bluuebunny/crossref_metadata_2025_split huggingface dataset:
967 Scrubbing Up: A Drain on Sustainability
Authors: Yoganathan S , Zabkiewicz C , Jones T , Shingles L 
Published: August 2023

Abstract

Aim
Surgical scrub is a vital step in infection control prior to operating. Hospitals typically opt for a traditional tap or a sensor-operated tap to control their water source. This project compared the water usage and efficiency per surgical scrub for the two different taps.

Method
Theatre system was reviewed to determine total number of staff members who scrubbed in for each operation, over a one-month period within one health board. Average scrubbing time and quantity of water used per scrub was calculated by observing multiple different staff members.

Results
During September 2022, 6076 staff members scrubbed in for theatres. The average time spent handwashing was 2 minutes and 26 seconds, however only 47 seconds worth of running water was used to wash their hands. Sites using traditional taps used approximately 18.6L of water whilst sensor-operated taps used 13.2L per surgical scrub. This equated to 110,752 litres of water used over the month solely for scrubbing up. Sensor-operated taps would run for 63 seconds when activated with the modal number of times sensors were activated 3. Therefore, traditional taps were more efficient with 32% of running water used for surgical scrub compared to 25% for sensor-operated taps.

Conclusions
Sensor-operated taps used less water per surgical scrub; however, the operating time of the taps reduced its efficiency. Coordinating scrubbing up and ‘sharing’ one tap or adjusting the sensor taps operating time are simple step to minimise water wastage. Furthermore, the use of ‘waterless scrub’ solution is a viable option whilst also minimising infection risk.
317 A Systematic Review of Quality-of-Life Instruments in Acute and Chronic Pancreatitis: A Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) Approach
Authors:   STARSurg Collaborative
Published: August 2023

Abstract

Aim
To identify and evaluate the methodological quality of the quality of life (QoL) instruments used for patients with acute or chronic pancreatitis.

Method
Prospective studies that evaluated QoL in acute or chronic pancreatitis were identified from systematic review of MEDLINE, EMBASE, and Web of Science until 5th August 2021 (PROSPERO: CRD42021274743). Characteristics of QoL instruments were extracted, and their methodological quality assessed using COSMIN guidelines and GRADE approach. A narrative synthesis was conducted, with recommendations for instrument use based on COSMIN criteria regarding internal consistency and content validity (evaluated according to WHO QoL domains: physical health, psychological health, social relationships, level of independence, environment, and personal values).

Results
From 3850 records screened, 43 QoL instruments were identified across 131 studies included, involving 20,331 patients. The majority (69.8%, n = 30) were designed to assess general health related QoL, with 7 (16.3%) specific to abdominal pathologies, and 6 (14.0%) specific to chronic pancreatitis. Approximately half of the instruments (51.1%, n = 22) demonstrated sufficient content validity, incorporating items in ≥3 WHO QoL domains. However, only a minority of instruments incorporated public and patient involvement (34.8%, n = 15) or had undergone validation (22.3%, n = 10). Only the “Gastrointestinal Quality of Life Index” met the criteria to be recommended for use based on COSMIN methodological assessment.

Conclusions
There is significant heterogeneity in instruments used to assess QoL after pancreatitis, with almost all studies incorporating instruments with either insufficient methodological quality or construct validity. Robust, validated, and relevant instruments are needed to better understand and determine appropriate interventions to improve QoL for these patients.
373 Scoping Review: Definition of Major Abdominal Surgery
Authors: Clymo J , Dorudi Y , Courtney A , Dorudi S , Moonesinghe S R 
Published: August 2023

Abstract

Aim
The aim of this scoping review was to propose a definition major abdominal surgery (MAS).

Method
We searched the following databases: Medline, EMBASE, Web of Science, Global Health, Health Management Information Consortium, APA PsycInfo. Original research articles, systematic reviews or meta-analyses published between 1980 and 26 April 2022 were included in this scoping review. Inclusion criteria consisted of: specific reference to the operation, adult population, treatment within secondary care, and availability of full text. Three authors assessed each article’s eligibility for inclusion.

Results
5,663 articles were identified in our search, of which 767 underwent full-text review and 312 were included in the scoping review. Half of the included articles were observational trials (54.5%) and one third were randomised control trials (37.8%). A significant proportion of studies were conducted in Europe (47.4%) or North America (19.2%), with a minority of studies conducted in the UK (4.5%). Just under half of these studies were led by anaesthetists (47.4%) rather than surgeons with 45.8% of studies focused on post-operative care and outcomes. Analysis of these studies revealed that the description of major abdominal surgery fell into 4 broad categories: anatomical criteria, procedure-based criteria, specialty-specific resections, and arbitrary procedures.

Conclusions
We established that there is no agreed definition of major abdominal surgery. We propose that any definition of major abdominal surgery should be based on anatomical criteria alone. Research is underway to confirm a difference in the post-operative recovery profiles of patients undergoing MAS and non-MAS procedures as per our classification.
1058 Jejunal or Ileal Exocrine Drainage in Pancreas Transplantation?
Authors: Tan J , Doherty D , McFarlane R , Kingston J , Moinuddin Z , Khambalia H , Augustine T , van Dellen D 
Published: August 2023

Abstract

Aim
Pancreas transplantation (PT) is performed for restoration of endocrine function in type 1 diabetes mellitus with amelioration of diabetic complications. However, PT can have serious complications requiring salvage pancreatectomy and surgical approaches should be carefully considered. Anastomoses to jejunum or ileum are most often employed. We compare outcomes between these techniques.

Method
A retrospective analysis was performed on simultaneous pancreas and kidney transplants (SPK) at Manchester University Hospitals NHS Foundation Trust between 2013 and 2015. Follow up was completed until 2020.

Results
86 SPK were performed. 59.2% were male with mean age of 41.5yo (SD±8.4). 72.4% (n = 55) were donors after brain death and 98.7% (n = 75) were receiving first PT. 43 SPK were performed with ileal anastomosis, 33 jejunal. There were no significant differences in demographics of recipients, donors, immunosuppression regimens, overall patient and graft survival and frequency of GI complications. Length of hospital stay was higher with ileal anastomosis (median 14 v 19 days, p&lt;0.05), as was cold ischaemic time (median 8:48 v 9:31 hours, p&lt;0.05). Three patients required salvage pancreatectomy and loop ileostomy formation with multi-organ support and prolonged ITU stay.

Conclusions
Long term outcomes between groups were comparable in this cohort. Catastrophic complications occur in the minority requiring salvage surgery. Here more occurred with ileal anastomosis, but this approach allows graft pancreatectomy and formation of loop ileostomy, avoiding a more proximal stoma in a clinically unstable patient. Further powered studies are required to rigorously examine the impact of enteric anastomosis site.
104 Audit on Adherence to the BOAST Guidelines on the Safe Use of Intraoperative Tourniquets
Authors: Dosani S , Devarakonda S 
Published: August 2023

Abstract

Aim
Tourniquets can prevent blood loss and improve the surgical viewing field however incorrect use leads to local tissue damage and production of harmful metabolites, causing further damage. The aim of this audit was to investigate the usage of correct tourniquet techniques during intraoperative procedures, comparing them to updated BOA guidelines.

Method
Conducted a retrospective clinical audit documenting discrepancies between operation notes/data against BOA standard guidelines. All procedures, both elective and emergency, during the period of November 2021 to February 2022 which required the use of tourniquets were included.

Results
A total 291 procedures were carried out, 90% were limb and the remaining 10% were finger/toe tourniquets. In the former pressure was recorded in 230 (87.8%) procedures and the mean pressure in upper limbs was 248 (+-14)mmHg and 270 (+-27) in lower limbs. 95.2% of patients in the study were &gt;16 years old and the mean tourniquet time was 61.5 (+-36.4) mins, exceeding 120 minutes in only 13 cases. The Tourniquet type was documented for only 8.2% of procedures and the method of exsanguination for 34.7%. There was no record of skin isolation methods and skin condition.

Conclusions
Adherence to guidelines was not sufficient for some components of the procedures, including site information, method of isolation and method of exsanguination. Possible interventions include educational tutorials for staff and setting up visual aids within the OT. Results were presented in a local meeting and a re-audit is planned for 3-4 months’ time.
301 Weight Bear That Ankle ASAP
Authors: Hammond R , Wong M , Ibrahim Y , Janipireddy S 
Published: August 2023

Abstract

Background
BOAST guidelines suggest that most patients should be advised to weight bear as tolerated, immediately after surgery, in a splint or cast unless there are specific concerns about the stability of the fixation or any contraindications.
The purpose of this audit is to determine the weight-bearing practice of surgically managed ankle fractures. Secondarily we aimed to assess whether a reduction in time to weight-bear would impact patient outcomes.

Method
Sixty-one surgically managed ankle fractures were included (35 retrospectively between March 2021 - September 2021 and 26 prospectively between March 2022 - July 2022).
Intervention after primary data analysis included the presentation of audit findings in T&O MDT meeting. The foot and Ankle consultant body encouraged the department to weight-bear patients as soon as possible post-operatively.

Results
There was a significant (p = 0.0072) reduction in the time-to-weight-bear between cycle 1 (39.7 ±15.2 days) and cycle 2 (27.3 ±19.7 days).
After intervention, 22% more people were weight-bearing before 14 days (ie. a significant increase from 8.6% to 30.8%; p = 0.025). This was not associated with an increased incidence of complications.
64.3% of all post-operative complications occurred in patients’ weight-bearing only after 6 weeks. There was no increase in complications if patients weight bear before the traditional '6 week' rule (p = 0.11). The presence of pre-operative risk factors was significantly associated with an increase in complication rates (p = 0.017).

Conclusions
This audit suggests reducing the time-to-weight-bear in patients with surgically managed ankle fractures is safe and does not result in worse patient outcomes.
1035 Puppy Pandemic: A Review of Injuries Sustained from Dogs Before and After the UK Lockdowns in a Major Trauma Centre
Authors: Northway J , Garus P , Jack C 
Published: August 2023

Abstract

Aim
The COVID-19 pandemic saw a boom in UK pet ownership, dogs in particular, with 3.2 million households acquiring a pet during the lockdown period. While dog bites are well-documented, there is little research on other injuries sustained from dogs. This study aimed to identify and describe the various dog-associated injuries and their management, as well as determine if there was an increase in hospital attendance with dog-associated injuries during the lockdown period.

Method
A retrospective review of all patients seen by the orthopaedic team at a major trauma centre with dog-related injuries was conducted, comparing attendances between June and September 2019 (‘pre-panemic’) and the same period in 2021 (‘post-pandemic’). Demographics, injuries sustained, mechanism of injury, length of stay and operative management required were among the data analysed.

Results
There was a 32.7% increase in dog-related injuries between 2019 (n = 49) and 2021 (n = 65), the majority being fractures and lacerations. The most common mechanism of injury was tripping over a dog, followed by falls while walking and bites/scratches. Most injuries occurred in the home, with 71% of patients being the dog owner. Operative management was required in 51% of cases in the 2019 group and 29% in 2021.

Conclusions
To our knowledge, this is a novel research area, describing all dog-related injuries versus only bites. Fractures were the most common dog-related injury in both groups. This mechanism of injury presents a burden to healthcare in terms of resources. Fragility fractures need to be considered for this mechanism of injury.
996 Circumcisions in the Community; a New Initiative
Authors: Caratella S , Desai B , Patel J , Rai J 
Published: August 2023

Abstract

Introduction
The average waiting time for an initial outpatient appointment in urology at UHL is 23 weeks and waiting times for circumcisions are significantly longer. A new initiative in Leicester has enabled a proportion of fit and healthy NHS patients to have their circumcision under LA within the community.
Our aim was to audit our practice to determine if this initiative could be trialled across other urological departments in the UK.

Method
A prospective database has been maintained and 76 patients who underwent a circumcision in the community between November 2021 and August 2022 were identified. 16 patients were excluded since they were not contactable via telephone. Online hospital records and GP records were used in addition to contacting patients via telephone to collect data.

Results
The mean satisfaction level with the service provided was 8.28. The total post-operative complication rate was 35% with a 25% post operative surgical site infection rate.
There were 2 (3.3%) admissions to hospital secondary to penile abscesses and possible skin necrosis of which both required drainage in theatre. The average length of admission for these patients was 2.5 days. 3 (5%) patients were unhappy with cosmesis, and 2 patients have had/are awaiting a redo circumcision.

Conclusions
Through this new initiative 76 patients have been removed from the NHS waiting lists for circumcision thereby reducing waiting times with very high patient satisfaction. This indicates that this new initiative could be trialled in other departments and could also be used to reduce waiting lists for other minor procedures.
529 Institutional Experience of Patients with Complex Abdominal Aorta Aneurysms Undergoing Fenestrated Endovascular Repair: A Retrospective, Single-Centre Study
Authors: Joyce D , Kerr S , Gannon M , Renwick B , Bachoo P 
Published: August 2023

Abstract

Aim
To determine the short- and long-term outcomes of patients with complex abdominal aorta aneurysms (CAAAs) managed with fenestrated endovascular aneurysm repair (fEVAR) at a tertiary vascular unit.

Method
All patients undergoing fEVAR for elective CAAA between January 2013 and December 2021 were retrospectively identified. Primary outcomes were mortality rate and stent patency (assessed by CT imaging). Secondary outcomes included rates of reintervention. Follow-up intervals were at 30 days, 1 year, 3 years and 5 years. Descriptive statistics are reported.

Results
61 patients were identified; 5 were excluded due to follow-up in a different health board. Of the 56 analysed, 49 (88%) were male and median age was 75 (IQR 68-83). The average number of fenestrations used per fEVAR graft was 3 (range 2-6). Mortality rate was 2% at 30-day, 9% at 1-year and 25% at 5-year. At 5-year follow-up, all patients (n = 11) had grafts with all fenestrations patents. There was an 11% (n = 6) reintervention rate in a 5-year period. Median time to reintervention was 12 months (range 5-36 months). Reintervention included 4 requiring embolization for a Type II endoleak, 1 patient required an iliac stent extension, and 1 patient required a renal stent.

Conclusions
With fEVAR being a relatively newly adopted technique, this data demonstrates technical success with low re-intervention rates when used for CAAAs. Future work should include organising a multi-centre study to gain a larger sample size to compare rates of fEVAR success in different centres.
1040 Impact of Common Femoral Artery Calcification on the Comparative Efficacy of Vascular Closure Device Deployments Following Large Bore Vascular Access
Authors: Hakeem A , Khokher Z , Najem M , Chaudhuri A 
Published: August 2023

Abstract

Introduction
The suture-mediated ProGlide and more recently, the plug-based MANTA are commonly used vascular closure devices (VCDs) for large-bore vascular access haemostasis, though both devices operate differently. The site and extent of the common femoral artery (CFA) calcification are significant determinants of the choice of VCD. Anterior calcification may hamper ProGlide deployments, while posterior calcification may represent a similar consideration for the MANTA.

Method
A retrospective analysis of procedures with large-bore CFA access from 2017 to 2022 was undertaken. The access sites are grouped as Group A (Proglide) and Group B (MANTA). Calcification graded as (0 = none, 1 = Anterior, 2 = Posterior and 3 = Anterior & Posterior) on preoperative CTA along 10mm segments with 0.625mm slice thickness. Minitabv21 was used for Statistical analysis, particularly analysing the correlation of calcification to VCD deployment success rates.

Results
We assessed 207 endovascular procedures with 374 large-bore accesses (243 Group A, 127 Group B). The mean age was 74.9±8 (183 males), the average BMI was 28±5.8 (44 diabetics), and 180 (86.9%) were smokers. Grade 1 Calcification was 1.8%, Grade 2, 49% (120 Group A, 63 Group B) and Grade 2, 14.3% (31 Group A, 22 Group B). Successful deployment was achieved in 91% (337 groins, p = 0.86). The correlation of calcification with successful deployment was not significant p = 0.33.

Conclusions
Posterior calcification was more common in both groups. The site of calcification did not impact the efficacy of the closure device. All our percutaneous accesses were ultrasound-guided, we concluded it can improve the effectiveness of VCD, avoiding calcification.
New clues to the elusive aetiology of nodding syndrome
Authors: Spencer Peter S 
Published: August 2023

Abstract
Nodding syndrome is a paediatric epileptic encephalopathy of unknown aetiology that affects children in impoverished communities of Eastern Africa subject to internal displacement. Set in southcentral South Sudan, where nodding syndrome first surfaced circa 1990, an important new study of recent-onset cases of nodding syndrome examined parasitic, bacterial, viral, immune-mediated, metabolic and nutritional factors associated with the brain disease. Infection with the nematode Mansonella perstans, but not with Onchocerca volvulus, was the most prominent finding in nodding syndrome cases versus controls. While M. perstans is unlikely to be causal of nodding syndrome, investigation of the freshwater habitats, where insect-to-human transmission of the filarial larvae takes place, may reveal a clue as to the aetiology of this neurodegenerative disease. The culpable environmental agent(s) must be able to induce neuroinflammation and tau pathology preferentially in infants and children.
Myocarditis with concomitant tuberculosis infection presenting with solitary ventricular tachycardia: a case report
Authors: Clivillé David Belmar , Moliner-Abós Carlos , Gallego Irene Menduiña , Camprecios Marta 
Published: August 2023

Abstract

Background
Myocarditis is an infrequent extrapulmonary manifestation of tuberculosis that confers an unfavourable prognosis.

Case summary
A 36-year-old man presented to the hospital with palpitations and dyspnoea. Tests revealed the presence of non-sustained ventricular tachycardia, with mild elevation of troponin and C-reactive protein levels. Coronary angiography showed normal results. A cardiac magnetic resonance (CMR) showed moderate hypertrophy, preserved ejection fraction, and an extensive multi-segmental pattern of fibrosis and oedema. An 18F-fluorodeoxyglucose positron emission tomography–computed tomography (18F-FDG-PET–CT) scan revealed multiple hypermetabolic adenopathies and patchy cardiac uptake. A tuberculin skin test and interferon-gamma release assay were both positive. An endomyocardial biopsy (EMB) showed inflammation without granulomas; and microbiological stains were negative. Biopsy of an adenopathy revealed the presence of multiple necrotizing granulomas with Langhans cells. Based on the test results and clinical presentation, the suspected diagnosis was tuberculous myocarditis. Treatment with anti-tuberculosis drugs was started. One month later, the presence of mycobacterium tuberculosis (MT) was detected in the lymph node culture. At 7 months of follow-up, the patient remains asymptomatic, ventricular arrhythmias have ceased, and radiological signs of inflammation have resolved.

Discussion
Ventricular arrhythmia is one of the clinical manifestations of tuberculous myocarditis. Cardiac magnetic resonance and 18F-FDG-PET–CT imaging are an essential component of the non-invasive evaluation of inflammatory cardiomyopathy. However, a confirmatory biopsy may be required to identify potentially treatable aetiologies. Although the diagnosis of tuberculous myocarditis requires an isolation of MT by staining or culture in EMB, the diagnostic yield is very low. For this reason, extra-cardiac findings may provide the definitive diagnostic clue.
Aortic size distribution among normal, hypertension, bicuspid, and Marfan populations
Authors: Wu Jinlin , Zeng Weiyue , Li Xiaoshan , Zhu Jiade , Zhou Chenyu , Fan Ruixin , Sun Tucheng , Fei Hongwen , Li Xin 
Published: August 2023

Abstract

Aims
Large-scale investigations on ascending aortic diameter, especially in the Asian population, are lacking. Furthermore, relevant evidence regarding the distribution of hypertension (HP), bicuspid aortic valve (BAV), and Marfan syndrome (MFS) is scarce. We aimed to examine the distribution of ascending aortic diameter in these populations in China.

Methods and results
The data of a total number of 698 795 individuals who underwent cardiac ultrasound were subjected to retrospective analysis. After screening, 647 087 individuals were included in the final analysis. In the normal population, the mean ascending aortic diameter was 28.1 ± 3.2 mm (27.2 ± 3.1 mm in women vs. 29.0 ± 3.1 mm in men) (P &lt; 0.001). Aortic diameter increased gradually with age (P &lt; 0.001). The prevalence of aortic dilation, aneurysm, and dissection in individuals with HP was 12.83%, 2.70%, and 4.77%, respectively. In individuals with MFS, the corresponding rates were 43.92%, 35.31%, and 26.11%. Notably, although BAV patients had high incidences of aortic dilation (37.00%) and aortic aneurysm (16.46%), the incidence of aortic dissection was relatively low (0.74%). Most cases of aortic dissection occurred at an aortic diameter of less than 55 mm. However, in the overall population, the incidence of aortic dissection significantly increased with the increase in the aortic diameter, revealing the existence of an ‘aortic paradox’.

Conclusions
(i) The ascending diameter increases with age and is larger in men than in women; (ii) ‘Aortic paradox’ is explained; (iii) BAV bears a high rate of aortic dilation, but a low incidence of aortic dissection.