bluuebunny/crossref_metadata_2025_split huggingface dataset:
299 Predictive Performance of NELA Versus P-POSSUM Mortality Scores; Are We Underestimating the Risk of Mortality Following Emergency Laparotomy?
Authors: Barghash M , Iskandar A , Fawzy S , Effiom D , McComb K , Huck C , Hajibandeh S , Mansour M 
Published: August 2023

Abstract

Aim
To compare the performance of NELA and P-POSSUM mortality risk scores in predicting 30-day and 90-day mortality in patients undergoing emergency laparotomy.

Method
A retrospective cohort study was conducted to compare predicative performance of pre-operative NELA, post-operative NELA and P-POSSUM predicted mortality scores in patients undergoing emergency laparotomy between 2014 and 2021. The outcomes of interest included the observed 30-day and 90-day mortality. The discrimination of the mortality tools was assessed and compared by determining the Area Under the Curve (AUC) for each tool using Receiver Operating Characteristic curve analysis.

Results
A total of 681 patients were included. The observed risk of 30-day and 90-day mortality were 10.4% (71/681) and 14.2% (97/681), respectively. In terms of 30-day mortality, the AUC was 0.791 (0.727-0.855) for pre-operative NELA score, 0.784 (0.721-0.848) for pre-operative P-POSSUM score, and 0.761 (0.699-0.824) for post-operative NELA score. In terms of 90-day mortality, the AUC was 0.765 (0.708-0.821) for pre-operative NELA score, 0.749 (0.692-0.807) for pre-operative P-POSSUM score, and 0.745 (0.691-0.800) for post-operative NELA score. Observed/Expected ratio for 30-day and 90-day mortality were calculated as 3.25 and 4.43 for pre-operative NELA, 2.81 and 3.84 for pre-operative P-POSSUM, and 2.17 and 2.96 for post-operative NELA, respectively. Pairwise comparisons showed no statistically significant difference in discrimination among the three models.

Conclusions
Pre-operative NELA, post-operative NELA and P- POSSUM scores underestimated the risk of 30-day and 90-day mortality for patients undergoing emergency laparotomy. No significant difference in predictive performance was found among the three models.
795 Predictors and Timing of Recurrence After Surgical Resection of Pancreatic Adenocarcinoma
Authors: Ang A , Michaelides A , Tissue Bank Barts Pancreas , Kocher H 
Published: August 2023

Abstract

Aim
To investigate the predictors and timing of recurrence after curative resection for pancreatic adenocarcinoma (PDAC).

Method
Consecutive patients who underwent curative resection for PDAC (2011-21) and consented to data and tissue collection, were followed up prospectively in a single institution. Clinico-pathological variables were analysed using the Cox proportional hazards model.

Results
91 patients (median age 71 years (range 43 – 86)) had a median follow-up of 51 (95% CI 40–61) months. 66 (72.5%) patients experienced recurrence (12 locoregional, 11 liver, 5 lung, 3 peritoneal, 29 simultaneous locoregional and distant and 6 multi-focal distant). Median time to recurrence was 8.5 (95% CI 6.6-10.5) months and median survival after recurrence was 5.8 (95% CI 4.2-7.3) months.
Stratification by recurrence location revealed no significant differences in time to recurrence (p = 0.24). Significant predictors for any recurrence were lymph node ratio ≥0.33 (p = 0.005, HR 2.8, 95% CI 1.4 – 5.8), adjuvant chemotherapy (p = 0.002, HR 0.4, 95% CI 0.2 – 0.7) and systemic inflammation score ≥500 (p = 0.01, HR 4.5, 95% CI 1.4 – 14.3).

Conclusions
Lymph node ratio, adjuvant chemotherapy and systemic inflammation score were significant predictors for recurrence after curative resection for PDAC: this needs validation in large national cohorts.
1273 Ethical Considerations in Paediatric Bariatric Surgery: A Systematic Review
Authors: Shah A , Kumar N 
Published: August 2023

Abstract

Aim
With childhood obesity prevalence increasing rapidly, bariatric surgery is being given greater consideration in the paediatric population. Paucity of long-term evidence, physical and emotional risks, and reliance on parental decision-making are factors constituting this subject’s moral complexity, forming debate around the eligibility and timing of offering the procedure. Consequently, a systematic review was conducted to evaluate ethical considerations.

Method
All relevant synonyms of “Paediatric”, “Bariatric Surgery” and “Ethics” were used to identify papers for inclusion in the systematic review and reference lists were also scanned. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adhered to.

Results
10 papers were included. A key ethical dilemma frequently explored was the issue of consent, and ensuring the child is at the forefront of the decision. Paediatric bariatric surgery causes controversy as children are exposed to surgical risk early in life, and thus prolonged preventative measures are encouraged with the aim to mitigate obesity by adulthood causing unnecessary harm. Children without a strong support network have additional obesity risk, whereby withholding surgery may be viewed as inequitable and non-beneficent. There is also conflict between delaying surgery until the child is Fraser-competent versus increased complication risk.

Conclusions
Further evidence to guide assessment criteria are needed to facilitate informed consent. Post-operative support should be audited, with inclusive care and sustained health outcomes monitored. Although preventative methods are important in the paediatric population, clinicians must not discriminate against those for whom it proves ineffective, with bariatric surgery being a last resort for high-risk obese patients.
208 Evaluating the Usefulness of Crash Courses in Anatomical Education
Authors: Abelleyra Lastoria D , Rodriguez J , Miller P 
Published: August 2023

Abstract

Aim
To evaluate the usefulness of Crash Courses for learning Anatomy, and to explore their role in anatomical education.

Method
51 students attended an Anatomy crash course ahead of their university assessments. This consisted of 6 one-hour sessions, delivered by three 4th year medical students, taking place on a single day. A survey was presented to and responded by all participants. Parameters including, but not limited to, perceived usefulness of crash courses, and confidence in anatomical knowledge before and after the event, were enquired about. These were measured using a 5-point Likert scale. Consent was obtained from all participants for the evaluation and inclusion of their survey responses in any presentation or publication following the event.

Results
51 students (100%) reported their confidence about their upcoming exam increased after the course. On a 5-point Likert scale (1 = not confident at all, 5-very confident) confidence rating increased from 2.04 ±0.11 to 3.73 ±0.11. The Crash course’s usefulness was rated at 4.51 ±0.01 (1 = not useful at all, 5 = very useful). Top reasons for attending included learning concepts before the exam, and practising exam questions. All students reported Crash courses have a place in anatomical education. In addition, 48 (94.1%) preferred sessions to be led by students rather than lecturers. Reasons included familiarity with examinations, and relatability to the tutors.

Conclusions
Crash courses can be an effective way to enhance student learning, with high satisfaction reported. Anatomy departments and student-led anatomical societies should incorporate them into teaching schedules given their potential to enhance student learning.
1302 Should All Excised Suspected Epidermoid and Pilar Cysts Undergo Histological Analysis?
Authors: Rashid S , Pizanias M , Sekhon Inderjit Singh H K , Howlader M 
Published: August 2023

Abstract

Aim
Within our department, there is variation as to whether excised suspected epidermoid and pilar cysts (both often referred to as sebaceous cysts) are sent for histology. This study aimed to assess the clinical risk of not routinely sending these lesions for histological examination.

Method
A retrospective review was undertaken of consecutive patients undergoing excision biopsy of suspected epidermoid/pilar cysts between September 2016 and August 2021. Data recorded included pre-operative suspected diagnosis, operative diagnosis, histology results and whether these results had been reviewed by the surgical team.

Results
202 patients underwent excision of suspected cysts from a single District General Hospital. 112 were pre-operatively diagnosed by Registrars and 85 by consultants. In 177 cases a sample was sent for histology (88%). In 113 of these cases, the result was reviewed by the surgical team (64%).
The concordance between pre-operative diagnosis and histology was 73.8%. Concordance in pre-operative diagnosis with histology results was similar between Registrars and Consultants (80% vs 73.8%, p = 0.007).
The concordance between the operative diagnosis and histology was 82.1%. Of the 36 cases misdiagnosed at operation, histology revealed malignancy in one case (basal cell carcinoma) and pre-malignancy in another (keratoacanthoma).

Conclusions
In our study, there is a high concordance between operative diagnosis and histology (82.1%) with a relatively low risk of missing malignant or premalignant lesions (2/177, 1.1%). Given the potential economic savings, it may be possible for the surgeon to safely select which cysts need histological review rather than routinely sending all specimens.
702 Hindfoot Stability Test - Introduction and Validation of a Diagnostic Test of Subtalar Instability in Deltoid Ligament Injury Associated with Ankle Fractures
Authors: Mason L , Philpott M , Aamir J , Caldwell R , Bond A 
Published: August 2023

Abstract

Aim
Deltoid ligament complex (DLC) injury repair in the presence of an ankle fracture remains a topic of controversy in the current literature. No work in the current literature has commented on hindfoot and subtalar instability in the presence DLC injury associated with ankle fracture fixation. Our aim was to introduce and validate a new method for assessment of hindfoot instability, when fixing an ankle fracture with associated DLC injury.

Method
DLC injury, specifically superficial DLC, controls not only the ankle but the subtalar joint and medial longitudinal arch. Valgus stressing can unmask subtalar instability. It was noted by referencing the hindfoot position to a line parallel with the lateral aspect of the fibula, the lateral fibula line, subtalar instability was probable. We used six morphologically normal cadaveric specimens to validate the test.

Results
Six cadaveric specimens were used for validation of the hindfoot stability test. Pre-injury, no specimen illustrated bisection of the calcaneal tuberosity by the lateral fibular line on hindfoot stability test under fluoroscopy. Post-injury, all specimens showed bisection of the calcaneal tuberosity by the lateral fibular line on hindfoot stability test.

Conclusions
The hindfoot stability test assesses hindfoot stability on valgus stressing of the hindfoot using the calcaneal tuberosity bisection of a line drawn from the lateral border of the fibula as a reference point for instability. This was validated using morphologically normal cadavers.
294 Evaluation of the Clinical Utility of ANCHOR (An Artificial Neural Network for Chronic Subdural Hematoma Referral Outcome Prediction): An External Validation Study of 1713 Patient Referrals
Authors: Biswas Sayan , MacArthur Joshua , Pandit Anand , Sarkar Ved , Joshi George K 
Published: August 2023

Abstract

Aim
Chronic subdural hematoma (CSDH) incidence and referral rates to neurosurgery are rapidly increasing. We have previously shown that ANCHOR, a locally developed deep learning machine learning (ML) model can accurately predict CSDH referral outcome with a high degree of precision. Our objective for this study was to externally validate the accuracy of the ANCHOR model at predicting CSDH referral outcomes in an external tertiary neurosurgical centre.

Method
Patients referred to the external validation neurosurgical centre for CSDH were retrospectively analysed for 7 patient features previously identified over the same 5-year period (2015-2020). The optimal ML model identified in the previous study, the Artificial Neural network for Chronic subdural HematOma Referral outcome prediction (ANCHOR), https://medmlanalytics.com/neural-analysis-model/, was then evaluated on 6 performance metrics using the new cohort.

Results
1713 referrals were identified, of which only 29.5% (505) were accepted referrals. The ANCHOR model demonstrated good discrimination and calibration, with an accuracy of 92.294% [95%CI: 90.952 – 93.520], sensitivity of 82.970 [95%CI: 79.644 – 86.180], specificity of 96.190% [95%CI: 94.951 – 97.202], PPV of 90.108% [95%CI: 87.197 – 92.688], an AUROC of 0.896 [95%CI: 0.878 – 0.912], and a brier score loss of 0.077 [95%CI: 0.065 – 0.091]. Decision curve analysis further demonstrated superior clinical net benefit across all patient risk threshold probabilities.

Conclusions
This study successfully validated the clinical utility of the ANCHOR ML model in predicting CSDH referral outcome at an external centre. ANCHOR was able to accurately predict referral outcomes and can potentially be used in clinical practice to support CSDH referral decision making.
96 Looped Prospective Audit of Compliance to the British Orthopaedics Association Standards for Trauma and Orthopaedics (BOAST): Safe Use of Intraoperative Tourniquets in Upper Limb Surgery
Authors: Wen J , Lin Z , Bommireddy L 
Published: August 2023

Abstract

Background
New BOAST standards were published in October 2021, advocating the need for all tourniquet pressure to be inflated 50-100mmHg above the adult patient’s systolic blood pressure when undergoing upper limb surgeries. The aim was to assess whether conformity was present towards this standard.

Method
A closed-loop prospective audit was implemented in a specialist hand unit from October to December 2021. Readings, including blood pressure before tourniquet inflation, final inflation pressure, tourniquet time, and level of performing surgeon, were collected from documentation and analysed.

Results
A total of 100 patients were assessed. The initial audit and re-audit demonstrated low compliance levels of 36% (18/50) and 38% (19/42), respectively, despite specific educational interventions regarding the newly published standard. When comparing junior and specialist hand consultants, non-compliance was more significant at the more senior level (63.4%). All non-compliance was a result of the overinflation of the tourniquet. The average overinflation was 20.6mmHg, and the average tourniquet time was 40.9 minutes. No tourniquet complications were documented in any case.

Conclusions
The primary rationale resulting in the non-compliance from the experienced hand surgical team was that the increased risk of obscuring the operative field from bleeding, thus leading to structural damages, outweighs the complications of overinflating the tourniquet. Furthermore, systolic blood pressure cannot always be maintained within a restricted window from the anaesthetic perspective. Therefore, we propose that the guideline be opened for further discussion and more up-to-date research implemented in this field.
216 Sentinel Lymph Node Biopsies for Malignant Melanoma – a Single Centre, Closed-Loop Audit
Authors: Campos M , Mendis K , Ibrahim A , Esmaeili A 
Published: August 2023

Abstract

Aim
Sentinel Lymph Node Biopsy (SLNB) has been used as staging tool for Malignant Melanoma (MM) for over 15 years. This audit sought to ensure that standards of care are being met in melanoma patients undergoing SLNB at the Royal Free Hospital (RFH).

Method
A retrospective audit examined electronic notes for patients undergoing SLNB for MM at RFH March-September 2021 (Loop 1, n = 139) and September 2021-March 2022 (Loop 2, n = 100). The standard used to determine eligibility for SLNB originated from a UK consensus statement recommending SLNB in primary cutaneous melanoma ≥pT2a or pT1b and either lymphovascular invasion or a mitotic rate ≥2/mm2.

Results
In Loop 1 of the audit, 6.5% of patients undergoing SLNB (n = 9) did not meet the criteria. A further 4.3% (n = 6) did not have documented lymphovascular invasion or mitotic index and, therefore, potentially also did not meet criteria. Between loops 1 and 2, standard referral letters were disseminated to referring sites, who were also instructed to include full histology reports with referrals. In Loop 2 of the audit, 3% of patients undergoing SLNB (n = 3) did not meet the criteria. A further 11% (n = 11) did not have a documented lymphovascular invasion or mitotic index in the referral and, therefore, potentially also did not meet criteria.

Conclusions
SLNB carried out on non-eligible patients carries risks of increased morbidity and mortality. Interventions implemented between loops 1 and 2 in our single-centre audit did not lead to sustained change and highlight the need for further research and improvements.
568 Audit of Laceration Management and Documentation
Authors: Kremneva A 
Published: August 2023

Abstract

Aim
Evaluate adherence of emergency department (ED) staff to NICE guidelines on laceration management. Evaluate quality of laceration management documentation in ED. Re-evaluate the above following the introduction of a laceration template for ED clerking.

Method
ED documentations of 53 adult patients presented with laceration in November 2022 were analysed and evaluated based on the presence of the following components: wound size, infection risk, tetanus vaccination status & appropriateness of booster administration, wound cleaning, appropriateness of wound closure method, type of dressing, appropriateness of antibiotic prescribing, and wound care instructions (e.g., suture/ dressing removal time).

Results
49% of documentations mentioned the laceration size. Only 9% commented on the wound infection risk, making it impossible to comment on appropriateness of antibiotic prescribing in most cases; 6% of the cases were prescribed antibiotics despite the wound being closed, against guidelines. Most cases had wound cleaning (72%) and appropriate closure method (77%) documented. Dressing type was only documented in 19% of cases. Just over the half of the patients had tetanus history clarified and booster administered appropriately (59%). Only 36% of the patients received detailed wound care instructions.

Conclusions
The first audit cycle highlighted concerning gaps in ED clerking. This may lead to the NICE guidelines being incorrectly applied, which in turn presents a significant risk to patients. A laceration clerking template will be introduced in 2023 with compulsory elements that will encourage more rounded history taking. Therefore, a re-audit will be performed in February to assess efficacy of changes.
581 Documentation of Peripheral Sensory Function Assessment in Hand Trauma at a Regional Referral Unit
Authors: Dawidziuk A , Tickunas T 
Published: August 2023

Abstract

Aim
This audit aimed to assess the quality of documentation of sensory function assessment in hand trauma patients treated at a regional referral unit. The audit was based on The British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) “Peripheral Nerve Injury” national guideline, last updated in December 2021.

Method
The scope included all hand trauma referrals received between the 1st and 10th of March 2022. Initial case screening excluded missed appointments, telephone consultations, missing hand assessment sheets and reviews of old injuries. Following that, patients with diagnoses of pulp injury, amputation, closed central slip injury, mallet injury, phalanx infection, old injuries, and removal of metalwork, which were not relevant to the audited guideline, were excluded. All remaining records were analysed for any description of sensory assessment and description of the sensation level using a 1-10 scale. Additionally, cases of volar lacerations were checked for documentation of two-point discrimination (2PD).

Results
The search yielded 97 patient records. Following the initial screening, 10 cases were excluded. 56 out of 87 remaining cases had diagnoses relevant to the audit. 24 cases were classified as volar injuries. 73% of hand assessment sheets contained any description of peripheral sensory assessment (41/56). 1-10 assessment was documented on 23% of records (13/56). 17% of volar injury records contained 2PD examination documentation (4/24).

Conclusions
Documentation of sensory assessment in hand trauma, especially two-point discrimination in volar lacerations, requires improvement. One possibility to improve the adoption of 2PD evaluation would be an introduction of a cheap and widely available assessment device.
664 Rapid-Access Head and Neck Lump Imaging Clinics Improve Compliance to the NHS Faster Diagnosis Standard, With Reduction of Head and Neck Cancer Diagnosis Times
Authors: Dar T , Maitra S , Michaels J , Bhatt N , Iyngkaran T , Sood T , Tornari C 
Published: August 2023

Abstract

Aim
The NHS “Faster Diagnosis Standard” (FDS) recommends patients referred for suspected cancer to be diagnosed or have cancer ruled out within 28 days. Reducing time to diagnosis and treatment in head and neck cancer is associated with improved patient outcomes. Our aim was to improve compliance to the 28-day standard in a large tertiary head and neck department, by introducing a rapid-access clinic for head and neck lumps including same day ultrasound-scanning with biopsy.

Method
Data was collected in two rounds: 3 months before and after introduction of the rapid-access clinic in September-2022. Data collected included referral reason, time from referral to specialist review, to ultrasound, and to diagnosis. Patients not fitting agreed criteria for the clinic were excluded.

Results
In the first round 39 patients had a diagnosis at time of analysis; as had 13 in the second round: Initial compliance to the 28-day FDS was 33%, this increased to 85% in the second round. Median time to diagnosis was 36 days, decreasing to 12 in the second round (p-value &lt;0.001). Median time to ultrasound was 28.5 days in the first round, decreasing to 9 in the second round (p-value &lt;0.001).

Conclusions
Preliminary data shows a 53% improvement in compliance to the 28-day FDS, after introduction of the rapid-access clinic. This suggests the model could significantly improve compliance to national standards for diagnosing head and neck cancer presenting via neck lumps. This should encourage other tertiary head and neck services that creating rapid-access clinics can reduce delays in cancer diagnosis and treatment.
730 An Audit of Antibiotic Prescription in Acute Pancreatitis
Authors: Othman A , Ben Abdalla M , Baston T , McComb K , Barghash M , Sadic J 
Published: August 2023

Abstract

Aim
To assess the prescription of antibiotics in the management of acute pancreatitis in North Manchester General Hospital and to determine adherence to NICE Guidelines (NG104).

Method
Retrospective analysis of patients admitted to North Manchester General Hospital, with a diagnosis of acute pancreatitis, between 1st January 2021 and 31st December 2021. Analysis performed by assessing case notes, electronic Prescribing and Medicines Administration (ePMA) system, radiological imaging, and blood test results. The Atlanta Classification was used to define the inclusion criteria for acute pancreatitis.

Results
A total of 98 patients were diagnosed with acute pancreatitis. Subsequently, 11 patients were excluded due to insufficient evidence to support their diagnosis. 65.5% of patients were prescribed antibiotics on admission. 12.1% of patients were prescribed antibiotics for necrosis, 12.14% for concurrent cholecystitis and 33.4% were prescribed antibiotics without indication.

Conclusions
Poor compliance with national guidelines on the recommended management of acute pancreatitis. Audit results and the recommended NICE Guidelines were disseminated to all members of the General Surgery team with further consolidation at the local governance meeting to improve knowledge and streamline practice.