bluuebunny/crossref_metadata_2025_split huggingface dataset:
480 The Quality of Reporting Inflammatory Bowel Disease Randomized Control Trials: A Systematic Review
Authors: Gordon M , Khudr J , Sinopolou V , Lakunina S , Rane A , Akobeng A 
Published: August 2023

Abstract

Aim
Our objective was to perform a systemic evaluation of the risk of bias of randomized control trials’ (RCTs) reports published on IBD.

Method
We assessed the risk-of-bias using the Cochrane tool, as indicators for poor methodology or subsequently poor reporting. We focused on assessing the risk-of -bias pertaining to appropriate sequence generation, allocation concealment, blinding, incomplete outcome data reporting and other bias.
We systematically selected, with dual independent judgements, all studies published on IBD with no time limits and assessed the methodological quality of included studies again using independent dual ratings, with disagreement solved through a third author.

Results
563 full texts were included after selection and review. When excluding blinding, 103 papers exhibited low risk of bias in all reporting domains, none of which were publications. RCTs published in journals with higher IF were associated with an overall reduced rate of being at high risks. However, only 6% of full RCT publications in journals with IF greater than 10, published in the past 5 years, were free of bias.
The trend over time is towards improved reporting in all areas. Trials published by larger author teams, in full-text form and by industry and public sponsorship were positively correlated with lower risk of bias. Only allocation concealment showed a statistically significant improvement with time (p = 0.037).

Conclusions
These findings are consistent with those of other specialties in the literature. Whilst this may represent poor reporting instead of poor quality, it leaves readers and future secondary researchers with significant questions regarding such key issues.
902 Systematic Review of Suturing Dermatotraction Techniques in Closing Fasciotomy Wounds
Authors: Obuh O , Esomu E J O 
Published: August 2023

Abstract

Aim
A surgical patient post fasciotomy presents a challenge to restore cover of the muscle groups. The use of the suturing dermatotraction techniques presents a cheap and easy means of native cover. This systematic review of case series and case controls explored the trend of this technique including duration to delayed primary wound closure, complications and failure rates.

Method
A literature review was conducted on Medline, Embase and CINAHL yielding a combined total of 820 articles between 1946 and 18 June 2022. Human studies with suturing dermatotraction techniques were included. Twenty-one (21) studies reviewed met the criteria.

Results
The basic anatomy of the dermatotraction technique involves: An anchor point on the skin; A material for traction and a suture pattern. The Shoelace technique was the predominant suture pattern, with staples as skin anchor material and silastic vessel loops as traction sling used by 9 studies. Modifications of this method included use of intradermal prolene sutures and pediatric catheters. The shortest duration to skin apposition was 2 days and 113 days longest, with most mean closure rates at 7 days. This shoelace technique had fewer or no complications. Data showed superficial and early complications were more likely than deep or delayed complications. NPWT and skin graft salvaged few failed closures in 2 studies.

Conclusions
Most fasciotomy wounds closed with suturing techniques can expect to close within 7 days, with minimal complications. There are varying practices of traction rates, and this may account for the wide range to delayed primary closure.
1282 Comparing Overall Survival and Oncological Recurrence in Laparoscopic and Open Hepatectomy for Colorectal Cancer Metastases: A Systematic Review
Authors: Dogan S F 
Published: August 2023

Abstract

Aim
The use of laparoscopic surgery (LS) for liver resection has risen exponentially and is competing, in popularity, with open surgery (OPS). The aim of this study is to compare the oncological recurrence and overall survival of LS and OPS approaches for colorectal cancer liver metastases resection.

Method
A literature search was conducted, in-line with the PRISMA guidelines, via Ovid and PubMed to collect manuscripts dated between 01/01/2010-01/03/2021. The outcomes of interest were recurrence-free survival (RFS), overall survival (OS), and negative resection margins (R0). A modified quality assessment was achieved using the Newcastle-Ottawa Score (NOS) and the ROBINS-I Tool, and the data was analysed using Stata 16.0.

Results
Overall, 10 studies were selected of which included a total of 1924 patients. The results show the 1-, 3- and 5-years RFS and OS for LS and OPS were comparable, therefore not significant. Whereas the R0 differences were small yet significant - the LS group had an 89.9% R0 (95% CI: 87% to 92.8%) and for OPS was 85.4% (95% CI: 81% to 88.9%), Z – score of 1.6550, p = 0.0490 (p &lt; 0.05). Even though the results are not significant for RFS and OS, LS is preferable for patients in improving the quality of life in the long-term.

Conclusions
There is little difference between OPS and LS methods as it pertains to the quality of life. With LS being less invasive and having marginally better results, doctors should consider prioritising LS for patients with colorectal cancer liver metastasis as an alternative to OPS.
255 Attitudes and Perceptions Among Iraqi Young Adults Towards Organs Donation and Transplantation: A Call for Action
Authors: Al-Abbasi G , Al-Jasim A 
Published: August 2023

Abstract

Aim
Organ’s transplantation is the only treatment for end-stage organ failure. However, the disparity between organs availability and the number of patients in the waiting lists is widening globally, especially in Iraq for many reasons. This study aims to assess the level of attitudes and perceptions among Iraqi young adults towards organs donation and transplantation as the first study to be conducted in Iraq for such purpose.

Method
This observational study was conducted among 912 Iraqi young adults through a structured questionnaire which was disseminated among social media platforms. Participants consented before filling the questionnaire and their responses were analyzed to test the hypothesis of the study.

Results
Most of the participants were females, Muslims and in their undergraduate level. Overall, 84.2% of the participants were willing to donate their organs after death and (97.9%) of them actually agreed to sign for organs donation. Most of those who were not willing to donate have no idea whether their religion approves it or not. There was no statistically significant difference in willingness to donate between different socioeconomic classes or residency areas.

Conclusions
Most of the participants are convinced with donating their organs after death and are willing to sign for organ donation programs, advocating for initiating an official governmental transplant agency with multiple local committees distributed among health directorates all over the country managing it. The hesitancy to donate organs was attributed mostly to religious and associated with lack of knowledge issues, thus education might be the key to positive attitudes.
1195 Association of Vessel-Specific Coronary Artery Stenosis with Major Adverse Cardiovascular Events in a Renal Transplant Cohort
Authors: Chow B J , Khurram M A , Yaqoob M , Mohamed I H 
Published: August 2023

Abstract

Aim
Coronary artery stenosis is a key risk factor for major adverse cardiovascular events (MACE). Left anterior descending (LAD) artery stenosis is regarded to be the most severe vessel-specific coronary artery stenosis as depicted by its appellation widow-maker. We hypothesised that right coronary artery (RCA) stenoses may present poorer or similar outcomes to LAD. This study sought to investigate the association of vessel-specific coronary artery stenosis using computed tomography coronary angiogram (CTCA) with MACE in a renal transplant cohort.

Method
This was a single-centre retrospective study of all end-stage renal disease (ESRD) patients eligible for kidney transplantation who underwent CTCA between 2012 to 2014. MACE occurrences (heart failure, AMI, unstable angina, CVA, PVD, and TIA) were recorded within a 10-year follow-up period. CTCA datasets were assessed by 2 independent specialists, visually grading stenosis severity into 2 classifications (&lt;50% or &gt;50% coronary diameter reduction).

Results
Of 106 patients in our study, a total of 419 coronary arteries (106 RCA, 104 LAD, 104 circumflex (CX), 104 left mainstem (LM)) were graded by CTCA. 43 patients (40.6%) experienced at least one MACE within the timeframe. Statistical significance in MACE was observed when stratified by RCA stenosis severity (p = 0.022) while no statistical significance in MACE observed when stratified by LAD (p = 0.904), CX (p = 0.472) & LM (p = 0.222).

Conclusions
This challenges the conventional wisdom on individual vessel-specific coronary artery stenosis and suggests that RCA stenoses are associated with MACE in the transplant cohort. This also offers the possibility of RCA stenosis as a prognostic tool in predicting MACE in ESRD patients.
1221 Recipient Outcomes After Simultaneous Pancreas and Kidney Transplant Delineated by Donor eGFR
Authors: Owen R , Fitzpatrick N , Counter C , Malik A , Mahendran B , Tingle S , Wilson C , Manas D , Sheerin N , White S 
Published: August 2023

Abstract

Aim
This study aimed to assess if the use of kidneys with a decreased eGFR had an adverse effect on patient and graft survival.

Method
Data on all UK SPKT’s from 2001-2021 were obtained from the NHSBT UK Transplant Registry (n = 2,631). Cases with missing information were removed, leaving a final cohort of 1,819 (69.1%). eGFR was calculated using the CKD-EPI equation. Pancreas Graft (PGS), Kidney Graft (KGS) and patient survival analyses were conducted using Kaplan-Meier plots and Cox-regression models.

Results
71% (n = 1,292) of grafts were from donors with an eGFR&gt;90 and 29%(n = 530) were from donors with an eGFR&lt;90. Donors with an eGFR&lt;90 were statistically significantly more likely to be older (p&lt;0.0001), a DBD donor (p = 0.0086**) and have a higher BMI(p&lt;0.0001). Recipients who received a graft from a donor with an eGFR&lt;90 were well matched with those who received a graft from a donor with an eGFR&gt;90. Univariate analysis showed a statistically significant decreased KGS(p = 0.007**) when the donor had an eGFR&lt;90. This trend was not seen when comparing patient or pancreas survival.

Conclusions
We accept a lower GFR could be indicative of either an AKI or a sign of early chronic kidney disease. In this current data analysis, we have been unable to successfully distinguish between the two however we have shown poorer KGS in those with a lower eGFR (&lt;90). This had no impact on pancreas or patient survival. Further analysis is needed to explain the precise reasons for the lower eGFR’s at the time of organ donation.
131 Clinical Value of Elective Post Operative Radiographs in Total Knee Arthroplasty
Authors: Ponsworno K V , Keehan R , Ahmad R 
Published: August 2023

Abstract

Background
Post operative radiographs following total knee arthroplasty are requested as part of routine follow up in some institutions. The purpose of this study was to assess the clinical value of performing elective post operative radiographs.

Method
All patients who underwent total knee arthroplasty at a district general hospital from 2019 to 2020 were included. Data was collected retrospectively from medical records. Alterations to clinical management based on radiographic findings were reviewed.

Results
This study looked at 116 patients who underwent total knee arthroplasty and 28 (24%) were excluded due to having no clinic follow up. Of the 88 (76%) patients included, 31 (35%) had post operative elective radiograph, while 43 (49%) had none. There were no abnormalities detected from the elective radiographs and none of the patients returned to the theatre. The remaining 14 (16%) presented with new symptoms and had non-elective radiographs. 8 out of 14 patients did not have any intervention, while the remaining 6 returned to theatre.

Discussion
In our institution, a 2-view knee radiograph costs £28.75 and takes roughly 48 minutes. In the larger context, the cost associated with elective radiographs is significant. The value of not performing these radiographs saves time, cost, and prevents radiation exposure. However, performing post operative radiographs remains beneficial for patients who have clinical indication.

Conclusions
Elective post operative radiographs did not detect any abnormalities. Information from these radiographs have no clinical significance and did not change management. Therefore, this study recommends that there is no rationale requesting elective post operative knee radiographs.
280 Does Delayed Physiotherapy Assessment Postoperatively Affect Mortality or Length of Stay in Patients Following Surgery for a Neck of Femur Fracture?
Authors: H'ng E T H , Hoggett L , Van-Meirlo R , McLauchlan G 
Published: August 2023

Abstract

Aim
National guidance states that patients with a neck of femur fracture (NOFF) should be assessed by a physiotherapist on the first postoperative day. This can pose problems given the finite availability of physiotherapists. This study aims to determine if delayed assessment impacts patients' postoperative mortality or length of stay in the hospital.

Method
A prospective case series of all NOFFs surgically treated at a major trauma centre between 2013-2022 was performed. Patients ≥65 years of age were included from a unit-based prospective database.

Results
A total of 3411 patients were included. 3062 were assessed by a physiotherapist on the first postoperative day (POD1), and 349 on day two and beyond (POD2+). Delayed physiotherapy was principally due to the day of operation, where the POD2+ group more likely had surgery on a Friday or Saturday, p&lt;0.001. The two groups were comparable in age, gender, fracture morphology, preoperative ASA and Rockwood frailty scores, and surgical procedure. The average length of stay for POD1 was 16.9 days (SD = 21.1), and 16.0 days (SD = 12.4) for POD2+, p = 0.450. Mortality was lower in the POD2+ group at 30 days after surgery, p = 0.040. There was no difference in mortality at 1 year, p = 0.295, 2 years, p = 0.724, and overall, p = 0.826.

Conclusions
Delayed physiotherapy assessment does not worsen length of stay in NOFF patients. Lower early mortality in this group indicates a possible benefit in delaying physiotherapy assessment although there was no significant difference in mortality beyond 30 days. However, a seven-day physiotherapy service would still be required for continuity of postoperative care.
565 The SPAIRE Technique for Hip Hemiarthroplasty - an Alternative Approach to the Hip
Authors: Leong D , Apostolides M , Thomas W , Robu B , Patel N 
Published: August 2023

Abstract

Aim
Over 20,000 hip hemiarthroplasties for hip fractures are performed annually in the UK. NICE currently recommends performing these via the anterolateral approach, to reduce the risk of dislocation, with the potential expense of reducing function and mobility post-operatively. To address these issues, muscle-sparing approaches have been utilised and "SPAIRE" (Sparing Piriformis and Internus Repairing Externus) is one of them.

Method
Retrospective analysis of prospectively collected data over a 10-month period was performed at a single centre. All hip fracture patients who had hip hemiarthroplasty as their primary treatment were included. We collected demographic data, pre- and post- operative mobility status, and time to reach that, surgical approach, duration of surgery and complications. Our primary outcome was the dislocation rate and secondary outcomes were post-operative time to mobilisation and duration of surgery.

Results
Between October 2021 and August 2022, we identified 194 cases, divided into three groups based on the surgical approach used: SPAIRE = 43, Anterolateral = 97, Posterior = 54. All groups had similar demographics and a minimum two-month follow-up. There were no dislocations in the SPAIRE group, compared to 2 (2%) in the Anterolateral and 2 (3.7%) in the Posterior groups. The mean return to mobility was 1.4 days for "SPAIRE" patients, compared to 2 and 2.6 days for patients in other groups. All three groups had similar mean surgical times (74min, 79min, and 71min respectively).

Conclusions
The "SPAIRE" approach seems to be lowering the risk of dislocation, and reducing the time to mobilisation, potentially improving function for patients undergoing hip hemiarthroplasty.
788 Virtual Scaphoid Fracture Management; How Effective Is It?
Authors: Murhekar S 
Published: August 2023

Abstract

Background
The virtual clinic has been used to manage patients out of the hospital setting, decreasing footfall in the hospital, avoiding the need for unnecessary travel and helping decrease carbon footprint. A similar clinic has been running to manage patients presenting to the orthopaedic department with the presentation of suspected scaphoid fracture. As missed scaphoid fractures potentially lead to non-union and complications arising due to it, this study was thought of to see how effective the virtual clinics are in managing suspected scaphoid fractures.

Aim
To assess a number of suspected scaphoid presentations, and their management. Delay in diagnosis and potential presentation with non-union or SLAC wrist.

Method
Retrospective data collection for a year of patients presenting to the orthopaedic unit at a busy secondary hospital. The outcome of their presentation associated complications.

Results
Over a duration of one year from January 2021 to December 2021, 160 patients presented to the virtual clinic. Average age 44yrs. 32% of patients were offered second scaphoid series imaging. 9% of patients underwent MRI with a suspected diagnosis of occult scaphoid fracture. Average gap in second imaging was 21 days. Almost 33% of patients were discharged from virtual clinic with no further need for imaging. 16% of of the suspected cases were confirmed as scaphoid fracture.

Conclusions
This study highlights the effective use of a virtual clinics in managing scaphoid fractures presenting to a secondary unit.
925 Consent for Carpal Tunnel Decompression and Trigger Finger Release – Are We Following Standards? a Closed Loop Audit
Authors: Roberts-Walsh S , Minty I , Tse S , White A , Davy A 
Published: August 2023

Abstract

Aim
Every surgeon has a legal and ethical duty to ensure the consent process is comprehensive and documented. The RCS and GMC have provided guidance on this. Our aim was to assess current practice of consent in two common hand surgical procedures - carpal tunnel decompression (CTD) and trigger finger release (TFR). We evaluated the effect of departmental education following a previous audit of standards.

Method
A retrospective review was conducted on patients who underwent CTD or TFR during the three-month period of September–November 2021. Auditing against GMC and RCS standards, medical records were assessed for documentation of risks of procedure, presentation of alternative options to surgery, and whether risks on the consent form were consistent with pre-operative clinic discussions. Following re-education of surgeons on the consent process, the audit loop was closed with re-evaluation between September–November 2022.

Results
57 patients were included in the first audit cycle and 50 patients in the second. Prior to re-education, 88% of patients had risks explained and 61% had alternatives discussed and documented in clinic. Post-intervention, both improved to 100%. 79% (vs 66% before) had “new” risks on the consent form not documented on the clinic letter. However only 3.5% of cases in the first cycle and 2% in the second cycle had identical risks documented in the consent form and clinic notes.

Conclusions
Education on the gold-standard consenting process had a positive impact on compliance. We also recommend departmental standardisation on risks and benefits for common procedures which can be supplemented by patient-focused literature.
1081 The Challenge of Fixing Multi-Fragmentary Neck of Femur Fractures: A Retrospective Case Control Study for Unstable A2 Type Neck of Femur Fractures Fixed with Dynamic Hip Screws, and Short Intramedullary Nails
Authors: George H , Salih S , Patko J , Bhosale A 
Published: August 2023

Abstract

Aim
Not all Neck of Femur (NOF) fractures are equivalent. AO-A2 subtype are multi-fragmentary and include a lesser trochanter fracture; they can be inherently unstable. Some believe Intramedullary Nails (IMN) offer greater stability however there is concern regarding increased operative time and blood loss. This project compared operative time and perioperative blood loss between Dynamic Hip Screw (DHS) and IMN used to treat matched groups of A2 NOF fractures.

Method
A patient list was compiled from the national hip fracture database from 01/01/2020 to 31/05/2022. Fractures were classified according to AO standards; radiographs pre- and post-surgery, blood results, and operative records were reviewed.

Results
A total of 41 IMNs were performed for A2 NOF fractures, a comparison group of 41 patients treated with DHS was created. Patients were matched for ASA grade. The IMN group had an average ASA of 3.0 (DHS 3.1), perioperative haemoglobin drops of 30.8 (DHS 29.8), operation time of 64 minutes (DHS 57), and Tip Apex Distance (TAD) of 19.6mm (DHS 24.8). The difference in perioperative haemoglobin drop and operating time were not statistically significant. The TAD was significantly lower in the IMN group.

Conclusions
There was no difference in surgical time or perioperative blood loss. An improved TAD in the IMN group, despite less surgical experience with this implant, may correlate with lower long-term rates of failure. Our project suggests IMN is a safe implant, at least in the short term for A2 fractures, but further research of long-term benefits including mobility and pain is required.
1100 Fragility Fractures Post-Operative Mobilisation - A Major Trauma Centre Audit
Authors: Narayana Murthy S , Cheruvu S M , Narayanswamy N E , Nasr H 
Published: August 2023

Abstract

Introduction
Fragility fractures occur as a result of "low energy trauma" often from fall from standing height or less that would not normally result in fracture. Early post-operative mobilisation is the key for successful rehabilitation. BOAST guidelines suggest, all surgery in frail patients should be performed, to allow full weight-bearing (FWB) for activities required for daily living and within 36 hours of admission. The purpose of this audit is to determine the weightbearing practice of operatively managed fragility fractures in the setting of Major Trauma Centre.

Method
Retrospective data collection, from July 1st to September 30. Inclusion criteria: Aged 60 years and older, isolated lower limb fragility fractures managed operatively. Exclusion criteria: Fractures from high energy mechanisms, multiple injuries, associated, with infection/metastasis. Fragility fractures which were managed non-operatively.

Results
A total of 157 patients [mean age 82 years (SD 9.5), 135 having a hip fracture, 22 non-hip fractures] were included. Overall, 146 patients (93%) were allowed FWB, of which 133 (98.5%) were hip fractures and 12 (54.5%) were non-hip fractures. Mean days of restricted weight bearing was 42 (range 28 to 56).

Conclusions
Surgeons are confident to allow hip fracture patients to bear full weight post-operatively; however only 54.5% of non-hip fracture patients are allowed the same. We pose a question that even though the national guidelines mandate FWB post-operatively, is it still valid to limit weightbearing for fragility fracture patients when the benefits of early mobilisation are significant?
The routine use of frailty assessments would aid the surgeons to assess this population.