bluuebunny/crossref_metadata_2025_split huggingface dataset:
O170 Open-label prospective cohort evaluating stem cell enriched lipotransfer as the treatment for vulvar lichen sclerosus
Authors: Jasionowska S , Almadori A , Ioannidi L , Hansen E , Boyle D , Zenner N , Swale V , Reid W , Mclean A , McKenzie M , Goble M , Langridge B , Butler P 
Published: May 2023

Abstract

Introduction
Vulval lichen sclerosus (VLS) is a chronic skin disease characterised by pain, itching, apareunia, loss of vulval architecture and scarring, resulting in poor quality of life. Stem cell enriched lipotransfer has been proposed as a treatment for patients with VLS experiencing scarring and fibrosis.

Methods
This study was an open-label prospective cohort aiming to assess the effectiveness of stem cell enriched lipotransfer in improving signs, symptoms and quality of life of patients with VLS. Patients were recruited from the local clinic. All patients received at least one treatment. Validated outcome measures were used to prospectively assess the sexual function, quality of life, and symptoms. Vulvar Architecture Severity Scale (VASS) was used to report physician-assessed disease signs.

Results
Fifty-nine patients were included. The average age was 52.9 yrs. The mean follow-up was 11.9 months. The most common symptoms included itching and pain. The most reported signs were loss of vulvar architecture and scarring. The median number of procedures was 2. The mean volume of fat injected was 11.38 cc. Patients reported a reduction in itching and burning. Lipotransfer also resulted in better sexual function and decreased distress associated with sexuality. Anxiety due to VLS was reduced by the treatment. The VASS score varied by region but there was an improvement in all affected areas.

Conclusion
Stem cell enriched lipotransfer improved signs, symptoms and quality of life of VLS patients in this cohort. A randomised controlled trial is needed to demonstrate its efficacy, safety and the underlying molecular mechanism of action.
O171 Evaluation of remote surgical wound assessment in routine surgical practice: a mixed-methods pilot implementational study of a novel mobile digital intervention
Authors: McLean K , Sgrò A , Brown L , Buijs L , Daines L , Potter M , Bouamrane M , Harrison E 
Published: May 2023

Abstract

Introduction
Remote postoperative wound surveillance provides an opportunity to strengthen postoperative community care and minimise the burden of surgical-site infection (SSI). This study aimed to pilot remote digital postoperative wound surveillance and evaluate the readiness for implementation in routine practice.

Methods
A single-arm implementational study of remote postoperative wound surveillance in two tertiary care hospitals (clinicaltrials.gov: NCT05069103). Adults undergoing abdominal surgery received smartphone-delivered wound assessment for 30-days postoperatively (photographs and patient-reported SSI symptoms). Technology acceptance was assessed using 5-point Likert scales from the validated Telehealth Usability Questionnaire (TUQ), and summarised using means and 95% confidence intervals (CI). A mixed-methods approach was used with synthesis according to the WHO framework for monitoring and evaluating digital health interventions.

Results
200 patients participated between July 2021 and April 2022, with 115 (57.5%) undergoing emergency procedures. The 30-day SSI rate was 16.5% (n=33/200), with 72.7% (n=24) diagnosed post-discharge. Usage of the intervention was 83.0% (n=166/200), with subsequently 74.1% (n=123/166) TUQ completion. Patient acceptance was high with regards to satisfaction (4.27, CI: 4.13-4.41) and usefulness (4.07, CI: 3.92-4.23). Communication was rated lowest (3.86, CI: 3.71-4.02), related to the desire for more frequent and personalised interactions with the surgical team. Nevertheless, the majority perceived improved quality (3.72, CI: 3.56-3.89) and efficiency (4.08, CI: 3.93-4.23) over routine postoperative care.

Conclusion
Remote postoperative wound surveillance successfully demonstrates readiness for implementation according to the WHO framework. Both patients and healthcare services can benefit from enhanced community support to ensure appropriate and timely management.
P03 Surgical trainees’ burnout during COVID-19 pandemic
Authors: Egbe A , Abuelgasim M , El Boghdady M 
Published: May 2023

Abstract

Introduction
The impact of the COVID-19 pandemic has been particularly significant for surgical trainees. We aimed to systematically review the prevalence of burnout in surgical trainees during the pandemic, to compare rates of burnout between different specialities, and to identify factors that may modify the risk of burnout.

Methods
A systematic review was performed in compliance with the PRISMA guidelines to identify articles related to the keywords “surgeons’ burnout and Covid-19’’ and “surgical trainees’ burnout and Covid-19”. A search was performed on PubMed/Medline and ScienceDirect for articles published from January 2020 to August 2022.

Results
A total of 19 articles met the inclusion criteria, 3866 surgical trainees included across all the studies. The overall prevalence of burnout in surgical trainees during the pandemic was between 9.0%-95.2% across the globe. Burnout rates were higher in general surgery (33.1%-95.2%) than in urology (17.6%-55%), neurosurgery (16.2%-44.1%), and orthopaedic surgery (9% - 44.1%). Otorhinolaryngology trainees had the lowest burnout rate (10.9%). Factors associated with an increased risk of burnout included female gender, being a more junior trainee, and increased working hours.

Conclusion
There has been a high level of burnout amongst surgical trainees across the globe during the pandemic. In light of the devastating effect of COVID-19 on surgical training, and the serious consequences of surgeons’ burnout both for the individual, and for patients, targeted interventions for the prevention and treatment of burnout in surgical trainees are urgently needed and must be prioritised by healthcare institutions and training programmes.
P08 A systematic review of the optimal assessment tools to evaluate treatment efficacy in vulval lichen sclerosus
Authors: Jasionowska S , Almadori A , Goble M , Langridge B , Iakovou D , Kamel F , McKenzie M , Butler P 
Published: May 2023

Abstract

Introduction
Vulval lichen sclerosus (VLS) is an inflammatory skin disease characterised by pain, itching, burning, apareunia, loss of vulval architecture and scarring. Despite its detrimental effect on patients’ quality of life, the evidence on currently available treatments remains scarce. Heterogeneity in outcome reporting precludes a meaningful comparison and evaluation of different treatments. This study aimed to systematically review the available evidence for VLS treatments and methods of outcome reporting.

Methods
The review followed PRISMA guidelines using a registered protocol (PROSPERO:CRD42022356738). Multiple databases were searched, along with grey literature on Clinicaltrials.gov, European Union Clinical Trials, and International Standard Randomised Controlled Trial registries. All randomised controlled studies (RCTs) assessing the outcomes of patients undergoing any treatment for VLS were eligible for inclusion.

Results
A total of 775 patients were assessed across 21 RCTs. The identified assessment tools reported outcomes in the following domains: patient-reported symptoms assessed with one validated scale in 12 studies and seven non-validated scales in nine studies; sexual function with validated FSFI and FSDS in two studies and two non-validates scales in two studies; quality of life with three validated scales in three studies; clinician-reported objective outcomes with two validated scales in three studies and six non-validated scales in fourteen studies. Histological changes were assessed in 10 studies and tissue biomechanics in one.

Conclusion
There is high heterogeneity in assessing treatment outcomes for VLS. To appropriately evaluate and compare the effectiveness of any treatment as a VLS intervention, it is crucial to adopt a core set of outcome measures.
P09 Attitudes, barriers and difficulties to discharge – a qualitative approach
Authors: Lukaszewicz A , Linganathan S 
Published: May 2023

Abstract

Introduction
It is well accepted that prompt and effective discharges are crucial in order to sustain patient continuity of care, patient flow and create bed space for patients. Systematic difficulties and the health professional staffing crisis may create further barriers to satisfying the above statement. Thus, the authors have investigated the titled characteristics with a view to instigating beneficial changes.

Methods
A curated questionnaire was designed and emailed to all health care professionals who worked within the general surgical department at the authors’ trust who completed discharge summaries. A total of 26 respondents completed the survey.

Results
The main obstacle in completing discharges was lack of patient knowledge (40% of respondents) followed by time pressure (28% of respondents). In addition, each discharge usually took 11 minutes or more. Discharge priority is deemed to be of variable importance, with 52% ranking it as moderate priority and 24% deeming it to be high priority. Multiple symbiotic factors were thought to be important in improving the discharge process. However, the single key factor was dedicated protected time to complete discharge paperwork (17.39% of respondents). 60% of respondents ideally favoured a typed discharge summary with 28% preferring dictation despite a lack of knowledge and understanding of the available resources.

Conclusion
This work has offered a valuable insight into the attitudes, barriers and difficulties surrounding discharges with scope to instigate improvements, such as the use of dictation software, protected time and subsequent possible policy changes.
P11 Satisfaction rates with telephone follow-up clinic appointments
Authors: Murugan V , Wong T , Fouad M , Sanyal S 
Published: May 2023

Abstract

Introduction
Since the onset of the COVID-19 pandemic, telephone follow-up (TFU) clinics have been an integral part of delivering healthcare. Advantages of telephone clinics include reducing costs and increasing efficiency. This quality improvement project (QIP) aims to evaluate patient satisfaction rates in a hot biliary telephone clinic.

Methods
The Likert-scale is a 13-item questionnaire tool ranging from 1-5 (1=strongly disagree, 5=strongly agree) and was used to assess patient satisfaction with TFUs. Satisfactory cut-off point (score of 4) was analysed across all responses. Retrospective questionnaires were completed for 100 consented patients. Outcomes included overall satisfaction rate across gender and age groups.

Results
Overall, 75% of patients were satisfied with TFUs. No statistical difference was found between male and female rates of satisfaction (67.6% and 79.4% respectively, p-value=0.19). Likewise, satisfaction rates did not differ by age (&lt; 50 years: 72.2%, 50-59years: 88.9%, 60-69years: 71.4% and &gt;70years: 72%, p-value: 0.52).

Conclusion
Most patients were satisfied with TFUs. However, despite initial positive findings, there is still room to improve satisfaction. Prior to a re-evaluation, interventions such as offering patients the option of a telephone consult or a face-to-face appointment will be considered.
P13 Entrepreneurship in plastic surgery – a single departmental experience
Authors: Sequeira Campos M , Brady C , Ponniah A 
Published: May 2023

Abstract

Introduction
The specialty of Plastic and reconstructive surgery has long been at the forefront of innovation. However, perceptions of individuals focusing on entrepreneurship, particularly at a junior level, remain unclear. Anecdotally, trainees can be discouraged from participating in entrepreneurial efforts for fear of seniors’ disapproval.

Methods
A questionnaire was circulated amongst doctors at the Royal Free Plastic Surgery department aiming to establish knowledge and perceptions of entrepreneurship. It included 10 questions to be answered anonymously.

Results
18 individuals responded, including Foundation doctors (n=2), Junior clinical fellows (n=2), Core surgical trainees (n=3), Specialty registrars (n=5), Senior clinical fellows (n=2) and Consultants (n=4). All respondents (n=18) understood the meaning of the term “entrepreneurship” and 44.4% (n=8) had prior entrepreneurship experience. Perceptions of the connotations of the word “entrepreneurship” in surgery varied. 33% (n=6) reported “strongly negative” and 33% (n=6) “strongly positive” connotations. Notably, of those reporting “strongly negative” connotations, 80% (n=4) were junior trainees at Core surgical training or below, and 20% (n=1) were specialty registrars. Amongst the 4 consultants, mean perception on a 5-point scale was 3.75, indicating an overall “positive” connotation. Furthermore, 83.3% (n=15) of respondents felt their surgical career had not provided them with opportunities to develop entrepreneurship skills and 94.4% (n=17) would like further opportunities to develop entrepreneurship skills.

Conclusion
Perceptions on involvement in entrepreneurship in surgery are predominantly positive. Those associating entrepreneurial efforts with negative connotations seem to be predominantly junior. This result will hopefully encourage Plastic surgeons at all levels to become involved in entrepreneurial efforts.
P15 Prosthetic venous valves: short history and advancements from 2012 to 2020
Authors: Zervides C , Mahdi H , Staub R , Jouni H 
Published: May 2023

Abstract

Introduction
Venous diseases affect a majority of the population. It has both medical and cosmetic impacts on patients well-being. Patients have severe complications due to deep venous disease with few available therapies. A faulty venous valve is the origin of venous diseases, yet the treatment of such venous valves is invasive with a high recurrence rate. A prosthetic venous valve replacement is imminent and possibly provides better outcomes.

Methods
Articles addressing emerging implantable venous valve designs were examined. A systematic search resulted in thirty-five papers fitting the inclusion criteria. The focus was on the jugular vein and lower limbs veins and publication after 2012.

Results
Although no commercial model is in the market, many designs and models were studied especially in recent years. It was found that the composition of the valve determines its shape and the presence of inter/intra valve variability improved the approach toward a successful design. Three major models have been tested on animals awaiting further trials. Hence, a criterion for a successful prosthetic valve was formulated to avoid major complications and ensure the stability and durability of the valve.

Conclusion
The aim of the review is to shed light on the possible evolution in deep venous disease management especially since no ideal valve is available. If implemented, it can act as a treatment for early venous disease or to improve the quality of life if no alternative is available.
P17 Platelet-rich plasma as a treatment for vulval lichen sclerosus: a systematic review of safety and efficacy
Authors: Jasionowska S , Goble M , Langridge B , Iakovou D , Kamel F , McKenzie M , Almadori A , Butler P 
Published: May 2023

Abstract

Introduction
Vulval lichen sclerosus (VLS) is an inflammatory skin disease characterised by pain, itching, burning, apareunia, loss of vulval architecture and scarring. VLS has a significant impact on patients’ quality of life and certain patients find no symptomatic relief in the gold standard treatment of topical corticosteroids. Platelet-rich plasma (PRP) is derived from autologous plasma and injected into disease areas, it may provide superior outcomes for patients than current treatment options. This study systematically reviewed the safety and efficacy of platelet-rich plasma as a treatment for VLS.

Methods
This review followed PRISMA guidelines using a registered protocol (PROSPERO:CRD42022379894). Multiple databases were searched, along with grey literature on Clinicaltrials.gov, European Union Clinical Trials, and International Standard Randomised Controlled Trial registries. All studies evaluating the safety and/or efficacy of PRP for VLS were included.

Results
A total of 213 patients were assessed across nine studies. There was significant heterogeneity between studies, in the study design, PRP preparation method and injection volume of plasma used, and outcome measures. Forty-one percent (n=88) of patients reported resolution of symptoms on Quality-of-Life outcome measures or symptom assessment scales, 6% (n=12) patients had histological improvement of inflammation. PRP demonstrated symptom resolution and improvement, however the evidence is insufficient to conclude on its effectiveness or safety, and heterogenous outcome measures preclude pooled data analysis.

Conclusion
PRP may provide superior results than corticosteroids in certain patients with VLS, however further research is needed to ascertain the safety and efficacy profile of this treatment.
Validation of a microwave energy meter to non-lethally estimate energetic reserves in adult sturgeon
Authors: Daigle Nicole J , Djokic Matea A , Kappenman Kevin M , Gaylord T Gibson , Quinn Sierra , Verhille Christine E 
Published: May 2023

Abstract
Whole-body (WB) energetic reserves influence fish survival, growth, and reproduction but are typically quantified using lethal methods (i.e. proximate analyses) or interpreted through body condition indices. Energetic reserves can impact population dynamics through influences on growth rates, age-at-first-reproductive-maturity, and spawning periodicity at the individual-fish level, especially in long-lived sturgeon species. Therefore, a non-lethal tool to track the energetic reserves of endangered sturgeon populations could inform adaptive management and further our understanding of the sturgeon’s biology. The Distell Fatmeter is a microwave energy meter that has been validated to non-lethally estimate energetic reserves in some fish species, but never successfully for sturgeon. Here, stepwise linear regressions were applied to test commonly monitored body metrics and Fatmeter measurements at nine different anatomical sites on captive adult pallid sturgeon (Scaphirhynchus albus; total length of 790–1015 mm; WB lipid of 13.9–33.3%) compared with WB lipid and energy content determined by proximate analyses. Fatmeter measurements alone explained approximately 70% of the variation in WB energetic reserves, which outperformed models considering body metrics alone by a margin of approximately 20%. The top-ranked models based on AICc score (second-order Akaike Information Criterion) included a combination of body metrics and Fatmeter measurements and accounted for up to 76% of the variation in WB lipid and energy. We recommend the incorporation of Fatmeter measurements at a single site located dorsally to the lateral scutes at the posterior end of the fish above the pelvic fins (U-P) into conservation monitoring programs for adult pallid sturgeon (total length [TL] ≥ 790 mm; fork length [FL] ≥ 715 mm) and the cautious application of Fatmeter measurements for sturgeon between 435 and 790 mm TL (375–715 mm FL). Measurements at this U-P site combined with body mass explained approximately 75% of the variation in WB lipid and energy.
Strategies to mitigate emergency department crowding and its impact on cardiovascular patients
Authors: Baugh Christopher W , Freund Yonathan , Steg Philippe Gabriel , Body Richard , Maron David J , Yiadom Maame Yaa A B 
Published: May 2023

Abstract
Emergency department (ED) crowding is a worsening global problem caused by hospital capacity and other health system challenges. While patients across a broad spectrum of illnesses may be affected by crowding in the ED, patients with cardiovascular emergencies—such as acute coronary syndrome, malignant arrhythmias, pulmonary embolism, acute aortic syndrome, and cardiac tamponade—are particularly vulnerable. Because of crowding, patients with dangerous and time-sensitive conditions may either avoid the ED due to anticipation of extended waits, leave before their treatment is completed, or experience delays in receiving care. In this educational paper, we present the underlying causes of crowding and its impact on common cardiovascular emergencies using the input–throughput–output process framework for patient flow. In addition, we review current solutions and potential innovations to mitigate the negative effect of ED crowding on patient outcomes.
The underutilization of preventive cardiovascular measures in patients with cancer: an analysis of the Behavioural Risk Factor Surveillance System, 2011–22
Authors: Sayed Ahmed , Munir Malak , Addison Daniel , Abushouk Abdelrahman I , Dent Susan F , Neilan Tomas G , Blaes Anne , Fradley Michael G , Nohria Anju , Moustafa Khaled , Virani Salim S 
Published: May 2023

Abstract

Aims
This study aimed to characterize the influence of a cancer diagnosis on the use of preventive cardiovascular measures in patients with and without cardiovascular disease (CVD).

Methods and results
Data from the Behavioural Risk Factor Surveillance System Survey (spanning 2011–22) were used. Multivariable logistic regression models adjusted for potential confounders were applied to calculate average marginal effects (AME), the average difference in the probability of using a given therapy between patients with and without cancer. Outcomes of interest included the use of pharmacological therapies, physical activity, smoking cessation, and post-CVD rehabilitation. Among 5 012 721 respondents, 579 114 reported a history of CVD (coronary disease or stroke), and 842 221 reported a diagnosis of cancer. The association between cancer and the use of pharmacological therapies varied between those with vs. without CVD (P-value for interaction: &lt;0.001). Among patients with CVD, a cancer diagnosis was associated with a lower use of blood pressure-lowering medications {AME: −1.46% [95% confidence interval (CI): −2.19% to −0.73%]}, lipid-lowering medications [AME: −2.34% (95% CI: −4.03% to −0.66%)], and aspirin [AME: −6.05% (95% CI: −8.88% to −3.23%)]. Among patients without CVD, there were no statistically significant differences between patients with and without cancer regarding pharmacological therapies. Additionally, cancer was associated with a significantly lower likelihood of engaging in physical activity in the overall cohort and in using post-CVD rehabilitation regimens, particularly post-stroke rehabilitation.

Conclusion
Preventive pharmacological agents are underutilized in those with cancer and concomitant CVD, and physical activity is underutilized in patients with cancer in those with or without CVD.

Lay Summary
•This paper compared the use of preventive cardiovascular measures, both pharmaceutical and non-pharmaceutical, in patients with and without cancer.
•In patients with cardiovascular disease and cancer, there is a lower use of preventive cardiovascular medications compared with those with cardiovascular disease but without cancer. This includes a lower utilization of blood pressure-lowering medications, cholesterol-lowering medications, and aspirin.
•Patients with cancer reported lower levels of exercise but higher levels of smoking cessation compared with those without cancer
For a Universal Standard for Conflicts Disclosures
Authors: Mourre Alexis 
Published: May 2023

Abstract
Amongst the many reforms of international arbitration that are currently discussed, the adoption of a universal standard for conflicts disclosures is particularly necessary. Currently, the subjective standard “in the eyes of the parties” that is adopted by the IBA Guidelines and the ICC Rules coexist with the objective standard “from the perspective of a fair-minded and informed observer”, as defined by the English Supreme Court in Halliburton. The author submits that the IBA-ICC standard is preferable for it fosters more complete disclosures and encourages transparency. However, the subjective standard does not eliminate the moral hazard of non-disclosures and the author recommends that it be combined with a purely objective requirement to disclose based on a pre-established list of circumstances.