bluuebunny/crossref_metadata_2025_split huggingface dataset:
977 The Impact of Post-Mastectomy Radiotherapy on Immediate Free Flap Breast Reconstruction
Authors: Suhail D , Brennan C , Akali A 
Published: August 2023

Abstract

Aim
Radiotherapy following free flap breast reconstruction has historically been thought to increase complication rates, worsen patient reported outcomes (PROs) and lead to poorer cosmetic results. We aim to assess the impact post-mastectomy radiotherapy (PMRT) has on immediate free flap breast reconstruction using these variables, with patients acting as inherent controls.

Method
We conducted a retrospective cohort study on all patients receiving immediate bilateral free flap breast reconstruction followed by unilateral radiotherapy between 2008 and 2022. Complication rates were assessed by comparing prevalence of fat necrosis, volume depletion requiring lipofilling, and flap loss among irradiated vs non-irradiated breasts. PROs were assessed by comparing “Satisfaction with Breasts” and “Chest Physical Well-Being” (two sections of the Breast-Q survey) among irradiated vs non-irradiated breasts. Cosmetic outcomes were assessed by scoring postoperative pre-radiotherapy and postoperative post-radiotherapy patient images using “Objective Breast Cosmesis Scale” (OBCS) and “Harvard Breast Cosmesis Scale” (HBCS).

Results
9 patients underwent immediate bilateral free flap breast reconstruction followed by unilateral radiotherapy. Median age was 40 years (IQR 32-44). Complication rates did not vary significantly between irradiated and non-radiated breasts. “Satisfaction with Breasts” did not vary significantly between irradiated and non-radiated breasts; however, “Chest Physical Well-Being” did vary significantly between both breasts. Cosmetic outcomes did not vary significantly between pre-radiotherapy and post-radiotherapy images.

Conclusions
PMRT following immediate free flap breast reconstruction does not have significant deleterious effects on complication rates, patient satisfaction with breasts or cosmetic outcomes. However, radiotherapy has a significant effect on patient’s chest physical well-being, hence we aim to study this further.
980 The Impact of Anticoagulant, Antiplatelet, and Nonsteroidal Anti-Inflammatory Drug (Nsaid) Use on Faecal Immunochemical Testing Measurements in Fast Track Referral Patients
Authors: Suhail D , Elbeltagi A , Lim M 
Published: August 2023

Abstract

Aim
Faecal immunochemical testing (FIT) has been used as a prioritisation tool and diagnostic adjunct for detection of colorectal cancer (CRC) patients on the fast-track pathway. Many patients referred through the pathway are on medications associated with gastrointestinal bleeding. We chose to study the impact of such medications on FIT measurements.

Method
A retrospective review of patients between March 2020 and August 2022 was conducted. Data on patient demographics, medication use, FIT results and colonoscopy findings were gathered. Patients who did not undergo further investigations and patients diagnosed with CRC were excluded. Patients with a FIT measurement greater than 7μg of haemoglobin/gram of faeces were deemed positive. Chi squared test was used to compare the proportion of patients with a positive FIT in those who were and were not on the above medications. A p-value of &lt;0.05 was deemed significant.

Results
There were 1668 (778 male) patients. Median age was 71 (IQR 62-78) years. CRC was detected in 92 patients. In the 1576 patients without cancer, 164 (10.4%) were on anticoagulants, 242 (15.4%) were on antiplatelets and 82 (5.2%) were on NSAIDs. A significantly greater proportion of patients had a positive FIT when on anticoagulants compared with those who were not (40% vs. 23%, p-value = 0.00). Use of antiplatelets or NSAIDs had no impact on FIT measurements (29% vs 24%, p-value = 0.32 and 18% vs 25%, p-value = 0.36).

Conclusions
Anticoagulants can impact FIT measurements, hence thresholds for a positive result may need to be altered for these patients. We seek to study this further.
985 The Temporal Changes in the Urine of Severe Traumatic Brain Injury Patients
Authors: Cetin M 
Published: August 2023

Abstract

Aim
Neuroinflammation is a secondary injury mechanism that contributes to significant mortality and morbidity with severe traumatic brain injury (TBI). This study aimed to evaluate the temporal neuroinflammatory pattern of the ionised calcium-binding adaptor molecule 1 (Iba1) and transmembrane Protein 119 (TMEM119) microglia marker proteins in the urine of severe TBI patients for 7 days post-injury.

Method
Urine samples were acquired from fifteen patients with severe TBI upon hospital admission and the subsequent 7 days post-injury. Western blot analysis was used to quantify the urinary levels of Iba-1 and TMEM119 expression in each sample. The patients were stratified by functional outcomes (group 1, death- vegetative state; group 2, moderate-to- severe disability; group 3, good outcomes).

Results
Iba1 was detected in all (100%) whilst TMEM119 was detected in 65% of acquired urine samples. The mean total normalised Iba1 expression increased for group 2 whilst the opposite response was observed for groups 1 and 3. The mean total normalised TMEM119 expression decreased for group 3 whilst the opposite response was observed for groups 1 and 2. However, these findings were not statistically significant. No significant differences were found in Iba1 or TMEM119 expression between favourable and unfavourable outcome groups.

Conclusions
Overall, this study cannot associate urinary Iba1 or TMEM119 expression with functional outcomes. However, the presence and temporal patterns of the urinary microglia markers suggest it may be reflective of the underlying neuroinflammatory process and merits further studies.
1051 Procedure-Specific Consent Forms in Clinical Practice: A Systematic Review
Authors: Norvill J , Bent C , Mawhinney J , Johnson N , Bainbridge C 
Published: August 2023

Abstract

Aim
Consent forms play an active role in the consent process. Generic, hand-written consent forms are used as the standard across the NHS. However, increasingly procedure-specific consent forms (PSCF) are being used as an alternative. Their proponents suggest PSCF improve the consent process however concerns remain about whether they meet the standard for consent. We therefore conducted the first review evaluating the use of PSCF in clinical practice and give suggestions regarding their future use.

Method
A literature review was conducted via PubMed using the key terms ‘pre-printed consent form’ and ‘procedure-specific consent form'.

Results
Few studies investigating PSCF in clinical practice were identified including no systematic reviews. Most studies identified were quality improvement projects. However, no studies assessed the role of PSCF in litigation after procedural complications. PSCF were associated with improved legibility, documentation and patient understanding versus generic consent forms. PSCF generally improved documentation of procedure-specific complications and risks versus generic consent forms. PSCF are not routinely used in clinical practice and are not endorsed by the Department of Health and Royal College of Surgeons. There is no definitive legal guidance attesting to their use in the consent process, despite concerns their use will lead to procedures and associated complications not being fully explained to patients.

Conclusions
Evidence supporting the use of PSCF is available however it is heterogeneous and substantial legal concerns remain. Additional, high-quality studies evaluating their use is warranted, including their impact on medico-legal claims. Finally, a collaborative approach between clinicians and those within the legal profession is necessary.
1110 Reconstructing the Stereotype - a Systematic Review of Medical Students’ Perceptions, Awareness, and Influences for a Career in Plastic Surgery
Authors: Petmeza C A , Georgiannakis A , Glynou S P , Zargaran A , Zargaran D , Mosahebi A 
Published: August 2023

Abstract

Aim
This systematic literature review evaluates medical students’ knowledge and perceptions of plastic surgery as a primary outcome, whilst identifying barriers and facilitators to choosing a career in plastic surgery as a secondary outcome.

Method
A systematic literature search was conducted on EMBASE, PubMed, PsychInfo and Web of Science according to the PRISMA statement. Three independent reviewers screened the studies on COVIDENCE to set inclusion and exclusion criteria. Cochrane and STROBE checklists were used for risk of bias assessment as well as a qualitative and quantitative synthesis of the results.

Results
A total of 17 studies were included after inclusion and exclusion criteria were applied. The most frequently reported negative perceptions concerned a focus on non-life saving cosmetic procedures, with little variety and the salience of financial incentives. Positive perceptions included financial benefits, skills, and challenging specialty. Studies after 2010 identified social media as a significant determinant of perception and awareness of plastic surgery, whilst studies prior to 2010 suggested that lectures and student-surgeon interaction were the primary influence. Plastic surgery courses or rotations had a positive effect on perceptions, awareness, and interest in the specialty.

Conclusions
There is a lack of knowledge of the breadth of plastic surgery driving negative perceptions, with greater awareness of cosmetic surgery amongst medical students. Social media is an important influencer of student perception of plastic surgery. Greater positive exposure to plastic surgery and its subspecialties both in medical school and on social media may represent an important avenue for future recruitment to the specialty.
1165 National Surgical Undergraduate Peer-to-Peer Teaching Course. Analysis and Insight From Feedback for Predictors of Teaching Success
Authors: Zhang J , Stevenson A , Boylan C , Rawlins E , Zhu J 
Published: August 2023

Abstract

Aim
Throughout the COVID-19 pandemic, ward-based teaching to medical students has been disrupted. Remote teaching platform options have emerged and encourage inter-regional collaborations in learning. This style is likely to remain. We report on our course and elucidate factors that could guide iterative improvement.

Method
The authors organized a 12-week, 36-session teaching course for medical students nationally. Each week, one university representative recruited three students to deliver topics on a surgical specialty to a national audience. Anonymized information about pre/post-session subject confidence, quality of teaching, relevance and usefulness was collected in a Likert type 1-10 scale and analysed.

Results
A total of 176 responses were noted for the first 9-week portion of the course. On paired t-test, there was an increase (mean = 2.9,s.d = 1.5,p&lt;0.001) in confidence post seminar. Pre-(p&lt;0.001) and post-(p&lt;0.001) course confidence, perceived quality of teaching (p = 0.029), relevance to course (p&lt;0.001), usefulness for exam preparation (p&lt;0.001), and right level taught (p&lt;0.001) were all positively associated with higher year groups. Percentage increase in confidence was negatively associated with year group (p = 0.001). Single teacher sessions had higher absolute (p = 0.011) / percentage (p = 0.020) change in confidence, perceived quality of teaching (p&lt;0.001) compared to two teacher led sessions.

Conclusions
Online, inter-regional peer-to-peer teaching provides an invaluable way of providing medical education during and beyond the global pandemic. Our analysis elucidates different factors that may have an effect on teaching effectiveness and outcome. We hope these insights will guide us for the remainder of the course, as well as similar courses for the readers organised in the future.
282 Radiological Features Predicting Shunt Response in Normal Pressure Hydrocephalus, a Systematic Review and Meta-Analysis
Authors: El-Khatib M , Thavarajasingam S G , Vemulapalli K , Iradukunda H A S , Vishnu K S , Borchert R , Russo S , Eide P K 
Published: August 2023

Abstract

Aim
To produce a systematic review and meta-analysis to identify radiological features that predict shunt response in normal pressure hydrocephalus (NPH), evaluate their effectiveness and therefore recommend the most predictive feature.

Method
The authors searched MEDLINE, Embase, Scopus, PubMed, Google scholar and JSTOR databases for all original studies investigating NPH radiological features that predict shunt response. Selected studies were assessed with ROBINS-1 tool and included studies were evaluated by a univariate meta-analysis.

Results
301 full text papers were selected from screening, 28 studies were included, and 26 features were identified, of these 5 were selected for the meta-analysis based off the inclusion criteria: disproportionately enlarged subarachnoid space (DESH), callosal angle, periventricular white matter changes, cerebral blood flow (CBF), and computerized tomography cisternography. The diagnostic odds ratios of colossal angle (1.88) and periventricular white matter changes (1.01) showed they were significant differentiators between shunt responders from non-responders. None of the other features could differentiate between the two.

Conclusions
Colossal angle and periventricular white matter changes are the only statistically effective features which can identify shunt responders. Their role, however, may be overstated as their DORs approximate 1, therefore it is advised they be used in combination with other diagnostic predictors, such as clinical tests, of shunt responders. More research is required to evaluate the combined use of multiple radiological features together.
814 Bifrontal Craniectomy and Reconstruction with Synthes - a Surgical Approach for the Management of Symptomatic Hyperostosis Frontalis Interna
Authors: Matthews J , Matthews M , Randle J 
Published: August 2023

Abstract
57-year-old Caucasian female presented with depression, apathy, and personality changes with a markedly “flaccid face”. A computerized tomography (CT scan) revealed remarkable bilateral hyperostosis frontalis interna with significant frontal lobe compression. A definitive operative procedure with bilateral craniotomies was undertaken to relieve frontal compression and prevent further complications.
During surgery, the bone flaps were found to be very hard to cut through with a craniotome or even a drill. The procedure was further complicated by dense adherence to the underlying dura. Craniotomy was eventually completed with multiple drilling efforts. Trimming down bone flaps proved to be difficult, thus they were not replaced back and were elected to be removed. Dura was covered with DuraGen and the galea was closed without the skull plates. Postsurgical imaging was done and synthetic bone plates made by “Synthes” were placed in a second-stage procedure. The patient recovered without significant focal deficits and remained stable at six months with an improved mental state. Pathology showed benign hyperostosis.
This case highlights the difficulties of the surgical management of this rare case and discusses the improvised techniques adopted for the successful completion of the procedure with excellent outcomes.
1316 Chronic Epidural Hematoma: A Systematic Review and Meta-Analysis
Authors: Agada N , Bankole N D A , Badirou O B A , Nyalundja A D , Dossou M W , Lawson L D , Obame F L O , Murhega R B , Togbenon N D L , Emeka A C , Dokponou Y C H 
Published: August 2023

Abstract

Background
Epidural hematoma constitutes a common condition in neuro-traumatology. If its acute form is well known, the chronic one remains less described. In this study, we aimed to evaluate the epidemiology, presentations, management, and outcomes of chronic epidural hematoma (CEDH).

Method
Systematic searches of PubMed, Google Scholar, and ScienceDirect were performed from a database searching for all studies reporting CEDH. Pooled statistics were calculated using measures of central tendency and spread.

Results
Totally, 3009 studies were identified, of which 95 were included with 359 patients. CEDH was more common in intracranial than spinal (91.9% vs 8.1%). The average age of onset was 37.2 +/- 4.83 years. The common cause found was trauma (n = 279; 77,72%) with 271 (97.1%) cases for the head and 8 (2,9%) cases for the spine. The median delay between the trauma and the first symptoms was 13.31 +/- 3.43 days in intracranial level and 16.37 +/- 5.87 days in spinal level. CT-scan constituted the main diagnosis tool. The lesion was predominantly located in the temporal region at the intracranial level and lumbar region at the spinal level. Craniotomy and laminectomy constituted the most reported treatment option respectively at the intracranial and spinal level. The outcome was commonly uneventful. Correlation and Regression test for publication bias assessment show no significant Funnel plot asymmetry with high p-value (p = 0.8458 and p = 0.9596, respectively).

Conclusions
There was no clear risk factor found for CEDH. The treatment was mostly surgical.
220 A Systematic Review on Under-Recognized Condition: Duodenogastric Reflux After Cholecystectomy
Authors: Win M , Htet W , Sanyal J , Sanyal S 
Published: August 2023

Abstract

Aim
About 66,660 cholecystectomies are performed yearly in the UK. Dissatisfaction rates following surgery range from 7-41% and abdominal pain can persist post-operatively in 33% of cases according to literature. Duodenogastric reflux (DGR) has been suggested as a cause of persistent symptoms after cholecystectomy. Our study was the first systematic review to assess the DGR after cholecystectomy.

Method
Medline, Embase, and Cochrane were searched by two independent researchers up to June 2022. Eligible studies were appraised on correlation between DGR and post-cholecystectomy symptoms as well as on how DGR was diagnosed and managed.

Results
Initial 379 records were identified and screened leaving 11 papers in total. Out of included papers (2013-2022) studying 1334 patients from seven different countries, there were 2 randomised controlled trials (RCT) and 9 observational studies. The average Newcastle-Ottawa scale for observational studies was 6. Included RCTs had low to some risks of bias. Only 1 study could correlate between DGR and post-cholecystectomy symptoms. Six studies identified alkaline reflux and gastritis with combined investigations after cholecystectomies. The gold-standard investigation was yet to be identified although gastroscopy was commonly used. Single or combined medications were better than no treatment for DGR.

Conclusions
DGR induced gastritis was confirmed with investigations in this study. However, further research is required to prove extensive DGR related symptoms after cholecystectomy. There were limitations such as having more observational studies than RCT and having small samples in some studies. More substantial studies with great randomization and longer duration of follow up are recommended for future studies.
584 Extended VTE Prophylaxis in Patients Undergoing Oesophagogastric Cancer Surgery
Authors: Kuan J Y , Liew Y Y , Van Staa S , Turner P , Pursnani K , Ward J , Ball C , Shetty V D 
Published: August 2023

Abstract

Aim
Venous thromboembolism (VTE) is a life-threatening complication in cancer patients undergoing surgery. NICE recommends VTE-prophylaxis to 28days for patients undergoing major abdominal cancer surgery. The efficacy of in-hospital VTE-prophylaxis is well-documented, but the optimal duration of postoperative VTE-prophylaxis remains controversial. Patients undergoing oesophagogastric cancer surgery have a higher risk of VTE due to suboptimal oral intake, dehydration, need for adjuvant and neoadjuvant chemotherapy. Hence in 2014, extended VTE-prophylaxis to 28days from hospital discharge (HD) was adopted as a departmental policy. This study aims to evaluate its effectiveness, prescribing compliance and safety.

Method
This is a 10-year retrospective study from July 2012-2022. All patients who underwent cardio-oesophagectomy or gastrectomy for oesophagogastric cancers were included. Patients who died during the index admission, benign oesophagogastric surgery including excision of GIST, and central line associated VTE were excluded. The primary outcome is prescribing compliance with 28-day VTE prophylaxis from HD. The secondary outcome includes the incidence of VTE and bleeding complications requiring hospital readmission within 28days from HD.

Results
582 patients were included in our study. Since 2014, 423/490patients (86.3%) have been discharged with 28days VTE-prophylaxis from HD compared to pre-2014 (13/92patients,14.1%). There was a statistically significant difference in improving prescribing compliance following the introduction of this policy (p&lt;0.05). No patient was readmitted due to bleeding complications. Only 1 patient (1/582,0.17%) developed VTE within 28days from HD.

Conclusions
We recommend extending VTE-prophylaxis for 28days from hospital discharge for all patients undergoing oesophagogastric cancer surgery. This improves prescribing compliance, reduces the incidence of post-discharge VTE and is safe.
713 The Role of Enteral Feed Composition on Chyle Leak Prevalence and Severity in Post-Oesophagectomy Patients
Authors: Pan S , Bushra R , Cheah L , Ribbits A , Grimes S , Bennett J , Hindmarsh A , Safranek P , Sujendran V , O'Neill R 
Published: August 2023

Abstract

Aim
Chyle leak presents as an uncommon yet significant complication for post-oesophagectomy patients. This study aims to evaluate the role of enteral feed in the prevalence and severity of chyle leaks post-oesophagectomy.

Method
We identified 334 patients who underwent an open or minimally invasive oesophagectomy for oesophageal cancer at a single institution between 2015-2022. The prevalence, classification (ECCG scale) and respective management of chyle leaks were retrospectively recorded. Patients who had significant post-operative complications and did not start enteral feed on post-operative day 1 were excluded from the study.

Results
The median age at operation was 68 (31-82), of which 82% comprised of males. In patients who were started on Nutrison standard feed (high energy or high protein), 22% of patients developed a chyle leak (ECCG IA – IIB). In contrast, in patients who were initially started on Nutrison high energy and high protein feed (HEHP), 11% developed a chyle leak (ECCG IA-IIA). All cases were initially managed conservatively (ECCG I) with a success rate of 81%, before escalating to parenteral nutrition. Moreover, patients with a chyle leak demonstrated an increased length of stay (14.4±7.4 days) in comparison to patients without a chyle leak (12.3±8.7 days; p = 0.03).

Conclusions
The heterogenous management of post-oesophagectomy patients is heavily influenced by centre and surgeon-specific preferences. This study suggests a potential correlation between enteral feed composition and its role in preventing and minimizing chyle leaks following an oesophagectomy. Further prospective, multicentre studies are required to elucidate an optimal nutritional approach in managing post-oesophagectomy patients.