bluuebunny/crossref_metadata_2025_split huggingface dataset:
650 “Promoting Adequate Consenting for the Risks of Peri-Operative COVID-19 Complications in Patients Undergoing Surgery During the Pandemic”
Authors: Mazumdar E , Valenzuela T 
Published: November 2022

Abstract

Introduction
Patients with COVID-19 infection peri-operatively can suffer with significant cardiovascular and pulmonary complications, increasing mortality. Clinicians should discuss these risks with their patients as per the Royal College of Surgeons of England guidance (2020), so that patients can make informed decisions.

Method
Our aim was to identify whether the complications associated with COVID-19 in the peri-operative period was documented on the consent forms of both emergency and elective general surgical patients. To encourage clinicians to consent their patients, we devised a colourful poster, the ‘COVID-19 Consent Poster (CCP)’ which was placed next to the consent form on wards, outpatient clinics and the emergency department.

Results
A total of 49 procedures took place in the two-week period, of which 67% (n= 34) of patients were consented for the COVID-19 risk, and 33% (n= 15) were not. Following implementation of the CCP, data was recollected to identify whether practice had changed. During this time frame, 26 procedures took place out of which 50% (n=13) were not consented for the risks of COVID-19 complications.

Conclusions
Following implementation of the CCP, we saw initial rise in the number of consents, but this soon declined. We believe, this might be due to the rates of COVID-19 decreasing in the hospital and the community during the data collection period. Despite these figures, the importance of informed consent around peri-operative complications of COVID-19 remains with more of the population still getting infected with new variants emerging each year.
664 Superior Mesenteric Vein and Portal Vein Thrombosis in a Patient With COVID-19: A Rare Case
Authors: Jeilani M , Riad M 
Published: November 2022

Abstract
A 68-year-old man was referred to the general surgeons on account of his abdominal pain of unknown cause. He had contracted COVID-19, 9 days prior. CT chest abdomen and pelvis revealed an extensive thrombus extending from the portal vein to the superior mesenteric vein. Further investigation ruled out haematological causes, and COVID-19 was determined to be the cause. He was treated with an extended course of therapeutic dose low molecular weight heparin under the guidance of the haematology team. He was discharged once he was clinically stable and pain-free, with a plan to be followed up by both the surgeons and haematologists. This case highlights the different ways in which COVID-19 presents, and the need for clearer guidance on the treatment and prevention of thromboembolism in COVID-19.
701 Outcomes for Paediatric Patients Awaiting Bilateral Myringotomy and Ventilation Tube Insertion for Otitis Media with Effusion Listed Prior to the COVID-19 Pandemic
Authors: Lovett A , Walters B , Kumar Bhimrao S 
Published: November 2022

Abstract

Aim
The decline in the incidence of otitis media with effusion (OME) during the COVID-19 pandemic has become apparent. This review investigates the outcomes for children with OME awaiting bilateral myringotomy and ventilation tube (BMT) who were referred prior to the COVID-19 pandemic.

Method
All patients were reviewed in otolaryngology clinics between 1st February and 30th April 2021. Patients included were referred due to hearing, vestibular or developmental disorders prior to the first COVID-19 lockdown on 23rd March 2020. Analysis of routine consultation and audiological assessment was completed from records.

Results
There were a total of 48 patients awaiting BMT. The average age was 6.8 years, with a male to female ratio of 1.38:1. Most initial referrals (54.2%) were due to hearing loss, followed by recurrent ear infections (33.3%). Forty-four patients were diagnosed with OME. Of those, only 9% remained awaiting BMT. All others were removed from the waiting list. One patient remained listed for an adenotonsillectomy, 30 were discharged, and nine required follow-up appointments.

Conclusion
Our review demonstrates a significant reduction of BMT for OME following COVID-19. Further research on public health measures and changes in clinical practice during the 2020 lockdown would clarify the impact on OME.
947 COVID19 and Its Impact on the North and East of Scotland Orthopaedic Trainees
Authors: Lim JW , Rehman H 
Published: November 2022

Abstract

Aim
We conducted a trainee survey at the first peak of the pandemic to investigate the impact of COVID-19 on the North of Scotland (NoS) and East of Scotland (EoS) orthopaedic trainees.

Method
An online survey was distributed to all NoS and EoS orthopaedic trainees. All data collection was anonymous.

Results
Across both Scottish deaneries, 28 trainees had responded: 39% from EoS and 61% from NoS. Trainees at all stages of training responded to the survey, with the most responses received from specialist trainees in third year of training (ST3) (25%). In response to the pandemic, 18% of trainees had been redeployed and they were from NoS. Since the reconfiguration of service, 18% of trainees had done &gt;20 operations in a month and they were senior trainees. If COVID-19 outbreak is likely going to reduce operating opportunities for a long period, only 36% of trainees would be open to the idea of making standard surgical specialty training longer whereas 57% of trainees would be open to longer working hours to achieve certification in Trauma and Orthopaedic surgery within 96 months.

Conclusion
The outbreak of COVID-19 has impacted both deaneries orthopaedic training and urgent restoration of surgical training is essential for individual trainees. Changes in working practices necessitated by COVID-19 have known to impact theatre efficiency. Actions should be taken to improve the theatre efficiency while prioritizing training opportunities.
985 The Impact of COVID-19 on Cardiac Surgery Services at a Tertiary Cardiac Surgery Centre in the UK
Authors: Abu Taha K 
Published: November 2022

Abstract

Aim
This project aims to assess the impact of COVID-19 on cardiac surgery services at one UK tertiary cardiac surgery centre.

Method
Data was collected from 2nd January 2020 to 1st April 2021. Three timeframes were selected, each encapsulating a 9-week period: pre-COVID (2nd January 2020 to 28th February 2020), during the first wave (Peak 1: 23rd March 2020 to 22nd May 2020, where peak infection date is 22nd April 2020), during the second wave (Peak 2: 30th November 2020 to 29th January 2021, where peak infection date is 29th December 2020). The data comprised of number of operations performed and cancelled, including cancellations due to lack of critical care bed availability. Mean and standard error was calculated in Microsoft Excel.

Results
The results show a substantial reduction in the service provided, with the average number of operations performed per week decreasing from 15.8 during the pre-COVID timeframe to 3.2 during the first wave, and 7.6 during the second. There was a greater percentage of cancellations due to lack of critical care beds during the first wave (50%) and the second wave (35%), compared to pre-COVID (34%).

Conclusions
During this pandemic, many health services, including tertiary cardiac surgery centres, were faced with significant burden, and forced to shift focus towards managing an unknown disease. This cardiac surgery department has adapted admirably and is gradually resuming to normal service. It is vital that insight gained from this pandemic is maintained and utilised to develop guidelines to improve and prepare services for future unprecedented events.
1009 Severe Thoracic and Abdominal Surgical Emphysema in a Patient with COVID-19 Pneumonia
Authors: Dada O , Baig F , Johnston A 
Published: November 2022

Abstract

Introduction
Surgical emphysema is a relatively common occurrence in intensive care unit but its degree of spread in our patient is unusual. We present a case of a young adult with rapid widespread crepitus and worsening respiratory dynamics.

Case description
35-year-old male with hypertension, type 2 diabetes and obesity was invasively ventilated for severe COVID-19 pneumonia. He developed reduced chest compliance, required high driving pressures, and had persistent hypoxia despite a high fraction of inspired oxygen. He was ventilated using protocolised ARDSNet lung protective ventilation (LPV) including periods of ventilation in the prone position. After 19 days of ventilation, worsening surgical emphysema was noted following a tracheostomy. Chest radiography demonstrated extensive extra-pulmonary air. Subsequent computed tomography confirmed widespread surgical emphysema from the face to the scrotum, bilateral pneumothoraces and pneumoperitoneum. Bilateral intercostal drains were inserted and LPV was continued. The pneumoperitoneum resolved with conservative management. The patient was mechanically ventilated for 59 days and was discharged home on day 104.

Discussion
Pneumothorax, pneumomediastinum and surgical emphysema can occur following high-pressure ventilation and surgical tracheostomy. However, pneumoperitoneum with extra-alveolar air collections communicating via potential fascial planes, perivascular sheaths or trans-diaphragmatic extension is rare. The cytokine storm postulated to occur in COVID-19 infection may cause alveolar destruction, leading to Macklin's phenomenon whereby air tracks along peri-bronchial vascular sheaths towards the mediastinum following alveolar rupture. In this patient, prolonged ventilation and high airway pressures probably compounded this effect and led to the complications described.
1030 Did the COVID-19 Pandemic Impact on Medical Students Knowledge of Plastic Surgery Emergencies?
Authors: Hunt K , Herron J 
Published: November 2022

Abstract

Aim
The aim of this study was to look at the teaching and knowledge of plastic surgery emergencies and referral criteria in medical students from 3rd to 5th year.

Method
400 students were sent a survey via email and invited to participate 278 replied (69.7%). Students were asked 20 questions including demographics, if they were interested in surgery/ED, if they had teaching in B+P and what type, if there was clinical exposure, how to classify TBSA and factors deciding considered in classifying the burn, if they were confident to treat a burn, when to make a referral and burn mechanisms, common complications of burns, what is a flap and types and how to assess, what a plastic surgeon does.

Results
58% (161) declared an interest in surgery or ED, 32% (88) had teaching in B+P with 63% (252) attending a lecture and 5% (13) a formal Placement, others were adhoc and 21% (59) had clinical exposure. 74% (205) identified depth as important, 42% (117) TBSA. 58% (161) could not classify TBSA, 97% (271) did not feel confident treating a burn + only 8% (32) knowing when to refer although most could identify mechanisms. 92% (368) knew infection was a complication but only 1 knew why smoking was contraindicated. 1 student knew what a flap was with non able to classify or assess. few could identify what B+P do.

Conclusions
There is a lack of consistent undergraduate education on plastic emergencies and knowledge, perhaps resulting from less experience from cancelled placement.
119 Axillary Intra-Aortic Balloon Pump, Biventricular Assist Device Implantation and Subsequent Orthotopic Heart Transplantation in a Patient with Sickle Cell Trait
Authors: Mouyer Z , Taylor M , Callan P , Shaw S , Venkateswaran R , Nwaejike N 
Published: November 2022

Abstract
A 38-year-old Caucasian male presented to a local hospital with breathlessness. After thorough investigation, transthoracic echocardiography demonstrated dilated cardiomyopathy. He continued to deteriorate and developed florid pulmonary oedema, necessitating transfer to our centre. Routine work-up for cardiac transplantation found him to be a carrier of the HbS sickle cell trait, with an HbS concentration of 34.4%. Due to uncertainty of candidacy and further deterioration, axillary-IABP supported his bridge-to-decision. An IABP was inserted under fluoroscopic guidance via the right axillary artery using Seldinger technique. He continued to deteriorate requiring implantation of a BiVAD. He developed cardiac tamponade 23 days after BiVAD implantation demanding surgical evacuation. His condition improved with recovery of renal and liver function and resolution of pulmonary oedema. As there was no evidence of myocardial recovery, he was placed on the super-urgent heart transplant (HTX) list. After 45 days of BiVAD support, he underwent orthotopic HTX. The donor heart was from a 31-year-old male transported on cold storage. The patient remained normothermic throughout and diastolic arrest was achieved with cold blood cardioplegia delivered via the aortic root. Upon completion of anastomoses, bleeding from the posterior aortic wall occurred, requiring further aortic cross-clamping, cold-blood cardioplegia and administration of multiple blood products. Subsequently, the right ventricle distended, and the septum became dyskinetic. Central veno-arterial extracorporeal membrane oxygenation was initiated uneventfully. VA-ECMO was weaned on the 5th-postoperative day, and he was discharged from the CTCCU six days later, he returned home 28 days after HTX. He maintained recovery and remains alive and well 34 months after discharge.
137 Salvage Pulmonary Resection in Stage IIIb-IV Lung Cancer After Treatment with Immune Checkpoint Inhibitors - A Case Series
Authors: Robinson D , Smith A 
Published: November 2022

Abstract

Aim
Immune checkpoint inhibitors (ICIs) have been shown to prolong survival in patients that have locally advanced stage III/IV and metastatic non-small cell lung cancer (NSCLC). The role that salvages surgery plays in persistent localised disease and unresponsive synchronous cancer following treatment with a course of ICIs is not yet fully clear. We present a case series of nine patients with stage III/IV NSCLC that underwent surgical resection after treatment with the ICI, pembrolizumab.

Method
Six cases underwent salvage surgery after downstaging of the primary cancer following pembrolizumab treatment and three patients had resection of contralateral lung nodules that were unresponsive to ICI therapy. Three of the cases were open thoracotomies, 3 were robotic-assisted and 2 were video-assisted. One case was converted to open due to pulmonary artery involvement.

Results
There was complete, successful macroscopic resection in all cases with each showing histological evidence for active cancer cells. One patient died of COVID pneumonitis in the community within 60 days of surgery. All other patients are alive with no evidence of localised disease or of any disease reoccurrence within 3–18 months of their surgery.

Conclusions
Our case series demonstrates the potential for salvage pulmonary resection in select patients with advanced stage NSCLC who have persistent localised disease or unresponsive synchronous cancer after treatment with the ICI, pembrolizumab. Salvage surgery in this group of patients is safe and pragmatic despite high levels of post-immunotherapy hilar fibrosis. Further studies will be required in order to assess overall survival rates.
192 Uniportal Non-Intubated Subxiphoid VATS Thymectomy Compared to Uniportal Intubated Subxiphoid VATS Thymectomy: The Technical Feasibility, Safety, Level of Post-Operative Pain, and Adequacy of Oncological Resection
Authors: Bushra R , Nizami M , Hogan J , Peryt A , Coonar A , Aresu G 
Published: November 2022

Abstract

Aim
Subxiphoid video-assisted thoracoscopic surgery (SVATS) has been associated with less pain and subsequent opioid requirements. Furthermore, a non-intubated approach reduces sedatives and opioid requirements and may enhance recovery. The current retrospective comparative study is aimed to compare the technical feasibility, enhanced recovery, safety, and adequacy of oncological resection in patients undergoing non-intubated subxiphoid video-assisted thoracoscopic thymectomy and in patients who underwent a traditional intubated subxiphoid resection.

Method
We conducted a retrospective study of 42 patients who underwent Subxiphoid VATS thymectomy from September 2016 until June 2021. Among them, 21 carefully selected patients underwent non-intubated SVATS thymectomy.

Results
A total of 42 patients were included in the analysis, of which the mean age was 59.6 years, and 52% were female. The mean age for the non-intubated group was 57.5 and 54.5% female. Among them, 12 patients had myasthenia gravis. Significant complications were bleeding, mandating conversion, acute kidney injury, prolonged air leak and vocal cord palsy. In total, for Group 2, there were 3 cases converted to sternotomy, compared to Group 1. Both groups' median hospital length of stay was two days. Complete resection was achieved in all cases in Group 1, whereas, in Group 2, 4 patients were reported with an R1 resection margin.

Conclusion
Non intubated subxiphoid thymectomy is technically feasible, safe and associated with adequate oncological resection. Reduced sedation and opioid requirement lower the risk of postoperative respiratory failure and delirium, thus enhancing early recovery. However, more extensive studies are required to confirm this hypothesis.
470 Redo Mitral Valve Surgery via Median Sternotomy Versus Mini-Thoracotomy: A Systematic Review and Meta-Analysis of Clinical Outcomes
Authors: Shirke M , Ravikumar N , Tan S , Mutsonziwa N , Soh V , Harky A 
Published: November 2022

Abstract

Aim
Redo mitral valve surgery is a high-risk cardiac procedure. Median re-sternotomy (MS) remains a common approach in many centres. However, there is a significant risk of morbidity and mortality associated with this approach. Alternative procedures such as the right anterolateral minithoracotomy (MT) have been explored. This review compares the clinical outcomes of re-sternotomy versus right mini thoracotomy in mitral valve surgery.

Method
A systematic, electronic search was performed according to PRISMA guidelines to identify relevant articles that compared outcomes of the MS versus MT procedures in redo mitral valve surgery. Data regarding mortality, length of hospital stay, stroke, infection were extracted and analysed

Results
Thirteen studies were identified, enrolling 4,549 patients. Length of hospital stay (MD= -3.70, 95% CI[-4.89, -2.51]), 30-day mortality (OR=0.58, 95% CI[0.39, 0.87]), new-onset renal failure (OR=0.38, 95% CI [0.22, 0.65], and length of ICU stay (MD=-0.62, 95% CI[-1.21, 0.02]) were statistically significant in favour of the MT approach. Infection rates (OR=0.52, 95% CI[0.24, 1.12]) were lower in the MT group; however, the difference was not significant. No significant differences were observed in the CPB time (MD=-2.68, 95% CI[-8.53, 3.17]), aortic cross-clamp time (MD=-2.40, 95% CI[-17.07, 12.27]), and rates of stroke (OR=1.03, 95% CI[0.55, 1.92]).

Conclusions
Right mini thoracotomy is a safe alternative to the traditional re-sternotomy for patients who have had previous cardiac surgery. The approach offers a reduced length of hospital stay, ICU stay, and a lower risk of new onset renal failure requiring dialysis. This review calls for robust trials in the field to further strengthen the evidence.
471 Assessing the Accuracy and Bias of Digital Symptom Checkers with Myocardial Infarction Patients
Authors: Wallace W , Chan C , Chidambaram S , Hanna L , Iqbal F , Acharya A , Normahani P , Ashrafian H , Markar S , Sounderajah V , Darzi A 
Published: November 2022

Abstract

Aim
The accuracy and safety of symptom checkers in diagnosing and triaging patients is of concern; especially those with life-threatening conditions. The study's aims were to: 1. assess the accuracy of symptom checkers in diagnosing and triaging myocardial infarctions (MI) and, 2. determine whether differences in gender or presentation type exist.

Method
This prospective diagnostic accuracy study assessed 8 symptom checkers using 100 MI patients of various presentations: typical or atypical. The ability of a symptom checker in providing MI as the first diagnosis (D1) and the first 3 (D3) diagnoses were diagnostic accuracy measures. Triage advice was deemed correct if the symptom checker recommended seeking emergency treatment.

Results
Symptom checkers correctly diagnosed 48.0±31.4% of cases with MI first. D3 accuracy was 72.6±20.2%. Mean triage accuracy was 82.6±12.6%.
24.0±16.2% of atypical cases had a correct primary diagnosis. D3 accuracy for atypical MI was 43.8±20.6%, significantly lower than that of typical MI (p&lt;0.01). Atypical case triage accuracy was 52.7±20.0%, significantly lower than typical cases (84.2±14.7%, p&lt;0.01).
10.0% of the atypical female cases were diagnosed correctly with MI as the first diagnosis. Female atypical cases had significantly lower accuracy than typical female cases for all accuracy measures (p&lt;0.01).

Conclusions
Symptom checkers generally provide low accuracy for diagnosing MI. Approximately 20% of cases were under-triaged. Results varied between symptom checkers: patients who presented with atypical symptoms tended to be under-diagnosed and under-triaged, especially those who were female. This demonstrated potential gender bias and therefore raises questions regarding symptom checker regulation and safety.
524 Infective Endocarditis Timings and Indications for Intervention in Neurological Complications
Authors: Nwakwu C , Badran A 
Published: November 2022

Abstract

Background
Infective endocarditis (IE) is the inflammation of the endocardium. Cardiac surgery is reserved for patients that deteriorate despite best medical therapy. Neurological complications are a serious IE complication. There is still not a clear consensus on how and when IE should be treated when neurological complications occur. Identifying in which patients to intervene and when can help improve patient management.

Aim
To evaluate the management and outcomes of patients that presented with IE in the Wessex region of England with a particular focus on treatment of patients with neurological complications.

Method
Patient records were accessed to collect data on patient demographics, infection status and clinical management of patients between 2019–2020.

Results
147 patients with IE were included, 19 patients with neurological complications underwent early surgery (n=15) or late surgery (n=4). The mean ages were 54 (30–76) and 55 (22–82) respectively. There was no statistical association between timing of surgery, early (within 14 days of CT) or late, and mortality (p=0.53). The median stay in hospital for early and late surgery was 28 days and 47 days respectively. The only significant indicator for having early surgery was the presence of staph aureus (p=0.008). The 6-month survival for early and late surgery was 73.3% and 100% (p=0.212).

Conclusions
Early surgery was not shown to be significantly associated with 6-month mortality but did lead to earlier discharge from hospital. Neurological complications in endocarditis significantly affects survival. Due to the limited number of patients considered further data is needed to draw more conclusive results.