bluuebunny/crossref_metadata_2025_split huggingface dataset:
110 HPV-Positive Oropharyngeal Cancer: A Review of De-Escalation Strategies Used to Improve Outcomes for This Patient Cohort
Authors: Shaw A 
Published: August 2023

Abstract

Aim
Human Papillomavirus (HPV) positive oropharyngeal cancer (OPC) has been shown to provide improved survival compared to HPV negative patients with similar disease. This has led to a new staging criteria for these patients and attempts to de-escalate treatment for this group, to maintain high survival and reduce associated side effects. This review aims to assess current research into treatment techniques and compare results of these studies.

Method
Pubmed online database was used to gather studies containing primary research dated from within the last 10 years detailing the study design, the striation of patients into higher and lower risk groups, and the outcome of de-escalation of treatment to these groups.

Results
Published studies vary in their definition of their ‘low risk’ group, however minimal smoking history, smaller tumour size and increased HPV DNA expression within the tumour are all identified as good prognostic indicators and could be and have been used to identify suitable candidates for treatment deintensification. The combination of radiotherapy and chemotherapy are often used with good success however, no consensus has been reached regarding dosing of these. Transoral robotic surgery may also be used in conjunction with chemoradiotherapy, however large ongoing studies regarding this are yet to publish their final results.

Conclusions
This is an evolving area of oncology with an increasing evidence base improving prognosis and minimising side effects for this group of patients, however more research is necessary to gain consensus on the gold standard treatment for these patients.
510 What Is the Posterior Condylar Offset Ratio for Both the Medial and Lateral Femoral Condyles?
Authors: Mikova E , Beaumont H , Slade G , Walton E , Murray J 
Published: August 2023

Abstract

Aim
Traditionally, the posterior condylar offset ration (PCOR) has been calculated from lateral radiographs however new evidence suggests that a measuring technique based on 3D imaging may be superior. MRI has been trialled, but no protocol has been standardised and evaluated for reliability. This study aims to create a reproducible and reliable MRI technique as well as exploring whether there are any morphological differences in PCOR.

Method
A team of 5 researchers collaborated to create 2 novel ways of evaluating PCOR on healthy knees, one based on the transepicondylar axis (TEA) and one on the posterior condylar axis (PCA). The hospital database was searched for all MRI scans reported as having no internal derangement. From the 103 eligible scans a sample of 10 scans was selected and analysed by 4 independent reviewers in order to assess inter-rater reliability. The same sample was also analysed by one reviewer on two separate occasions in order to establish intra-rater reliability.

Results
Both methods demonstrated no significant difference in morphology between the condyles. Gender was found not to be a significant factor in condylar morphology. When calculating the PCOR the TEA method has a good intra-rater reliability and shows a higher degree of inter-rater reliability than the PCO protocol, yet consensus was not achieved among all reviewers using either method.

Conclusions
No significant morphological differences between condyles or genders were found. A TEA method may be superior for measuring PCOR nevertheless it is difficult to establish an easily applicable, reliable, and reproducible protocol.
811 Surgeons Are Under-Represented in International Multidisciplinary Cardiac Guidelines
Authors: Hara N , Navarro A , Lopez-Marco A , Yates M T 
Published: August 2023

Abstract

Aim
Cardiac guidelines are written by experts in the field based on the strongest scientific evidence and clinical experience. Authorship should theoretically be equal between cardiac surgeons and cardiologists to ensure there is sufficient medical and surgical input. Therefore, this study aims to determine whether there is equal representation and contributions of surgeons and cardiologists in international cardiac guidelines.

Method
Eight international guidelines on coronary revascularisation, atrial fibrillation, aortic disease and valvular heart disease from both Europe and USA were identified. The author's primary speciality was determined using the internet search engine. Their roles were classified and presented as (Cardiologist; Surgeon; Other). Other consisted of roles including but not limited to; anaesthetists, nurses and emergency doctors.

Results
In eight international guidelines there were a total of 228 authors (Cardiologist 151; Surgeon 58; Other 19) This was distributed as follows: Coronary European (14; 7; 1), USA (13; 7; 4), Atrial Fibrillation European 17; 3; 4), USA (12; 1; 2), Aortic European (65; 14; 7), USA (8; 15; 6), Valve European (11;2;2) USA (11;7;0). Across the guidelines, there was an average of 24.7% of surgeons and 63.3% of cardiologists contributing to the authorship.

Conclusions
There is a significantly higher number of cardiologists contributing to international cardiac guidelines that guide treatment management and diagnosis of both medical and surgical patients. The inclusion of more surgeons in the authorship may provide a more balanced synopsis of optimal patient care.
1314 Prediction of Raised Intracranial Pressure in Traumatic Brain Injury Patient by Non-Invasive Methods in Lower-Middle Income Countries: Systematic Review and Meta-Analysis
Authors: Dokponou Y C H , Badirou O B A , Agada K N , Dossou M W , Lawson L D , Ossaga M A D , Nyalundja A D , Adjiou D K F P , Lassissi K U , Houndodjade S M C , Gbenou F B B , Lantonkpode R P , Togbenon N D L , Bankole N D A 
Published: August 2023

Abstract

Background
The prediction of raised Intracranial Pressure (ICP) with accuracy in Traumatic Brain Injury (TBI) patients is a clinical important decision and therapeutic tool. This study aimed to evaluate the existing methods used for non-invasive ICP monitoring in TBI patients in LMICs.

Method
Systematic searches of PubMed, Google Scholar, and ScienceDirect were performed from database inception to November 2021. Studies reporting the prediction of raised ICP in TBI patients by non-invasive means in LMICs were included. Pooled estimates of sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios with 95%CI were calculated for each index test in JAMOVI 2.2.5. We carried out a “Medical Decision”, “Plots”, “Fagan Normogram” and the ROC curve to find the perfect discrimination point of all the five tests used for the non-invasive measurement of ICP in the TBI patients in LMICs.

Results
A total of 1032 studies were identified, of which, 15 included 3316 patients with male predominance (n = 2458, 74.13%). Patients' ages range from 15-96 years with 40-80 (n = 1205, 36.34%), being the most represented population. The ICP measured by Transcranial Doppler (TCD) had a sensitivity of 92.3%, and a specificity of 70%. The positive predictive value was 66.67%, with a negative predictive value of 93.33%. Furthermore, the positive Likelihood Ratio (+LR) was 3.69; 2&lt;+LR&lt;5, and the negative Likelihood Ratio (-LR) was 0.103; 0.1&lt;-LR&lt;0.2.

Conclusions
The TCD had shown high performance in its sensitivity and specificity, placing it on top of the other four different tests used in LMICs for the management of patients with TBI.
954 Oesophagectomy vs. Gastrectomy; a Type II Dilemma
Authors: Owen A , Robinson D B T , Thomas G , Powell A , Witherspoon J , Blackshaw G , Lewis W , Foliaki A , Abdelrahman T 
Published: August 2023

Abstract

Aim
The optimal operation for Siewert type II cancers is unclear, with both oesophagectomy and total gastrectomy being undertaken. This study aimed to investigate the overall survival and associated operative outcomes of both approaches.

Method
A retrospective cohort study was performed of all Siewert type II Gastro-Oesophageal Junctional (GOJ) resections from a single oesophagogastric centralised service between 2010 and 2017. The primary outcome was 5-year overall survival (OS). Secondary outcomes were recurrence rate and operative morbidity.

Results
A total of 163 patients were included; 127 (77.9%) oesophagectomy vs. 36 (22.1%) gastrectomy. The 5-year OS for oesophagectomy vs. gastrectomy were 50.4% vs 41.7% with a median survival of 57 months vs. 31 months respectively (p = 0.062). No differences in the rate of recurrence (44.9% vs. 33.3%, p = 0.216) or overall rate of complications (63.8% vs. 63.9%, p = 0.990) were identified. Yet, significantly more major (Clavien-Dindo III+) complications occurred in the gastrectomy compared to the oesophagectomy cohort (38.9% vs. 20.5%, p = 0.012), driven partially by a higher anastomotic leak rate (19.4% vs 9.4%, p = 0.099). Cox regression revealed no significant difference in the 5-year OS between the two groups when accounting for confounders (HR 0.906, 95% CI 0.339-2.060, p = 0.814). Only age (HR 0.971, 95% CI 0.944-0.999, p = 0.046) and pT stage (HR 1.794, 95% CI 1.097-2.935, p = 0.020) were determinants of 5-year OS.

Conclusions
When accounting for confounders there were no significant differences in the overall survival based on the two approaches. Further multi-centre prospective studies would be advantageous to establish a consensus on the best approach.
750 Fluid Therapy Regimen and Free Flap Failure in Post-Resection Reconstruction for Head and Neck Cancer: A Systematic Review
Authors: Torabi S , MancKenzie A , Rahman T , Arjomandi Rad A , Vardanyan R 
Published: August 2023

Abstract

Background
The importance of developing standardized approaches away from wide-range fluid administration regimens has been growing. The aim of the following study is to evaluate the current evidence with regards to fluid therapy regimens and their effects on flap complications in free-flap reconstruction of head and neck cancer.

Method
A systematic database search was conducted of original articles that included fluid therapy regimens in free-flap reconstruction of head and neck cancer in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to January 2021. Our main outcomes were presence of a flap complication or failure and total length of hospital stay.

Results
We identified 327 studies from our search, of which 11 studies met the inclusion criteria, comprising a total of 1,133 patients. Five studies showed that greater perioperative fluid volume was associated with higher rates of flap complication, with one drawing a cut-off at 5.5 L to predict any flap complication and 7 L to predict a major complication that required re-operation. Three studies assessed goal directed fluid therapy, with two showing significantly reduced intraoperative fluid volume within this group, but no significant difference in flap outcomes. Two studies comparing crystalloid and colloid fluids concluded that there was no significant difference in outcomes when using either.

Conclusions
Excessive fluid administration negatively impacts surgical outcomes. Goal directed therapy presents insufficient evidence as a method for reducing flap complications and length of hospital stay. The clinical benefit of colloid fluid intra-operatively over crystalloids have not been unanimously demonstrated in this review.
1259 Clinical Outcomes of Vascularised Versus Free Regenerative Peripheral Nerve Interface in Upper Limb Neuromas: A Systematic Review
Authors: Satkunabalan M , Tay J Q , Ng Z Y 
Published: August 2023

Abstract

Aim
To compare clinical outcomes of vascularised regenerative peripheral nerve interface (vRPNI) versus free regenerative peripheral nerve interface (fRPNI) in upper limb neuromas.

Method
A systematic review on upper limb neuromas treated with either fRPNI or vRPNI was performed in October 2022 in accordance with the PRISMA 2020 guidelines. A PubMed search using the term “RPNI” was performed. Only papers with clinical results from patients who had undergone either fRPNI or vRPNI to the upper limb were included; review and laboratory papers were excluded. Patient and clinical data collected include the underlying aetiology, time interval to RPNI procedure, as well as mean patient age, post-operative follow-up period and neuroma pain score reduction.

Results
Of 43 papers identified, only four papers fulfilled the inclusion criteria. This provided data for upper limb neuromas in 32 patients where a total of 83 RPNIs (22 vascularised) were performed (43 prophylactically). The means for patient age, duration of neuroma pain, length of reported post-operative follow-up, and reduction in neuroma pain scores were 44.0 years, 1.4 years, 12.2 months and 51.3% respectively.

Conclusions
The currently available data support the use of both fRPNI and vRPNI for the treatment of upper extremity neuromas, both after the development of symptoms and prophylactically at the time of surgery, despite the heterogeneity and inconsistencies in data reporting. Further studies are required in the form of randomised control trials to assess for the superiority (or not) of fRPNI versus vRPNI.
48 Evaluation of Regional Anaesthesia Practice in Plastic Surgery; a Retrospective Cross-Sectional Study
Authors: Mousa S , Adam M , Kerstein R 
Published: August 2023

Abstract

Aim
Our project aimed at assessing the regional anaesthesia practice in plastic surgery department Buckinghamshire trust and finding out ways to improve the service in collaboration with the anaesthesia team.

Method
It is a retrospective study associated with a questionnaire filled by plastic surgeons and anaesthetists to get the full picture behind the numbers. The study period was between 1/3/2022 and 23/5/2022 (12 weeks). Criteria of suitable candidates for regional block were put by the consultant anaesthetists.

Results
For 12 weeks, 1061 operations were performed by plastic surgeons. Local cases were excluded leaving 319 cases. Of the 319, 102 patients were suitable candidates for regional block after applying the criteria. However only 7 patients had their operations under regional block and the rest had general anaesthesia that could have been easily avoided.
An online questionnaire was filled by both plastic surgeons and anaesthetists of different training level to find out the reasons behind the obvious preference of general over regional anaesthesia even if this was against the patients’ interest.
Forty-four clinicians filled the questionnaire, among which was 23 plastic surgeons and 21 anaesthetists. The actual percentage of patients who were good candidates for RA but had GA instead is 93%.

Conclusions
The recommendations were in 5 main accesses which areProtocols and pathways for regional blocksMore training opportunities for anaesthetists on regional blocksProviding a separate block room in the hospitalBetter communication between surgeons and anaesthetistsPatient education about the benefits of regional blocks
130 The GLIMPSE Study: Global Variation in the Quality of Multiparametric Magnetic Resonance Imaging of the Prostate
Authors: Asif A , Ng A , Giganti F , Chan V W S , Rossiter M , Nathan A , Khetrapal P , Dickinson L , Punwani S , Brew-Graves C , Freeman A , Emberton M , Moore C M , Allen C , Kasivisvanathan V ,   PRIME Quality Improvement Group
Published: August 2023

Abstract

Aim
Multiparametric MRI (mpMRI) is standard-of-care in patients with clinical suspicion of prostate cancer (PCa). However, high variability in MRI quality remains. We aim to offer the first global 'GLIMPSE' into prostate mpMRI quality, analysing PRIME Trial data, to determine whether modifications to MRI protocols improve diagnostic quality.

Method
PRIME (NCT04571840) is an international non-inferiority trial comparing biparametric MRI to mpMRI in detecting clinically significant PCa.
For each scanner, centres were invited to submit MRI scans of patients with suspected PCa, detailed MRI protocols, PI-RADS v2.1 scores and pathology results. Expert radiologists evaluated these in consensus, blinded to MRI and biopsy results. MRI quality was assessed using the PI-QUAL scoring system — using PI-RADS v2.1 recommendations and each MR sequence (DWI, T2-WI and DCE). PI-QUAL score 5/5 demonstrates scans of optimal diagnostic quality. Recommendations were provided for scanners not reaching PI-QUAL 5. Centres were invited to re-submit using modified protocols for re-evaluation.

Results
71 scanners were evaluated from 42 centres across 5 continents. On initial review, 13% scanners scored PI-QUAL 3, 55% scored PI-QUAL 4 and 32% scored PI-QUAL 5. 100% scanners were of adequate diagnostic quality for T2-WI and DWI, whilst only 82% were for DCE.
Recommendations focused on DCE (62%), followed by DWI (35%), then T2-WI (25%). Overall MRI quality increased from 32% to 87% PI-QUAL 5 between initial and final review.

Conclusions
GLIMPSE offers the first global overview into prostate MRI quality. Initial MRI quality needed improvement, particularly with DCE imaging. Basic changes derived from PI-RADS recommendations can improve global MRI quality.
333 Inequity of Access to Investigations and Treatment of Varicose Veins by Clinician Grade: A Single Centre Retrospective Audit
Authors: Farndon D , Bennett P 
Published: August 2023

Abstract

Aim
Following COVID-19, restrictions on investigations and theatre capacity led to a change in the Norfolk & Waveney Clinical Commissioning Group (CCG) referral to treatment (RTT) criteria for varicose veins (VV); Only &gt;C4 disease should be treated. An audit was performed to check for variability in outcomes between grade of surgeon.

Method
Retrospective audit of all VV referrals between 01/04/21-28/02/22. Case notes were reviewed assessing compliance with CCG criteria by surgeon grade and subsequent referrals for investigations and treatment.

Results
250 VV referrals were made, 43.5% Male, mean (±SD) age 54.8 (16.9) years. 71 were rejected outright, 158 should have been rejected and 70 were subsequently reviewed in clinic. 20 were seen by SpRs and 50 by consultants. 62.9% (22) of ineligible patients attending clinic went on to have investigations. Of those seen in clinic, 35 did not meet the RTT criteria and should have been discharged. Significant differences in discharges were seen between SpRs & Consultants (13.3% vs. 45% respectively (p = 0.046)). Duplex scans organised by SpRs (75%) were more likely to not meet the RTT criteria than Consultants (30.3%), p = 0.003. However, once a scan was performed there were no significant differences in proportion of these patients listed for treatment (64.3% vs. 29.4% (p = 0.247)).

Conclusions
SpRs are less likely to discharge patients from clinic who don’t meet RTT criteria than consultants and are more likely to request unnecessary investigations and treatment compared to consultants demonstrating inequity of care. SpRs should be educated on RTT criteria changes when working in different hospitals.
344 Are Rings Removed in Hand Trauma? a Closed Loop Audit
Authors: Guy J , Kolaityte V , Nolan C , O'Hara N , Langley C 
Published: August 2023

Abstract

Aim
Constriction injury secondary to jewellery can be a serious consequence of hand injury. National guidelines therefore advise that all jewellery is removed as the initial step in managing hand trauma, prior to any imaging. This audit evaluated adherence to this guideline, and to assess the effect of a patient and clinician centred intervention.

Method
All patients who had plain film radiographs of the hand performed by the emergency department of a major trauma centre were assessed for radiopaque jewellery in situ. Further data were then collected including demographics, mechanism of injury, and resultant surgical procedures.
A 4-month baseline audit was conducted in 2021. Interventions were implemented, including patient- and clinician-facing posters. A post intervention cycle was completed over 5 months in 2022.

Results
7563 individual patients presenting with hand trauma were included in the audit across both cycles. In 2021, 115 of 3542 patients had jewellery identified in situ. In 2022, 107 of 4021 patients had jewellery identified, an improvement of 18.1%.
General demographics of these patients remained broadly similar across both cycles. The patients were predominantly female (64%) and the jewellery seen most frequently was a metal ring, often on the left ring finger (84%). Injury types included lacerations, fractures, and soft tissue injuries. 1 in 4 of these patients required a further surgical procedure from the injury.

Conclusions
This audit demonstrated the success of both patient and clinician facing interventions to improve the rate of removal of jewellery as the first stage of hand trauma.
366 Vitamin D3 Assessment and Supplementation in Elderly Hip Fracture Patients: A Closed Loop Quality Improvement Project
Authors: Siddiqui R S , Abou Hader K , Mathias C , Pemmaraju G 
Published: August 2023

Abstract

Aim
to improve the assessment and supplementation of vitamin D3 in elderly hip fracture patients in a trauma unit.

Method
This is a single-centre quality improvement project utilising the PDSA cycle based in a trauma unit covering the black country within the West Midlands. Data was collected retrospectively using the National Hip Fracture Database and hospital electronic systems such as clinical web portal, ICE, GP records, edischarge and ePMA. Inclusion criteria consisted of patient age greater than 60 with a radiologically confirmed neck of femur fracture, treated operatively with an orthogeriatrics review within 72 hours of admission, and COVID-19 negative PCR.
Pre-intervention data included 15 patients from July 2020. We assessed 3 parameters including pre-admission vitamin D3 supplementation, measurement of vitamin D3 during admission and vitamin D3 supplementation on discharge. Interventions placed in February 2021 comprised of a postoperative hip blood profile pathway on ICE and guidelines on how to order bloods were circulated with information posters. In addition, teaching sessions for doctors and nurses with twice weekly orthogeriatric reviews emphasising bone protection. Post-intervention data included 15 patients from April 2021.

Results
Improvement in vitamin D3 level assessment during admission; 20% to 93.3% however, decline in vitamin D3 supplement prescribed on discharge; 73.3% to 26.7%.

Conclusions
Interventions showed an improvement in quality of vitamin D3 assessment however, the decline in supplementation on discharge may be due to further planned intravenous bone protection bisphosphonate therapy and miscommunication due to ward doctors rotating every 4-6 months on how to appropriately assess and supplement vitamin D3 levels.