bluuebunny/crossref_metadata_2025_split huggingface dataset:
ОЦЕНКА ЭКОНОМИЧЕСКОЙ ЭФФЕКТИВНОСТИ МЕРОПРИЯТИЙ ПО ЭНЕРГОСБЕРЕЖЕНИЮ В СФЕРЕ ЖИЛИЩНО-КОММУНАЛЬНОГО ХОЗЯЙСТВА
Authors: Surovtsov Maksim M. , Moreva Yuliya A. , Novoselova Yuliya N. 
Published: May 2023

Энергосбережение является стратегическим направлением развития экономики Российской Федерации. Львиная доля потребления энергоресурсов приходится на жилищно-коммунальное хозяйство. Важную роль в экономии тепловой энергии, затрачиваемой на отопление жилищного фонда, играет качество их теплозащиты. В настоящее время в эксплуатации находится огромное количество зданий, построенных до ввода в действие современных норм по требованиям теплозащиты. Показатели удельных расходов тепловой энергии на отопление в таких зданиях значительно превышают значения для современных зданий, построенных с учетом актуальных требований и норм. В связи с этим представляет интерес поиск правильного технико-экономического решения – согласиться с увеличенными расходами тепловой энергии или проводить утепление наружных ограждающих конструкций. В статье приведена оценка результатов определения приведенного сопротивления теплопередаче наружных стен жилого здания, эксплуатируемого с 1970 г. Для рассматриваемого здания предложен вариант утепления наружных ограждений в соответствии с действующими нормами, определена сметная стоимость строительно-монтажных работ. Определена экономическая целесообразность выполнения мероприятий по повышению теплозащиты наружных ограждающих конструкций обследуемого здания.
Цель – определение эффективного способа управления объектами жилищного фонда с учетом политики энергосбережения.
Метод или методология проведения работы: в статье использовались результаты натурного эксперимента, а также технико-экономические методы анализа.
Результаты: определены показатели, определяющие технико-экономическую целесообразность проведения энергосберегающих мероприятий для эксплуатирующихся объектов жилой застройки.
Область применения результатов: полученные результаты целесообразно применять на уровне управляющих компаний или муниципалитетов.
CLINICAL CASE SYSTEMIC SCLERODERMA A MIDDLE-AGED WOMAN
Authors: Demin M. , Avdeeva Ol'ga 
Published: May 2023

Systemic scleroderma is a rare chronic disease characterized by the development of diffuse fibrosis, pathological changes in the skin, blood vessels, joints and internal organs.
The article presents a clinical case of a patient with systemic scleroderma with such obvious manifestations of skin and vascular lesions as sclerodactyly, masking of the face, "purse-string mouth", Raynaud's syndrome, as well as lesions of the joints, muscles, immunological disorders, the development of steroid osteoporosis with multiple fractures
Laparoscopic colorectal resections during the COVID-19 pandemic – business as usual?
Authors: Kalaiselvan R , Scott M , Rajasundaram R , Samad A 
Published: May 2023

Introduction To analyse the outcomes of major colorectal resections performed during the COVID-19 pandemic, to assess safety and explore all precautionary measures. Method All patients who underwent major elective colorectal resections at St Helens and Knowsley Teaching Hospital NHS Trust between 24th March 2020 (the date that the Royal Colleges of Surgery produced their guidelines re operating during the pandemic) and 17th April 2020 were analysed from a prospectively maintained database. The primary outcome was 7-day mortality and secondary outcomes were the development of a positive COVID-19 test consequent to hospital stay and the overall complication rate. Results In this 24 day time frame 27 patients (17 males) underwent elective colorectal resections at St Helens and Knowsley NHS Trust. The median age was 69 (41–84) years and median ASA was 2 (1–3). The median Body Mass Index was 30 (21–40.7). Twenty-five patients underwent surgery for cancer and two patients had urgent resections for low-grade sepsis secondary to diverticular colovesical fistulae. 24 patients underwent laparoscopic colorectal resections and 3 patients underwent planned open surgery. 7-day mortality was 0%, and no patients/staff contracted COVID-19 during the post-operative period. The overall complication rate was 14.8%. At a median follow-up of 29 (17–44) days via telephone, there have been no reported COVID-19 related symptoms in any of these patients. Conclusion Our experience demonstrated that it was possible to undertake laparoscopic colorectal resections despite the COVID-19 pandemic posing a major threat to humanity, providing that adequate and stringent precautions are undertaken.
Evaluating the potential utility of three-dimensional printed models in preoperative planning and patient consent in gastrointestinal cancer surgery
Authors: Povey M , Powell S , Howes N , Vimalachandran D , Sutton P 
Published: May 2023

Introduction The Future of Surgery report from the Royal College of Surgeons of England acknowledges the important role that three-dimensional imaging will play in support of personalised surgical interventions. One component of this is preoperative planning. We investigated surgeons’ and patients’ perceptions of this evolving technology. Materials and methods Ethical approval was obtained. From a normal computed tomography scan, three-dimensional models of the stomach, pancreas and rectum were rendered and printed on an Ultimaker™ three-dimensional printer. Semi-structured interviews were performed with surgeons and patients to explore perceived model effectiveness and utility. Likert scales were used to grade responses (1 = strongly disagree; 10 = strongly agree) and qualitative responses recorded. Results A total of 26 surgeons (9 rectal, 9 oesophagogastric, 8 pancreatic) and 30 patients (median age 62 years, interquartile range, IQR, 68–72 years; 57% male) were recruited. Median surgeon scores were effectiveness for preoperative planning, 6 (IQR 3–7), authenticity, 5 (IQR 3–6), likability, 6 (IQR 4–7), promoting learning, 7 (IQR 5–8), utility, 6 (IQR 5–7) and helping patients, 7 (IQR 5–8). Median patient scores were usefulness to the surgeon, 8 (IQR 7–9), authenticity, 8 (IQR 6–8), likability, 8 (IQR 7–8), helping understanding of condition, 8 (IQR 8–9), helping understanding of surgery, 8 (IQR 7–9) and feeling uncomfortable, 1 (IQR 1–4). Median overall decisional conflict score (0 = no; 100 = high) was 22 (IQR 19–28) and decision effectiveness was 25 (IQR 19–30). Discussion Overall, patients and surgeons considered that three-dimensional printed models were effective and had potential utility in education and, to a lesser extent, preoperative planning. Patient decisional conflict and effectiveness scores were weighted towards certainty in decision making but had room for improvement, which three-dimensional models may help to facilitate.
The impact of a fellow on a regional robotic-assisted partial nephrectomy service
Authors: Crockett MG , Malki M , Hussain M , Mueller G , Segaran S , Tadtayev S , Barber NJ 
Published: May 2023

Introduction Training a fellow has a cost in time and effort for the surgeon and their team. Their relative inexperience may also negatively affect the patient. The aim of this study was to determine and quantify the impact of a fellow on a regional robotic-assisted partial nephrectomy service and on perioperative outcomes. Materials and methods We reviewed the prospectively collected data for 522 patients who had undergone robotic-assisted partial nephrectomy since 2015 during the tenure of six fellows. Perioperative outcomes for three groups were compared: group A (no fellow participation), group B (some participation) and group C (fellow completed entire operation). We also reviewed progression over 12 months. Results Demographics were similar in all groups apart from the percentage of men, which was lower in group C (p < 0.05). Operative time was 27 minutes longer for group B (p < 0.001). Warm ischaemia time was significantly shorter for group A but the difference was only four minutes (p < 0.001). Length of stay was slightly shorter for group C compared with the other groups (p < 0.01). Trifecta achievement was greatest for group A (p < 0.001). There were no perioperative deaths in any group and positive margins, complications and readmissions were low and similar in all groups. Towards the end of their fellowship, fellows performed more operations independently. Conclusion There is a measurable, but small, negative impact of a fellow on a robotic-assisted partial nephrectomy service, which reduces with experience. With appropriate supervision and patient selection, a fellow can be taught robotic-assisted partial nephrectomy without affecting patient safety or treatment outcome.
Rectal foreign body removal: increasing incidence and cost to the NHS
Authors: Bhasin S , Williams JG 
Published: May 2023

IntroductionInsertion of foreign objects into the rectum is a well-described phenomenon and not an uncommon referral to the general surgeon on call. Although usually not life-threatening, there can be consequences following migration of the object or perforation of the large bowel. This study looks at the incidence of removal of foreign objects from the rectum over the last decade and the financial burden it presents to the NHS.MethodsHospital Episode Statistics for 2010–2019 were used to calculate the number of rectal foreign bodies that required removal in hospital. Data for age groups and genders have been compared.ResultsA total of 3,500 rectal foreign bodies were removed over the course of 9 years. Males accounted for 85.1% of rectal foreign bodies whilst 14.9% were females. This equates to 348 bed-days per annum. Admission peaks were observed in the second and fifth decades of life.ConclusionThis study shows that the incidence of rectal foreign bodies is higher in men and has been increasing over the period studied. Most foreign bodies can be removed trans-anally with the use of anaesthesia, with only a small proportion of patients requiring hospital stay over 24 hours (mean length of stay = 24 hours). Nearly 400 rectal foreign body removals are performed each year with an annual cost of £338,819, illustrating the effect this has on NHS resources.
Medical negligence in urology: an untapped database
Authors: Whitfield HN 
Published: May 2023

Introduction The aim of this study was to identify the causes of urological litigation in the NHS and to make recommendations how to reduce the burden of litigation to both injured patients and urologists. Methods Under the Freedom of Information Act, the National Health Service Resolution (NHSR) was asked to provide the figures for the number of cases of litigation in urology reported between 2010 and 2020. Results The number of urological claims more than doubled between 2011 and 2020. Many of the claims that are made result from avoidable errors. Conclusion More education is needed, of both urologists in training and consultant urologists, on the causes of errors that lead to litigation and how many of them can be avoided.
Vitamin D repletion in primary hyperparathyroid patients undergoing parathyroidectomy leads to reduced symptomatic hypocalcaemia and reduced length of stay: a retrospective cohort study
Authors: Acharya R , Kopczynska M , Goodmaker C , Mukherjee A , Doran H 
Published: May 2023

Introduction Vitamin D deficiency co-exists with and can confuse the diagnosis of primary hyperparathyroidism (PHPT). Vitamin D replete (VDR) status may prevent significant postparathyroidectomy hypocalcaemia; however, reports from previous studies are conflicting. This study aimed to assess differences in early and/or late postoperative hypocalcaemia and length of stay (LOS) postparathyroidectomy between VDR and vitamin D non-replete (VDNR) PHPT patients. Methods This was a retrospective cohort study of a prospectively maintained single surgeon operative database. All records of patients who underwent parathyroidectomy over a four-year period (July 2014 to December 2018) were extracted. Data were collected on vitamin D and corrected calcium levels pre- and postoperatively as well as postoperative complications and LOS. Results On presentation, there were 91 (47.9%) VDR and 99 (52.1%) VDNR patients. Following vitamin D therapy there were 148 (77.9%) VDR and 42 (22.1%) VDNR. The multivariate analysis showed that vitamin D status was the only significant factor impacting on the hypocalcaemia symptoms (OR 4.9, 95% CI 1.8–13.7, p = 0.002) and the most significant factor for the calcium supplementation (OR 6.5, 95% CI 2.1–19.4, p = 0.001). Bilateral neck exploration was associated with increased likelihood of transient hypocalcaemia (p = 0.007) but no other post-op complication. Median LOS was significantly shorter for VDR (1 day) versus VDNR (1.5 days) patients (p = 0.001). Conclusion There is a statistically significant increased likelihood of postoperative hypocalcaemia symptoms, requirement for calcium supplements and increased LOS in VDNR patients. This study suggests optimising preoperative vitamin D status improves patient experience and could reduce healthcare costs.
Time, cost and carbon-efficiency: a silver lining of COVID era virtual urology clinics?
Authors: Croghan SM , Rohan P , Considine S , Salloum A , Smyth L , Ahmad I , Lynch TH , Manecksha RP 
Published: May 2023

Introduction The COVID-19 pandemic has demanded radical changes in service delivery. Our centre adopted the use of outpatient telemedicine to reduce close-contact interactions between patients and staff. We hypothesised that incidental gains may be associated with this. We evaluated financial, practical and environmental implications of substituting virtual clinics (VCs) for in-person urology outpatient appointments. Methods VCs were studied over a 3-month period. Based on patient-reported ‘usual mode of transport’ to the hospital, travel distance, time, petrol and parking costs, and the carbon emissions avoided by virtue of remote consultations were calculated. The underlying symptom/diagnosis and the ‘effectiveness’ of the VC were evaluated. Results Of 1,016 scheduled consultations, 736 (72.44%) were conducted by VCs over the study period. VCs resulted in an agreed treatment plan in 98.4% of a representative patient sample. The use of VCs was associated with an overall travel distance saving for patients of 31,038 miles (49,951km) over 3 months, with an average round-trip journey of 93.8 miles (151km) avoided for each rural-dwelling patient and an average financial saving of £25.91 (€28.70) per rural-dwelling car traveller. An estimated 1,257.8 hours of patient time were saved by avoidance of travel and clinic waiting times. Based on car-travelling patients alone, a 6.07-tonne reduction in carbon emissions was achieved with the use of VCs. Conclusions In appropriate clinical circumstances, VCs appear to provide efficiency across a number of domains. Future healthcare may involve offering outpatients the option of telemedicine as an alternative to physical attendance.
Malpractice litigation and spinal surgery in the National Health Service: a single tertiary-level centre perspective over 12 years
Authors: Quraishi NA , Shetaiwi A , D’Aquino D , Salem K 
Published: May 2023

Introduction Medical malpractice litigation is a major concern for all spine surgeons. Our aim was to evaluate the incidence and burden of successful litigation relating to the management of spinal disorders over 12 years within a UK NHS tertiary-level spinal unit and compare these litigation costs with those of other specialties. Methods We obtained all data held by our claims department from its inception in January 2008 to December 2019. We also obtained costs for the total financial burden incurred by our Trust during this period. Results In total, there were 83 closed claims involving spinal pathologies. Over 80% of these comprised negligent surgery (n = 28, 34%), delay to diagnose/treat (n = 25, 30%) and negligent care (n = 18, 22%). The vast majority of claims were withdrawn without incurring any cost to the hospital (n = 59, 71%) and only 24 (29%) resulted in successful litigation for the claimant. The total cost of damages for these 24 successful claims was just over £8 million, including legal costs of £2.5 million, out of total litigation costs of £381 million over this period. Discussion Fewer than 30% of initial claims against a tertiary spinal surgical referral unit resulted in a successful financial outcome for the claimant. The total costs incurred were just over £8 million, with one-third apportioned to high legal costs, reflecting the complexity of resolving spinal litigation. Our entire legal expenses accounted for only 2% of the total legal bill paid by our hospital over a 12-year period.
To block, or not to block … is it still the question? Effectiveness of alpha- and beta-blockade in phaeochromocytoma surgery: an institutional analysis
Authors: Van Den Heede K , Paspala A , Chander N , Chidambaram S , Wernig F , Todd JF , DiMarco AN , Palazzo FF 
Published: May 2023

Introduction Phaeochromocytomas/paraganglioma (PPGL) surgery was historically associated with significant risks of perioperative complications. The decreased mortality (<3.0%) had been attributed in part to optimal preoperative alpha-blockade. The value of alpha-blockade in decreasing morbidity is being challenged. The aim of our study is to present an institutional experience of preoperative alpha-blocking of PPGL and its effect on cardiovascular stability and postoperative morbidity. Methods A retrospective study using data from our institutional database was conducted. All patients undergoing adrenalectomy for PPGL from October 2011 to September 2020 were included. All patients were routinely alpha-blocked. Intraoperative cardiovascular instability (ICI) was assessed through number of systolic blood pressure (SBP) episodes >160mmHg, SBP <90mmHg, the need for vasoactive drugs and volume of intraoperative crystalloids administered. Morbidity was also evaluated. Results A total of 100 consecutive patients undergoing surgery were identified of whom 53 patients had complete anaesthetic records available for analysis. Thirty-two patients (60%) had at least one episode with an SBP >160mmHg. Nine (17%) cases had no intraoperative hypotensive episodes, while 3 (6%) patients had >10 intraoperative episodes of an SBP <90mmHg. Twenty-one (40%) patients received vasoactive drugs during surgery. The median volume of intraoperative crystalloids was 2 litres (1–4). Postoperatively, no patient experienced cardiovascular complications, including arrhythmia or myocardial ischaemia. Only two were admitted to an intensive care unit (ICU) and one 30-day readmission occurred. Conclusions Cardiac instability remained significant in PPGL surgery despite optimal alpha- and beta-blockade. While omitting blockade would appear empirically questionable, a randomised controlled trial (RCT) of surgery with and without alpha-blockade will provide an answer.
A simple intervention to improve the use of postoperative antibiotics and intra-abdominal drains in appendicectomy patients
Authors: Sorooshian P , Ward R , Sandison AJP 
Published: May 2023

Introduction Appendicitis remains the most common intra-abdominal surgical emergency, yet many patients receive postoperative antibiotics and intra-abdominal drains against recommended guidelines. This study assesses the impact of an educational poster on the appropriate use of postoperative antibiotics and intra-abdominal drains in appendicectomy patients. Methods Patients who underwent an appendicectomy between January and April 2019 (‘Poster absent’ group) as well as between November 2019 and February 2020 (‘Poster present’ group) were identified. Data were collected on patient demographics, the presence of complicating features (ie appendiceal abscesses, intraperitoneal pus, gangrene and/or perforation) as well as the use of postoperative antibiotics and intra-abdominal drains in accordance with World Society of Emergency Surgery guidelines. Results One hundred and thirty patients were included in the ‘Poster absent’ (73 patients) and ‘Poster present’ (57 patients) groups. After introducing the educational poster there was a significant reduction in the use of postoperative antibiotics (60.5% to 13.8%; p<0.0001) and an insignificant reduction in intra-abdominal drain use (15.2% to 13.2% p>0.05) that were contraindicated in simple appendicitis. There was a significant improvement in the use of postoperative antibiotics (71.9% to 100%; p=0.0019) and an insignificant increase in intra-abdominal drain use (58.8% to 64.3%; p>0.05) that were indicated in complicated appendicitis. The rates of wound infection (4.10% to 0%; p=0.2556) and ileus/obstruction (5.48% to 1.75%; p=0.3846) also reduced. Conclusion This small study demonstrated that a simple and appropriately targeted intervention of an educational poster can significantly improve and reduce variation in the management of appendicectomy patients and may reduce postoperative complications.
A comparison of cytoreductive and non-cytoreductive management strategies for nephron-sparing approaches to tumours in solitary kidneys
Authors: Nayak A , Piedad J , Wagh Y , Nathan P , Sharma A , Pullar B , Hanbury D , Adshead J 
Published: May 2023

Introduction Tumours in a solitary kidney pose challenges in management. Metastatic tumours and those in difficult locations complicate treatment further. The advent of immunotherapy has shed new light on the management of such tumours. We present a series of three cases treated with nephron-sparing surgery following neoadjuvant immunotherapy and compare the outcomes with patients who underwent robotic partial nephrectomy in a solitary kidney. Methods We present the outcomes of three patients with solitary kidney tumours who underwent delayed nephron-sparing surgery following good response to immunotherapy. All patients had solitary kidney following a previous nephrectomy, two of which were nonmetastatic but, due to size/location, not amenable to primary treatment; the third patient had metastatic disease and responded to immunotherapy. Two patients underwent robotic partial nephrectomy and one opted for cryotherapy. We compared the preoperative, intraoperative and postoperative parameters of the two patients who underwent robotic cytoreductive partial with patients who underwent robotic partial nephrectomy in a solitary kidney. Results Out of 231 partial nephrectomy patients in our centre, 2 underwent cytoreductive partial nephrectomy and 5 underwent solitary partial nephrectomy. There was no statistically significant difference in the patient demographics in the two groups. Patients in both groups had comparable operative time, warm ischaemia time, blood loss and length of stay. Two of the five patients in the non-cytoreductive robotic partial nephrectomy had Clavien Dindo 1 complications compared with one patient in the robotic cytoreductive partial nephrectomy group. This was not statically significant. Conclusion Neoadjuvant immunotherapy can play a valuable role in shrinking renal tumours in solitary kidneys to facilitate robotic partial nephrectomies. There were no significant differences in the intra- and postoperative parameters in patients who underwent cytoreductive partial nephrectomy when compared with patients undergoing robotic solitary partial nephrectomy.