bluuebunny/crossref_metadata_2025_split huggingface dataset:
1191 Novel Biomarkers for the Diagnosis of Chronic Pancreatitis: An Exploratory Case-Control Study
Authors: Goldsworthy M , Purssell H , Al-Omari D , Barciela C , Brown J , Athwal V , Geraghty J 
Published: August 2023

Abstract

Aim
Chronic pancreatitis is a complex inflammatory syndrome with manifestations including abdominal pain, malnutrition, and diabetes. Early recognition is necessary for optimal management; however this remains clinically challenging and there are no established biomarkers for diagnosis. This exploratory study aims to determine the expression of a set of fibrosis-related serum biomarkers in patients with chronic pancreatitis relative to controls.

Method
Participants were recruited from specialist outpatient clinics at a single centre. Ethical approval was granted via the institutional biobank. Cases were defined as adult patients with a radiological and/or histological diagnosis of chronic pancreatitis. Controls were adult patients with no history of pancreatic disease. Blood samples were collected from each participant and the serum concentrations of candidate biomarkers measured in duplicate by enzyme-linked immunosorbent assays.

Results
In cases (n = 17; median age 53 years) compared to controls (n = 4; median age 54 years), the mean serum concentration of osteoactivin was 39.32 ng/ml vs. 18.70 ng/ml (2.1 fold); fibronectin was 512.33 μg/ml vs. 328.83 μg/ml (1.6 fold), osteopontin was 8.19 ng/ml vs. 7.47 ng/ml (1.1 fold), vimentin was 637.94 ng/ml vs. 562.14 ng/ml (1.1 fold), TIMP1 was 0.25 μg/ml vs. 0.23 μg/ml (1.0 fold) and osteonectin was 3.8 μg/ml vs. 4.71 μg/ml (0.8 fold).

Conclusions
This pilot study demonstrated differential expression of several fibrosis-related serum biomarkers in patients with chronic pancreatitis compared to controls. An expanded study will aim to establish the utility of these biomarkers for the early diagnosis of this condition.
53 The Patient Demographic Details of Referrals for Risk Reducing Breast Surgery and Reconstruction to St Helen’s and Knowsley Teaching Hospitals Over a 5 Year Period
Authors: Nelson A , Taghizadeh R 
Published: August 2023

Abstract

Background
Breast cancer is the most common cause of cancer in women affecting 1 in 7 women in the UK. Hereditary breast cancers are present in up to 10% of all cases and are most commonly related to BRCA gene mutations. Bilateral risk reducing mastectomy (RRM) +/- reconstruction is the most effective strategy reducing breast cancer mortality risk. Reconstruction options can be classified into immediate vs delayed reconstruction and autologous vs alloplastic reconstruction. Complete reconstruction may take considerable time depending on waiting lists and may include additional aesthetic corrections such as lipomodelling and nipple reconstruction.

Method
Retrospective analysis of referrals (all ages) to a single surgeon at Whiston Hospital for breast reconstruction following RRM between 1/04/2015-1/04/2020.

Results
There were a total of 467 referrals. Of these, 76 (16%) were referred for breast reconstruction following RRM, 51 (67%) of these patients had confirmed genetic mutations and 24 (32%) had no genetic mutation. 48 (94%) patients were BRCA gene carriers of which 32 (63%) were BRCA2 carriers, 14 (27%) were BRCA1 carriers and 2 patients with unknown BRCA variants. There were 2 (4%) patients with CHEK2 mutations and 1 (2%) patient with Cowden’s syndrome.

Conclusions
There is currently no standardised guidance on the timing of RRM and reconstruction in high-risk patients. The risk of breast cancer in high-risk patients increases with age, and there is need for a risk stratification tool for RRM and reconstruction waiting lists, to identify patients with the highest risk of breast cancer development considering their personal and family history.
65 Conservative Management of Wound Dehiscence Following Inguinal Lymph Node Dissection Using Topical Metronidazole Gel Compared to Simple Wound Packing - a Cohort Study
Authors: Ridwanul Hassan M , Henry N 
Published: August 2023

Abstract

Aim
The aim of this study is to determine the effect of simple packing against topical metronidazole in the management of wound dehiscence following inguinal lymph node dissection.

Method
This is a retrospective cohort study of all adult patients who underwent groin dissection between 2014 and 2020 at the Queen Elizabeth Hospital Birmingham. Patients who had flaps or grafts for wound closure, and those with incomplete follow up records were excluded. Patients who developed wound dehiscence were treated with either topical metronidazole or simple packing and were followed up regularly by specialist wound care nurses. Data was collected from electronic medical records from the date of procedure to the latest follow up and analysed in SPSS. The two groups were compared for the time taken for the wound to heal in days as the primary outcome.

Results
From the 157 patients that had groin dissection, 76 (48.4%) developed wound dehiscence. Eight of them were still unhealed at the time of data collection. Among the 68 healed patients, 32 (47%) had been treated with metronidazole-soaked packing, and 44 (53%) had received packing without metronidazole. The two groups were comparable in terms of age, sex, indication for groin dissection and wound size. The mean time to healing for patients treated with topical metronidazole was 63.7±40 days, compared to 45 ±24.7 days in the non-metronidazole group. The difference is significant with a p value of 0.02.

Conclusions
Simple packing of dehisced wounds following groin dissection leads to significantly shorter healing times compared to topical metronidazole.
126 When Does a Pressure Dressing Become a Tourniquet: A Prospective Single Centre Study Assessing Variation and Factors Affecting Pressures Exerted by Pressure Bandages
Authors: Brzeszczynski F , McGhee J , Rust P 
Published: August 2023

Abstract

Introduction
Pressure bandages are frequently used for emergency haemostasis in arterial forearm injuries. This study assesses the range of pressures exerted by pressure bandages and the relevant variables, thus evaluating the safety of use.

Method
We measured pressures under a standard Oleas modular pressure bandage using Flexiforce Prototyping Kit when applied by various members of the hand trauma unit with differing levels of experience.

Results
15 measurements of pressure were recorded. The mean applied pressure was 209mmHg (range: 50 – 485mmHg) with 40% measurements exceeding pressure of 250mmHg. Multivariate regression analysis showed the colour of the hand is statistically significantly related to exerted pressures (p&lt;0.005), but not related to clinical experience (p = 0.101), perceived force of application (p = 0.203) or gender (p = 0.289). Pink hands had a mean pressure equal to 79mmHg compared with purple hands; 336mmHg.

Conclusions
Pressure bandages have large variation in the pressure created, often exceeding safe pressure ranges. Our results suggest if the hand is purple, pressures under the dressing are similar to that of a pneumatic tourniquet. If pressure dressings are required in an emergency setting, these should be removed after 2 hours to prevent the risk of compression injury.
547 Evaluating the Excision and Diagnosis Rates of Non-Melanoma Skin Cancers in a Plastic Surgery Department
Authors: Richardson P S , Khashaba H 
Published: August 2023

Abstract

Aim
Skin cancer is the most common cancer in the UK. 95% of complete excision is considered the national average and achieving this is important for our patients and our practice.
The aims of our study were to evaluate our complete excision rates, sensitivity, and specificity in diagnosing and excising Non-Melanoma Skin Cancers (NMSC) as a department.

Method
We conducted a retrospective audit of adult patients undergoing excision of NMSC in our department in July 2022. Data was collected on age, gender, clinical and pathological diagnosis, surgeon grade, complications, site and subtype of lesion excised.

Results
Of the 100 cases identified, 43% of lesions excised were BCC and 22% were SCC. 72% of procedures were carried out by registrars. 98% of excisions were complete with 2 incomplete excisions and 13 excisions with narrow margins. 86% of specimens with narrow margins or incomplete excision were excised from craniofacial areas. Clinical diagnosis sensitivity for BCC was 79% and 86% for SCC, whereas specificity was 79% for BCC and 58% for SCC. The overall clinical diagnosis sensitivity for NMSC was 81% and negative predictive value was 88%.

Conclusions
Our complete excision rate and sensitivity is above the national average, however our ability to distinguish benign from cancerous lesions has room for improvement. This may reflect surgeon grade and concerns over prolonged waiting times delaying treatment. We therefore recommend regular skin cancer teaching and encourage all grades to use loupes, dermatoscopes and adequate lighting in clinic and theatre to ensure adequate margins and adherence to national guidelines.
549 Foot Syndactyly: Operative Management, Postoperative Webspace Splinting, and a Retrospective Review of Cases Across 15 Years at a Tertiary Plastics Centre
Authors: Skan O , Fleet M , Nikkhah D 
Published: August 2023

Abstract

Aim
Syndactyly of the foot is a common congenital abnormality, with an estimated prevalence of 1 in 2,000. While thought to be more common than hand syndactyly, there is considerably less discussion of foot syndactyly in the literature. We describe our operative approach to foot syndactyly and a postoperative technique for splinting with silicone moulds to reduce webcreep complication. We sought to further characterise the nature of, and postoperative outcomes for, foot syndactyly cases managed at our centre.

Method
We performed a retrospective analysis of cases of paediatric foot syndactyly managed at our centre over the last 15 years.

Results
47 patients (52 primary foot syndactyly repair operations), involving 75 webspaces were identified (80.0% simple syndactyly, 1.3% complex, 18.7% not specified). 54.7% webspaces were incomplete syndactyly (21.3% complete, 24.0% not specified). The second webspace was the most commonly involved (57.3%). Median age of first operation was 47.5 months.
Of patients with documented follow-up, 24.1% of webspaces developed a complication. Complications included webcreep (13.8%), keloid (5.2%) and hypertrophic (5.2%) scarring, graft loss (3.4%), infection (3.4%), overgranulation (1.7%), clinodactyly (1.7%), and suture granuloma (1.7%). The most common documented repair technique involved ‘V-shaped’/’triangular’ interdigitating local flaps. There was no difference in webcreep rates between FTSG and STSG repairs.

Conclusions
Webcreep remains the most common complication of foot syndactyly, and one parents must be suitably informed about. This work adds to a relatively small body of work internationally and describes a simple method to help reduce post-operative contracture.
680 A Systematic Review of Outcomes Measures Evaluating Treatment Efficacy in Vulval Lichen Sclerosus
Authors: Goble M , Jasionowska S , Langridge B , Iakovou D , Kamel F , McKenzie M , Almadori A , Butler P 
Published: August 2023

Abstract

Aim
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. Significant heterogeneity in outcome reporting precludes evaluation and meaningful comparison of different treatment options. This study aims to systematically review the different outcome measures used to evaluate efficacy of all VLS treatments.

Method
This 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-validated 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.

Conclusions
There is high heterogeneity in assessing treatment outcomes for LS. To appropriately evaluate and compare the effectiveness of VLS treatments it is crucial to adopt a core set of outcome measures in future studies.
881 Content Evaluation of First Aid Information of Burn Centre Websites Worldwide
Authors: Deliyannis E , Stanley G , Pitt E , Squires O , O'Brien A M , Aquilina C , Tandle S , Lau C , Tarafdart A , Daly P , Al-Khalil M , Kim E , Lun A , Leong S , Gierzstein S , Wood F , Pleat J 
Published: August 2023

Abstract
While the internet is an invaluable resource for both patients and healthcare providers in the management of burns, websites are often unregulated and highly variable in the quality of their content. Burns centres are in the unique position of possessing presumed reputability amongst the public. It is therefore imperative that their websites provide information that is consistent in its content, through a format that is accessible and coherent.
In this study, we aimed to evaluate first aid websites of burns centres in the UK, Ireland, USA, Canada, Australia and New Zealand. This study highlights the importance of the leadership role that these centres should possess online. A multicentre, observational, cross-sectional study was performed over a period of two years (October 2020 to July 2022). Each centre’s website was evaluated using a 10-point scoring system to assess burns first aid content accuracy. The content was evaluated using a scoring system by Burgress et al, that is based on the basic burns first aid principles of “stop, remove, cool and cover”.
188 burn centres across the stated countries were included. The country with the highest average score was Australia & New Zealand (5), followed by the USA (2.89), Canada (1.78) and the UK & Ireland (2.89). The consistency of content and quality of these resources remains an area for potential improvement and should be considered in the future design of such websites. The most common step missed in burn first aid was to keep victims warm to prevent hypothermia.
117 Achilles Tendon Rupture Clinic, a Successful and Reproducible Model
Authors: Eniola G , El-Gendy M , Soliman E , Shah N , Hassan A , Leong E , Rudge B 
Published: August 2023

Abstract

Background
In the view of busy Emergency departments and general fracture clinics, a delay in the assessment, diagnosis and treatment of Achilles tendon injuries can lead to poor outcomes. A dedicated Achilles tendon rupture clinic can provide efficient care and avoid such complications.

Aim
To assess the efficiency of the dedicated Achilles tendon rupture clinic (model) in avoiding delay in the assessment and management of Achilles tendon injuries.

Method
Analysis of retrospectively collected data of the patients who have been reviewed in the Achilles clinic. All patients had Ultrasound scan (USS) by trained Orthopaedic surgeons to assess the size of the gap. Non operative treatment followed an approved functional rehabilitation protocol in the department. Data for analysis included : demographic data, Time interval between injury and assessment in the Achilles clinic ,size of the gap (USS) and ATRS (The Achilles tendon Total Rupture Score ).

Results
45 patients have been reviewed in the Achilles tendon rupture clinic over nine months, the mean age was 52.05 the mean time interval between referral and assessment in the Achilles clinic was 6.1 days (SD 3.59 ), The mean size of the tear was 10.65 mm (SD 5.95). The mean ATSR score at three months follow up was 70.29 ( SD 15.3).

Conclusions
The model of dedicated Achilles tendon rupture clinic including on-site USS can help deliver a safe and more efficient arm of the trauma service to patients and avoid delay in management that might affect the patients functional outcome and require complex surgical procedures.
142 Comparison of Patients’ Satisfaction Outcome of Primary Closure and Traditional Volcano Dressing Following Ileostomy Reversal
Authors: Rezacova M 
Published: August 2023

Abstract

Introduction
Reversal of ileostomy is usually last step following major surgery. For patient this is quite significant procedure, and the outcome is vital. Not only they achieve continuity of GI tract again, but they can live without stoma. Providing them with skin closure that results in minimal scaring can improve patient satisfaction with cosmetic outcome of surgery.

Method
I have designed patient outcome and satisfaction questionnaire over 2 hospital sites. One hospital performs in majority of cases traditional volcano dressing, while the other attempts primary closure.

Results
50 patients were included in total. One group (25 patients) underwent closure with traditional volcano approach while the other (25 patients) had primary closure of skin. The patients with the volcano dressing needed further visits to health care providers for dressing change and this had huge impact on their recovery. From the patients who had primary closure, 2 patients had minor wound infection with partial wound breakdown. The rest of a group healed with no complications. Patients in the primary closure group were satisfied with cosmetic result after the surgery while only 32% of patients from the volcano group have been satisfied with the cosmetic result. However, this was not related to the overall satisfaction from surgical outcome.

Conclusions
Primary closure is a very plausible option and when performed correctly, has minimal complications. It results in longer but more cosmetically acceptable scar than volcano dressing. Overall patients' satisfaction is mainly guided by the functional result of surgery but the cosmesis should be considered when planning ileostomy reversal.
332 Improving Preparedness of Junior Doctors in Surgery Through Development and Implementation of an Induction Booklet
Authors: Smith C , Richardson D , Watt J , Haji A 
Published: August 2023

Abstract

Aim
Disruption to undergraduate clinical training during the COVID-19 pandemic caused a perceived lack of preparedness amongst newly qualified junior doctors. We aimed to improve junior doctor preparedness in surgery, through development and implementation of an induction booklet.

Method
An electronic survey distributed in December 2021 assessed junior doctors’ perceived preparedness for their surgical job and identified inadequacies in the existing induction programme. Through feedback and suggestions, we designed a 30-page induction booklet containing information for each surgical sub-specialty, on-call commitments, the rota, practical tips, and important contact numbers. The booklet was distributed to the subsequent two junior doctor cohorts, six weeks prior to them joining, in April and August 2022. They completed an electronic survey within their first week to assess the impact of the induction booklet.

Results
Survey response rate was 60% (n = 29) from the pre-intervention cohort and 55% (n = 28) from the post-intervention cohort. Prior to intervention, most junior doctors felt unprepared for their day-to-day surgical job (79%) or their first on-call shift (69%). Following the implementation of the booklet, only 11% of respondents felt unprepared for their day-to-day surgical job, more than a seven-fold improvement (p&lt;0.0001). The proportion of respondents who felt unprepared for their first on-call shift significantly decreased to 32% (p = 0.0081). 93% of respondents reported that the induction booklet was useful in preparing them for their surgical job.

Conclusions
Development and implementation of a departmental induction booklet is a useful tool to improve preparedness amongst junior doctors in surgery.
338 Wide-Awake Hand Surgery in Trauma: Optimising Patient Experience and Strategies to Advance Patient Care
Authors: Shah S , Amin K , Elzaagh A , de Berker H , Bedford J 
Published: August 2023

Abstract

Background
Our regional hand trauma unit in Greater Manchester underwent significant service reorganisation from predominantly GA to WALANT early in the COVID-19 pandemic. We implemented a variety of strategies to optimise patient care and maintain adherence to national standards. Here, we present a review of these strategies.

Method
Five domains throughout the patient pathway were explored, with chi-square and student t-testing used to assess significance.

Results
‘Time-to-treatment’ compliance with national standards were maintained following reorganisation, with an improvement in compliance for extensor tendon repairs. A pre-operative information leaflet resulted in significant improvements in patient knowledge and anxiety levels. A knowledge-gap in post-operative analgesia administration amongst patients was identified and addressed through a standardised protocol and supplemental written guide to optimally manage peak post-operative pain. Additionally, the shift of our services to our ambulatory unit has resulted in a significant in reduction in our theoretical carbon footprint through reduced patient travel and gaseous anaesthesia use.

Conclusions
Despite dramatic service reorganisation to a primarily WALANT service, we have demonstrated a multi-faceted approach to optimise the patient journey, whilst upholding compliance with national standards and reducing our overall ecological footprint.
349 How a Service Evaluation Carried Out by Junior Doctors Helped the Post Pandemic Management of Lumps and Bumps
Authors: Delaney C , Driver K , Salfity L , Tawfik L , Tomasi I 
Published: August 2023

Abstract

Aim
The GI surgery department deals with many clinical conditions including lumps and bumps that affect the torso, posterior neck, groin, buttock, perianal and perineal areas. Over the pandemic it was noted that there were many referrals for ‘lumps and bumps’ at a time where theatre capacity and staffing was limited. To create a referral pathway to assess patients for suitability for referral and treatment in the secondary care setting/ to determine which lesions were suitable for treatment in the community.

Method
A review of 374 cases of lumps and bumps referred between 2019 and 2021. Various patient factors were taken in to account, as well as the size and type of lesion to determine whether it could be managed in the community under local anaesthetic.

Results
Of the total cases, 45% were deemed to be suitable for treatment in community. Of all lesion types, epidermoid cysts were most suitable for GP treatment. Patients were travelling long distances to reach the hospital and we were treating patients outside our catchment area. We also found that the average waiting time from referral until treatment for lesions managed in community was nearly 9 times shorter than when managed in the hospital setting.

Conclusions
A new referral pathway was created for all of South East London to reduce the number of lumps and bumps referred. This ultimately allowed for increased theatre capacity for more complex cases, ensured faster treatment and reduced travel distances for patients.