bluuebunny/crossref_metadata_2025_split huggingface dataset:
872 The Role of Clinical Core Biopsy in Palpable Breast Lumps with Normal Imaging: 10 Year Experience of a Tertiary Symptomatic Breast Service
Authors: O'Hanlon Emily , Moynihan Alice , Barry Mitchell , Kell Malcolm , Stokes Maurice , Siun Walsh , Heeney Anna 
Published: November 2022

Abstract

Aim
Patients presenting with a palpable breast lump with normal imaging presents an investigative challenge. While the reported sensitivity of US and mammogram is high, radiologically occult cancers do occur. Traditionally these patients have undergone clinical core biopsy. The aim of our study was to examine the use of clinical core biopsy in our department over a 10-year period and assess its efficacy in diagnosing radiographically occult malignancies.

Method
We performed a retrospective review of a prospectively maintained database of all clinical core biopsies performed from 2010–2019 in a symptomatic tertiary breast cancer unit. Patients who underwent fine needle aspiration or skin punch biopsy without breast clinical core biopsy were excluded. A number of patients underwent clinical core biopsy despite abnormal radiological findings for clinical reasons, these patients were excluded from the final analysis. Clinical examination findings, radiological findings and ultimate pathological findings were reviewed.

Results
370 clinical core breast biopsies were performed over the study period. 11 patients were excluded as they underwent clinical biopsies despite abnormal imaging. Of the remaining 359 biopsies, 349 (97.21%) were benign and 9 (2.51%) required further investigation. Of these patients, 6 underwent excisional biopsy with one patient being diagnosed with DCIS. The remaining excisional biopsies were benign. 1 patient (0.29%) with normal imaging was diagnosed with a malignancy on clinical core biopsy.

Conclusions
The management of patients with palpable breast lumps despite normal imaging is challenging. Clinical core biopsy, in the context of normal imaging, has a low rate of detection of malignancy.
256 The Effect of Intraperitoneal Drain Placement on Postoperative Outcomes After Emergency Colorectal Surgery: A Propensity-Score Matched Analysis
Authors: Collaborative EuroSurg 
Published: November 2022

Abstract

Introduction
The use of intraperitoneal drain placement after emergency colorectal surgery is controversial. While the general consensus recommends against their routine use, there remains a paucity of evidence supporting this in the setting of emergency colorectal surgery. This study aimed to describe the efficacy and safety of intraperitoneal drain placement.

Method
This was a prospective, international, cohort study including consecutive adult patients undergoing emergency colorectal surgery (February-March 2020). Outcomes included: rate and time to diagnosis of intraperitoneal postoperative collections; rate of drain-related complications; and 30-day major postoperative complications (Clavien–Dindo grade ≥3). After propensity-score matching, multivariable logistic and Cox proportional hazards regressions were used to estimate the independent association of the outcomes with drain placement.

Results
Some 730 patients were included (353 females; median age 68.5 years, IQR 20) and the drain-placement rate was 53.6% (391/730). After matching, drains were not associated with lower rates of intraperitoneal postoperative collections (OR 1.30, 95% CI: 0.62–2.75, p=0.486) nor did they allow for earlier detection of such collections (HR 0.76, 95% CI: 0.19–3.05, p=0.698). Although not associated with worse major postoperative complications (OR 1.10, 95% CI: 0.63–1.90, p=0.740), drains carried an increased surgical site infection (SSI) risk (OR 3.41, 95% CI: 1.78–6.52, p&lt;0.001).

Conclusions
This is the first study on the role of intraperitoneal drains in emergency colorectal surgery. Drains did not confer any clear clinical benefits after emergency colorectal surgery, but they were associated with increased SSI risk. Further trial evidence is needed to establish their net overall benefit or harm.
854 The Establishment of a National Peritoneal Surface Malignancy Programme: The Success, Pitfalls and Difficulties of the Moroccan Experience
Authors: Essangri Hajar , Bahaoui Nezha El , Souadka Abdelilah , Majbar Mohammed Anass , Benkabbou Amine , Mohsine Raouf , Souadka Amine 
Published: November 2022

Abstract

Aim
Peritoneal surface malignancy (PSM) programmes offer curative options to previously terminal cases through cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). However, this requires special expertise and resources, which may not be available to low- and middle-income countries (LMIC). The study aims to document the Moroccan experience of a national PSM programme.

Method
This is a mixed method study involving the retrospective assessment of patients with PSM following CRS between 2004 and 2018, alongside interviewing the founding surgeons leading the programme establishment to depict the pitfalls, difficulties, and processes of a PSM programme creation. This operation extended on an initiation, transition, and consolidation phase. Progress was demonstrated by outcome comparison of incomplete cytoreductive surgery (ICRS) rate, serious complications ≥ 3b according to the Clavien-Dindo scoring, and early oncologic failure (EOF; disease progression within 2 years of treatment) between periods.

Results
In total, 198 CRS procedures were performed in the three phases with outcome assessment showing significantly better results with lower ICRS (34%, 18% and4% p=&lt;0.001), serious complications (30.6%, 20% and11.2%, p=0.019), and EOF (38.8%, 23.3% and12.4% p=0.002). Programme founders highlighted the importance of project initiators’ motivation and leadership qualities, team readiness to overcome resource’ restrictions while improving their surgical expertise in CRS techniques, and collaborations development to reinforce multidisciplinary and institutional progress before adding HIPEC.

Conclusions
Implementing a PSM programme in a LMIC can be a challenging process, which motivation, training and good resources usability can help overcome.
939 Enhancing Core Surgical Training with the Implementation of Key Performance Indicators: A Closed Loop Quality Improvement Project
Authors: Goh En Lin , Tsui Adrian , Quinn Dominic , Gilling Jessica , Emery David 
Published: November 2022

Abstract

Aim
The COVID-19 pandemic has brought innumerable challenges to surgical training, especially with regard to theatre opportunities for core surgical trainees. This study aims to evaluate the implementation of training-oriented key performance indicators (KPIs) in supporting trainees to meet the Joint Committee on Surgical Training (JCST) quality indicators for core surgical training.

Method
A six-month long closed-loop quality improvement project. Two KPIs were developed following discussion with trainees and departmental leads, evaluation of the rota, and review of the JCST quality indicators: theatre/normal-working-day-attendance (T/A) ratio and missed-theatre-sessions/normal-working-day-attendance (M/A) ratio. Our calculations projected a T/A ratio of 1.00 and M/A ratio of 0.20 to be fully compliant with the JCST quality indicators. Data were collected prospectively from eight trainees, who provided feedback on training opportunities and allocation equitability.

Results
Following implementation of the KPIs, there was a significant increase in the mean T/A ratio from 0.70 (range=0.55–0.82) to 1.00 (range=0.95–1.17) (p=0.03), and a significant decrease in the mean M/A ratio from 0.55 (range=0.45–0.70) to 0.20 (range=0.11–0.22) (p=0.01). There were significant improvements in trainee satisfaction with training opportunities from 50% to 85% (p=0.02) and allocation equitability from 66% to 95% (p=0.01).

Conclusions
The development and implementation of training oriented KPIs led to increased allocation and fewer missed theatre sessions, enabling trainees to meet the JCST quality indicators. Furthermore, our data demonstrate smaller variances between trainees, thus, highlighting greater equitability of training opportunities. These findings are supported by the improved trainee satisfaction with training opportunities and allocation equitability reported.
371 Topographical Anatomy of the Annulus of Zinn
Authors: Lacey Hester , Oliphant Huw , Smith Claire , Koenig Michael , Rajak Saul 
Published: November 2022

Abstract

Aim
The anatomy and even existence of a common tendinous origin of the extraocular eye muscles, or annulus of Zinn, has widely been debated in anatomical literature. This study explored the anatomical origins of the recti muscles, their course into the orbit and the dural connections of the common tendinous origin with the skull base.

Method
Twenty orbits of ten adult human cadavers were dissected. The orbital apex and its dural connections were photographed. Histological examination of apical specimens was performed.

Results
In all cadavers, extraocular muscles were observed to have a common tendinous origin at the orbital apex, continuous with dural connections extending into the skull base. Accessory slips of the medial rectus were observed across all cadavers. Dual heads of the lateral rectus were observed in fourteen orbits of seven cadavers. The origin of the levator palpebrae superioris appeared to be contiguous with the superior rectus at the common tendinous origin in all but one cadaver.

Conclusions
These results support the existence of a common tendinous origin of the extraocular muscles, that is continuous with the skull base dura. In addition, they support the existence of variations in orbital anatomy including dual or accessory muscle slips of the extraocular muscles.
52 Functional Outcomes and Return to Sport Following Anterior Cruciate Ligament Reconstruction in Recreational Athletes: A Systematic Review
Authors: Brzeszczyński Filip , Forsyth Kirsty , McLelland Colin , McDonald Donnie , Lawson Graham , Hamilton David 
Published: November 2022

Abstract

Introduction
Outcomes of anterior cruciate ligament reconstruction (ACLR) are well reported in athletic populations, however surprisingly little information is available for outcomes in the recreational athletes that make up the majority of cases. The aim was therefore to assess post-operative outcome and return-to-sport in recreational athletes following ACLR.

Method
A systematic search was conducted in Ovid MEDLINE, CINAHL, AMED and the grey literature according to the PRISMA guidelines. Studies involving a clear definition of recreational athletes who underwent ACLR and recorded postoperative outcomes were included. Publication quality was assessed using Newcastle-Ottawa Scale.

Results
107 studies were identified, 19 full-text records reviewed and 13 included, reflecting 1342 patients with an average age of 31.7 (SD 9.8). Mean follow-up was 43.6-months (SD 42.8). Functional activity change was reported in 92% (12/13) papers. Functional outcome was assessed with the Tegner activity score in seven studies, with 43% (3/7) reporting a post-operative improvement. The Lyshom score was used in five, of which, 60% (3/5) showed post-operative improvement, 20% (1/5) showed no difference and 20% (1/5) showed a decrease. 69% (9/13) studies reported return-to-sport, with a mean rate of 55% (S.D. 19.2) at a mean follow-up of 32-months (SD. 34.8). Reported return-to-sports rate increased with length of follow-up.

Conclusions
Approximately only 50% of recreational athletes increase activity level and return-to-sport following ACLR. There is wide variation in return-to-sports timeframes reported, and the link between return-rate and post-operative timeframe suggests that longer follow-up periods may be required to accurately capture return-to-sport rates in recreational athletes.
194 ORIEL (Mortality Risk Prediction in Emergency Laparotomy): A Comparison of Mortality Risk Prediction Tools
Authors: Matias Nadia , Shehata Zak , Thomson Jack , Fegredo Daniel , Baltatzis Minas 
Published: November 2022

Abstract

Aim
Emergency laparotomies carry significant risk of morbidity and mortality. Risk calculation tools are essential to identify high-risk patients and inform clinicians in decision making. As part of a multi-centre research initiative, a retrospective study of all emergency laparotomies in a major trauma centre was conducted to determine the most accurate predictor of thirty-day mortality by comparing four, internationally recognised, risk assessment tools.

Method
Patients who underwent emergency laparotomy were identified using hospital databases. National Emergency Laparotomy Audit (NELA) was used to record pre- and post-operative mortality scores. The Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (P-POSSUM); American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and Surgical Outcome Risk Tool (SORT) were used to calculate risk of mortality for each patient. The Receiver Operating Curve (ROC) statistical method was chosen to compare the results of each in order to establish the tool most pertinent to prediction of local mortality.

Results
274 patients underwent emergency laparotomies at the Trust between December 2017 to December 2019. Of these, 96.7% (n=265) survived the 30-day post -operative period and 3.3% (n= 9) died. The ROC comparator demonstrated 100% sensitivity for the calculation of NELA, P-POSSUM and ACS-NSQIP and specificity of 77%, 76% and 63% for NELA, ACS-NSQIP and P-POSSUM respectively. SORT was found to be the poorest indicator of post-operative mortality.

Conclusions
NELA is the most accurate predictor of 30-day mortality in patients who undergo emergency laparotomy. Comparison with the outcomes of other centres will help confirm our results.
159 Current Practice of Intra-Operative Sampling During Revision Surgery of the Knee for Prosthetic Joint Infection at a High-Volume District General Hospital
Authors: Sehmbi A , Ali A , Shah S 
Published: November 2022

Abstract

Aim
Successful treatment of prosthetic joint infection (PJI) involves surgical interventions and identification of infecting organisms to enable targeted antimicrobial therapy. Current PHE guidelines recommend 3–5 intra-operative samples to be taken using separate instruments for each, swabs are discouraged. We audited the revision arthroplasty practice at Barking, Havering, Redbridge University Trust (BHRUT), specifically comparing intra-operative sampling for infected revision knee procedures with these guidelines.

Method
Retrospective cohort study of all prosthetic knee infection cases, as defined by the Musculoskeletal Infection Society criteria, at BHRUT between December 2011 to May 2020. A review of case notes collected various key data points, focusing on intraoperative sample, type, number, and technique. Point biserial correlation analysis was performed to determine statistical significance.

Results
119 revision knee arthroplasty procedures were performed in the 8.5-year study period. 31 (26%) were for prosthetic joint infection (n=29 patients), n=2 patients had re-revision procedures for second PJI. Number of samples taken ranged from 1–12 with a mode of 6. N=27 (87%) cases had the recommended number of total samples taken, of these n= 20 (65%) had five or more samples taken, N=24 (77%) cases had three or more samples taken and n=18 (58%) had five or more samples.

Conclusions
Current management of infected knee arthroplasty presents great variability in intra-operative sampling technique. Sample collection adheres to national guidelines in 77% of cases. We recommend implementation of a standardised approach to sampling through inclusion of a five scalpel and five forceps pack specifically for sampling in theatre for all suspected PJI's.
429 Clinical Audit Ankle Fractures
Authors: Ghauri AU , Ijaz O , Sabir N , Chaudhery MI , Saleem MM , Ahmed R 
Published: November 2022

Abstract

Aim
Ankle fractures are common among adult age group with an incidence of 174 per 100000 per year and they pose serious problems in management of geriatric age group because of osteoporotic bone. Our aim of current clinical audit was to introduce changes in current clinical practice by recommendations according to Standard BOAST guidelines of management of Ankle Fractures.

Method
Clinical Audit was carried out in Department of Orthopedics Benazir Bhutto Hospital in Outdoor and Emergency in March 2021 in patients of age group 20–70 years taking 50 patients for pre- and post-audit assessment. Emergency, Outdoor Slips were evaluated according to Standards of Practice formulated. Then a presentation was given to medical staff on Guidelines of Ankle fractures management, and they were informed about the deficiencies in their documentation and management. Panaflexes of Guidelines were displayed in ER, ward and then re-evaluation was done after 4 weeks in April 2021 using proformas in which clinical notes, discharge certificates and emergency slips were used for data analysis and observing improvement.

Results
The results of asymmetric data were calculated by Fischer Exact Test and with a p-value of &lt;0.05 considered as significant. Results were very pleasing as they showed great improvements in documentation as well as management of patients in accordance with the set guidelines and protocols.

Conclusion
Clinical Audits should be carried out on regular basis in hospital settings as they help to improve the standards of care as well as proper documentation which has medico-legal importance.
644 Improving VTE Prophylaxis in Spinal Patients – a Closed Loop Audit
Authors: Ziolkowska K , Ismail N 
Published: November 2022

Abstract

Aim
Venous thromboembolism (VTE) prophylaxis is one of the key components of safe patient care and can be particularly challenging when it concerns spinal admissions to the orthopaedic trauma ward. The first cycle of our closed loop audit aimed to assess the safety of VTE prescribing in spinal admissions at a district general hospital. The current cycle aims to evaluate guideline compliance following our interventions.

Method
Quality of VTE prophylaxis prescribing was measured against NICE (NG89) recommendations as well as local guidelines. Patients were identified based on prospectively maintained admission lists. The initial audit cycle was presented locally, and the following measures were introduced in order to improve prescribing: staff teaching sessions, nomination of a VTE guardian, inclusion of VTE plans in op-notes, publication of a dedicated spinal guideline and addition of a spinal section into the trust principal VTE guideline. The current audit cycle identified 22 spinal admissions.

Results
Out of the 22 patients, only one (4%) received inadequate VTE prophylaxis which is a significant improvement compared to the initial data (8 cases - 18%). Minor prescribing concerns were noted in three cases (14%) versus 15 cases (34%) in the first cycle. Overall, the re-audit proved that following departmental interventions the majority of patients received appropriate VTE prophylaxis with no prescribing or documentation errors (82% in the current cycle vs 48% initially).

Conclusions
We have demonstrated that significant improvement in VTE prophylaxis prescribing can be achieved by the means of educating staff and introducing simple and cost-effective measures.
735 Day Case Hemithryroidectomy Audit
Authors: Akbar S 
Published: November 2022

Abstract

Aim
Post-operative haematomas are a serious complication of thyroid surgery, causing potential airway compromise and fatality. Over time, hemithyroidectomy operations are increasingly being carried out as day case procedures to encourage enhanced recovery programmes post-operatively as well as reduce bed pressures on an overwhelmed National Health Service due to the COVID-19 pandemic.

Method
Hemithyroidectomy procedures carried out from 2018–2021 were analysed in 3 separate audit cycles. Outcome measures included total length of stay (LOS) in hospital, average time of operation note documentation, admission reason and any complication during or after the procedure, including complications within a 10-day period of the procedure.

Results
The percentage of same-day discharges increased reliably from audit cycle 1 (2018) to audit cycle 2 (2019) to audit cycle 3 (2021); it was found that same-day discharges increased from 48% to 64% to 70%, respectively. It was further found that if operation notes (assumed to act as a proxy for approximate time-out for procedure) were documented towards the end of the working day i.e., 5pm in most units, it was more likely for patients to be admitted overnight. There was one patient from the period of 2018–2021 that was deemed to have had a serious post-operative event.

Conclusions
There was a reliably increase in same-day discharges for each successive audit cycle. There is a limited requirement for patients undergoing hemithyroidectomy procedures to have a surgical drain placed. Hemithyroidectomy operations can be carried out safely as day case procedures based on the observations of this audit.
594 Reporting of Weight Loss Outcomes Following Bariatric Surgery in Comparison to ASMBS Guidelines
Authors: Shahwan S , Oochit K , Kourounis G 
Published: November 2022

Abstract
A large volume of literature supports bariatric surgery as an effective therapy. The heterogeneity of weight loss (WL) outcomes significantly limits synthesis and meta-analysis. In 2015, the American Society for Metabolic and Bariatric Surgery (ASMBS) published reporting standards to achieve consistency in the literature. We aim to assess the effect of the ASMBS guidance in the bariatric surgery literature.
Nine PubMed journals focusing on bariatric surgery were screened for articles published in the first six months of 2015 and 2021. Of 1807 articles, 105 and 158 articles in 2015 and 2021 respectively, reported on WL outcomes following bariatric surgery.
Overall ASMBS compliance increased from 5% to 20%, p&lt;0.05. Initial weight and BMI were reported in all studies but clarification of this as the immediate preoperative weight reduced from 15% to 6%, p&lt;0.05. Percent Total WL (%TWL) increased from 17% to 61%, p&lt;0.05. Change in BMI (ΔBMI) stayed 41%. Percent BMI or Excess WL (%EBMIL or %EWL) did not significantly change from 76% to 69%, p=0.203. In 2021, two of the nine included journals gave guidance on reporting WL in their instructions to authors. 30% (n=42/142) of articles did not comply with the journal's WL reporting guidance. Other unique reported WL outcomes increased from 44 to 55.
Significant heterogeneity in reporting WL outcomes remains hindering robust meta-analysis of published articles. Use of referral weight instead of preoperative weight can inflate WL in those with mandated preoperative WL, clarifying initial weight is needed. Other non-standard measures of WL have increased.