bluuebunny/crossref_metadata_2025_split huggingface dataset:
1000 Handwritten Operative Note Compliance in Plastic Surgery
Authors: Ridgley J , Al-Hity S , Harper Machin A 
Published: August 2023

Abstract

Aim
Accurate and comprehensive documentation of operations is crucial to optimise patient care. Omissions may cause compromised management, or medicolegal issues. A closed-loop audit was completed at a plastic surgery centre to identify whether Royal College of Surgeons (RCS) standards were met. It aimed to identify and address limitations of hand-written notes, which were completed free-hand or on departmental proformas (burns, bite, Mohs, skin and hand).

Method
Mandatory operative note domains were taken from the RCS guidance within Good Surgical Practice (2013). Acceptable compliance in domains was agreed at 90%. Cycle-one included all operations performed by the department over three days in November 2021. In cycle-two, a twenty-operation sample was taken across one week in May 2022.

Results
Compliance was met in the domains of date (100%), surgeon (100%), procedure (92.7%), diagnosis (95.1%), findings (95.1%), closure (93.9%), antibiotics (100%) and post-operative instructions (100%). Domains below standard included: time (32.9%), anaesthetist (60.9%), incision (78.0%) and blood-loss (2.4%). As a result, proformas were modified to include domains below standard (if not already included). On re-audit, no new domain achieved agreed standard.

Conclusions
Whilst most domains met agreed standards, a lack of improvement on re-auditing demonstrates challenges in paper documentation. Paper-noting for some may be more time consuming and susceptible to omission of required information. Whilst not feasible in this instance, transitioning to e-noting may improve compliance, due to automations and the ability to mandate certain fields. In the interim, a generic paper template may be advantageous for operations not covered by proformas.
1010 Assessing Completion of Check Radiographs in the Trauma and Orthopaedic Department
Authors: Taiwo B , Menyah E , Garcia S 
Published: August 2023

Abstract

Background
Postoperative check radiographs are routine practice in Trauma and Orthopaedic surgery, allowing for radiographic assessment of components and evidence of bony injury (1). All trauma cases requiring postoperative imaging as per operation note should have this completed in a timely fashion.

Method
Patient records were assessed over 4 months across two sites within an NHS Trust to determine the following - Time from surgery to request of post-operative radiograph, time from request to completion of radiograph, and evidence of a documented review in patient notes.

Results
120 patients at site 1 and 134 at site 2 were assessed. At site 1, 11 patients did not have radiographs completed before discharge in comparison to 2 patients at site 2. The average time from surgery to radiograph request was 2.26 days at site 1, 1.07 days at site 2. The average time from request to completion of radiograph was 2.25 days at site 1 and 0.95 days at site 2. Documentation of review of radiographs was poor across both sites. A patient discharged prior to check radiograph re-attended hospital with a dislocation of hip hemiarthoplasty.

Conclusions
Numerous recommendations were made to ensure that good practice was established across sites. Operating surgeon or assistant should request post-operative imaging, at the same time as completion of the operation note. A trial of intra-operative fluoroscopy for hip hemiarthroplasty at Site 2 was started to see whether this could streamline current processes.
1028 Why Is Changing Old Habits So Hard?
Authors: Kronberga M , Suresan S , Cartner E , Khawgali M , Bonner C , Matias M , Saha A , Peter M 
Published: August 2023

Abstract

Aim
Acute uncomplicated diverticulitis (AUD) has been traditionally managed by inpatient admission for bowel rest, intravenous antibiotics, and fluids. World Society of Emergency Surgery (WSES) updated their guidelines in 2020 recommending that patients with AUD with no significant co-morbidities or immunocompromise should be treated in an ambulatory setting. This full audit cycle aimed to assess the compliance with these guidelines at our trust.

Method
Retrospective data collection was conducted from June 2021 to July 2021 (1st cycle). Inclusion criteria was applied: CT proven AUD, patients below the age of 80 with the ability to tolerate oral intake, had full mental capacity and were not immunocompromised. Educational sessions for clinicians and nurses were implemented to inform of current guidelines. Data was re-audited from June 2022 to July 2022 (2nd cycle).

Results
The first cycle included a total of 31 patients with AUD matching our inclusion criteria where 45% of patients were treated via ambulatory care. Two patients had re-presented but didn’t require admission. The second cycle had a total of 19 patients 47% of which were managed ambulatory. Average length of hospital stay between the inpatient and outpatient groups were 2-3 days versus 4.5 hours.

Conclusions
The compliance rate with current guidelines increased by 2%, however remained low. With low re- presentation rates and re-admission rates, this audit shows that patients with AUD could be safely managed in ambulatory setting. Shifting engrained mindsets and improving compliance with the current guidelines could greatly save NHS resources and alleviate existing bed pressures.
187 Master Students' Perception and Attitude on Methods of Anatomy Teaching and Assessment, Khartoum, Sudan 2014-2020
Authors: Hassan R , Awad K , Hassan R 
Published: August 2023

Abstract

Aim
Anatomy is the cornerstone of medical education; anatomical knowledge is undoubtedly essential for doctors regardless of their specialty. Teaching and learning anatomy are one of the most important and challenging subjects for both teachers and students. This study aimed at improving the postgraduate teaching and assessment methodologies by eliciting the perception and attitude toward anatomy teaching approaches among anatomy master students.

Method
A descriptive cross-sectional study was conducted among three consecutive batches of anatomy master students. A structured questionnaire was used as a tool of data collection and data was analysed using IBM statistical package for social sciences version 24 (SPSS 24).

Results
44 candidates responded to the questionnaire. Among them, 90.9% chose dissection room sessions as the best tool in attaining the intended learning outcomes. Practical dissection was the best teaching method with regards to interest 81.1%, enjoyment 70.5%, retention of information 65.9% and satisfaction 59.1%. 72.7% of the respondents think that practical dissection test was the best assessment method in fulfilling the intended learning objectives. Multiple choice questions were the most helpful in learning anatomy effectively and was the best tool for assessing knowledge.

Conclusions
The results have shown a strong positive perception towards the use of cadaveric dissection in teaching and learning anatomy. However, many did not seem to prefer lectures as a tool in anatomy teaching and learning. In addition, practical dissection test and multiple-choice questions were the best assessment methods in attaining the intended learning objectives and learning anatomy effectively respectively.
353 Targeted Axillary Dissection Does Benefit Patients with a Single Positive Node Prior to Neoadjuvant Chemotherapy
Authors: Ragunathan Janani , Ledwidge Serena 
Published: August 2023

Abstract

Aim
Targeted Axillary Dissection (TAD) is a procedure where positive axillary nodes are clipped with a view to sentinel lymph node dissection plus removal of clipped nodes post-neoadjuvant therapies (NACT) rather than axillary lymph node clearance (ANC), reducing morbidity. This study aimed to assess whether patients with a single positive node undergoing NACT would benefit from TAD.

Method
Patients planned for TAD post-NACT were identified from the surgical diary from March 2020 – July 2022. Data were recorded for age, histopathology, MRI response and surgical procedure.

Results
Eighteen women were identified, mean age 46.7 (33- 63 years). 44% (8) had ER positive, HER2 negative invasive ductal carcinoma (IDC), 28% (5) had HER2 positive IDC, 22% (4) had triple negative IDC and 6% (1) had ER positive, HER2 negative lobular carcinoma.
Treatment response on MRI was complete in 22% (4), near complete or very good in 11%(2), partial in 61% (11) with 6% (1) patient having stable disease. Four patients including the patient who had no response to chemotherapy opted for ANC post-NACT. Only 17% (1/6) patients with complete or good response had positive nodes post-NACT whereas 58% (7/12) of patients with partial or no response had positive nodes post-NACT.

Conclusions
Although the numbers in our study are small, TAD did benefit patients with a single positive node who have complete or good response to NACT. Larger multicentre studies are needed to confirm this and determine whether TAD is of benefit in patients who have partial or no response.
1124 Staging CT in the Work Up for Primary Breast Cancer – Indications, Incidentalomas, Metastases and the Impact on Patient Management
Authors: Clinton P , Rice L , Hickie C , McNally S , Prichard R , McCartan D , Rutherford C 
Published: August 2023

Abstract

Aim
There is considerable variation amongst units in the use of staging CT in breast cancer. The current ABS guidelines advise staging in those with &gt;/ = N2, T3/4 or those with symptoms suspicious for metastatic disease. The aim of this study was to assess the indications for primary breast cancer patients undergoing staging CT scan, and the subsequent detection rate of incidentalomas and metastatic disease.

Method
This was a retrospective cohort study conducted in a high-volume tertiary referral centre of patients diagnosed with a primary breast cancer between January 2018 and December 2018 who underwent staging CT. Data was assessed for patient demographics, tumour characteristics and findings on CT.

Results
714 patients were diagnosed with breast cancer in this 12-month period, of which 120 had a staging CT. Twelve had recurrent disease and were excluded. There was an overall incidentaloma rate of 66.6% and metastases rate of 11.1%. The group was subdivided into those who fulfilled the guidelines and those who did not. 46 patients met the staging criteria, with metastatic and incidentaloma rates of 21.7% and 65.2% respectively. 62 patients did not meet the staging criteria, with metastatic and incidentalomas rates of 3.2% and 67.7% respectively.

Conclusions
This study demonstrates that the detection of metastatic disease in patients who do not meet the criteria is low with a rate of 3.2%. CT staging in primary breast cancer should be reserved for patients who meet the guidelines in order to better direct resource, avoid over investigation and mitigate patient anxiety.
151 How Do Mortality Rates From COVID-19 Differ Between Vaccinated and Unvaccinated People in a Tertiary Centre of Bangladesh
Authors: Noor M , Islam M F , Islam R 
Published: August 2023

Abstract

Aim
To find out the difference in mortality rates between vaccinated and unvaccinated COVID-19 positive patients who admitted in a tertiary center (Ward Vs Intensive care) of Bangladesh.

Method
Retrospective analysis of data over 6 weeks (February- March 2021).
100 confirmed COVID-19 positive patients were included- 50 from ICU (Intensive Care Unit) and 50 from ward irrespective of age, gender, vaccination status and comorbidities.

Results
75% of all confirmed COVID 19 positive patients were vaccinated. Mortality among vaccinated people was less compared to unvaccinated 41.3% Vs 52%.
Interestingly pregnancy was found to be the most significant risk factor in child-bearing age female group- 86.7% of pregnant and peripartum female required ICU admission and mortality was 40% although none of them had any co-morbidities. Again, mortality among vaccinated was significantly less (35.7%) compared to 100% mortality among unvaccinated.
Mortality rate among ICU admitted patients was significantly high- 72% Vs 16%.
83% of patients who died in ICU were vaccinated (90% had 2 doses, 10% had 3 doses). 87.5% who died in ward were unvaccinated.
Among the survivors from ICU - 93% were vaccinated (Vs 7% unvaccinated).
Overall, pre-existing comorbidities increased mortality by 18.1% (59% Vs 40.9%).

Conclusions
Vaccination against COVID-19 reduces mortality irrespective of co-morbidities or disease severity. Recovery rate was significantly increased in vaccinated ICU admitted patients.
Pregnancy was found to be the most important risk factor for ICU admission and mortality in otherwise healthy child-bearing age females and mortality was 100% (limited data availability) in unvaccinated.
These results require further revalidation on larger population.
133 Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Case Report.
Authors: Paudel S 
Published: August 2023

Abstract

Introduction
We present a case of chronic subdural hematoma refractory to burr hole surgery treated successfully with middle meningeal artery embolization.

Presentation of Case
61-year-old gentleman presented with a history of headaches and single episodes of vomiting. Neurological examination was normal. A non-contrast computed tomography (CT) scan of the head showed chronic subdural hematoma with midline shift. The patient was managed with burr hole surgery but there was no improvement in the symptoms and CT findings of recollection of blood in subdural space. The patient was then managed endovascularly with embolization of the middle meningeal artery (MMA), patient recovered fully after the endovascular treatment.

Discussion
Chronic subdural hematoma can present clinically with vomiting and headache, if refractory to burr hole surgery it can be managed with the embolization of the middle meningeal artery.

Conclusions
Subdural hematoma can be successfully managed by endovascular treatment.
518 Testicular Mass: A Rare Presentation of Richter’s Syndrome
Authors: Desouky E , Al-Salti W , Kalsi J 
Published: August 2023

Abstract
A 72-year-old male patient who presented with a painless right sided scrotal swelling for few months.
History of stage A Chronic Lymphocytic Leukemia (CLL) since 2015- under surveillance by hematology team.
On examination; 10 X 10 cm hard non-tender right-sided scrotal mass, normal left testicle, no peripheral lymphadenopathy or organomegaly.
WBC count = 17.5 × 109 /L with neutrophils of 4.39 × 109 /L & lymphocytes of 11.16 × 109 /L. Testicular tumour marker; within normal
CT chest, abdomen, and pelvis (CAP); some borderline enlarged left para-aortic and aorto-caval lymph nodes and unremarkable abdominal viscera.
Right inguinal orchiectomy
Histopathology and immunohistochemistry profile were consistent with a high-grade Richter’s transformation to diffuse large B cell lymphoma.
MDT plan with hematologist: 6 cycles of R-CHOP and IV as well as intrathecal Methotraxate for CNS prophylaxis. Patient was given the option testicular radiotherapy vs orchidectomy and he opted for orchidectomy.
After more than 24 months follow up, the patient had no relapse.
Richter’s syndrome (RS) is the transformation of CLL to an aggressive form of lymphoma mostly represented by diffuse large B cell lymphoma (DLBCL) in 2 -10% of CLL patients.
RS is clinically characterized by development of B symptoms (fever, night sweats and weight loss), rapid clinical deterioration and a rapid increase in the size of lymphadenopathy and /or splenomegaly.
RS commonly arises in lymph nodes or bone marrow and disseminates to other organs.
Presenting as a testicular mass, as in this case, is quite rare and our patient represents the 4th case reported in the literature.
663 Squamous Cell Carcinoma of the Scalp Following Synthetic Hair Transplantation: A Case Report
Authors: Shah J , Dunne J , Wood S 
Published: August 2023

Abstract
Androgenetic alopecia is the most common form of hair loss. Surgical treatment options include autologous and synthetic hair transplantation. Synthetic hair fibres can overcome the challenges of poor hair quality and density however there are reports of severe cutaneous complications following their use.
We report a case of an advanced squamous cell carcinoma (SCC) of the scalp in an adult male patient following chronic artificial hair transplants. The fungating mass eroded the inner cortex of the left parietal bone without intra-cranial extension on CT. Indeterminate lymph nodes in the parotid gland and level III of the left neck were identified on CT and MRI. Resection of the artificial hair fibres and SCC with a craniectomy, total parotidectomy with facial nerve preservation and upper neck dissection were performed. There was extensive dural involvement not detected on pre-operative imaging, which involved the superior sagittal sinus and was unresectable. The dural disease was fulgurated. The defect was reconstructed with a titanium plate and DIEP flap. Final histopathology showed a moderately differentiated pT4a N0 M0 SCC. The patient received adjuvant proton beam therapy and at 18 months post-operatively is recurrence free.
Development of scalp SCC following synthetic hair transplantation has been described, although a clear causation has not been defined. Clinicians should be aware of this presentation and aim to achieve an early diagnosis, timely referral to an appropriate specialist and prompt management.
773 Desmoid Tumor in the Cecum in a Pregnant Woman
Authors: Taniskidi A , Hassan Yare S 
Published: August 2023

Abstract
Desmoid tumors (DT) are benign growths that invade the mesenchymal tissue locally without metastasizing. Also known as aggressive fibromatosis, these tumors tend to affect the abdomen and limbs. The etiology is still unclear, but DT happens more frequently in women during or after pregnancy. Histologically, they consist of spindle cells that are damaging locally. The gold standard treatment is complete resection, however even with this DT has a high risk of local recurrence. Due to rarity and lack of specificity on imaging, spindle cell tumors can be misdiagnosed, especially with abdominal wall endometriosis.
A 36-year-old woman of Bangladeshi origin, gravida 3 and para 2, was booked into the antenatal clinic at 8 weeks gestation. This patient was thought to have a fibrothecoma, with plans to resect it during her elective cesarian. The lump was seen to be on the cecum instead and was removed. Immunohistochemical analysis of the resection pointed towards a desmoid tumor.
Apparent in this case was the delay in identifying the correct diagnosis for this patient, which has profound impacts on the management. This tumor was removed in a right hemicolectomy, delayed till after the cesarian. The delay was necessary as there was no consent for a hemicolectomy and the bowel was unprepared. Interestingly, the patient did present with pregnancy complications, including an unstable lie, which questions whether there is a correlation between DT and pregnancy. Due to the rarity of this disease, there is a high need for further research into investigations and appropriate management.
893 Posterior Location of the Facial Nerve in Vestibular Schwannoma: Report of a Rare Case and a Brief Literature Review
Authors: Bahuleyan B , Patel V T , Anto M , Madhavan G , Thomas S G 
Published: August 2023

Abstract

Background
The commonest location of the facial nerve on the surface of a vestibular schwannoma (VS) is ventral. The posterior location of the facial nerve on the surface of a VS is extremely rare and is reported to be between 0.6-3.8%. In this illustrative case report, we present a case of a large VS with posterior location of the facial nerve on its surface. The surgical strategy in this situation to preserve the facial nerve both anatomically and physiologically is discussed. Ours is the first illustrative case of the posterior location of the seventh nerve on these tumours.

Case Description
An elderly man presented with right cerebellopontine (CP) angle syndrome. MRI showed a partly cystic and partly solid right CP angle lesion extending to the internal auditory meatus. Electrophysiological stimulation of the tumour showed that the facial nerve was located on the posterior surface of the tumour. Under the microscope, the facial nerve was identified on the posterior surface of the tumour. Partial excision of the tumour was done with preservation of the facial nerve both anatomically and physiologically.

Conclusions
This case reiterates the fact that even though rare, surgeons should anticipate the posterior location of the facial nerve on the surface of VS. Electrophysiological stimulation of the posterior surface of the tumour should be done before tumour resection in all cases to look for the posterior location of the facial nerve. Careful microsurgical dissection should be done to achieve maximal cytoreduction of the tumour, preserving the facial nerve.
1212 Actinomycosis of the Middle Ear Mimicking Cholesteatoma – a Case Report and Literature Review
Authors: Modi S , Kiverniti E 
Published: August 2023

Abstract

Introduction
Actinomycosis, a rare infection of the middle ear, has less than 50 documented cases worldwide. Actinomyces are an anaerobic, filamentous bacterium causing granuloma formation and suppurative infection.

Case
We present a young male with a nine-month history of unilateral, yellow coloured otorrhoea and hearing loss. Swabs showed no growth, with infection not responding to oral or topical antibiotics. CT temporal bones was consistent with cholesteatoma and ossicular disruption. Surgical exploration revealed a yellow, cystic mass within the middle ear. Cortical mastoidectomy and washout were performed. Histological diagnosis confirmed actinomyces clusters with positive Gram stain.

Discussion
Actinomyces typically presents as chronic otitis media. It likely reaches the middle ear via the Eustachian tube. It is often misdiagnosed due to culture insensitivity; however clinical suspicion can aid labs in providing an optimum culture environment. Tympanomastoidectomy allows for histopathological diagnosis. Surgical resection should be followed by a prolonged course of antibiotics.
1219 A Rare Case of EBV Infection Presenting as Acute Appendicitis with Septic Shock - a Case Report and Review of the Literature
Authors: Westby K 
Published: August 2023

Abstract
18yo male presented to the emergency department (ED) with a 2-week history of progressive lower abdominal pain, weight loss of 8kg & diarrhoea. On examination he looked dehydrated, was tachycardic and had a large, tender, palpable mass in his lower abdomen up to the umbilicus. Blood investigations of note were white cell count (WCC) 29.7 and CRP 187.
Computerized tomography (CT) reported an extremely large abscess occupying the lower abdomen and pelvis resulting in bilateral hydronephrosis and hydroureter. The appendix was not visualised.
On the night of admission, the patient went into septic shock on the ward and was taken to theatre from emergency laparotomy. 4 litres of a large abscess were evacuated, the appendix was identified with an inflamed appearance and an appendicetomy performed.
His post operative course was complicated by an ileus and slow resolving, inter-loop abscesses that required multiple courses of antibiotics and eventual return to theatre for further washout.
During his early admission, EBV serology was recommended by the microbiology team on foot of a positive monospot test. Serology was also positive for EBV. Histopathological results of the appendix and lymph nodes showed EBV associated changes.
Acute appendicitis can be considered a complication of EBV infection with the proposed mechanism being obstruction of the appendiceal lumen due to swollen lymphoid tissue, this most commonly occurs in the acute phase of EBV infection.
In this case it has been shown that EBV and subsequent Infectious mononucleosis can cause acute appendicitis and may be its initial presentation.