bluuebunny/crossref_metadata_2025_split huggingface dataset:
724 Do Renal Mass Biopsies Influence Patient Management? a Case Series Study in a Tertiary Hospital
Authors: Kretzmer L , Nour E , Akinjise-Ferdinand O , Mohammed M , Bhatt R 
Published: November 2022

Abstract
In recent years renal mass biopsy (RMB) has been increasingly adopted to guide management in patients with renal lesions. Indications include the evaluation of renal masses or cysts, and diagnosis prior to initiating targeted chemotherapy or ablation.
A case series of 232 RMBs was collected from 2009–2020. Inclusion criteria were RMBs taken from native kidneys.
Participants' mean age was 64.7 years (SD = 13.57 years), with 67% being male. The diagnostic rate of RMB was 78.45% (n = 182/232). Whether masses were solid or cystic did not influence diagnostic rate (p = .94143). Positive predictive value (PPV) of RMB compared with surgical histology was .8775. Only 1.3% (n = 3/232) of cases had significant complications.
Patients with non-diagnostic biopsies were more likely to be managed with surveillance alone (56.0% vs 32.4%; p &lt; .05). Diagnostic RMBs did not statistically influence whether patients had surgical management (p = .188914). Of non-diagnostic RMBs, 100% (n = 7/7) of patients with surgical histology had renal cell carcinoma (RCC).
RMB has specific implications in two special populations: In small renal masses, PPV of RMB increased to 1.0. 16.7% (n = 3/18) of patients diagnosed with oncocytoma at RMB had a diagnosis of RCC.
RMBs are safe with a high diagnostic rate. However, it seems to not influence definitive patient management. Clinicians should be wary when dealing with special populations. Results must be viewed in the context of the patient's history and imaging, and management should be determined using a multi-disciplinary approach.
806 The Efficacy of Prostatic Arterial Embolisation as Indicated by Clinical Outcomes
Authors: Parmar S , McRae B , Hines J , Munneke G , Walkden M , Von Stempel C 
Published: November 2022

Abstract

Aim
PAE (prostatic arterial embolisation) is a non-surgical, minimally invasive procedure used to treat symptoms of benign prostatic hyperplasia (BPH). It is used to treat patients with moderate to severe lower urinary tract symptoms including those requiring long term urinary catheter placement and intermittent self-catheterisation. The incidence of urinary tract infection is greater in this group at baseline and the risk of infection as a complication of PAE is recognised in the literature. This study aimed to compare the clinical outcomes of PAE to those of TURP (transurethral resection of the prostate), the reference standard for BPH treatment.

Method
All patients who underwent PAE between 2019 to 2021 at a single centre were included in this retrospective study. Clinical outcomes of patients were also recorded including international prostate symptom score (IPSS) and urodynamic results. These were compared to TURP results provided in the UK ROPE study.

Results
82% of patients experienced an improved IPSS after PAE, with a median reduction of 15 points, compared with a median reduction of 17 points with TURP. PAE caused a greater reduction in median prostate volume but proved to be less effective in improving urodynamic test results when compared to TURP.

Conclusion
While still clinically effective, PAE is less effective for treatment of lower urinary tract symptoms from BPH when compared to TURP.
822 The Use of Prophylactic Antibiotics Pre-Orchidectomy – a Retrospective Cohort Study
Authors: Doherty J , Nambi Rajan T 
Published: November 2022

Abstract

Aim
NICE guidance recommends the use of antibiotic prophylaxis in clean-contaminated procedures and when a prosthetic is placed. However, the use in orchidectomies is not specified under the treatment summary heading of ‘Urological Procedures, Antibacterial Prophylaxis’. The use of prophylactic antibiotics pre-orchidectomy varied amongst senior urologists within a District General Hospital, where no specific protocol was in use. This retrospective cohort study aimed to decipher if the use of prophylactic antibiotics reduced post-operative infection incidence following radical orchidectomies.

Method
50 consecutive orchidectomies, performed between February 2019 and July 2021, were analysed. It was identified whether the patient had antibiotics administered pre-operatively and if they developed a subsequent wound infection through post-operative ward rounds, clinic letters and presentations to the Emergency Department. Orchidectomies performed by general surgeons were excluded from analysis.

Results
Of the 50 orchidectomies analysed, 30 patients received pre-operative antibiotics, four of whom subsequently developed a post-operative infection. Of the 20 patients that did not receive prophylactic antibiotics, nine developed a post-operative infection. The relative risk was calculated at 0.2963 with a 70.4% relative risk reduction if prophylactic antibiotics were administered. Chi squared tests calculated a p-value of 0.012 highlighting statistical significance. Eight patients had primary prosthesis placed at the time of orchidectomy, all of whom received prophylactic antibiotics.

Conclusion
Prophylactic antibiotics were effective in preventing post-orchiectomy wound infections and routine local protocols should advise the use in orchidectomies, which classify as clean-contaminated procedures as per NICE guidance.
894 What Proportion of Acute Admissions for Urinary Tract Infection Under Urology Require Surgical Intervention Within 6 Months?
Authors: Humayon D , Mowbray L , Baby A , Mahesan T 
Published: November 2022

Abstract

Introduction
All male patients with urinary tract infections (UTI) at this large district general hospital are admitted under the care of the urology department. This audit aims to establish how many male patients over the age of 70 with a diagnosis of UTI required surgical intervention in the 6 months following admission.

Method
We performed a retrospective audit of all patients over 70 admitted with a UTI over a five-month period. Patients with recent instrumentation or other pathologies, including visible haematuria or ureteric stones confirmed on imaging in the accident and emergency department were excluded.

Results
Of the 30 patients included, five (16.7%) required invasive intervention. Three (10%) acutely, (two ureteric stents, one nephrostomy), two (6%) as an outpatient on an elective basis (flexible ureteroscopy and prostate artery embolisation).

Conclusions
Over 80% of patients included in this audit did not require surgical intervention within six months. Whilst UTI is a significant finding in younger men suggestive of structural or systemic abnormality, UTIs in incontinent, catheterised, or older men does not carry the same risks and rarely requires intervention. Elderly care wards were established to ensure older patients receive support to improve health functioning and prevent acute deterioration in physical and mental health during admission. Given that less than 20% of men required intervention, this cohort of patients would be better admitted to wards geared towards elderly care who are better able to manage their co-morbidities and have the resources for early physiotherapy and occupational therapy input.
900 Documenting Escalation Status in Acute Urology Admissions with Known Urological Malignancy
Authors: Humayon D , Osmani Z , Mahesan T 
Published: November 2022

Abstract

Introduction
Knowledge of a patient's escalation status including cardiopulmonary resuscitation and invasive ventilation is crucial to ensure appropriate management. Patients with pre-existing advanced prostate or bladder cancer are often elderly and frail, and even more so in the context of an acute admission to hospital. This audit aims to establish how many patients admitted acutely under urology at a large district general hospital with known prostate and bladder cancers, had their escalation statuses appropriately documented.

Method
We performed a retrospective audit over a ten-week period. We included all patients admitted under urology with a diagnosis of prostate or bladder cancer.

Results
Of the 30 patients included, 4 (13.3%) had completed escalation forms. All were completed on admission.

Conclusions
Escalation status was poorly documented for this cohort of patients. This is likely due to a number of issues including pressure on the service and confusion about who can and should make these decisions.
That all forms were completed on admission highlights that this is likely to be the best opportunity and junior doctors must be encouraged to complete escalation forms at this time with decisions subsequently ratified by a consultant within 24 hours.
Moving forward, intervention is clearly needed. As a department an imminent move towards a consultant of the week model will likely improve documentation, however junior doctors too must be encouraged to open these discussions early in the patient journey. Only then can we ensure patients receives care that is both appropriate and reflects their wishes.
921 Establishing the Role of Bedside Disposable Cystoscopes for Emergency Urethral Catheterisation
Authors: Albnhawy A , Humayon D , Henderson J , Mahesan T 
Published: November 2022

Abstract

Introduction
Where urethral catheterisation fails, cystoscopy may enable urologists’ adequate views to identify the urethral channel. Traditionally this has required a slot on the emergency operating list. Our district general hospital introduced single use flexible cystoscopes to allow for bedside catheterisation and here we present our experience.

Method
Data was collected prospectively each time a disposable scope was used for urethral catheterisation over a 4-month period. A form was designed and distributed to all six clinicians who used the device. We evaluated both assessment of the scope and the success of the procedure.

Results
16 forms were collected. Overall, the experience was described as good in 14 out of 16 instances. Catheterisation was successful in 14 cases. 13 forms described the image of the scope as being average, with three describing it as good. 10 forms reported good flexibility, with six reporting it as average. On seven occasions the clinician denied difficulty passing the scope through the narrowing. Six clinicians found the views of the bladder adequate although in eight of 16 cases, the bladder was not visualised. Not all feedback was positive with some clinicians reporting weak irrigation and the challenge of the scope having only one channel.

Discussion
The disposable scope showed high efficacy for insertion of a urethral catheter in cases of difficult urethral catheterisation. Clinicians highlighted good lighting and irrigation as well as flexibility. The introduction of disposable cystoscopes saves resources as well as being financially sensible. we will continue its use in our departments.
962 Prognostic Value of Neutrophil to Lymphocyte Ratio (NLR) and Platelet to Lymphocyte Ratio (PLR) for Small Renal Cell Carcinomas (RCC) After Image-Guided Cryoablation or Radio-Frequency Ablation (RFA)
Authors: Asif A , Osman F , Koe JSE , Ng A , Cartledge J , Kimuli M , Vasudev N , Ralph C , Jagdev S , Bhattarai S , Smith J , Lenton J , Chan VWS , Wah TM 
Published: November 2022

Abstract

Aim
This is the first study investigating the relationship between NLR or PLR and outcomes of percutaneous cryoablation or RFA for small RCCs with long-term outcomes.

Method
All patients undergoing cryoablation or RFA for small RCCs (&lt;7cm) from 2003–2016 at a regional centre for RCC were included. Optimal cut-offs for NLR/PLR were determined using the ROC curve and AUC using the Youden method. Outcomes were compared using Cox or logistic regression.

Results
203 patients (Cryoablation:103, RFA:100) were included. Median follow-up was 75 months and 98 months, respectively.
Using the Youden method, high post-operative NLR values were associated with worsened local recurrence-free survival (LRFS) (NLR &gt;5.38; HR: 5.13, p=0.037) and worsened Overall Survival (OS) (NLR &gt;6.42; HR: 3.40, p&lt;0.001) in all patients.
High post-operative PLR values were associated with worsened OS in all patients (PLR &gt;192; HR: 2.31, p=0.006) and RFA patients alone (n=100; PLR &gt;260; HR: 8.27, p&lt;0.001).
Using continuous Cox regression model, greater changes in peri operative NLR were associated with worsened LRFS in cryoablation alone and all patients (Continous; HR: 1.09, p=0.028).
Higher post-operative NLR was also associated with worsened LRFS in cryoablation patients alone (HR: 1.10, p=0.046).
Post-operative NLR (HR:1.17, p=0.002), change in peri-operative NLR (HR:1.19, p=0.001), and change in peri-operative PLR (HR:1.20, p=0.009) were all associated with worsened CSS in all patients.
Pre-operative PLR and NLR were not associated with complications and change in renal function.

Conclusion
NLR and PLR are valuable prognostic factors for this group of patients and should be used to guide subsequent follow-up and monitoring of recurrence.
975 Evaluation of the Quality of Our Consent Forms Used for Ureteroscopy and Nephroureteroscopy - Is It Time to Go Digital?
Authors: Rafi AU , Breish M , Nadeem M 
Published: November 2022

Abstract

Aim
Consent documentation for surgical procedures must be precise and clear in order to achieve excellence in clinical practice. In this audit, we aim to compare our consent forms against BAUS information leaflets on ureteroscopy and stone procedure and assess the documentation of all serious and frequently occurring complications as mentioned on BAUS leaflet.

Method
We retrospectively reviewed the consent forms of 60 patients who underwent elective ureteroscopy between August 2020 - April 2021 to assess the quality of documentation as well as legibility of handwriting.

Results
As a total of 60 consent forms were reviewed. 35 males and 25 females contributed to the study with 59 being the median age. There were over 10 risks being commonly missed. Some of the important risks such as stone recurrence 95%, catheterisation 92%, major damage to ureter wall 86%, pain 71% and residual stone 61% were missed. The documentation also outlines other risks; ureteric stricture 53%, aesthetic risk 67%, failure to access ureter 51% and stent symptoms 47%. Minor damage to the wall of ureter 41%, alongside need of another surgery were recorded as other commonly neglected risks. However, only 7% of the consent forms did not mention bleeding and just 2% of the forms failed to include stent insertion as a common effect of procedure. Only 17% consent for did not have eligible handwriting, although this is subjective.

Conclusions
Documentation on consent forms for ureteroscopy lacks accuracy and missed important information. We propose use of digital consent form to assess compliance and quality of consent documentation.
46 Evaluating Clinical Outcomes in Temporal Artery Biopsy: A Retrospective Observational Study
Authors: Ishak P , Walker E , Boom S , Wallace D 
Published: November 2022

Abstract

Aim
Giant cell arteritis (GCA) is an inflammatory vasculopathy affecting large and medium calibre arteries, with temporal artery biopsy (TAB) constituting an important diagnostic component. The aim of this study was to analyse local practice in TAB and assess clinical outcomes with reference to current guidelines.

Method
All patients undergoing TAB in our institution between April 2018 and March 2021 were retrospectively studied and the American College of Rheumatology (ACR) score recorded.

Results
124 patients were included in the study. The female to male ratio was 2.2:1 and average age was 71±10 years. 95 patients presented with temporal artery signs and headache respectively. The mean time from steroid commencement to TAB was 6 days (range 0–36 days). 23 biopsies were positive (median ACR score of 4, range 2–4, excluding pathology result) – these patients were treated with steroids. 98 biopsies were negative or non-specific; most stopped steroid treatment, however 30 patients were clinically GCA and continued therapy (median ACR score of 3, range 2–4). Three patients were never prescribed steroids (median ACR score of 2).

Conclusions
GCA is a clinical diagnosis guided by symptoms and signs, inflammatory biochemical markers, and medium artery biopsy. The provisional ACR scoring is highly suggestive of the outcome of TAB.
54 Evaluating Best Medical Therapy Provision in Peripheral Arterial Disease Patients: A Prospective Audit
Authors: Ishak P , Iftikhar N , Nadarasa A , Boom S , Wallace D 
Published: November 2022

Abstract

Background
Best medical therapy (BMT) is a collection of evidence-based cost-effective interventions, which significantly decreases cerebrovascular and coronary mortality and morbidity risk by at least 20% in peripheral arterial disease (PAD) patients. Its implementation was audited in patients attended our vascular unit.

Method
A prospective audit of BMT implementation in PAD patients in University Hospital Ayr over a three-week period: diabetic and hypertension control, statin and antiplatelet therapy were audited from electronic notes and prescription charts. Exercise and smoking cessation advice given during consultations was recorded and audited.

Results
35 patients were randomly selected from ward admissions and vascular clinics. Their mean age was 69±12, 25 were male. 4 out of 11 current smokers received smoking cessation advice. All the patients attending the vascular clinic were given exercise advice. 3 patients had never had their HbA1c checked. 7 of 14 diabetic patients with poor control had changes to their medication. Stains were started in 7 out of 14 patients not currently on a statin and another 4 patients had their statin dose increased. 32 patients had their lipid profile checked. Both patients with newly diagnosed hypertension were not prescribed antihypertensive. Only 5 out of 12 patients who should have had an antiplatelet agent received them. 5 patients were changed from a single antiplatelet agent to dual therapy.

Conclusions
Primary and secondary care education is essential to improve BMT provision in PAD patients.
165 Antithrombotic Therapy for Aortic and Peripheral Artery Aneurysms: A Systematic Review and Meta-Analysis
Authors: Wong KHF , Zlatanovic P , Bosanquet D , Aboyans V , Saratzis A , Kakkos S , Hinchliffe R , Twine C 
Published: November 2022

Abstract

Aim
This systematic review and meta-analysis aimed to assess the impact of antithrombotic agents on extracranial aneurysms under surveillance or undergoing intervention.

Method
Medline, Embase, and CENTRAL databases were searched. Randomised-controlled trials and observational studies investigating the effect of antithrombotic therapy on clinical outcomes for patients with aortic or extracranial peripheral arterial aneurysms were included. Aneurysm growth rate, major adverse cardiovascular or limb events, mortality, endoleaks, re-intervention rates, and other outcomes were captured.

Results
Fifty-seven studies involving 121,451 patients were included (26 antiplatelets, 12 anticoagulants, 16 any antithrombotic agent(s), 2 intra-operative heparin). Aspirin reduced growth rates of aortic aneurysms under surveillance (mean difference -0.9mm/y, 95%CI -1.74 to -0.07, p=0.03; GRADE certainty: moderate). For aortic aneurysms undergoing intervention, antithrombotics increased 30-day mortality (odds ratio [OR] 2.30, 95%CI 1.51 to 3.51, p&lt;0.001; GRADE certainty: moderate). Antiplatelets reduced long-term all-cause mortality (hazard ratio [HR] 0.84, 95%CI 0.76 to 0.92, p&lt;0.001; GRADE certainty: moderate), whilst anticoagulants increased this risk (HR 1.64, 95%CI 1.14 to 2.37, p=0.008; GRADE certainty: very low). Anticoagulants increased incidence of endoleaks under 3 years, and re-intervention rates (p&lt;0.05 for all). Antithrombotic agents did not significantly affect rupture rates in aortic aneurysms. Meta-analysis was not possible for ruptured aneurysms and popliteal aneurysms.

Conclusions
There is moderate quality evidence that aspirin reduces aneurysm growth rates. Antiplatelet agents reduced all-cause mortality in aneurysms after intervention; whilst anticoagulants increased this risk, along with endoleaks and re-interventions. Well-designed trials are required to determine therapeutic benefits of antithrombotic agents for patients with aneurysms.
412 Knowledge and Practices for the Prevention of the Diabetic Foot in North Wales
Authors: Morris R , O'Malley J , Gilliland E , Shaikh F 
Published: November 2022

Abstract

Aim
Diabetes mellitus can result in a wide range of foot complications such as ulceration, infection, and amputation. The National Institute for Health and Care Excellence (NICE) recommend that all diabetic patients should receive verbal and written information relating to their foot care. Here we assess our compliance with the national guidelines and the levels of patient knowledge amongst the diabetic population in the North West of Wales.

Method
A questionnaire was provided to all adult diabetic patients attending the outpatient podiatry service over the course of three weeks at Ysbyty Gwynedd, North Wales. The survey included compliance and knowledge-based questions regarding foot care.

Results
A total of 65 patients were recruited and completed questionnaires. The majority of the patients were males (male:female ratio 2:1) and over 70 years and had type II diabetes.
98% of patients admitted to receiving verbal diabetic advice while only 57% received written information. Compliance with daily foot checks was 82%. Regarding patient knowledge, over 90% of patients selected the correct answer to 11 out of the 15 knowledge-based questions. Despite 95% recognising that poor footwear can contribute to diabetic foot complications, only 86% recognised that walking barefoot carries similar risks.

Conclusions
Diabetic foot knowledge is high within our studied population. Use of patient information leaflets can be further improved to help educate patients in avoiding barefoot walking and to prevent diabetic foot complications and limb loss.
590 The Value of Peripheral Pulse Examination in the Diagnosis of Intermittent Claudication
Authors: Shannon J , Srinivasamurthy D 
Published: November 2022

Abstract

Aim
The primary aim was to objectively evaluate the use of peripheral pulse examination as a screening tool for IC by calculating the sensitivity and specificity. Our secondary aim was to describe the cohort of patients referred to the clinic by their GP and identify areas for improvement and early initiation of best medical therapy.

Method
This study used a retrospective analysis of a prospectively maintained database. Records of all patients referred to the claudication clinic were collected from October 2018 to October 2019. The most distal palpable pulse of each leg was assigned a value and combined to create a ‘peripheral pulse score’. Risk factors, ABPI results, Peripheral Artery Disease (PAD) status and details of ongoing medical therapy were also recorded.

Results
211 patients referred by their GP were included in the study. The absence of bilateral foot pulses was found to have a sensitivity of 86%, specificity 92%, PPV 95% and NPV 79%. There is a strong correlation between peripheral pulse score and ABPI. Only 27% of patients suspected of having IC by their GP were on best medical therapy at their initial clinic visit.

Conclusions
Peripheral pulse examination is a valuable diagnostic tool for identifying patients with IC and can be used to guide referral to specialist services. We provide evidence for the use of foot pulses as a screening tool to be used by primary care providers. More patients being referred to the IC clinic can be started on best medical therapy for secondary prevention at the time of referral.