bluuebunny/crossref_metadata_2025_split huggingface dataset:
1101 Patient Experiences of Teleconsultations Follow-Up After Cancer Surgery Within the National Health Service. a Qualitative Systematic Review
Authors: Klaud Francheska B , Lee R , Oni G , Wilson E 
Published: August 2023

Abstract

Background
Teleconsultations were introduced for cancer surgery follow-up to ease pressure on hospital services and facilitate patients’ access to those services. Currently, there is limited evidence of patients’ perception of the swift shift in service provision.

Aim
This qualitative systematic review aimed to explore patient experiences of teleconsultations within UK-based NHS cancer surgery follow-up services; to better understand patient perception, satisfaction, and acceptability of the teleconsultation approach.

Method
MEDLINE, EMBASE, PUBMED, and Google scholar were searched up to the 1st of January 2022. Articles were screened by two independent reviewers and qualitative studies were synthesized using the Braun and Clarke framework. Concepts identified were summed up into relevant themes and subthemes.

Results
A total of 1226 articles were screened, of which six were retained after full-text screening and quality assessment. The main findings revealed three overarching themes: accessibility, patient experience, and consultation. Most patients reported a positive experience with remote consultation, although others had uncertainties about its effectiveness due to the inability to build rapport with clinicians and the lack of emotional support.

Conclusions
Teleconsultations were widely accepted among cancer surgical patients. More research is needed to explore clinicians’ views of teleconsultations in cancer surgery and audits should be carried out to evaluate the system currently in place.
462 Is Donor Renal Arterial Anastomosis to the External Iliac Artery Comparable to the Internal Iliac Artery in Living Donor Renal Transplantation?
Authors: Chacko A , Mukherjee P , George S J A , Mukha R , J C 
Published: August 2023

Abstract

Background
In renal transplantation, the donor artery may be anastomosed to the external iliac artery (EIA) or the internal iliac artery (IIA). Few retrospective studies have not observed any difference in outcomes between these techniques. We aimed to compare these two techniques in a series of living donor renal transplants from a single institution.

Method
We retrospectively included 345 patients undergoing living donor renal transplantation who were divided into two groups: Group A (153 patients): anastomosis to IIA; and Group B (192 patients): anastomosis to EIA. The recipient characteristics, post-operative complications, Resistivity Index (RI) measured by colour Doppler on day 5 and at last follow-up and renal function were compared between the two groups.

Results
The demographic characteristics were similar. Mean operative time was longer in Group B compared to Group A (284 versus 244 minutes; p&lt;0.001). Post-operative complication rates were similar. Mean follow-up was 27 months. Renal artery peak systolic velocities were higher in Group B compared to Group A (192 versus 135 cm/sec, p&lt;0.01) while mean RI values were similar (0.73 and 0.61, p = 0.28) at last follow-up. There was no difference in mean creatinine (A: 1.23 mg% vs B: 1.36 mg/dL) at last follow-up.

Conclusions
The operative time was longer in EIA compared to IIA anastomosis. However, there was no difference in complications, vascular and renal function between the two groups. Therefore, the two techniques are comparable.
658 Adolescent-Targeted Organ Donation Education to Improve the Impact of Opt-Out Legislation
Authors: Song K , Duck E , Convill J , Byrne M , Symington M , Battle J , Green M , Brathwaite-Shirley C , Whitter L , Whitby J ,   We Are Donors Collaborative
Published: August 2023

Abstract

Aim
Opt-out organ donation legislation in the UK has not led to sustained improvements in donation rates. Given poor familial authorisation rates (66% in 2021-2022) in the soft opt-out model, altering public perceptions of organ donation, through means including engaging young people and promoting family discussion, are prerequisites for successful legislation changes. We explore the impact of an educational intervention on organ donation, family discussions and knowledge of the opt-out law.

Method
We delivered a 15-minute educational presentation, along with an optional questionnaire, to UK secondary schools across five counties between Jan-May 2022.

Results
616 students aged 11-18 years (mean 14.6±1.9) completed the survey. Following the intervention, the proportion of individuals on/planning to join the ODR increased from 9% to 31%. Of the remaining students, 48% said they would consider joining.
Pre-intervention, 58% of adolescents agreed they had knowledge of organ donation, which increased to 85% post-intervention. Originally, 28% knew about the opt-out law, this increased to 77% post-intervention. The proportion of students that expressed knowledge of issues relating to organ donation in Black, Asian and ethnic minority communities, increased from 27% to 72% post-intervention. 28% had previously discussed organ donation with family, whilst 70% intended to do so post-intervention. 91% of responders would or would consider recommending the presentation to their peers.

Conclusions
Educational intervention increased adolescent understanding of organ donation, opt-out legislation, and intention to join the ODR and discuss donation with family. Through promoting wider public discussions, adolescent educational interventions can positively impact public perceptions of organ donation.
107 OPEN to Change: Can District General Hospitals Deal with Open Fractures Too?
Authors: Solomon D J , Niggher J , Magil P 
Published: August 2023

Abstract

Introduction
Fractures compromising soft tissues puts patients at risk of significant morbidity, therefore require timely multidisciplinary management. The British Orthopaedic Association Standard for Trauma (BOAST) Guidelines, updated December 2017, state “Patients with open fractures of long bones, hind foot or midfoot should be taken directly or transferred to a specialist centre that can provide Orthoplastic care.” Northern Ireland’s population is estimated at 1.8 million, within this there are between 370 and 500 cases of major trauma each year.

Method
This review looks at patients presenting to Craigavon Area Hospital in Northern Ireland, between October 2021 to October 2022, with open fractures.

Results
Over the study period, 41 Open fractures presented, 12 meeting criteria for transfer to a major trauma centre with orthopastic’s present as per BOAST Guidelines point 1. However, 11 patients were managed in Craigavon Area Hospital and 1 patient required transfer to a site with plastics available.

Conclusions
Can we learn from this same subgroup of patients? There is an ever-growing demand to major trauma centres in Northern Ireland some of the burden on which can be dealt with by DGH’s. This data should help contribute to any future updates of BOAST’s guidelines.
134 Simultaneous Bilateral Patella Tendon Rupture: A Systematic Review
Authors: Fernandes A , Rufino M , Hamal D , Sousa A , Fossett E , Cheema K 
Published: August 2023

Abstract

Aim
A single patella tendon rupture is relatively uncommon, but a simultaneous bilateral event is a rare occurrence and has been scarcely reviewed in the literature. This review was carried out to analyse the existing literature on this event, with the aim of proposing a standardised approach to the diagnosis and management of this injury.

Method
A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three independent reviewers conducted searches in PubMed, OvidSP for Medline and Embase, as well as Cochrane Library using the same search strategy. From a total of 183 studies, 45 were included, i.e., 90 patellas.

Results
46 patellas had a Type 1 Rupture equating to 51%, with Type 3 being the least common, with only 7 patellas sustaining this injury. The mean Insall-Salvio ratio for each knee was 1.62 (R) and 1.60 (L). Direct Primary Repair was the most common surgical technique compared to Tendon Reconstruction, with End to End and Transosseous techniques split almost equally. Brace immobilisation was preferred overcast, with a mean start to weight-bearing of 3.23 weeks post-op.

Conclusions
Bilateral patellar tendon rupture is a rare injury that should be considered in patients with knee extensor mechanism disruption. The key limitation of this study was the low number of patients encompassed by the eligible literature. There is space for a higher level of evidence study, specifically regarding surgical treatment choice and methods, as well as post-operative management, which could potentially improve the outcomes in the management of this injury.
173 Performance of PERSARC as Prognostic Tool of Extremity Soft Tissue Sarcoma
Authors: So C P , Jayasankar V , Mahendra A 
Published: August 2023

Abstract

Aim
To review extremity soft tissue sarcoma (ESTS) in MSK sarcoma unit in Glasgow Royal Infirmary. To assess reliability of PERSARC nomogram in estimating outcomes of FNCLCC Grade II and III ESTS.

Method
A retrospective study of 72 patients with primary ESTS, treated surgically at GRI from 2010-2015 was performed. Patients were followed up as per local sarcoma protocol up to 10 years. Overall survival (OS), Local recurrence (LR) and Distant metastasis (DM) at 3 years and 5 years post-op were calculated and PERSARC nomogram was used to estimate predicted OS, LR and DM at 3 years and 5 years post-op. The reliability of PERSARC to estimate ESTS outcomes was assessed using discrimination and calibration. Concordance index was used to assess discrimination. Calibration plot was used to assess calibration.

Results
Observed 5-year OS, LR and DM were 77.78%, 12.5% and 27.77% respectively. Concordance indices for 3-year OS, LR and DM were 0.82, 0.68 and 0.70 respectively. Concordance indices for 5-year OS, LR and DM were 0.77, 0.69 and 0.66 respectively. Calibration plot showed PERSARC underestimated 3-year and 5-year OS. Calibration plot showed good calibration for 3-year and 5-year LR and DM.

Conclusions
PERSARC nomogram showed good discriminative ability for 3-year OS, 3-year DM, and 5-year OS as the concordance indices were &gt;0.7 and good calibration for 3-year and 5-year LR and DM. PERSARC could be beneficial to guide shared decision making between patients and healthcare professionals, leading to focused and personalised care for patients with ESTS.
264 Observational Study of Clinical Impact of E-Scooter Injuries at Major Trauma Centre
Authors: Metry A , Lui D , Arnander M 
Published: August 2023

Abstract

Aim
Is to focus on frequency E-scooter associated injuries especially open fractures and to see its burden on health system.

Method
Data of E-scooter injuries was extracted from trauma database from November 2017 to July 2022. Outcome measures were type of injuries: site of bony fractures, closed Vs open fracture, number of operations, complications and Length of Hospital Stay.

Results
Number of patients enrolled was 104. The mean age was 34.3 years and 78.8% were males. The main mechanism of injury was riding 91%. Patients with bony injuries were 65.4% with 22.1% of them were open fractures. Most common bony injuries were lower limb only fractures 45.6%, then upper limb only injuries 39.7%. Head and neck injuries composed 23.1% of the reported injuries including: intracranial haemorrhages (9.6%), extensive traumatic brain injury (3.8%), hematoma/lacerations (3.8%), cervical spine fractures (1.9%) and skull fractures (1.9%). Mean duration of hospital stay was 8.6 days and 9.6% patients needed ITU admission. Number of patients presented as trauma calls were 55.8%. Patients that needed surgical intervention either under Orthopaedics or other specialities were 52.9% and 21.2% of total patients had complications either due to surgical intervention or long hospital stay.

Conclusions
E-scooter riding can lead to serious injuries that can end with limb or life-threatening conditions. There should be more emphasis on wearing protective gear like wrist and elbow guards in addition to helmets. Future prospective studies with larger cohorts across multiple regions and hospitals are necessary to truly characterize the nature and cost of e-scooter injuries.
358 What Is the Caregiver Experience of Soft-Cast Removal at Home Following Paediatric Upper Limb Trauma? a Qualitative Analysis
Authors: Wang J , Hughes K , Wickramasinghe N , Baird E 
Published: August 2023

Abstract

Aim
At-home soft-cast removal has shown to be safe and effective following paediatric orthopaedic trauma. It minimises clinician contact time, reducing costs for hospitals and families. Limited qualitative evidence on caregiver experience exists. This study explores the caregiver experience of at-home soft-cast removal.

Method
Retrospective analysis of fractures (&lt;16yrs) requiring application of circumferential soft-cast, later removed at home, between July–August 2022. Demographic data collected included age, fracture type and angulation, need for manipulation and complications or unplanned re-attendance.
A caregiver telephone Likert questionnaire, friends and family satisfaction score and qualitative descriptors were used to assess the caregiver experience.

Results
30 families were contacted at mean 110 days post-injury. Mean age 8 years. 25 successfully removed their soft cast at home with no further orthopaedic follow-up. 36% distal radius and 36% both-bone forearm. 64% of injuries required manipulation under procedural sedation with mean fracture angulation 26 degrees. Two patients re-attended due to parental concern regarding the appearance of the limb after soft-cast removal. 64% of families were ‘extremely’ or ‘somewhat’ satisfied, and 56% were ‘extremely’ or ‘somewhat’ likely to recommend at-home soft-cast removal. Qualitative descriptors indicated a range of experiences, from ‘easy’ and ‘convenient’, to ‘difficult’ and ‘traumatic’.

Conclusions
Our tertiary centre experience confirms that at-home soft-cast removal with no further orthopaedic follow-up is safe and feasible, even after displaced upper limb fractures requiring manipulation under sedation. The majority of families report at-home soft-cast removal to be a positive experience, however this is not universal. Developing patient information resources is likely to improve caregivers’ experiences.
457 Tourniquet Pressures in Orthopaedic Surgery - Is the Standard 250mmHg Safe?
Authors: Barclay A , Turner T 
Published: August 2023

Abstract

Aim
To determine safe levels of tourniquet inflation pressures in trauma and orthopaedic surgery.

Method
Data was collected on 150 patients retrospectively from the intraoperative and anaesthetic records of patients undergoing trauma and elective orthopaedic surgery at a single site. Data collected included demographic data, tourniquet inflation pressures and maximum intraoperative systolic blood pressures. British Orthopaedic Association (BOA) standards for safe intraoperative tourniquet use were used to determine safe tourniquet inflation pressures.

Results
The average maximum intraoperative systolic blood pressure was 125mmHg. In 134 cases (91%) the tourniquet pressure used was 250mmHg. Of the cases studied 54% of upper limb and 33% of lower limb tourniquets were overinflated when compared with BOA standards. Given the average maximum intraoperative systolic blood pressure, standard tourniquet inflation pressures of 200mmHg for upper limbs and 225mmHg for lower limbs should be used in preference to the more commonly used standard used pressure of 250mmHg.

Conclusions
All patients should ideally have an individual tourniquet pressure set based on their systolic blood pressure. However, if a standard pressure is to be used, values of 200mmHg for upper limbs and 225mmHg for lower limbs should be used in preference to 250mmHg as appears to commonly used currently.
509 Diagnosing Paediatric Compartment Syndrome and Its Challenges
Authors: Siddiqui R S 
Published: August 2023

Abstract

Aim
to conduct a critical analysis of current published evidence and key papers in relation to diagnosing paediatric compartment syndrome.

Method
A thorough literature search was conducted using databases including Pubmed, Cochrane central register, Medline and google scholar. Specific eligibility criteria was applied to studies within the last 20 years to incorporate post neonatal paediatric patients till the age of 16 with a high clinical suspicion of limb compartment syndrome presenting acutely.

Results
There is an overall good literature overview in diagnosing paediatric compartment syndrome and a general consensus in assessing agitation, anxiety and increasing use of analgesia as the 3A's for clinical diagnosis. Several studies recommend measuring delta P by subtracting compartment pressure from diastolic blood pressure. The majority of evidence is level IV and level V as pressure monitoring in children is challenging and user dependent. Literature fails to agree on a cut off for emergency fasciotomy using pressure monitoring and there is limited evidence to validate normal paediatric compartment pressures. Non-invasive compartment pressure monitoring such as near infrared spectroscopy, pulse phase locked loop ultrasound and mechanical myotonometry is currently being researched.

Conclusions
Compartment syndrome is an orthopaedic emergency requiring emergency fasciotomy in theatre. It is primarily a clinical diagnosis however there is lack of a validated diagnostic test in paediatric patients due to limitations of using needle manometry in an upset child. There is a need for an evidence-based database with further research to determine the extent of pressure monitoring in children identifying normal versus abnormal compartment pressures.
560 Evaluating the Utility of Plain Radiograph and Computerised Tomography Scanning in Identifying Concomitant Foot Fractures in Patients with Unstable Lisfranc Injuries
Authors: Aamir J , Caldwell R , Karthikappallil D , Tanaka H , Elbannan M , Mason L 
Published: August 2023

Abstract

Aim
Lisfranc fracture dislocations are uncommon injuries. There is varying evidence on the utility of plain radiographs (XR) and CT in identifying Lisfranc injuries and concomitant fractures. Our aim was to identify the utility of XR as compared to CT, with the nul hypothesis that there was no difference in fracture identification.

Method
A retrospective assessment of patients who had sustained a Lisfranc injury between 2013 and 2022 across two trauma centres within the United Kingdom who underwent surgery. Pre-operative images were reviewed independently by 2 reviewers to identify the presence of injuries.

Results
A total of 175 patients were included. We found that XR images significantly under-diagnosed metatarsal and midfoot fractures. The largest discrepancies between XR and CT in their rates of detection were in fractures of the cuboid (5.7% vs 28%, p&lt;0.001), medial cuneiform (20% vs 51%, p = 0.008), lateral cuneiform (4% vs 36%, p = 0.113), second metatarsal (57% vs 82%, p&lt;0.001), third metatarsal (37% vs 61%, p&lt;0.001) and fourth metatarsal (26% vs 43%, p&lt;0.001).
As compared to CT, the sensitivity of XR was low. The lowest sensitivity for identification however was lateral foot injuries, specifically fractures of the lateral cuneiform (sensitivity 7.94%, specificity 97.3%), cuboid (sensitivity 18.37%, specificity 99.21%), fourth (sensitivity 46.7%, specificity 89.80%) and fifth metatarsal (sensitivity 45.00%, specificity 96.10%).

Conclusions
From our analysis, we can determine that XR significantly under-diagnoses associated injuries in patient sustaining an unstable Lisfranc injury, with lateral foot injuries being the worst identified. We advised the use of CT imaging in all cases for appropriate surgical planning.
561 A Morphological Review of Medial Malleolar Fractures – a Large Single Centre Series
Authors: Aamir J , Caldwell R , Long S , Sreenivasan S , Mavrotas J , Panesa A , Jeevaresan S , Lampridis V , Mason L 
Published: August 2023

Abstract

Background
Medial Malleolus Fractures (MMF) are frequently managed by orthopaedic surgeons and are one of the most treated fractures of the ankle. Many approaches to management are described in the literature however, their morphology is under investigated.

Method
Patients who had surgical fixation of their MMF were identified from 2012 to 2022. Analysis of their pre-operative, intra-operative and post-operative radiographs was performed. Lauge-Hansen classification was used to characterise ankle fracture morphology and Herscovici classification to characterise MMF morphology.

Results
A total of 647 patients were identified across a 10-year period who had sustained a medial malleolar fracture. The most common Herscovici fracture in Supination Adduction injuries was a Herscovici D (43.9%, 17/39), in supination external rotation injuries was Herscovici C (52.75%, 259/491), in pronation external rotation injuries was Herscovici C (48.81%, 41/84) and in pronation abduction injuries was Herscovici B (45.45%, 12/33). Medial wall blowout occurred in 19.23%, occurring in supination adduction injuries most commonly (51.28%, 20/39). Herscovici A fractures were significantly more malreduced at time of surgery compared to other fracture types (21.88%, 7/32, p = .003). There was no significant difference in union rates across the classification groups (range 11.67% Herscovici D to 22.86% for Herscovici B).

Conclusions
Knowledge of the medial malleolar morphology allows greater assessment and planning in their surgical treatment. There was a high rate of medial wall blowout even in the non-adduction fracture types, and this should be assessed to prevent over compression during surgical treatment. Herscovici A fracture malunions may need further investigation and different methods of fixation.
564 Pelvic Fracture Incidence in EU15+ Countries: Trends Over a 30-Year Period
Authors: Hagroo A G , Ali R , Goodall R , Sugand K , Borsky K , Salciccioli J , Marshall D , Shalhoub J 
Published: August 2023

Abstract

Aim
Pelvic fractures (PF) are relatively uncommon but significant injuries accounting for approximately 3% of all skeletal injuries. We aimed to assess the burden of PFs across high health expenditure countries by describing the trends in PF incidence rates over the last three decades.

Method
Using the Global Burden of Disease (GBD) Study database, we extracted sex specific PF age-standardised incidence rates (ASIRs) from 1990-2019 for each of the 19 European Union (EU) 15+ countries. We performed Joinpoint regression analysis to further characterise the trends.

Results
Over the 30-year period of study, 89% of countries experienced a decline in ASIRs for males, with a median percentage change of -11.8%, in comparison to females where 53% of countries experienced an increase in ASIR (median percentage increase of +3.1%). For females, the largest increases in PF incidence were observed in the Netherlands and Belgium; these were also the only two counties with increased overall PF incidence in males over the study period observed. The countries with the greatest decrease in ASIRs were Italy and Denmark for females and Portugal and Spain for males. Joinpoint regression identified that over the time periods covered by the most recent trends, PF incidence rates had increased in 58% of countries for females and 52% of countries for males.

Conclusions
We found overall decreased incidences of PFs amongst males over the last 3 decades, compared with increased incidence in females. However, joinpoint regression analysis demonstrated a trend towards rising incidence of PFs amongst both males and females in recent years.