scoping review was conducted using the Arksey and O'Malley framework. MEDLINE, EMBASE, Cochrane Library, African Index Medicus, and African Journals Online were searched for relevant articles from database inception to August 10th, 2021. The Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews guidelines were used to report the findings of the review.

Results
Of the 5,779 records identified, 133 articles were included. The mean age of 35.7 years and the majority (52.3%) were males. The majority (n = 4,732/8,330, 84.4%) of IcFIs presented as meningitis, and the most common predisposing factor of IcFIs was HIV/AIDS (n = 8,176/9,054, 90.3%). Cryptococcus species was the most common (n = 8,789/9,054, 97.1%) causative organism. The most commonly used diagnostic modality was cerebrospinal (CSF) cultures (n = 5,793/9,054, 64.0%). The most common treatment modality was medical management with antifungals only (n = 4,242/9,054, 46.9%). The mortality rate was (n = 3,810/9,054, 42.1%).

Conclusions
Most IcFIs occurred in immunosuppressed individuals, and despite the new diagnostic techniques, CSF culture was mostly used in Africa. The outcome of IcFIs in Africa was poor.
407 Robotic Assisted Cholecystectomy and Common Bile Duct Exploration for Single Stage Management of Complex Gallstone Disease
Authors: Lewis H , Latif J , Bandlamudi N , Bhatti I , Awan A 
Published: August 2023

Abstract

Aim
Laparoscopic cholecystectomy and common bile duct exploration (LC-CBDE) is an alternative to endoscopic retrograde cholangiopancreatography (ERCP) for treatment of choledocholithiasis. The ‘Achilles heel’ of LC-CBDE is the choledochotomy incision and closure following duct clearance. Robotic assisted surgery (RAS) aspires to overcome these technical challenges by providing improved views (3D enhancement) and articulated instruments potentially improving surgical precision. We aim to scrutinise the outcomes of an early series of robotic assisted cholecystectomy and common bile duct exploration (RC-CBDE) cases performed at our institution.

Method
Retrospective analysis from a specialist benign pancreatico-biliary unit in the United Kingdom was undertaken from April 2022 – December 2022 inclusive. All patients who underwent RC-CBDE for complicated gallstone disease were included. Collated data included patient demographics, perioperative investigations, intraoperative approach, and postoperative outcomes.

Results
10 patients were identified. Median (IQR) age was 51 (33 – 66) years. Median (IQR) BMI was 26 (21 – 32) kg/m2. Median (IQR) Charlson Co-morbidity Index (CCI) was 1 (0 – 4). 4 patients were operated on during the acute presentation, with median (IQR) bilirubin 51 (34 – 252.5). Median (IQR) operative time was 176 (124 – 222) minutes. Median (IQR) post-operative length of stay was 4 (1 – 5) days. One patient required reintervention for port site hernia repair from drain site.

Conclusions
RC-CBDE is a safe and effective treatment for choledocholithiasis with equivocal outcomes to LC-CBDE. Benefits of RAS include enhanced views and ergonomics aiding precise closure of choledochotomy, which may both reduce complications and promote wider uptake of common bile duct exploration – a previously underutilised, technically-challenging operative procedure.
530 False Positive Rate from Pet-Ct in Cutaneous Malignant Melanoma – a Systematic Review and Meta-Analysis
Authors: Martin J , Smith B , Abed H , Hardwicke J 
Published: August 2023

Abstract

Aim
Cutaneous Malignant Melanoma (CMM) is increasing in incidence and is the leading cause of skin cancer mortality. Diagnosis involves primary excision followed by appropriate staging tests. Positron Emission Tomography combined with Computed Tomography (PET-CT) use has increased in recent years for clinical staging and detection of recurrence. False positive (FP) results are not uncommon and can have deleterious psychological, physical, and economic consequences. Few studies have quantified this. Thus, we present the first systematic review and meta-analysis of the pooled proportion of FP results in prospective studies of CMM and distribution of these by system.

Method
A systematic review and meta-analysis of FP results in prospective CMM PET-CT studies with distribution of FP results by body system.

Results
14 studies were included with 851 patients. Primary reasons for exclusion were lack of FP reporting or studies being retrospective. Patient-based reporting had the lowest pooled proportion of 5.8% (95% CI = 3.5% to 8.6%), lesion-based was highest with 9.6% (95% CI = 3.1% to 19.1%) and combined was 6.9% (95% CI = 4.4% to 10.2%). Bias was low to unclear other than for FP reporting. Heterogeneity (I2) was considerable for all analyses. FP findings were mainly lymphatic, dermatological, respiratory, or skeletal.

Conclusions
Our data suggest that between 5.8% and 9.6% of PET-CT results are FPs; far higher than reported FP rates in current CMM literature. FP reporting was often inconsistent between studies and lacking in detail. Future work should include retrospective studies also and PET-CT research should consistently report FP results in more detail.
1288 Animated Patient Information Videos to Enhance Understanding of Free Functional Muscle Transfer Surgery for Dynamic Treatment of Facial Palsy
Authors: Brown S , Zubler C , Ressis Di , Grobbelaar A 
Published: August 2023

Abstract

Aim
Facial palsy affects approximately 25-30 per 100,000 people a year causing physical and psychological symptoms including facial asymmetry, a lack of facial expression, oral incompetence, difficulties in articulation and reduced quality of life. The treatment of choice for many patients is free functional muscle transfer (FFMT), a highly complex surgery. Due to the complexity, patients’ ability to understand and retain information during traditional consultations poses a barrier to truly informed consent. Our study aims to utilise animated patient videos and integrated messaging platform to improve patients’ understanding of FFMT surgery, its potential complications, and recovery period.

Method
We developed a new electronic adjunct for patients undergoing FFMT surgery to complement the traditional consent process. The platform employs narrated animations and secure integrated messaging service for patients to directly communicate with their surgeon. A multilingual narrative script, suitable for all ages, complements the animations outlining the details of FFMT surgery in multiple subcategories including scar placement, wound care and signs to identify complications.

Results
We will present a series of patient information videos from 7 subcategories covering all portions of FFMT surgery, demonstrate the ease of use of the messaging platform and summarise the feedback collected.

Conclusions
We have successfully developed an electronic patient information platform to support the traditional informed consent process for FFMT as a treatment of facial palsy which increases patients’ understanding and engagement. Patients can review every step of their journey, from first entering the hospital until the end of rehabilitation, at their own pace, and as frequently as required.
253 Virtual Acute Shoulder (VAS) Clinic in University Hospital Crosshouse (UHC): Developing a New Pathway and Delivering Cost-Effective Patient Care in Compliance with British Orthopaedics Association (BOA)
Authors: Al-Abbasi G , Taylor G , Tanagho A 
Published: August 2023

Abstract

Aim
Setting up this model reduces the waiting time for specialty review of shoulder fractures, provides a timely management plan which would eventually lead to a better patient journey and outcome.

Method
A retrospective 3-cycles QIP of the shoulder fracture clinic in UHC from Jan 2020 - May 2022. We analysed the outcomes of these patients; number of telephone reviews, hospital review appointments, number added to the trauma list for intervention and/or discharged and the cost-benefit analysis.

Results
In 2020 VAS was introduced, out of 383 scheduled patients 14.36% (55) of them were virtual appointments. This percentage increased to 40.17% (188) in 2021 and 42.06% (53) so far in 2022. All of the VAS attendances met the 4-hour A&E target and did not require admission. All patients were contacted by an advanced physiotherapy practitioner following virtual review of clinical notes and radiographs by the senior author within 7 days. The VAS model saved at least £5500 (2020), £18,800 (2021) and £5300 (2022) by avoiding physical appointments and admissions. In addition, we avoided unnecessary preoperative admission and repetition of outdated COVID-19 PCR tests which saved additionally up to £1660 since 2020, this is because all operations (56) were allocated to designated sub-specialty trauma lists.

Conclusions
UHC pioneered a new VAS model in times of rising pressures and financial constraints to manage all shoulder fractures attending A&E; including injuries that potentially require surgery. It reduced unnecessary outpatient appointments, admissions and provided specialist input in a timely manner (right person, right time).
444 Post Colonoscopy Colorectal Cancer, Are We Compliant? A Year in Review
Authors: Basamh M , Manoharan M , Mohamed E , Kulkarni N 
Published: August 2023

Abstract

Post Colonoscopy Colorectal Cancer (PCCRC) is defined as a Colorectal Cancer (CRC) that is diagnosed after a colonoscopy in which no cancer was found.

Aim
To identify the incidence of PCCRC at a district hospital trust and to check our compliance with national guidance (audit against Joint Advisory Group on GI Endoscopy standards). We review the performance in our second cycle and take lessons forward.

Method
Phase 1 collected data from January 2016 to June 2019 following approval. Patients with colorectal cancer were identified from the MDT pathway. Those newly diagnosed with CRC who had colonoscopy within 6-36 months prior to their diagnosis were included. Patients with appendiceal tumours, anal SCC, small bowel GIST, carcinoid tumours or those who had surveillance endoscopies were excluded. Hospital records were used to collect data retrospectively on patient demographics and comorbid diseases. Phase 2 collected data from 01/09/2021 to 01/09/2022 with similar criteria.

Results
The first phase of the study identified 1334 patients. Those not meeting the inclusion criteria as set out from the World Endoscopy Organisation (WEO), or those with non-primary CRC were excluded. Histologically confirmed CRC from phase one yielded 1323 cases. The rate of PCCRC according to the WEO classification was 3%. Phase 2 identified 330 patients with histologically proven CRC, the rate of PCCRC in phase 2 was a marginal decrease to 2%.

Conclusions
Our rate of PCCRC is compliant with national guidance, however key learning points and recommendations are drawn to help NHS services to reach national targets and improve care.
868 Development & Implementation of a Patient Information Leaflet for Elective Daycase Laparoscopic Cholecystectomy – a Quality Improvement Project
Authors: Hamid O , Dorudi Y , Walker T 
Published: August 2023

Abstract

Aim
Daycase surgery reduces post-operative complications. Facilitating safe discharge is of paramount importance. One way of ensuring this is to enable patient access to reliable information.
In this quality improvement project, we aimed to create and implement an information leaflet that would give succinct information to patients on what to expect on discharge, and signposting to further resources if required. It was felt that this would ultimately result in a better and safer patient experience.

Method
A leaflet was designed in conjunction with surgical, nursing, and anaesthetic colleagues, using information available from the Royal College of Surgeons and British Association of Day Surgery. This was then given to all relevant patients post-operatively. Subsequently, a cohort of patients were called and asked for feedback on the usefulness of this leaflet, using a questionnaire approach based on the psychometric Likert scale.

Results
A total of 15 patients were contactable, of which 14 (n = 15, 93%) reported having received the leaflet. A further 12 (n = 14, 86%) described the leaflet as useful, with comments such as ‘it was a comfort blanket’ and that ‘it allayed some anxieties I had about my recovery’. 2 people (n = 14, 14%) mentioned that some information was difficult to understand.

Conclusions
Information leaflets make a positive contribution to the post-operative patient experience. In future, we will look to conduct further study into whether the introduction of this leaflet has improved our day case rate, reduced re-admissions and whether patients have had an overall better experience of care.
1263 Venous Thromboembolism (VTE) Risk Assessment and Thromboprophylaxis Among Hospitalised Patients: A Single-Centre Closed Loop Audit
Authors: Quek F F , Cyclewala S , Smith J 
Published: August 2023

Abstract

Aim
With an estimated incidence rate of 1 to 2 cases per 1,000 population, venous thromboembolism (VTE) remains a significant cause of morbidity and mortality in the United Kingdom. It is reported that VTE is responsible for approximately 60,000 deaths per annum. Furthermore, VTE has a huge financial impact on the NHS. It is reported that VTE treatment costs the NHS approximately £640 million every year.
Notably, at least two-thirds of hospital-acquired VTE are preventable. NICE guideline recommends that all patients should be risk-assessed on admission and re-assessed at the point of consultant review [NG89]. The purpose of this closed-loop audit was to evaluate the effectiveness of simple interventions in improving the efficiency of VTE risk assessments at a large teaching hospital.

Method
Results from the first cycle were analysed and interventions were implemented with the aim to improve the standard of practice. These include the utilisation of technology in VTE risk assessments, mandatory teaching sessions and the development of prompts within clerking proformas. A repeat audit was subsequently performed to re-assess the new standard of practice and the effectiveness of these interventions.

Results
Our VTE risk assessment completion rates increased substantially from 16.67% to 100% and the median time taken to complete VTE risk re-assessments also improved notably from 97 to 21 hours. Positive feedbacks have been received on the effectiveness of these interventions.

Conclusions
By implementing these simple interventions, we can see a substantial improvement in the standards of VTE risk assessments, in compliance with the NHS Standard Contract and NICE guidelines.
1309 A Quality Improvement Project on Small Bowel Obstruction Operative Mortality Rate
Authors: Azri Yahaya A M , Hollingshead J 
Published: August 2023

Abstract

Aim
Higher than average emergency laparotomy mortality rates had been identified via the National Emergency Laparotomy Audit (NELA), at a particular hospital. Small bowel obstruction (SBO) is the commonest cause for emergency laparotomy. The aim of this project was to evaluate the management of SBO, and to implement changes to reduce the operative SBO mortality rate.

Method
NELA was used to assess emergency laparotomy cases between 1st Dec 2018 - 30th Nov 2019; (n = 198), of which there were 24 mortalities. The dataset was filtered for SBO (n = 87), of which there were 12 mortalities. The clinical management of these 12 SBO mortality cases were analysed and compared to the latest ASGBI and NCEPOD recommendations on SBO management.
Following this review, a systematic change in the management of SBO was introduced with the aim of reducing time to operation, appropriate candidate selection and avoiding drifting in management. This consisted of producing a SBO management flowchart as well as ensuring allocation of theatre slot within 72 hours for patients suitable for operation.

Results
Following the intervention, we assessed cases between 1st April 2021 - 31st March 2022 (n = 152), of which there were 13 mortalities. The dataset was filtered for SBO cases (n = 57), of which there were 3 mortalities. Emergency laparotomy mortality rate reduced from 12% to 9%. SBO operative mortality rate reduced from 14% to 5%. Emergency laparotomy deaths relating to SBO reduced from 50% to 23%.

Conclusions
The intervention resulted in improvement in SBO operative mortality rates as well as overall emergency laparotomy mortality rates.
844 Surgical Outcomes and Mortality for Patients Undergoing Total Pelvic Exenteration for Colorectal Cancer at One Year
Authors: Ralston C , Schizas A , Hainsworth A , Ferrari L , George M 
Published: August 2023

Abstract
Total pelvic exenteration (TPE) is undertaken at specialist centres for locally advanced rectal cancer. It carries significant morbidity and mortality. Research is often performed on small sample sizes resulting in limited data on surgical outcomes and mortality.
A retrospective study conducted in St Thomas’ Hospital analysed colorectal cancer patients who underwent TPE’s from 2017-2021. Demographics and perioperative data including Clavien-Dindo (CD) score, 90 day and 1 year mortality was collected. Significant post-operative complications were considered for patients scoring &gt;2 on CD scale.
124 patients were included in the study, mean age 63 (SD 10), (87% male; 13% female). TPE was undertaken for a primary rectal cancer in 77% and for recurrent disease in 23% of patients. Mean blood loss was 1688mls and median length of hospital stay was 18 days. Significant complications seen in 34% of patients. 69% patients had R0 resection, 25% R1 resection. Disease recurrence was significantly more prevalent in patients with R1 resections (p&lt;0.0001). In total 42 patients experienced disease recurrence (60% metastatic, 40% local), mean disease free period was 405 days. 71% of relapsed patients had adjuvant therapy advised, with only 27% of advised patients going on to receive treatment. 1 year mortality shown to be 12% with 3 patients within 90 days of surgery.
Patients experience a considerable risk of post-operative complications following TPE with over a third experiencing significant complications in the immediate post-operative period. Patients with R0 resections go on to have significantly less disease recurrence. Further research required into long term survival.
193 The Effect of a Targeted Teaching Program on Patient Care in SMART Vascular Unit
Authors: Elkawafi M , Al-kassar A , Barclay A , Elgzairi M , Ghatwary T 
Published: August 2023

Abstract

Introduction and Aim
The usual outcome for any QIP is education focused around the topic in order to raise awareness. At South Mersey arterial (SMART) unit, we developed a targeted teaching program to address key topics. We aim to identify the effect of the program targeted at Foundation and core training level doctors on our patients ward based care measures using regularly audited data points.

Method
The program at SMART started in 2020 and is a repeated selection of talks which address specific recommendations per national guidelines. We have correlated the timing of the teaching programs with the start of each rotational change (4 to 6 monthly). We have repeated multiple audits to assess specific outcomes including antiplatelet, DVT prophylaxis, diabetic control, amputation pathway, lipid modulation. We reviewed the results of the multiple audits in conjunction with the repeated teaching program.

Results
The results of the Multiple Audits show an overall improvement on the adherence to Best medical therapy, DVT prophylaxis, Amputation pain-control pathway (25% to 92%), lipid modification therapy (74.3% to 99%) and diabetic screening and control (32% to 100%). Overall, the feedback on the teaching program was encouraging from all grades.

Conclusions
We recommend based on our multiple Audit outcomes, A regular repeated teaching program targeting specific topics especially at the transition periods for Foundation and Core training level doctors is a useful method to improve patient care and target specific defect areas as well as provide educational benefit to the attendees.