bluuebunny/crossref_metadata_2025_split huggingface dataset:
267 Perforated Meckels diverticulitis; a cautionary tale highlighting the importance of accurate vetting information in the selection and interpretation of radiological investigations
Authors: Mitchell Robert , Kulendran Myutan 
Published: August 2023

Abstract

Background
Failure of the vitelline duct involution process during the 7th week of gestation gives rise to the most common congenital anomaly of the GI tract; Meckel’s diverticulum. Clinical presentation is extremely variable. We present an unusual case of a perforated Meckel’s diverticulitis and a cautionary tale highlighting the importance of accurate clinical information when requesting radiological investigations.

Case report
An 18 year old gentleman presented acutely with 24 hours of rectal pain and associated fever. There were no urinary or penile symptoms. Examination revealed lower abdominal tenderness. Rectal and prostatic examination were normal. Abdominal ultrasound revealed a dilated appendix with surrounding free fluid. Diagnostic laparoscopy revealed pus in the right iliac fossa with a submerged and mildly injected appendix. A separate cause was sought – a perforated small bowel diverticulum was found in a 600mL pelvic collection. The procedure was converted to a Laparotomy with small bowel resection and side-side anastomosis plus appendicectomy and washout. Post-operative histology revealed a perforated Meckel’s diverticulitis.

Discussion
This unusual case highlights the importance of using the correct radiological investigation at the correct time for the correct clinical query. Clinical information supplied to radiologists, particularly ultrasonographer's, drastically alters the extent of examination and interpretation of imaging.

Conclusion
Providing accurate clinical information to Radiologists is key for accurate interpretation of imaging. Inaccurate information impacts the ability to arrive at the correct diagnosis, give the correct treatment and, in a surgical setting, complete the correct consent process for the patient.
275 Informed Consent for surgery: Have we learned from Montgomery v. Lanarkshire 2015
Authors: Ong Chon Sum , Ahmed Hager , Lala Anil 
Published: August 2023

Abstract

Introduction
Informed consent is the process in which a healthcare provider educates a patient about the risk, benefits, and alternatives of an intended procedure. However, the consequence could be detrimental if all risks were not explained appropriately to the patient.

Aim
To investigate if all relevant risks were patient-consented before elective and urgent cholecystectomy and appendicectomy.

Method
A prospective audit was conducted at a District General Hospital for 2 weeks in September 2022 by checking the consent forms of the respective procedure. Peer-reviewed leaflet produced by EIDO Healthcare was used as the standard. Intervention was done by preparing a checklist of procedural risks to be used by the consenter. The data was collected for 2 weeks in October 2022 and analysed using Microsoft Excel.

Results
For cholecystectomy (n=15), 12 were done electively and 3 were urgent. Out of the 17 common cholecystectomy risks, 9 were discussed in all consents post-intervention compared to 3 before. 6 of the risks were discussed in ³30% more consents post-intervention. Explanation of post-cholecystectomy syndrome achieved the best improvement of being discussed in 53.3% more consent. For appendicectomy (n=9), out of the common 14 risks, only 2 risks were discussed in 30% more consents post-intervention.

Conclusions
The likely explanation for the sub-optimal improvement in the appendicectomy consent process was due to urgency. The nature of the procedure might have triggered a speeding up of the consent process which consequently exposed to unintentional omission. This emphasises the importance to address difficulties with the consent process to promote patient autonomy and prevent harm.
285 Trends in Emergency General Surgery activity in a dedicated unit: impact of a 5-consultant EGS team over a 3-year period
Authors: Guy Richard , Smallwood Suzy , Gallucci Antonio , Ishak Rafik , Buckley Katherine , Pilavas Andreas 
Published: August 2023

Abstract

Aims
A 5-Consultant EGS team was established for all acute General Surgery admissions to a 900-bed DGH. The aim was to evaluate management, outcomes and trends over a period of almost 4 years, incorporating the COVID-19 pandemic period.

Methods
Data was collected prospectively between 01/04/2019 & 09/01/2023 and included number and source of admissions, admission decision, surgery rates and lengths of stay. Three separate time periods were compared: (A) an 11-month pre-pandemic period (B) the official pandemic lockdown period (Mar 2020-Dec 2021) (C) a 12-month post-pandemic period.

Results
Direct GP-to-Consultant telephone referral was mandatory from the start of Period B, with around 200 calls/month, resulting in significant reductions in admission rates. Median weekly admissions for Periods A, B & C were 158, 127 & 132, respectively. Corresponding mean proportions coming from Primary Care vs Emergency Department were 55% vs 31.5%, 38.1% vs 46% & 39.9 vs 41%, respectively. Data since 06/12/2021 shows that 61.6% of admissions were seen by an EGS Consultant within 4 hours. The mean proportions of patients undergoing surgery during the three periods were 19.8%, 18% and 19.2%, respectively. Median length of stay (data available after Mar 2022) was 5 days.

Conclusions
A dedicated Consultant-led EGS service with GP collaboration is associated with improved efficiency, a reduction in GP admission rates, short hospital stays and greater use of ambulatory care. Despite fewer pandemic admissions, there was no significant change in the proportion requiring surgery, reflecting appropriateness of patient selection. Regular data analysis allows service modification responsive to needs.
292 Surgical Registrar Hot Clinic - Quality Improvement Project
Authors: Rogers Michaela , Kapuge Lakith , Brunt Reece , Harries Callum , Okocha Michael , Shamali Awad 
Published: August 2023

Abstract

Aims
Patient seen by the on-call general surgical team who require a semi-urgent clinical assessment, imaging or an operation who are well enough to go home, are discharged with plan to come back the following day to have these done. Unfortunately, these scan are often reviewed in the afternoon having a detrimental effect on patient satisfaction and flow. A possible solution to this is having a registrar-led dedicated morning hot clinic with allocated imaging slots where these returns could be seen.

Methods
2 months worth of SAU returns were reviewed. Patient lists were reviewed and data collected including date of return, brief history and the reason for coming back. Reasons for coming back were divided into 3 categories - Clinical review, Imaging, Theatre.

Results
A total of 159 patients were brought back to SAU over 2 months. 36 patients were brought back for review, 104 patients were brought for imaging and 19 patients were brought for theatre.

Conclusion
This project identified that on average 4 patients are asked to return daily. 85% of these returns are either for clinical review or imaging. As such having dedicated slots in the radiology department between 9 and 10 and a hot clinic from 10 and 11 would streamline the current process. This will have a number of benefits including quicker turn around for patients which will improve patient satisfaction and will reduce the number of patients waiting on SAU at any given time allowing both doctors and nurses to be able to provide safe and effective care in an already stretched and demanding environment.
310 Incarcerated incisional hernias should be managed surgically where possible, despite a high incidence of obesity and comorbidity: a 7-year experience in a District General Hospital
Authors: Omar Islam , Townsend Abby , Fotiou Georgia , Khogali Moataz , Said Ilhaam , Guy Richard , Newey Luke , Williams Catrin , Jones Annabel 
Published: August 2023

Abstract

Aims
Incisional hernia (IH) is a common complication of major abdominal surgery. This study describes the outcomes and burden of emergency management of incisional hernias.

Methods
A retrospective single-centre observational study was conducted on all patients with an incarcerated incisional hernia over seven years. Patient demographics, comorbidities, presentation mode, radiological imaging and management were analysed. Outcome measures were: postoperative complications, need for Level 2 or 3 care, mortality rates, hospital stay, readmission rates and hernia recurrence.

Results
194 patients were identified, of whom 54 were excluded. For the 137 patients analysed, the mean age was 66.54 SD± 14.6 with a median of 67 years; 80 (58 %) were females. The mean BMI was 34.6 SD± 10.08 kg/m2.
43 % had at least one comorbidity. 69 (57.7%) patients presented with small bowel obstruction, of whom 3 (2.2%) had bowel perforation. Over two-thirds of patients (93, 67.9%) were managed surgically, with 44 (32.1%) being managed conservatively.
The significant complication (Clavien-Dindo III and over) rate was 16.1%, and the most common complications were wound-related. The 30-day and 90-day mortality rates were 6.6% and 8.8%, respectively. The mean length of stay was 12 days SD± 25. Some 19.7% needed Level 2 or 3 care, and 24.1% had unplanned readmissions, the majority of whom were in the conservatively managed group.

Conclusion
Patients with complicated IH have significant comorbidities, and many are obese. Emergency presentation of IH carries a high risk of morbidity. High readmission rates are seen in conservatively managed patients, and surgical repair should be undertaken where possible.
319 Diverticular disease of the appendix: an unusual presentation (Case report)
Authors: Bukhari Ishtiyaq , Deeknah Abdulqudus , Ghosh Soumendu , Yiannikouride Maria , Nichita Vladimir , Alaghbari Maram 
Published: August 2023

Abstract

Background
Appendiceal diverticular disease is not a common consideration in the diagnosis of patients presenting with atypical right lower abdominal pain. This should be considered due to a potential increased risk of perforation and appendiceal neoplasm. Furthermore there is anecdotal evidence to suggest prophylactic appendicectomy for incidental findings of appendiceal diverticular disease can prevent future complications.

Case presentation
We describe the unusual case of a 42 year old male patient presenting with intermittent recurrent right iliac fossa pain who was found to have an appendiceal mass on diagnostic laparoscopy. Following radiological imaging, colonoscopy, multidisciplinary team (MDT) discussion and proceeding to laparoscopic appendicectomy, was found to have appendiceal diverticular disease on histology.

Conclusion
Diverticulitis of the vermiform appendix is a rare but possible diagnosis and should be considered when dealing with recurrent right iliac fossa pain in middle aged population.
356 Registrar confidence levels managing paediatric surgical patients in a busy district general hospital
Authors: George Jayan , Leeman Charlie , Wafai Ahmad Hisham , Durham-Hall Antonia 
Published: August 2023

Abstract

Introduction
The abdominal pain pathway and appendicitis toolkit (APPAT) was developed to harmonise care across our region, reduce the negative appendicectomy rate, identify appendicitis accurately and increase the number of children undergoing a laparoscopic procedure.

Aims

Methods
Doctors were surveyed in January 2023. Two questions used Likert scales (1 to 5: not at all confident to very confident) in assessing paediatric patients. Three closed questions to assess the use of guidelines. Nine open questions to assess the network appendicitis tool. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results
7 registrars (7/13) completed the questionnaire.
The majority of registrars felt very confident (5) assessing paediatric patients aged 8-16.
Few registrars use any guidelines or pathways when assessing a patient with abdominal pain (1/7).
Most registrars do not use a scoring system to assess for appendicitis (4/7).
No registrars were able to accurately answer all aspects of the local network tool.
No registrar was able to answer the low, medium or high-risk score of the tool.

Conclusions
Registrars feel confident assessing paediatric patients. Most registrars do not use scoring systems to assess these patients. Awareness and accuracy of the specific parameters of APPAT were low. Further awareness and education may support the management of these patients.
432 Returning to Surgical training. Are we meeting the need?
Authors: Richards Eleanor , Murphy Claire 
Published: August 2023

Abstract

Aims
The association of time out of training (TOOT) with skills fade is well documented. Despite the establishment of Supported Return to Training (SRTT) in 2017, engagement from Surgical trainees is suboptimal. We sought to evaluate this.

Methods
An online survey of Yorkshire Surgical trainees was conducted in January 2022. Results were analysed as were Yorkshire SRTT data for the past 2 years.

Results
Of 22 respondents, 18 had had time out, 3 were planning it and 3 considering it in future. SRTT was used by 52.6%, 21% felt it did not meet their needs whilst 15.8% were unaware of SRTT.
This is reflected in the regional HEE data. In the previous 2 years 85 surgical trainees had taken TOOT but only 22 (26%) had engaged with the SRTT process, compared with 60% of Obstetrics and Gynaecology (O&G) trainees and 87% of Anaesthetic trainees. Analysis of the reasons for TOOT showed that surgical trainees most commonly took time out for research (OOPR) (28%) or parental leave (28%) whilst 67% of Anaesthetics and 49% of O&G trainees had time out for parental leave.

Conclusions
Despite having higher numbers of returning trainees, engagement with the SRTT process from the school of surgery is poor. This is likely multifactorial, reflecting the demographics of what is perceived as a less family friendly specialty, failure to recognise or acknowledge skills fade among OOPR trainees and an existing offering that is not fit for purpose. A collaborative exploration of these issues is required to address this.
472 Right-sided diaphragmatic hernia causing gastric outlet obstruction 1 month after trauma
Authors: Alfardan Nadya , Fernandes Roland , Thomas Janine 
Published: August 2023

Abstract
Diaphragmatic hernias arising from trauma are rare, and scarcely present in a delayed manner. This case report highlights a case of delayed presentation of a right-sided post-traumatic hernia in a 73-year-old woman following a fall. This report sheds light on the diagnostic peculiarities and management. The woman presented with a 3-day history of abdominal pain and coffee-ground vomiting. This followed a fall a month ago. Computed Tomography confirmed the diagnosis of a gastric outlet obstruction secondary to a right-sided diaphragmatic rupture. At surgery, the herniated abdominal contents were reduced, and the diaphragmatic defect fixed. The postoperative recovery was unremarkable and the patient discharged on day 4. This case highlights that diaphragmatic hernias should be considered as differential diagnoses following recent trauma.
602 A simple and timely intervention can optimise patient’s anaemia before resectional surgery for Colorectal cancer
Authors: Shafiq Umar , Agarwal Anil , Boulos Christopher 
Published: August 2023

Abstract

Aims
Anaemia at the time of colorectal resection for cancer adversely affects outcomes. We performed an audit to quantify anaemia at pre-assessment. We incorporated an intervention of iron infusion at the point of diagnostic endoscopy for suspected cancers with anaemia. We assessed the improvement of anaemia in these patients at pre-assessment.

Methods
Patient records and blood results were used to determine haemoglobin levels and any treatment given for anaemia from referral to surgery. These included 53 anaemic patients in the pre-intervention group and 8 anaemic patients so far in the post-intervention group. The effect of the intervention was analysed.

Results
Pre-intervention 62.4% of patients undergoing right hemicolectomy were anaemic at pre-assessment. 32.1% had a Hb &lt;100 g/L; 47.1% of these were treated.
In the other group, 50% of anaemic patients had a Hb of &lt;100 g/L at colonoscopy; 75% of these patients improved their Hb at pre-assessment to &gt;100 g/L after receiving the iron infusion.

Conclusion
The treatments to correct anaemia in the control group were varied and inconsistent. It's routine that the colorectal nurses are informed of cancer diagnosis at the time of diagnostic endoscopy. The intervention used was for them to arrange iron infusion for patients found to be anaemic on a recent FBC. This intervention was easily incorporated in the patient pathway and required no extra resources. The infusion allowed sufficient time for the anaemia to improve before the operation. This simple and timely intervention can be widely implemented, and we recommend its use.
Acute cardiovascular complications of immune-mediated systemic inflammatory diseases
Authors: Weber Brittany N , Garshick Michael , Abbate Antonio , Youngstein Taryn , Stewart Garrick , Bohula Erin , Plein Sven , Mukherjee Monica 
Published: August 2023

Abstract
Immune-mediated systemic inflammatory conditions (IMIDs) are associated with an increased risk of atherosclerosis and adverse cardiovascular (CV) events secondary to pathogenic inflammation and derangements in the innate and adaptive immune responses inherent to the underlying rheumatic diseases. As the intersection of cardio-rheumatology continues to expand, a multi-disciplinary approach must be considered to optimize clinical outcomes and long-term survival. This review will highlight acute cardiac manifestations of systemic inflammatory diseases and propose a clinically relevant framework for diagnosis, management, and the role of integrated multimodality imaging.
Anatomical feasibility of a ‘semi-custom’ unibody single-branch endograft in previous zone 2 thoracic endovascular aortic repair
Authors: Leone Nicola , Andreoli Francesco , Bartolotti Luigi A M , Migliari Mattia , Baresi Giovanni F , Saitta Giuseppe , Silingardi Roberto , Gennai Stefano 
Published: August 2023

Abstract

OBJECTIVES
The aim of this study was to evaluate the suitability of a subclavian unibody single-branch endograft among patients treated with thoracic endovascular aortic repair (TEVAR) in landing zone 2 (LZ2).

METHODS
This is a pre-clinical, single-centre, real-world, all-comers, retrospective cohort study. Patients treated with TEVAR in LZ2 with an available preoperative computed tomography angiography were included. The primary outcome was the anatomical feasibility of the Castor endograft in patients receiving endovascular treatment in LZ2 between 1999 and 2022. Secondary outcomes were: a comparison of feasible and unfeasible patients; frequencies and description of exclusion causes; non-feasibility risk factor analysis; and analysis of the stent graft configurations necessary to treat 75% of the patients. A logistic regression model was used to find associations between baseline morphological data and non-feasibility.

RESULTS
A total of 473 procedures were performed and 72 patients fulfilling inclusion criteria were included. The mean distance between the left carotid artery and left subclavian artery (or between innominate artery and bovine trunk) was 12.4 ± 5.2 mm and its average diameter was 33.0 ± 10.6 mm. The pre-vertebral left subclavian artery’s diameter and length were 11.3 ± 2.5 and 38.7 ± 10.8 mm. Forty-nine (68.1%) patients were suitable for Castor implantation. Twenty-one configurations were required to treat 75% of feasible patients and might be lowered to 12 configurations applying less strict criteria.

CONCLUSIONS
The Castor endograft was anatomically feasible in several patients requiring TEVAR in LZ2. Three-quarters of feasible patients could be treated with a reasonable number of configurations, paving the path for future off-the-shelf applications.
Nurses, doctors, and mortality: the effectiveness of early health professionals in rural Finland, 1880–1938
Authors: Saaritsa Sakari , Simanainen Eero , Ristola Markus 
Published: August 2023

Abstract
This article estimates the mortality effects of introducing modern health professionals in rural Finnish municipalities in the years 1880 to 1938 using panel data with approximately 25,000 observations over 423 population clusters. Our results show that ambulatory nurses had a more significant impact on mortality than municipal doctors. The effect of doctors depended on their proximity to the population. Qualitative evidence suggests that a superior capacity to influence behavior in communities mattered more than treatment or medical knowledge in the pre-biomedical context. Doctors consequently advocated for the hiring of more nurses. Their estimated contribution to mortality decline still remained modest.
Perivascular adipose tissue as a source of therapeutic targets and clinical biomarkers
Authors: Antoniades Charalambos , Tousoulis Dimitris , Vavlukis Marija , Fleming Ingrid , Duncker Dirk J , Eringa Etto , Manfrini Olivia , Antonopoulos Alexios S , Oikonomou Evangelos , Padró Teresa , Trifunovic-Zamaklar Danijela , De Luca Giuseppe , Guzik Tomasz , Cenko Edina , Djordjevic-Dikic Ana , Crea Filippo 
Published: August 2023

Abstract
Obesity is a modifiable cardiovascular risk factor, but adipose tissue (AT) depots in humans are anatomically, histologically, and functionally heterogeneous. For example, visceral AT is a pro-atherogenic secretory AT depot, while subcutaneous AT represents a more classical energy storage depot. Perivascular adipose tissue (PVAT) regulates vascular biology via paracrine cross-talk signals. In this position paper, the state-of-the-art knowledge of various AT depots is reviewed providing a consensus definition of PVAT around the coronary arteries, as the AT surrounding the artery up to a distance from its outer wall equal to the luminal diameter of the artery. Special focus is given to the interactions between PVAT and the vascular wall that render PVAT a potential therapeutic target in cardiovascular diseases. This Clinical Consensus Statement also discusses the role of PVAT as a clinically relevant source of diagnostic and prognostic biomarkers of vascular function, which may guide precision medicine in atherosclerosis, hypertension, heart failure, and other cardiovascular diseases. In this article, its role as a ‘biosensor’ of vascular inflammation is highlighted with description of recent imaging technologies that visualize PVAT in clinical practice, allowing non-invasive quantification of coronary inflammation and the related residual cardiovascular inflammatory risk, guiding deployment of therapeutic interventions. Finally, the current and future clinical applicability of artificial intelligence and machine learning technologies is reviewed that integrate PVAT information into prognostic models to provide clinically meaningful information in primary and secondary prevention.
Using ChatGPT and Google Bard to improve the readability of written patient information: a proof of concept
Authors: Moons Philip , Van Bulck Liesbet 
Published: August 2023

Abstract
Patient information materials often tend to be written at a reading level that is too advanced for patients. In this proof-of-concept study, we used ChatGPT and Google Bard to reduce the reading level of three selected patient information sections from scientific journals. ChatGPT successfully improved readability. However, it could not achieve the recommended 6th-grade reading level. Bard reached the reading level of 6th graders but oversimplified the texts by omitting up to 83% of the content. Despite the present limitations, developers of patient information are encouraged to employ large language models, preferably ChatGPT, to optimize their materials.