bluuebunny/crossref_metadata_2025_split huggingface dataset:
131 The Health-Related Quality of Life of Patients Waiting for Anterior Cruciate Ligament Reconstruction Is Worse Than an Age and Sex Match Population: Increasing Time on Waiting List Was Independently Associated With a Worse Quality of Life
Authors: Raja A. , Clement N.D. , Sripada S. , Loader H. , Kam M. , Haggart J. , Fawcett T. , Peattie C. , Molyneux S. 
Published: February 2022

Abstract

Aim
To assess the health-related quality of life (HRQoL) of patients waiting for an anterior cruciate ligament (ACL) reconstruction compared to the population at risk, and whether knee specific function was predictive of HRQoL and to identify factors associated with a worse HRQoL.

Method
Sixty-seven patients (male n = 50, female n = 17, mean age 29) identified from the surgical waiting list completed a questionnaire that included demographics, BMI, time of injury, EuroQol 5-demension (EQ-5D), short-form (SF-)36 and International Knee Documentation Committee (IKDC) scores. Age and sex matched HRQoL data were obtained from population level data.

Results
The mean EQ-5D score for the study cohort was significantly worse than the matched score (difference 0.367, p&lt;0.001), and the same trend was observed for all eight dimensions of the SF-36 score. Thirty-three (49%) patients felt their health in general was somewhat or much worse compared to one-year ago. There was a correlation between the IKDC and EQ-5D scores (r = 0.540, p&lt;0.001), and linear regression was used to formulate the EQ-5D score: EQ-5D = (IKDCx0.013)–0.015(constant). The SF-36 physical component and the length of time on the waiting list were independently associated the HRQoL, with each 14-point drop or for every 200-days a clinically significant deterioration in a patients HRQoL occurred, respectively.

Conclusions
Patients had a significantly worse HRQoL when compared to age and sex match population, which deteriorates with worsening physical function and increasing length of time on the waiting list. The knee specific IKDC correlated with HRQoL and could be used to estimate the EQ-5D score.
133 A Quality Improvement Project to Improve the Appropriateness of Acute Clinic Referrals to a Local ENT Department Using an Electronic Booking System
Authors: Parmar V. , Maity A. , Singh P. 
Published: February 2022

Abstract

Aim
Assess and improve the proportion of inappropriate acute clinic referrals being made to our local ENT department via a telephone referral system with regards to nature and suitability for a junior grade doctor run clinic with senior supervision. Additionally, to make a more efficient, timely and failproof booking system with an auditable trail by transitioning to an electronic referral system.

Method
A guideline was created using based on common protocols from major Trusts within the UK which was then used to assess 101 acute clinic referrals taken from February 2021 to our local service. An electronic referral system was created, and guidelines disseminated to departments commonly making referrals to the acute clinic in anticipation for re-audit in September 2021 alongside introduction of the guideline to new doctors rotating to the specialty at induction in August.

Results
Initial audit revealed 29% of referrals were inappropriate, 50% of which were too complex, 45% were not acute and 5% were due to accidental double-bookings. Additionally, nasal fracture reviews were seen within 10 days only one third of the time, 37% of patients referred did not have a recorded contact number and 13.8% of all referrals were made with incorrect or unclear clinical information.

Conclusions
The lack of clear clinical guidance on referrals to an acute ENT service at our local centre with an outdated telephone referral system is associated with a large proportion of inappropriate referrals, delays to timely care and transcription errors potentially putting patients at risk of harm.
137 A Review of Current Criteria for Risk of Aneurysmal Subarachnoid Haemorrhage
Authors: Sharma S. , Daga K. 
Published: February 2022

Abstract

Introduction
There is a need to evaluate the existing guidelines regarding the size criteria for the risk of rupture of intracranial aneurysms. The current understanding is that small intracranial aneurysms (less than 7 mm) are not at significant risk for rupture according to the ISUIA 1 & 2 trials. However, there have been several published series of rupture and subarachnoid haemorrhage from aneurysms less than 5 mm in both, anterior and posterior cerebral circulation.

Methods
We conducted a systematic review of aneurysmal subarachnoid haemorrhage, specifically to identify their size and the anatomical location at the time of rupture, using the healthcare databases advanced search.

Results
Our search yielded 1438 results matching our inclusion criteria. Our results demonstrated that 50.4 – 76.8% of aneurysms were under 7 mm in diameter at the time of rupture. Subarachnoid haemorrhage from smaller aneurysms (&lt;5 mm) was also shown to present with poor prognoses (Hunt and Hess grades 4–5). There were no significant differences observed between the anterior and posterior circulation.

Conclusions
The existing criterion to determine the risk of rupture of intracranial aneurysms need to be updated, accounting for multiple clinical factors including, but not limited to, the size. With advances in endovascular treatments in recent years, the associated intra-procedural risks are greatly reduced compared to traditional neurosurgical approaches, making the argument for intervention at earlier presentations.
141 Evaluation of Use of NABCOP Frailty Score and Interprofessional Variety of WHO Performance Score in Breast Cancer Patients Over 70 Years of Age
Authors: Rezacova M. , Clark S. 
Published: February 2022

Abstract

Aim
There is requirement to assess frailty of older patients with breast cancer as it can influence practice of treatment. In our department the fitness assessment was inconsistent. Therefore, we have decided to conduct qualitative study to evaluate ease of use of NABCOP frailty score (in comparison with other scales) as well as interprofessional variety of WHO performance score.

Method
We have conducted prospective data over 2 weeks period in our busy fast track breast clinic. All new patients over 70 years of age have been identified and asked to perform self-rating assessment. The patient has been later evaluated by NABCOP frailty score and WHO performance score by consultant, nurse, and HCA. This was compared to GP assessment which is part of 2WW referral.

Results
There have been matching results between patient’s self-assessment, clinician, and HCA in majority of patients. HCA perform assessment well with no discrepancy to other physician.

Conclusions
Self-rating and HCA assessment of performance status is accurate and can speed up clinic time. WHO performance scale is found easier and less time consuming by users (and felt provides similar information). We have now provided new assessment system which is undergoing trial in practice at present.
151 Relevance of ESCC Grading and SINS System in the Management of Neurosurgical Patients with MSCC
Authors: Peris R. , Golash A. 
Published: February 2022

Abstract

Introduction
The use of ESCC and SINS scoring in the planning of surgery in Neurosurgical patients is something of mutual habit and standard practise. This project looks at the outcomes of patients referred to the centre via the Metastatic Spinal Cord Compression (MSCC) referral, the relevance of ESCC scoring and SINS scoring in surgical patients as well as the post-operative outcomes between neurosurgical and orthopaedic surgeons when treating the same cohort of patients.

Method
We looked at patients referred to a tertiary centre in the UK between January 2018 and December 2018, and June 2020 and December 2020 via the MSCC coordinator.

Results
The most common cancer that resulted in MSCC were urological malignancies, followed by cancers of the lung. Out of the patients that received radiotherapy, patients with urological malignancies had the best survival rate at 6 months post treatment, while gynaecological malignancies produced the lowest survival numbers.

Conclusions
In the groups that underwent surgery via the neurosurgeons and orthopaedic surgeons, there was no significant difference in outcome between the two, despite the those referred via neurosurgery having worse outcomes as a whole. We noted that there was a statistical significance between ESCC grading and patient’s mobility status in those who had MSCC between C7 and L1 vertebrae (p = 0.0478)- contrary to that mentioned in the literature. A higher ESCC score was associated with better mobility. We also found that the SINS score recommended guidance correlated with management of surgical patients who presented with MSCC within the tertiary centre.
153 The Patient Perspective on Day Case Arthroplasty
Authors: Jain A. , O'Dowd Booth C. , Cay P. 
Published: February 2022

Abstract

Introduction
Day Case Arthroplasty has been validated as a safe strategy for reducing length of stay for patients undergoing elective arthroplasty. With the ongoing recovery of elective activities following the COVID pandemic and long waiting lists; day case arthroplasty offers a solution for both hospitals and patients. Reducing length of stay will reduce the cost of day case arthroplasty which benefits hospitals, whilst the faster discharge reduces unnecessary exposure to an increased risk of COVID for patients. This study aims to establish the patient perspective on day case arthroplasty to inform the set-up of a patient cantered day case arthroplasty service.

Method
Data was collected at routine preoperative assessment clinics via a structured questionnaire which combined both quantitative and qualitative methods. The questionnaire covered patient demographics, issues pertaining to same-day discharge, level of concern related to common problems faced by patients after joint replacement surgery and patient preference for same day discharge versus more traditional rehabilitation methods.

Results
The study included 79 patients with 43% preferring same day discharge. Postoperative pain, surgical complications and wound healing were the most significant concerns elicited. Patients who preferred same day discharge were statistically younger. The majority of patients felt that their rehabilitation could be completed at home.

Conclusions
The results of this study highlight the demand for day case arthroplasty in this cohort of patients with younger patients preferring same day discharge. Identifying significant concerns will be important to formulate effective perioperative protocols to ensure successful implementation of a patient cantered day case arthroplasty service.
162 A Closed Loop Audit Assessing and Improving the Quality of Electronic Discharge Documents in a Neurosurgical Ward for Patient Safety and Continuity of Care
Authors: Ali T. , Ho J. , Solth A. 
Published: February 2022

Abstract

Aim
To assess the quality of neurosurgical electronic discharge documents (EDDs) as per the Scottish Intercollegiate Guidelines Network's (SIGN) discharge document guidelines, and to implement interventions to ensure patient safety and continuity of care.

Method
We performed a closed loop audit on the quality of EDDs at the neurosurgical unit at Ninewells Hospital. We collected six sets of two-weeks’ worth of EDDs from the Tayside EDD system coinciding with foundation trainee changeover times for a representative sample of pre- and intra-COVID-19 EDDs. We analysed our findings and developed interventions in collaboration with the MDT. These included a copy-paste template, educational poster, and presentation, and more. We implemented the interventions and reassessed EDDs after three months.

Results
A total of 207 EDDs were included. Pre-interventions, 88% of the EDDs were inadequate in quality when compared to SIGN’s guidelines. This had 33% reduction post-interventions. The percentage of EDDs adequate in quality doubled post-interventions, from 22% to 43%. The most commonly mistaken or missed criterion pre- and post-intervention was the neurological status on admission and discharge. Others were mistaking presenting complaint for diagnosis and vice versa, and not mentioning follow-up or new medications.

Conclusions
Accurate records of care, including discharge documents, are central to the principles of good medical practice outlined by the GMC. This study showed that EDD quality is compromised due to time pressures, lack of information and constant changeover due to COVID-19. We alleviated this by creating accessible interventions that assure safe patient care despite the challenges of changeover and COVID-19.
169 Can Volume Replacement with Local Perforator Flaps Reduce the Trauma to Patients Caused by Mastectomies and Cost of Reconstructions in Breast Cancer Treatment?
Authors: Karagiannidis G. , Mallidis E. 
Published: February 2022

Abstract

Aim
National reported mastectomy rate varies from 25% - 45%. Improved screening and raised breast awareness raise the demand for breast cancer treatment. 25% - 45% of breast cancer treatment will be mastectomies, some of them followed by reconstruction. Mastectomy +/-reconstruction is a traumatic procedure which affects quality of life of patients plus extra cost for NHS for reconstruction. We would like to investigate if the technique of local perforator flaps can reduce the volume of mastectomies.

Method
Retrospective review of yearly breast cancer treatment operations from 2016 to 2020 in Ipswich Hospital.

Results
1367 surgical operations performed for breast cancer.In 2016,52/273(19%) patients had mastectomy and 8/273(2.9%) underwent a perforator flap operation. In 2017, 85/292 (29,1%) had mastectomy and 13/292 (4,4%) had local perforator flap surgery. In 2018, the number of mastectomies was 74/299 (24.7%), while 4/299 (1.3%) patients underwent local perforator flap surgery. In 2019, the amount of perforator flaps increased to 24/305(7.8%) while the mastectomies remained in equivalent percentages [72/305 (23.6%)]. Finally, in 2020, despite the presence of COVID19 and the decrease in surgical management of cancer, 16/198(8.5%) had local perforator flaps surgery and only 34/198 (18%) had mastectomy.0/57 (0,00%) of the local perforator flaps failed.

Conclusions
Local perforator flaps have resulted in 11.1% reduction in mastectomy rate (also reducing reconstructions). The exchange of mastectomy and reconstruction with breast conserving surgery and local perforator flap reduces the operating time and cost of cancer treatment without compromising oncological outcome or patient satisfaction.
177 Broad Ligament Hernia: Two Contrasting Ways to a Common Goal – Two Case Reports
Authors: Harvitkar R.U. , Rohtagi Y. , Joshi A. 
Published: February 2022

Abstract

Introduction
Broad ligament hernia (BLH) is a rare but potentially life-threatening condition. One of the two cases described here is the only reported case of BLH in recent literature, where marsupialization was done. These two case reports comprise the only reported side-by-side pictorial comparison of the two laparoscopic surgical therapeutic options for BLH.

Presentation of cases
Both patients presented with classical symptoms and signs of acute intestinal obstruction. Imaging confirmed obstructed left BLH in case 2 and indicated a complete small bowel obstruction in case 1. Both cases were successfully managed laparoscopically. Both patients had an uneventful immediate postoperative recovery and have not had recurrence over a mean follow-up period of 34.5 months.

Discussion
BLH is rare among all types of internal herniae. It accounts for only 4% of internal herniae and is a difficult condition to diagnose. The advent of computed tomography has increased the chances of accurate preoperative diagnosis.

Conclusion
BLH can be successfully managed by minimally invasive surgery, even in the acute setting. When tightly entrapped bowel is unyielding; it is better not to risk injury to it by aggressive attempts at its reduction. It is safer to attempt widening of the defect into which it is entrapped, whenever feasible.
183 A Systematic Review of Sample Size Calculations in High-Profile Surgical Trials That Use Patient-Reported Outcome Measures.
Authors: Jacklin C. , Rodrigues J. , Collins J. , Cook J. , Harrison C. 
Published: February 2022

Abstract

Background
Patient reported outcome measures (PROMs) are increasingly recognised as a measure of treatment efficacy in randomised controlled trials (RCTs). It can be difficult to determine meaningful target differences in PROM scores for sample size calculations and this can risk over-recruitment and/or erroneous trial conclusions. The Difference ELicitation in TriAls (DELTA2) statement sets recommendations for sample size calculations in RCTs including target difference determination. We aimed to evaluate sample size calculations from high-profile surgical RCTs that used PROMs as their primary outcome, against DELTA2 standards, with a focus on target differences.

Method
Pubmed was systematically searched for surgical RCTs published in the five highest ranking journals, by Thomson Reuters impact factor, for medicine and surgery. Studies were included if surgery was the intervention and/or comparator arm, and a PROM was the primary outcome. Surgery was defined as using instrumentation to change macro-anatomy with the aim of improving health. Data were extracted with a piloted data collection sheet that included the DELTA2 reporting recommendations.

Results
Most target differences used in sample size calculations were determined with suboptimal techniques and target difference justification was overall poor. In this sample, £28 million of UK public research spending supported trials with poor target difference justification.

Conclusions
In this sample of trials, sample size calculations were generally not reported to DELTA2 standards. There was frequent use of sub-optimal methods to determine the target difference. This risks over-recruitment and/or erroneous trial conclusions. Clinicians should be aware of these potential pitfalls when interpreting published trials.
184 Group and Save Studies Prior to Appendicectomy
Authors: Da Costa K. , Islam R. , Peh J. , Gelber E. 
Published: February 2022

Abstract

Aim
Group and save studies prior to appendicectomy

Method
219 appendicectomy cases from Jan 2018 until Dec 2020. This was to look for whether patients had a blood transfusion post appendicectomy. Whether this was cost effective?

Results
19/219 did not have G and S studies performed. None of the patients required a blood transfusion post operatively. Price per bottle £20

Conclusions
Based on the above results we referred to the study performed by the RCS
Royal College of Surgeons did a study on ‘blood group and antibody screening prior to emergency laparoscopy’. Study included 562 cases. Concluded that routine G&S studies are not required and ‘majority of patients had a low risk of major intraoperative haemorrhage’ and thus G&S was not warranted O –ve blood can be used in cases of acute haemorrhage from major vessel injury Time taken to receive O neg blood = minutes.
192 An Early Innovation Report of an Epidermal Ventriculoperitoneal (VP) Shunt Pressure Sensor
Authors: Ho J.W. , Savvidis P. , Ismail M. A , Zonza S. , Kamath A. , Needham A. , Carmona Sánchez R.d.C. , Liao H. , Teo Mario. 
Published: February 2022

Abstract

Introduction
Ventriculoperitoneal shunt insertion, a common procedure for hydrocephalus, has a revision rate of approximately 20–30% within the first year, and continues to increase with each consecutive year. In Leeds, the average work-up cost for suspected shunt malfunctions was £765/patient. Additionally, patients with malfunctioning shunts present with vague symptoms potentially contributing to delayed presentation, especially important in Low-Middle Income Countries (LMICs) where neurosurgical expertise is less accessible. To reduce investigative costs and delayed presentations, we sought to design an epidermal shunt reservoir sensor to detect shunt malfunction by measuring the reservoir pressure.

Method
Literature searches were conducted to identify a proof of concept and suitable materials to engineer a concept device based on a Failure Modes and Effects Analysis (FMEA) table with design specifications to assess relative clinical risks. Using the IDEAL-D Framework, we designed our low-fidelity prototype using Solidworks® software.

Results
Literature revealed several devices aimed to detect shunt malfunctions. For our concept device, our focus was an accurate sensor and reliable connectivity. Our prototype uses gold nanowires to achieve high sensitivity to pressure change, as small as 15mPa. Near-field communication (NFC) for connectivity has less power requirement and has rapid connectivity compared to Bluetooth. Estimated cost of the device is £500.

Conclusions
Our device, in Stage 0 of the IDEAL-D Framework, identified potential sensors and connectivity methods. We could utilise magnets to adhere to the reservoir with overlying hair. However, magnetic fields and atmospheric pressure could cause interference. Power source options still require exploring before benchtop testing for accuracy, interference, and feasibility.
198 Caveat Chirurgicus- Opioid Use Following Surgery
Authors: Vijayagopal K.A. , Majeed T. , Wilson J. , Magee C. 
Published: February 2022

Abstract

Introduction
Over the last 20-years there has been increasing opioid related deaths, in the context of a worldwide epidemic of misuse including addiction and overdose. Startlingly, opioid commencement is usually iatrogenic. Most published data is from the USA with little evidence from UK surgical practice.

Method
Retrospective analysis of surgical unit opioid prescriptions. Data included opioids prescribed on discharge, 1, 3- and 6-months post-discharge usage and milligrams-of-morphine equivalence(mgEq) used to compare regimes.

Results
One hundred cases reviewed. 35% of patients were opioid naïve on admission and of these 20%, 5.71% and 8.57% remained on opioids at 1, 3- and 6-months post discharge respectively.
Females more likely to remain on long-term opioids at 6 months at lower doses (42% v 30%).
Only 6% of discharge summaries recommended GP follow-up and assessment of opioid requirements. Furthermore, none were prescribed a tapering dosage regime on-discharge.
Patients receiving Acute Pain Team reviews, more likely to remain on long-term opioids, at lower doses (30.67mgEq, 29.25mgEq and 32.63mgEq at 1-, 3- and 6-months post-discharge) compared to those without (69.16mgEq, 74.25mgEq and 65.13mgEq).
Only 11% of patients with pre-existing opioid prescriptions were reviewed by the acute pain team.
Worryingly, there was no documented assessment of opioid misuse risk in patients.

Conclusions
Standardised assessments i.e., opioid Risk Assessment Tools and mgEq need to be documented and monitored in primary and tertiary care. Acute pain team services should be offered to more patients. Our study hopes to raise awareness of the need for effective opioid stewardship in surgical patients.