bluuebunny/crossref_metadata_2025_split huggingface dataset:
884 Optimising Analgesic Strategies in Patients Post-Oesphagectomy – a Systematic Review and Network Meta-Analysis of Randomised Clinical Trials
Authors: Ramjit S E , Davey M G , Ryan E J , Arumugasamy M , Robb W B , Donlon N E 
Published: August 2023

Abstract

Aim
To perform a systematic review and network meta-analysis (NMA) of randomised clinical trials (RCTs) evaluating the optimal analgesia strategy post-oesophagectomy.

Method
A Network Meta-Analysis was performed according to PRISMA-NMA guidelines. Statistical analysis was performed using Shiny and R.

Results
14 RCTs which included 565 patients and assessed 9 analgesia techniques were included. Relative to systemic opioids (SO), thoracic epidural analgesia (TEA) significantly reduced static pain scores at 24 hours post-operatively (mean difference (MD): −13.73, 95% Confidence Interval (CI): −27.01−0.45) (n = 424, 12 RCTs). Intrapleural analgesia (IPA) demonstrated the best efficacy for static (MD: −36.2, 95% CI: −61.44−10.96) (n = 569, 15 RCTs) and dynamic (MD: −42.90, 95% CI: −68.42−17.38) (n = 444, 11 RCTs) pain scores at 48 hours. TEA also significantly reduced static (MD: −13.05, 95% CI: −22.74−3.36) and dynamic (MD: −18.08, 95% CI: −31.70−4.40) pain scores at 48 hours post-operatively, as well as reducing opioid consumption at 24 hours (MD: −33.20, 95% CI: −60.57−5.83) and 48 hours (MD: −42.66, 95% CI: −59.45−25.88). Moreover, TEA significantly shortened intensive care unit (ICU) stays (MD: −5.00, 95% CI: −6.82−3.18) and time to extubation (MD: −4.40, 95% CI: −5.91−2.89) while increased post-operative forced vital capacity (MD: 9.89, 95% CI: 0.91−18.87) and forced expiratory volume (MD: 13.87, 95% CI: 0.87−26.87).

Conclusions
TEA provides optimal pain control and improved post operative respiratory function in patients post-oesophagectomy, reducing ICU stays, one of the benchmarks of improved post operative recovery.
1007 Antithrombotics in Renal and Mesenteric Arterial Disease: A Systematic Review
Authors: Mercer R , Ahmed H , Wong K , Hinchliffe R , Twine C 
Published: August 2023

Abstract

Aim
This systematic review aims to pool the literature on antithrombotic therapy for patients with renal or mesenteric arterial disease.

Method
Medline, EMBASE, Cochrane library, and the ICTRP were searched for studies comparing outcomes in atherosclerotic renal or mesenteric arterial disease for patients using antithrombotic therapy. Primary outcomes included major adverse cardiovascular events, major bleeding, and mortality.

Results
Seventeen full texts were included for narrative synthesis (2427 patients). Five studies assessed antithrombotic use for atherosclerotic renal disease. One retrospective cohort study (serious risk of bias) found antiplatelets (62 patients) reduced all-cause mortality compared to those not receiving antiplatelets (162 patients) for renal arterial disease (P = 0.01). One study (77 patients) reported no significant differences in risk of renal artery restenosis between aspirin or clopidogrel (P = 0.052), the second study (28 patients) reported aspirin was associated with increased eGFR post intervention (P = 0.006) (both high risk of bias). One randomised control trial (some concerns for bias, 100 patients) found that those receiving both abciximab platelet inhibition and embolic protection devices had reduced platelet-rich thrombi compared to those on either therapy alone (P&lt;0.01). Bleeding rates were similar between all patient groups. Twelve cohort studies (serious risk of bias) assessed antithrombotic use for mesenteric disease. Results were mixed between a reduction (3 studies) or no reduction (9 studies) in all-cause mortality.

Conclusions
Disease-specific data supporting the use of antithrombotic therapy in renal and mesenteric disease are of low-quality. High-quality data (randomised or registry) is necessary to further support current treatment recommendations.
1084 The Prognosis of Physical Function Following Ankle Fractures. a Systematic Review and Meta-Analysis
Authors: Chowdhury M 
Published: August 2023

Abstract

Aim
This systematic review and meta-analysis aims to quantify the prognosis of physical function following a traumatic ankle fracture. The purpose of the study was to review the existing literature with a view to providing essential information for patient care and also to update the existing literature for healthcare professionals.

Method
A literature search was performed for studies using electronic databases MEDLINE (Interface: EBSCOhost); EMBASE (Interface: OvidSP); CINAHL (Interface: EBSCOhost); CENTRAL (Interface: Cochrane Library.) Two reviewers searched citations for inclusion, evaluated quality of methodology, risk of bias and extracted appropriate data relating to physical function and activity limitation. A 100-point scale was used to conform the data where higher scores correlated with improved outcomes. Estimating equations of a general nature was used to conduct the meta-analysis.

Results
57 studies were included. There is significant activity limitation in the short term (6 week: mean 48.9,95% confidence interval), but it improved in the short-to-medium term (6 month: mean 73.2, 95% confidence interval.) In the long term the recovery was not as marked (12 month: mean 84%, 95% confidence interval.) The demographics that had the worst results were male and the older populations.

Conclusions
Meta-analysis demonstrated that adults with traumatic ankle fractures improve rapidly in the initial stages but the recovery plateaus and is incomplete at 24 months. Healthcare professionals may consider this information to influence patient care.
1242 Clinical Outcomes in Combined Lung-Liver Transplants vs Isolated Lung-Transplants: A Systematic Review and Meta-Analysis
Authors: Sheehan R , Wong W , Bentley T 
Published: August 2023

Abstract

Background
The combined lung-liver transplant is an infrequent but established therapy for patients with end-stage lung and liver disease. Recent evidence suggests that the liver may reduce rates of graft rejection and increase overall graft survival for cotransplanted organs.

Method
To establish a comprehensive summary of safety and efficacy data and explore whether there may be a tolerogenic effect conferred by the liver in combined lung-liver transplants (CLuLi), we systematically searched 4 databases (Medline, Embase, Cochrane, OVID Transplant library) for all studies comparing clinical outcomes between CLuLi and lung transplants alone (LTA). Key outcomes included overall survival, acute rejection and length of hospital stay.

Results
3 observational studies were deemed eligible for inclusion including a total of 21, 608 transplant patients- 86 CLuLi and 21,522 LTA. The most common indications for CLuLi included cystic fibrosis (50%) and noncholestatic liver disease (23%). 1- and 5-yr survival rates for CLuLi ranged from 80-91% and 59-84%, respectively, and were not significantly different to LTA in any of the studies. Our random effects inverse variance meta-analysis demonstrated an insignificant difference in hospital stay length for CLuLi compared to LTA (95% CI -8.10 to +19.52, p = 0.42). 1 study reported on acute rejection and found comparable rates between CLuLi and LTA (40% vs 46%).

Conclusions
Overall, this systematic review has shown CLuLi transplants to be at least as safe and effective as lung transplants alone. At present, there is insufficient quality evidence to evaluate the tolerogenic effect of the liver in CLuLi transplants.
129 Evaluating Long-Term (≫5 Years) Patient Reported Outcome Measures and Kneeling Function in Patients with Tibial Intramedullary Nails
Authors: Johnson H , Han Win Aung A , Ahearn N 
Published: August 2023

Abstract

Aim
1) To assess the long-term (&gt;5 years) patient reported outcome measures (PROMs) and kneeling ability in patients with tibial intra-medullary nails (IMNs). 2) To correlate the PROMs with superior and anterior IMN cortex protrusion, measured radiologically.

Method
129 patients, from one UK centre, were invited to participate by completing a KOOS score, Kujala score, EQ-5D-5L and a four-posture kneeling assessment. Superior and anterior IMN prominence was measured using lateral radiographs. Pearson’s two-tailed correlation test was performed using SPSS v28.

Results
45 patients responded to the questionnaire. 81.8% of patients were satisfied with their surgery. 20.5% of patients experienced daily AKP. The mean Kujala score was 80.7 (74.5, 86.8). The mean KOOS score was 83.2 (77.9, 88.5), 83.9 (78.3, 89.5), 85.8 (79.6, 92.0), 70.7 (60.8, 80.7) and 72.8 (64.8, 80.8) for symptoms, pain, daily living, sport and quality of life, respectively. Participants found the praying position and high flexion kneel the most difficult postures, with pain being the most common limiting factor. More than half of participants found all four kneeling postures easy to achieve. No significant correlation was found between the overall KOOS or Kujala score and nail-plateau distance (p = 0.408, p = 0.979), nail-anterior cortex distance (p = 0.552, p = 0.492) or the overall nail prominence (p = 0.608, p = 729).

Conclusions
AKP effects a subset of patients more than five years post-tibial IMN, limiting their ability to kneel. Most patients experience little or no pain with good knee functionality. Tibial IMN prominence does not seem to be associated with AKP in our sample.
295 Education and Training to Improve Compliance to the BOAST Guidelines on Assessing and Documenting Peripheral Nerve Status and Injury
Authors: Khirsheh O , Yusuf K , Dutta A , Serino C , Rafiq I 
Published: August 2023

Abstract

Introduction
Peripheral nerve injuries affect 2-3% of trauma patients, with potentially high morbidity, and associations with litigation. BOAST guidelines were introduced in December 2021 outlining standards in assessing and documenting neurovascular status in trauma patients. Key elements included nerve-specific documentation and assessments pre- and post-interventions such as manipulation.

Aim
This project assessed departmental performance against the BOAST standards, then presented the results to both orthopaedic and emergency departments, as well as setting up teaching sessions to orthopaedic junior doctors in the assessment of neurovascular status and updating awareness on the guidelines.

Method
50 patient records were analysed retrospectively for the first arm, and 50 records prospectively for the second arm. Acute trauma presentations with a risk of peripheral nerve injury met the inclusion criteria. Intervention included practical senior-led teaching on clinically assessing neurovascular status, and the importance of detailed documentation, as well as when to repeat the examination.

Results
Results were improved drastically from initial audit against standards to post-intervention audit; documentation improved from 70% to 95% (n = 50 for both arms), with appropriate detail in documentation improving from 11% to 49%.

Conclusions
Neurovascular status is critical to be documented in detail, both pre and post-interventions. By using BOAST guidance as a standard, the initial inadequacies of the departmental practice were highlighted, and significantly improved through active teaching, distribution of the guidelines, raising the standards, clinical assessment, and documentation, thus improving patient care, and robustness of legal documentation.
302 A Systematic Review and Meta-Analysis of Intra-Articular Injections for Base of Thumb Osteoarthritis
Authors: Thakker A , Hau M , Ramchandani J , Johnson N , Dias J 
Published: August 2023

Abstract

Aim
Current literature is equivocal surrounding intra-articular injections for the treatment of thumb base osteoarthritis (TBOA), which is reflected in national and international guidelines. This systematic review assesses the effectiveness of different intra-articular injections for TBOA on pain and functional outcomes.

Method
MEDLINE, EMBASE, Cochrane Central Register of Control Trials and CINAHL databases were searched from inception to April 2022. Randomised controlled trials and comparative case series which investigated an injection-based intervention with any comparator/s were included. The protocol was registered to PROSPERO (CRD42022337265).

Results
Fifteen studies were included in the descriptive analysis of this review, with 4 included in the meta-analysis. From the intra-articular injection therapies, hyaluronic acid (HA) in 11 studies, corticosteroid (CS) CS in 10 studies, platelet-rich plasma (PRP) in 2 studies, dextrose (DX) in 1, HA mixed with NSAID in 1 study and placebo (saline) in 3 studies. Meta-analysis of visual analogue scale (VAS) showed that there was no statistically significant improvement in pain in the short-, medium- or long-term time points between HA vs CS injection therapies. Meta-analysis of functional outcomes showed an improvement in function with HA vs CS ((standardised mean difference (SMD) −1.05, 95% CI −1.43 to −0.68)) at the long-term time point. No significant adverse effects were reported.

Conclusions
There is no superior type of intra-articular injection for improving pain and limited evidence for HA for improving function. The choice of injection should be based on availability, guidelines and cost-benefit analysis until further methodologically robust trials can be completed.
429 Service Evaluation of the Royal Orthopaedic Hospital Bone Infection Service in Patients with Spinal Infections, Both Native and Following Surgery - Five Years of Experience
Authors: Nam R , Gardner A , Hughes S , Jenkins N 
Published: August 2023

Abstract

Aim
The Royal Orthopaedic Hospital Bone Infection Service (ROH BIS) is one of the four formal bone infection services in the United Kingdom, providing multidisciplinary care and community support for patients with bone infection. This service evaluation is to document burden, pattern of infection and subsequent treatment by the ROH BIS in treating those with spinal infection, both native and following spinal surgery.

Method
This is a retrospective analysis of spinal infections treated from 2017-2022 at the ROH BIS. Clinical, MDT and investigation notes were reviewed for demographics, comorbidities and details of identification and management of the infection.

Results
39 patients (median age = 63, IQR = 34, male = 46.2%) were identified. 23 patients had previous metal implanted, 16 did not. The infection rate in ROH spinal surgery is 3%, 15 infections were native, and 24 were iatrogenic. Cardiovascular-related disease (38.5%) is the most common comorbidity. The mean time taken to identify a bone infection and infectious organism was 1.5 days and 4.0 days. Enterobacteriaceae (33.3%) and Staphylococcus Aureus (20.5%) were most commonly identified. Recurrent infection rate was 5.1%, and 5 (21.7%) cases required removal of implant. The mean number of MDT meetings for each patient is 1.7 meetings, and the mean extra hospital stay is 20 days.

Conclusions
Infections following spinal surgery are well managed by the multidisciplinary ROH BIS model. Rapid referral acceptance, strict diagnostic sampling criteria and specialised nursing care enabled precise management and lessened the burden of reoperation or metal implant removal on patients
535 A Case Report of a Rare Post Traumatic Infected Regenerate Following Corticotomy for Lengthening Following a Frame Ankle Fusion
Authors: Haq L , Thomson L , Wright S , Bose D 
Published: August 2023

Abstract

Introduction
We present a case of a 49-year-old patient who initially presented in May 2020 with an open pilon fracture. Managed with initial debridement, fixation, and flap - who subsequently underwent circular frame application for failure of fixation, requiring a transport to fusion frame who developed beta-haemolytic streptococcus A within the site of the proximal corticotomy.

Method
A systematic review of the literature was conducted searching EMBASE, MEDLINE and Cochrane library for all articles discussing infected bone regenerate- a paucity of information was found. Abstracts were independently reviewed by 2 authors (LH and LT). In total, there were 16 papers, and then subsequently analysed we identified two case reports regarding infected regenerate.

Results
Developing an infection in a regenerate is highly rare with very few reported cases within the published literature. The literature identified risk factors for an infected regenerate, with open fracture and smoking being the two consistent factors. The open fracture deep infection rate is cited at 10% in most publications, this is at the site of the open fracture and not within the regenerate.

Conclusions
Infection within the regenerate during distraction osteogenesis is highly unusual, with only two other published papers in the literature to the best of our knowledge. This should be borne in mind when managing patients with infection of unknown sources in cases of distraction osteogenesis.
577 Risk Factors Associated with the Reported Scores on Symptoms Severity and Functional Limitations Scales of the Boston Carpal Tunnel Questionnaire: A Cross-Sectional Study
Authors: Al-Jasim A , Sarhan F , Al-Abbasi G , Ali A B , Alaraj R S N , Yasin D , Macciacchera M , Bouchard M , Ibrahim I K 
Published: August 2023

Abstract

Aim
We aim to identify risk factors associated with higher scores of CTS symptoms severity and functional limitations on the BCTQ.

Method
This cross-sectional study was conducted among 366 female participants. The data was mainly collected using the BCTQ. Demographics and risk factors of CTS were added to the study's complete questionnaire; Risk factors included: Rheumatoid Arthritis (RA), Diabetes Mellitus (DM), hypothyroidism, number of pregnancies, usage of Oral Contraceptive Pills (OCPs), use of smartphones and keyboards. A P-value of &lt; 0.05 was considered statistically significant.

Results
Most participants were in their thirties (44%) and housewives. RA, DM, hypothyroidism, and pregnancy were associated with reporting symptoms and functional limitations on BCTQ. OCPs and smartphone use were associated with functional limitations only.

Conclusions
Different risk factors are associated with reporting symptoms and functional limitations of CTS on the BCTQ. For example, RA, DM, hypothyroidism, pregnancy, OCPs and smartphone use have all been found statistically affect the outcome of the BCTQ in this study. Clinical confirmation of CTS diagnosis is required in future studies to make sure that these symptoms and functional limitations are associated with CTS pathology itself rather than other risk factors pathologies for proper targeted treatment plans and outcomes.
653 Evaluating the Effectiveness of Osseointegration for Traumatic Lower Limb Amputations: A Narrative Review
Authors: Adebayo O , Ahmed Z 
Published: August 2023

Abstract

Aim
Major trauma to the limbs often results in amputation and can have a debilitating effect on an individual’s physical and psychological health. Currently, the conventional management to remediate the consequences of limb amputation is a Traditional Socket-mounted Prosthesis (TSP) for the affected limbs. However, its use is associated with various complications, such as skin ulcers, increased fracture risk, nerve pain, and heterotopic ossification. To address this, a novel approach known as osseointegration; a procedure in which an artificial implant is surgically integrated and anchored into residual bone, has been developed.
This narrative review aims to primarily evaluate the efficacy and functional outcomes of lower limb osseointegration compared to TSP.

Method
A literature review was performed to identify and analyse studies addressing the efficacy, functional outcomes, and complications of lower limb osseointegration prosthesis compared to TSP. Studies were summarised according to type of osseointegration prosthesis, number of surgeries required, and amputation location.
Data on efficacy, functional outcomes, and complications of patients with osseointegrated prosthesis was extracted.

Results
Six studies were chosen for critical analysis of the primary and secondary aims. All studies reported osseointegration conferred significant improvements in mobility, walking capability, walking speed, quality of life, prosthesis comfortability, prosthetic control, and prosthetic use. Complications reported were mild infection, phantom limb pain and periprosthetic fractures although incidences were rare.

Conclusions
Osseointegration has been shown to increase prosthetic use, improve confidence, walking ability, and mobility. Complications are mild and easily treated. Overall, there is sufficient evidence to suggest osseointegration could become standard management for lower-limb amputations.
684 Lateral Extra-Articular Tenodesis Versus Anterolateral Ligament Reconstruction Lateral Augmentation for Primary Anterior Cruciate Ligament Reconstruction with Minimum 2- Year Follow-Up: A Systematic Review and Meta-Analysis
Authors: Abdelmoneim A , Shannon F 
Published: August 2023

Abstract

Background
Lateral augmentation (LA) of anterior cruciate ligament reconstruction (ACLR) aims to improve the anterolateral stability of the knee and patient functional outcomes while reducing complication rates. Despite growing evidence and popularity, there have been no studies directly comparing the main two methods of LA; Lateral extra-articular tenodesis (LEAT) and Anterolateral ligament reconstruction (ALLR).

Aim
To establish level I evidence by assessing studies with minimum two-years follow-up investigating LEAT and ALLR patient-reported outcome measures (PROM) and post-operative complications.

Method
This is a systematic review and meta-analysis conducted in accordance with the PRISMA guidelines. The primary investigators (AA/FS) on August 1st, 2022 undertook a comprehensive systematic review of electronic databases. Studies that met our inclusion criteria were selected.

Results
14 studies were included in our study with a total of 2374 patients. 1273 patients were included in the LEAT studies (666 male, 607 female) and 1101 in the ALLR studies (818 male, 283 female). Statistically significant improved PROM were found in the LEAT group for postoperative International Knee Documentation Committee Scores (MD 2.31; 95% CI: 0.54 – 4.09, P = 0.01), Tegner Activity score (MD 0.79, 95% CI: 0.58 – 0.99, P&lt;0.01), and for both the ALLR (MD 1.43, 95% CI: 0.33 – 2.52, P = 0.01) and LEAT (MD 4.07, 95% CI: 2.67 – 5.47, P&lt;0.01) groups for Lysholm scores. LEAT and ALLR are associated with reduced graft re-rupture risk and improved postoperative knee stability.

Conclusions
LA is associated with improved PROM, knee stability, and functional outcomes when compared to iACLR. No differences were found between LEAT to ALLR.