bluuebunny/crossref_metadata_2025_split huggingface dataset:
171 Developing & Centralising a Nurse-Led Local Anaesthetic (La) Transperineal (Tp) Biopsy Service During Covid: A Success Story
Authors: Winters D. , Mehmi A. , Odedra A. , Buttleman S. , Ancheta J. , Allchorne P. , Rajan P. , Khan S. , Green J.S.A. 
Published: February 2022

Abstract

Introduction
During the first COVID-19 wave, the BAUS Section of Oncology issued guidance to minimise risks of sepsis and general anaesthesia at prostate biopsy. Consequently, and as a result of diminished diagnostics capacity on Trust acute sites, we implemented a centralised network-wide nurse-led LA TP biopsy service on a COVID-secure “green” site and abandoned trans-rectal biopsies. We evaluated the impact of this service improvement on patient waiting times before and after national lockdown in March 2020.

Method
Classic Quality Improvement (QI) methodology was used with continuous data collection and waiting list management by clinical staff with standard admin support. Balancing measurements were collected. Run charts were used to confirm whether a change led to a real and sustainable improvement.

Results
The number of days waiting, from time of request to date of biopsy, is presented in the following run chart. The mean waiting time for those pre lockdown was 145 days (SD 57) whereas post lockdown was 23 days (SD 20). This identified that there was a significant difference between the average waiting time pre and post lockdown (U = 55.5, p = &lt;0.001) There were also reductions in waiting time when subcategorised into planned Active Surveillance cases, target cases and delayed cases.

Conclusions
Centralising the TP biopsy service and converting to a nurse led LA service has led to reductions in waiting lists and was safely expedited and resilient even in the COVID-19 pandemic. Allowing a second advanced TP practitioner to be fully trained, during COVID. The service was highly valued by patients and staff.
172 Septic Arthritis of the Wrist: Audit of Management and Awareness of National Guidelines Amongst Orthopaedic Surgeons in a District General Hospital
Authors: Raza F. , Seewoonarain S. , Willmott H. 
Published: February 2022

Abstract

Aim
Septic arthritis (SA) of the wrist is relatively uncommon and, in contrast to SA of large joints, can safely be managed with serial aspiration to dryness rather than traditional open surgical drainage. This is supported by BSR & BHPR, BOA, RCGP and BSAC guidelines for management of the hot swollen joint in adults. We conducted an audit of management of suspected wrist SA patients and surveyed awareness of relevant guidelines amongst orthopaedic surgeons.

Method
Electronic records of patients referred as suspected wrist SA to the orthopaedic department over a six-month period (August 2020 to February 2021) were retrospectively reviewed. Data analysis included demographics, diagnosis, management, and treatment outcome.
In addition, knowledge of wrist SA management amongst orthopaedic medical staff was determined via a multiple-choice questionnaire.

Results
11 patients were identified (5M:6F, age range 62–91).
6/11 patients underwent wrist aspiration though only one patient had a positive gram stain.
No patients underwent serial aspiration as advocated by national guidelines.
2/11 patients underwent formal surgical washout in theatre.
15 orthopaedic doctors were surveyed (8 Junior Doctors, 4 Registrars, 3 Consultants). 2/15 were aware of national guidelines. 11/15 chose joint aspiration as an initial investigation. 2/15 considered repeated joint aspiration to dryness as definitive management.

Conclusions
This audit highlighted low compliance with national guidelines when managing wrist SA, although this did not adversely affect patient outcomes. We demonstrated lack of awareness of relevant guidelines amongst orthopaedic surgeons. We propose relevant teaching and incorporation of national guidelines into Trust policy.
173 Causes of Death in Patients with Pancreatic Adenocarcinoma: A SEER-Based Study
Authors: Harvitkar R.U. , Harishkumar P. , Ramasamy S. 
Published: February 2022

Abstract

Aim
To identify the commonest causes of non-cancer mortality in patients with PAC and compare their mortality risk with the general population.

Method
This population-based study analyzed data of PAC patients registered in the Surveillance, Epidemiology, and End Results (SEER) database from 1975 to 2016. Patients were followed up until 2016.We studied cancer and non-cancer causes of death and investigated their possible association with age, sex, race, tumor stage at presentation, and treatment modality; each according to the time interval from diagnosis during which death events occurred (intervals included &lt; 1 year, 1–5 years, 5–10 years, and &gt; 10 years after diagnosis).We estimated the standardized mortality ratio (SMR) with the 95% confidence interval (CI) for each mortality cause in each time interval. Analysis was conducted using SEER*Stat software version 8.3.9.

Result
A total of 67,694 PAC patients included in the analysis; of these patients, 64,347 (95.06%) died during the follow-up period. Most deaths occurred due to cancers (61,685; 95.86% of deaths), while non-cancer mortality causes represented only 4.14%.The commonest causes of non-cancer mortality were heart diseases (SMR = 2.79;95%CI,2.6–2.98),cerebrovascular diseases (SMR = 3.11;95% CI, 2.71–3.56), and septicemia (SMR = 8.2;95%CI,6.9–9.68).PAC patients had a higher mortality risk than the general population for all studied mortality causes except Alzheimer's disease (SMR = 0.5;95% CI, 0.3–0.78) and homicide and legal intervention (SMR = 2.29; 95%CI, 0.47–6.68).

Conclusions
About 96% of PAC patients' deaths are due to cancers. While the dominant non-cancer causes of death in these patients include heart diseases, cerebrovascular diseases, and septicemia, with a higher risk of mortality for most non-cancer causes than the general population.
181 Can Movement Modelling Software, in a Digital Preclinical Trial, Help Understand the Optimal Sit to Stand Motion Using Commercially Available Peripheral Nerve Stimulators?
Authors: Noakes A. 
Published: February 2022

Abstract

Aim
Ethical approval is difficult to acquire for functional electrical stimulation trials, simulation may bridge the gap between FES concept and clinical trial approval. Using OpenSim modelling tool, this project aims to identify the minimum number of muscles, their strength and order of stimulation, that can produce the safest standing motion, using commercially available peripheral nerve stimulators.

Method
Modelling was executed using version 4.1 of OpenSim, utilising a previously validated, and extensively referred to, OpenSim lower limb model (Gait2354_Simbody) as the base model. Starting excitation values emulated previous literature for optimal sit to stand motion. EMG values were inputted using the excitation function of the forward dynamics tool, used to predict motion given defined neurological excitation values. Muscle groups and excitation values were altered iteratively to achieve the objective. Once the model performed the required function, within normal joint forces, the simulation was stopped.

Results
For optimal movement, the muscles required included, Gluteus Maximus, Rectus Femoris, Sartorius, Soleus, Tibialis Anterior, Vastus Intermedialis. This exceeded the 5-muscle objective, however muscles that shared a nervous supply could utilise a single FES port. Joint reaction forces remained within literature estimates, knee on tibia joint in the vertical plane achieved 2500N bilaterally, this represents a force equating to 3.64 times body weight.

Conclusions
Movement modelling software can become a fundamental tool in acquiring ethical approval for FES studies through simulation of full body motion. OpenSim requires iterative inputted improvements by the user, therefore a software which generates automated efficient movements would be more accurate and faster.
186 Thyroid Monitoring for Patients Born After the Chernobyl Disaster Within the Blast Radius: A Literature Review
Authors: Faraj A. , Tan S.J.T. , Hussain K. 
Published: February 2022

Abstract

Aim
There is a well-documented increase in incidence of thyroid cancer in individuals living within the blast radius at the time of the Chernobyl nuclear disaster. Following a case encountered in our clinical practice of a patient born within the blast radius but after the blast itself, we aimed to evaluate the evidence of increased thyroid cancer within such a cohort.

Method
We reviewed the existing literature for evidence for or against an increase in thyroid cancer in this population group. Identified articles were reviewed and appraised, evaluating the evidence for any possible increase in incidence.

Results
Very few papers looked at risk in such a population, but those identified suggested no increase in risk of thyroid cancer in individuals born within the radius, after the blast.

Conclusions
We conclude there is little evidence supporting routine monitoring for individuals born within the blast radius after the blast, and as such this should be included in the British Thyroid Association guidelines.
187 Pooled Waiting Lists for Primary Hip and Knee Arthroplasty: Are the Outcomes Inferior to a Named Consultant List?
Authors: Thacker J. , Peake C. , Balasubramani P. , Chongbang T.P. , Jayakanathan M. , Unnithan A. 
Published: February 2022

Abstract

Aim
A pooled waiting list model is where patients are treated in turn by the first available surgeon and works to use existing resources more efficiently to better match demand. Aim is to compare quantitative data of patients on the pooled list and named-consultant’ list and to determine the superiority of either list based on favourable outcomes.

Method
This single centre, retrospective study compared outcomes of primary elective hip and knee arthroplasty for osteoarthritis in patients from pooled and ‘named-consultant’ waiting lists over a 1-year period. The study period was before the corona virus pandemic. 371 total knee replacements (TKR) and 373 total hip replacements (THR) were included. Baseline characteristics were compared between patients from pooled and named-consultant lists.

Results
In the pooled TKR group, a significantly higher proportion of patients were older with higher BMI and ASA grade (p = 0.027, p = 0.479, p&lt;0.001 respectively). There was no difference in baseline characteristics in the THR cohort. Waiting time to surgery was less in the pooled TKR group (mean = 4.17months) with no significant difference in mortality, revision and infection rates, length of stay, operative blood loss, DVT/PE rate, proportion requiring pain team referral and the number with unsatisfactory range of motion at follow-up. There was no significant difference in any outcomes between two groups in the THR cohort.

Conclusions
Pooled lists can therefore be an excellent tool in primary THR/TKR to efficiently utilize all available resources (surgeons and theatre time) without compromising on patient outcomes and prompting use in all UK arthroplasty centres.
188 Quality of Documentation of Patient Notes in the Surgical Department
Authors: Da Costa K. , Islam R. , Khanfar A. , Gelber E. 
Published: February 2022

Abstract

Aim
Quality of documentation of patient notes

Method
Guidance for standards was taken from ‘The importance of Clinical Documentation, Ann R Coll Surg Engl(Suppl) 2014; 96:18–20’
Data of 100 patients over 2 weeks. Assessed:

Results
Availability of notes:
15/100 notes were not available on the wards at the time of data collection

Conclusions
Based on above results the significances of:

Results
Unable to provide proof of treatment if any abnormalities were found and medical negligence
190 Metabonomics in Chronic Venous Disease - Local and Systemic Phenotypes
Authors: Adenipekun A. , Bergner R. , Onida S. , Davies A. 
Published: February 2022

Abstract

Aim
Chronic venous disease (CVD) describes a spectrum of clinical presentations associated with a poorly functioning venous system, ranging from asymptomatic venous disease to varicose veins, skin changes and venous leg ulceration. These conditions negatively impact on quality of life.
There is evidence that ‘local’ blood sampled from lower limb veins contains different biomarkers to systemic blood, particularly with respect to inflammatory and prothrombotic mediators; however, the literature pertaining to metabolic phenotyping platforms is limited. The aim of this study was to assess whether the metabolic signatures in systemic serum differed from the signatures in truncal/varicose vein (local blood) in patients with CVD.

Method
64 patients presenting with CVD were recruited to participate in the study following clinical and duplex ultrasound assessment. Blood samples were collected from the antecubital fossa and from the lowermost refluxing vein or varicosity in the leg. Metabolic profiling was performed using Reversed-Phase Ultra Performance Liquid Chromatography (RP-UPLC) lipid profiling analysis. Univariate and multivariate statistical analysis were performed.

Results
Principal component analysis (PCA) of overall spectral data showed no separation amongst metabolites. Orthogonal Projections to Latent Structures Discriminant Analysis (OPLS-DA) revealed preliminary group differences between leg and arm samples, but this was not significant upon CV-ANOVA testing (P = 1)

Conclusions
The analysis via RP-UPLC did not identify significant differences in the metabolic profile of systemic and local serum samples; however, this may be due to the limited sample size, or the platform employed. Future work will include performing the analysis employing complimentary metabolic phenotyping platforms and a larger sample size.
191 Improving and Maintaining the Implementation of Local Guidance on Vitamin D Supplementation for Patients with Hip Fracture
Authors: Garnett A. 
Published: February 2022

Abstract

Introduction
With the number of older persons presenting to hospital with neck of femur (NOF) fractures climbing annually, there is an emphasis on reducing the impact of environmental factors in at risk individuals. The link between vitamin D deficiency and osteoporotic fractures has long been recognised in older populations and is incorporated in Department of Health ‘Best Practice Tariffs’ for hip fracture management.
Recommendations state that all patients admitted to hospital with a NOF fracture should be assessed for bone protection, and Wirral University Teaching Hospital has developed local guidance to aid appropriate prescription of vitamin D for patients with a deficiency. Concerns were raised by local Orthogeriatricians that this guidance was not being consistently implemented and a review of current practice was requested.

Method
A quality improvement project reviewed vitamin D supplementation for all NOF fracture patients over a 3-month period. Subsequently lanyard cards with a summary of local guidance and correct treatment were created and distributed to junior doctors. Compliance with the guidance on measurement and treatment of low vitamin D levels was reviewed after 3 months and a further 12 months.

Results
Initially the guidance was followed correctly in only 48% of patients. With the implementation of lanyard cards this rose to 78% after 3 months and more encouragingly further increased to 83% after a further 12 months.

Conclusions
Providing an easily accessible summarised version of local guidance improved measurement of vitamin D levels and appropriate treatment for at risk patients.
193 Aspirin Compared with Other Anticoagulants for Use as VTE Prophylaxis in Elective Orthopaedic Hip and Knee Operations: A Narrative Literature Review
Authors: Olukoya O. , Fultang J. 
Published: February 2022

Abstract

Introduction
Total hip and knee arthroplasty are effective methods for treating arthritis but have an associated risk of venous thromboembolism (VTE). To reduce this risk, prophylactic agents including Aspirin, Low Molecular Weight Heparin, Vitamin K antagonists and Direct Oral Anticoagulants are employed for up to 35 days after surgery. This narrative literature review utilised a systematic approach to critically assess the current evidence surrounding the use of Aspirin for VTE prophylaxis as compared to anticoagulants.

Method
An advanced multistage electronic search was performed in May 2021 using the OVID/Medline and Embase online libraries to identify available studies relevant to the subject from 1974. Additional evidence identified during the review process were added. The final papers meeting the inclusion criteria were then assessed using the Critical Appraisal Skills Programme (CASP) tool.

Results
12 studies (60%) (2 Meta-analysis, 3 randomised trials, 7 retrospective studies) favoured Aspirin over anticoagulants for VTE prophylaxis. 15 studies (75%) (2 meta-analysis, 3 randomised trials, 9 retrospective, 1 matched cohort) showed Aspirin had better bleeding profiles and complication rates; statistically significant in 7 (46.7%) (1 randomised trial, 6 retrospective studies). 8 studies (1 randomised trial, 6 retrospective studies, 1 matched cohort) reported statistically significant results for Aspirin - 5 (62.5%) declared Aspirin superior for VTE prophylaxis, while 7 (87.5%) declared Aspirin superior in terms of bleeding complications.

Conclusions
The current evidence indicates that Aspirin is superior to anticoagulants, in their various iterations, for VTE prophylaxis and in terms of their bleeding profiles.
199 The Influence of Pre-Operative Factors on Patient Length of Stay After Total Knee Replacement
Authors: Yadav S. , Jeyaweerasingam S. , Htwe S.M. , Gadde R. , Rossiter D. , Jacob J. , Unnithan A. 
Published: February 2022

Abstract

Aim
This study aims to assess the impact of pre-operative factors on the length of stay in patients following total knee replacement at our institution.

Method
A total of 478 patients following total knee replacement between January 2017-Decemeber 2019 are included in this study. All patients underwent total knee replacement with a medial rotating total knee prosthesis (MRK; Matt Ortho UK).
Data for each patient was collated retrospectively and included the following: Patient demographics (age and sex), American Society of Anaesthesiology (ASA) score, pre-operative range of movement (ROM), Body Mass Index (BMI), and pre-operative haemoglobin. Each factor was then compared with the length of stay for all 478 patients. Statistical significance was sort for each pre-operative factor for both men and women.

Results
Our cohort of patients includes 291 females and 187 males. Patients ranged from 39 to 90 years with an average age of 68. The average BMI of the cohort was 31.3(18.6–56.56) and the average ASA grade was 2.
Preoperative hemoglobin and the Age of the patient at the time of surgery were the only two factors which had a statistically significant impact on the length of hospital stay (p&lt;0.05). BMI, Pre- operative range of motion and ASA scores had no statistically significant effect on the length of hospital stay in our cohort.

Conclusions
Low pre-operative hemoglobin and increasing age have significant effects on length of stay after total knee replacement. The BMI, pre-operative range of movement and ASA scores do not influence the length of hospital stay.
204 Thoracic Outlet Syndrome After Nuss Procedure for Pectus Excavatum: An Unusual Complication of a Common Procedure
Authors: Gopalaswamy M. , Waterhouse B. , Dunning J. 
Published: February 2022

Abstract
Pectus excavatum is a common abnormality of the chest wall with variable severity. The Nuss procedure was introduced in 1987 and has since become a standard modality of treatment for this condition. This operation has a well-established safety record and significant complications are rare. Case report of a 21-year-old male with pectus exavatum operated on in our department. Symptoms discovered during post-operative follow up: - He complained of purple discolouration and swelling of his left hand, which was positional, particularly pronounced with arms hanging by his side, and relieved when he lifted his arm overhead.- This was also accompanied by his left arm feeling colder to the touch when compared to his right arm. Examination findings: - At rest, no objective sensory deficits were elicited.- On arm elevation and external rotation, the swelling and congestion resolved, but the arm turned white, with a positive Adson’s test.- Findings were highly suggestive of Thoracic Outlet syndrome Imaging findings: CT Angiogram: abnormally fused first and second rib on the left. Obvious kink in the artery suggesting presence of a cervical band. Operative findings: - The anterior scalene was abnormally deep and attached to the lateral and anterior surface of rib and tightly fibrous.- uscle was divided at its insertion and was found to encircle the Subclavian artery completely

Conclusions
205 Vascular Outcomes in TIA Patients
Authors: Manson D. , Johnston M. , Kent F. 
Published: February 2022

Abstract

Aim
To identify vascular outcomes in patients presenting with TIA

Method
We completed a closed loop audit at the University Hospital of Wales assessing vascular outcomes in TIA patients. We audited the first 100 patients with significant carotid ultrasound findings from January 1st, 2020, and then the first 75 patients with significant findings in the repeat study from July 1st, 2021. We assessed the time between symptom onset, referral, and consultation, whether that be geriatric or vascular, and the outcome of that consultation. If patients required surgical vascular intervention, we assessed whether this was conducted within the 14-day window outlined by national and international guidelines.

Results
We found that for a multitude of reasons, including delayed patient presentation and arduous referral processes, that patients with significant findings were not receiving vascular input within the 14-day window, let alone receive an operation. We suggested that a centralised vascular referral pathway and a consultant of the week would facilitate a more efficient TIA-vascular process, allowing for carotid endarerectomies to be performed within the internationally advised timeframe. The closed loop revealed that although patient presentation and referral times were obviously unaffected, that vascular consultations were occurring far more rapidly, as aided by the newly incorporated consultant of the week.

Conclusions
That a centralised departmental coordinator, and a consultant of the week delegated towards facilitating TIA referrals for potental carotid endarterecomy, was beneficial in terms of meeting standardised timeframes, but that more could be done to improve the service.