bluuebunny/crossref_metadata_2025_split huggingface dataset:
336 Reasons for Choosing Delayed Rather Than Immediate Contralateral Prophylactic Mastectomy (CPM) in Patients with Unilateral Breast Cancer
Authors: Soh CL , Muktar S , Malata C , Benson J 
Published: November 2022

Abstract

Introduction
Reasons for requesting CPM include prevention of recurrence, peace of mind and moving on after breast cancer. Some women seek CPM as a delayed procedure but factors influencing this are poorly understood.

Method
A retrospective analysis examined patients undergoing CPM as either an immediate or delayed procedure with or without breast reconstruction (BR) between January 2009 and December 2019. A cross-sectional survey based on validated questionnaires (5-point Likert scale) explored patients’ decision-making process in terms of timing of CPM and any BR.

Results
A total of 123 patients with unilateral breast cancer underwent CPM with 39 (32.5%) delayed procedures with or without BR. The response rate amongst patients receiving questionnaires (n=33) was 22/33 (66%). Within this delayed CPM cohort were three reconstructive scenarios 1) unilateral immediate BR with CPM (n=12); 2) delayed CPM with concomitant bilateral BR (n=22); 3) delayed bilateral BR after delayed CPM (n=3). Two patients had delayed CPM without BR. The most common reason for delayed CPM was to complete all cancer treatments (including radiotherapy) before surgery on the unaffected breast (score 2.91). The second reason was unavailability of genetic test results at the time of therapeutic mastectomy (score 2.64) whilst the third most cited reason was a subsequent change in family cancer history.

Conclusions
Factors for delayed CPM are patient-driven with few women spontaneously changing their mind having initially decided against immediate CPM for reasons also including surgical duration. CPM should be offered as a potentially delayed option with informed discussion of risks and benefits.
556 Case Report: Diagnosis of Bilateral PASH (Pseudoangiomatous Stromal Hyperplasia) in an 11-Year-Old Female
Authors: El Zayat I , Elzayat A , Farrow H 
Published: November 2022

Abstract
PASH (Pseudoangiomatous stromal hyperplasia) is a rare pathological finding, defined as a benign mesenchymal proliferative lesion of the breast, presenting more frequently in premenopausal women. Although benign, differentiation from low grade Angiosarcoma due to their histological similarities. Management guidelines for PASH remain primitive due to the rarity in diagnosis and reporting of such cases.
We present a very interesting case of an 11-year-old female assessed for her rapidly enlarging breasts. Initial management entailed right breast reduction Mammoplasty due to the presumed diagnosis of Macromastia. Histopathological assessment of the specimen initially reported the presence of Fibroadenoma. However, re-assessment by a senior Pathologist subsequently diagnosed the lesion as Pseudoangiomatous Stromal Hyperplasia (PASH).
Further MRI imaging of both breasts revealed multiple, large, bilateral lesions.
All identified bilateral breast lesions were excised, with a cumulative weight of 1.6 Kg, combined with WISE pattern reduction of the right breast overlying skin was carried out in due course.
There has been no previous reporting of PASH in an 11-year-old female, which itself is a rare condition. Further studies on PASH are recommended to reduce the risk unnecessary surgical management of such cases due to misdiagnosis.
572 Staging Breast Cancer Patients at a District General Hospital: The Colchester Experience
Authors: Kankam H , Akotat O , Gurung A , Saha S 
Published: November 2022

Abstract

Aim
Metastatic disease is detectable in 4% of breast cancer patients at the time of initial diagnosis. However, there are regional and national variations in staging criteria. We evaluated the outcomes of staging breast cancer patients at our unit before and after the introduction of the new trust guidelines.
Old Staging Criteria
Indications:
Staging investigations:
New Staging Criteria
Indications:
Staging investigations:

Method
A retrospective chart review of patients undergoing staging investigations for breast cancer was performed. The cohort was divided into group A (old staging criteria) and group B (new staging criteria). Each group spanned a period of sixteen weeks. Demographic, tumour, and radiological data were collected.

Results
Group A (30 patients staged): 22 CT abnormal findings (73.3%), 3 distant metastasis (10%), 1 new primary tumour (3.3%).
Group B (18 patients staged): 13 CT abnormal findings (72.2%), 2 distant metastasis (11.1%), 1 new primary tumour (5.6%).

Conclusions
A change in the staging criteria for breast cancer patients at Colchester Hospital has led to a 40% reduction in the number of patients staged, without compromising the rate of detection of malignant disease. This has obvious physical and psychological benefits for patients.
913 Patient Satisfaction with Personalised Stratified Follow-Up After Treatment for Breast Cancer at West Middlesex University Hospital
Authors: Arooj S , Elhadi L , Rawcliffe S , Rickute D , Phyu S , Khan A , Barkeji M , Riddle P , Elfadl D 
Published: November 2022

Abstract

Aim
Personalised stratified follow up (PSFU) is a programme that ensures safe follow-up of breast cancer patients following treatment completion, avoids un-necessary appointments, whilst offering rapid access to clinicians when required. A protocol for PSFU was designed and the programme introduced to West Middlesex University Hospital in 2019. We aim to assess patient satisfaction with nurse-led end of treatment consultations.

Method
200 Patients were enrolled from January 2019 to September 2021.The study was registered with the Clinical Governance department. All patients were initially contacted by telephone and later questionnaires were sent out either by post or using Google Docs via text messaging. Data was collected both from questionnaires and Somerset cancer registry platform and analysed using Microsoft Excel.

Results
Out of 200 patients, 150 were successfully contacted by telephone and sent questionnaires, with 68% response rate. This was largely electronic.
48% had video or phone consultations, with the rest attending in person. 90% thought they had sufficient time for discussion, with 82% feeling well informed regarding their management at the end of the consultation. 86% were satisfied or very satisfied with the consultation. 35% had their consultation within 3 months of completing treatment and 29% within 6 months.

Conclusion
Patients were largely satisfied with their end of treatment consultations. This was in spite of delays caused by the COVID-19 pandemic. Longer term follow up is required to determine satisfaction with the PSFU programme as a whole, and its efficiency.
1004 A Review of Over 300 Sentinel Lymph Node Biopsies, Is Magtrace Reliable?
Authors: Khan S , Wilson RL , Shaker H , Hobbs N , Abbas A , Absar SM , Nasir N , Wright C , Williams KE 
Published: November 2022

Abstract

Introduction
With the ever-growing evolution of sentinal lymph node biopsy techniques, Magtrace was introduced to our department as a radiation free technique. This study aims to review the outcomes of Magtrace for SLNB.

Method
Consecutive procedures invoking SLNB were conducted from 1st April 2020 to 29th July 2021. Retrospective data collection via theatre logs and patient notes was also performed.

Results
316 SLNB procedures were conducted during the above time period. In 197 (62.5%) procedures, Magtrace alone was used. Magtrace and blue dye was used in 104 (33%) procedures, radioisotope, and blue dye in 10 (3%) procedures, whilst radioisotope was used in 5 (1.5%).
Overall, there were five (1.5%) failures of SLNB (i.e., axillary node sample was required), three with Magtrace and blue dye, two with Magtrace alone. Radioisotope was used as a precautionary measure when there was either a retroareolar magseed or multiple magseeds to guide the wide local excision. There were no reported adverse events following the injection of Magtrace. There was one anaphylaxis following injection of blue dye. One patient required postoperative MRI after Magtrace was used making interpretation more difficult.

Conclusion
Magtrace outcomes are comparable to those reported for the traditional dual technique with blue dye and radioisotope and can be safely used as a single agent.
4 The Rise in Trauma & Orthopaedic Trainee-Led Research and Audit Collaborative Projects in the United Kingdom Since the Start of the COVID-19 Pandemic
Authors: Khaleeq T , Kabariti R , Ahmed U 
Published: November 2022

Abstract

Introduction
There has been a rise in trainee-led trauma & orthopaedic multi-centre research collaborative projects globally. These increase trainee involvement in research with an opportunity to deliver highly generalisable results on a particular topic.
Objective: To evaluate the number of trauma & orthopaedic trainee-led research collaborative projects that took part since the start of the COVID-19 pandemic in the UK and compare them to projects from 2019.

Methods
This was a retrospective study that evaluated trauma & orthopaedic trainee-led national collaborative projects within the UK since the start of the COVID-19 pandemic lockdown (March 2020 to June 2021). Our exclusion criteria included any regional collaborative projects, pre Covid- 19 projects and projects of other surgical specialities.

Results
In 2019, 0 trainee-led collaborative projects were commenced nationally in the UK. Since the COVID-19 pandemic, we identified 10 trainee-led collaborative trauma & orthopaedic projects with 6 being published so far. The level of evidence ranged between 3 and 4 and included 5 Audits and 5 cohort studies. The patients that were included in the studies ranged from 927 to 140,231 from a total of 2249 centres.

Conclusion
Covid-19 has placed significant challenges across healthcare. However, one positive aspect is the increase in multi-centre trainee-led collaborative projects within the UK. Our study highlights the feasibility of a trainee-led high quality collaborative research projects in the UK and the availability of new tools such as social media and centralised confidential online databases such as Redcap® facilitates such projects. Therefore, we recommend expanding this trainee-led collaborative platform in the field of trauma & orthopaedics worldwide.
144 Head and Neck Cancer and the COVID-19 Pandemic: Impact on Presentation and Management
Authors: Maqsood R , Flynn W , Douglas C 
Published: November 2022

Abstract

Introduction
We aim to establish if the first wave of COVID-19 has caused HNC patients to present later or with more advanced disease and if there have been delays in time to imaging, treatment or MDT discussion.

Method
Patients were identified retrospectively from a database of cases discussed at head and neck MDT between June and October of 2019 and 2020. New HNC cases were included, and benign or recurrent disease excluded. Data was extracted from electronic patient records and statistical comparisons were performed using JASP.

Results
Data was analysed from 216 patients (2019 n=98, 2020 n=118). No statistically significant differences were observed in age, ECOG, smoking and alcohol use. Significantly more patients presented with &gt;6 weeks history of red flag symptoms in 2020 than 2019 with an odds ratio (OR) of 2.44 (95% CI, 1.38 to 4.23), (p=0.002). Patients in 2020 were also significantly more likely to present as an emergency, OR 5.94 (95% CI 1.31 to 27.02), (p=0.013). The OR of being in a higher AJCC stage in 2020 versus 2019 was 1.69 (95% CI, 1.00 to 2.84), (p=0.05). There were no significant differences in time to MDT discussion, first dedicated imaging, or time to initiation of treatment.

Conclusion
This data supports concerns that COVID-19 has caused delays in patient presentation, evidenced by longer symptom duration, higher AJCC stage and more emergency presentations. The management was not impacted. HNC services are functioning well despite the pandemic and patients should be encouraged to present to facilitate earlier intervention.
253 Hospital Consultant Remote Consultations During COVID 19 - Experiences at a Large NHS Trust
Authors: Ahmed H , Oni G 
Published: November 2022

Abstract

Aim
COVID-19 has intensified the need for the NHS to almost utilise remote consulting technology overnight, with clinicians under increasing pressure to provide virtual services preferentially, in line with the NHS digital ideals. This study explores the clinician experience of virtual working during the pandemic in a large acute NHS Teaching Trust, and to identify the facilitators and barriers to remote consultations (RC).

Method
A multi-format online questionnaire was constructed and emailed to all 816 consultants across the trust. The survey was open for one month and during that time two reminders were sent. The data was tabulated and analysed using Microsoft excel.

Results
270 consultants responded to the questionnaire, giving a response rate of 33%, with 208 (77%) performing RCs. 92.8% of these (N=193) have increased the number of RC during the pandemic. 45.9% did not have their own office (N=124), with over half of those (N=63) sharing an office with 3 or more people. The majority of remote consultations were over telephone (82%) with only 54.4% feeling they had the right equipment for video consultations. The biggest barriers were patient related issues (technical, poor environment or not available at scheduled time).

Conclusion
The main challenges facing consultants, in the provision of virtual services were lack of appropriate hardware, an absence of a suitable environment, the prevalence of technical complications, and difficulties experienced by their patients. It is, therefore, important to recognise, both at an organisational level, and nationally, that virtual consultations may play a role in the worsening of health inequalities.
315 The Impact of COVID-19 on Training Opportunities and Long-Term Career Aspirations of UK Based Doctors
Authors: Khan A , Omakobia E , Rehman A , Khan S 
Published: November 2022

Abstract

Background
The onset of the COVID-19 pandemic in November 2019 has witnessed a reactive ‘covidisation’ of NHS care services. Training opportunities for junior doctors have suffered and psycho-social impacts are anticipated. This study will seek to assess these factors and their impact on doctors’ career aspirations.

Method
A five question survey was disseminated to 350 junior doctors in the Yorkshire and Humber deanery. 115 responses were gained; 78 Foundation doctors (FY1–2), 24 Core/Early specialist trainees (CT 1–2/ST1–2) and 13 Specialist Registrars.

Results
Negative impacts on training include teaching commitments (61.7%) and work-based assessments (48%). A change in treatment protocols (67%) and acute referrals (58%) were also identified. Concerns regarding personal wellbeing were highlighted by 65%, with a greater willingness to consider taking time out of training (32%) or leave UK medical practice altogether (22%).

Discussion
The number of doctors immediately progressing into specialist training has almost halved. COVID era practice has impacted on training opportunities, clinical experience, and the ability to meet ARCP requirements. It has also led to high levels of personal concern amongst junior doctors surveyed. These factors may stimulate a greater willingness to take time out of training (1/3) or leave UK based medical practice (1/4).

Conclusions
It is evident that new and existing concerns amongst junior doctors have been heightened by COVID-19. This data provides a useful snapshot and may be utilised in ensuring the continued health and robustness of the UK's junior doctor workforce and its ability to meet the evolving challenges of global healthcare.
394 The COVID-19 Pandemic's Impact on Deep Neck Space Infections: A Retrospective Cohort Study
Authors: Charlton A , Simon R , Simons A 
Published: November 2022

Abstract

Aim
This study aimed to evaluate whether changes in practice and patient behaviour due to the covid-19 pandemic impacted the presentation, management, and outcomes of patients with deep neck space infections (DNSI).

Method
Retrospective cohort study including all adults presenting to the otolaryngology department at a tertiary UK centre with a DNSI during the first 12 months of the covid-19 pandemic (n = 27), and those from the previous 12-month period (n = 26). Patients with peritonsillar abscess which did not involve deep neck spaces radiologically were excluded.

Results
The covid-19 pandemic cohort tended to present later after onset of symptoms (5.96 days vs 3.25 days, p = 0.0277), have abscess formation rather than inflammation only (77.8% vs 34.6%, p &lt; 0.01), and develop complications (33.3% vs 7.7%, p = 0.0394). Not reaching statistical significance, the covid-19 pandemic cohort also had larger volume abscess (25.18cm3 vs 14.5cm3, p = 0.291), longer hospital stays (14.48 days vs 6.35 days, p = 0.114), and longer intensive care stay (7.88 days vs 1.78 days, p = 0.0992). Non-significant changes were noted in management, with the covid-19 pandemic cohort being seven times more likely to undergo tracheostomy (25.9% vs 3.8%, p = 0.0504), and more likely to undergo trans-cervical drainage (37% vs 19.2%, p = 0.224) and hot tonsillectomy (11.1% vs 0%, p = 0.236).

Conclusion
This study demonstrates the covid-19 pandemic led to delayed presentation and more severe infection, requiring more radical management in patients with DNSI.
401 Squamous Cell Carcinoma Surgery During a Global Pandemic – a Single UK Tertiary Centre Experience
Authors: Pasha T , Okorocha C , Okafor C , Manoharan S , Roszpopa J , Shahid S 
Published: November 2022

Abstract

Aim
To determine excision rates for squamous cell carcinoma (SCC) both before and during the COVID 19 pandemic.

Method
Between April 2020 to March 2021, a retrospective cohort study of patients undergoing SCC surgery in Cambridge University Hospitals (CUH) was undertaken. Data was collected from the hospital patient record system (EPIC) and included preoperative diagnosis, excision margins, histological subtype, and operative technique.

Results
287 primary SCCs were excised during this period. 70% of SCC patients were male, with the commonest site being the head and neck (72%). The rate of incompletely excised SSCs doubled from 5.5% in 2018–19 to 11.3% in 2020–21. Of these, most incomplete excisions were due to inadequate deep margins (9.8%). The majority of incomplete excisions were performed by registrars (14.8%) followed by consultants (9.1%).

Conclusions
Whilst diagnostic accuracy remains high, we report a decline in complete excision rates. Deferral of non-urgent visits due to the COVID-19 pandemic may have resulted in delayed diagnosis of SCCs, resulting in larger and deeper cancers. The more invasive SCCs may have then resulted in a higher rate of inadequate excision. A potential solution is the use of templates in operative notes, in order to ensure an accurate record of deep and peripheral margins is made.
571 Evaluating the Effectiveness of Extracorporeal Shockwave Lithotripsy (ESWL) for Ureteric Stones During COVID-19 Pandemic - A Single Centre Experience
Authors: Farah M , Rizvi I , Fernandes R , Patel A 
Published: November 2022

Abstract

Aim
Reliance on ESWL for treating ureteric stone has increased during the COVID-19 pandemic. We examined the outcomes for ureteric stones treated with our on-site lithotripter to assess the success rate and determine the variables that could affect the outcome results.

Method
A retrospective review using electronic records and images of patients who underwent ESWL for ureteric stones (January to December 2020). Univariate and multivariate analysis used to determine stone-free rate predictors (Stone Free rate/SFR: No residual stones on post-ESWL imagining).

Results
A total of 36 patients underwent ESWL for ureteric stones. Mean age was 58 years (21–90), and mean stone size was 8 mm (5–20). Stones were located in the proximal (67%) or lower ureter (33%). Overall SFR was 64% (67% proximal, 33% distal). 64% of patients required only one session to be stone free, with 60% stone free after two sessions. Stones &lt;10mm had a SFR of 67%, compared to 58% for stone &gt;10 mm. The only statistically significant predictor was stone size (longest dimension, p=0.04). No statistical significance with stone location (P=0.09), skin-to-stone distance (SSD) (P=0.7), stone density (P=0.3) or stone volume (P=0.3). In treatment failure, time to definitive ureteroscopy was 4 weeks.

Conclusion
Our overall SFR was slightly lower than expected but comparable to available literature. This data highlights the importance of patient selection for ESWL and would be useful in counselling about local success rate. More than half of the patients required only one session for stone clearance and stone size was the only significant predictor for successful ESWL.
608 Optimising Return to Elective Total Hip Arthroplasty (THA) Following the COVID-19 Pandemic: Lessons Learned and Future Directions
Authors: Paluch A , Tariq H , Small O , Ratford E , Sokolowski S , Kassam AA , Hubble M , Howell J , Charity J , Gowda S , Panteli M , Wilson M 
Published: November 2022

Abstract

Aim
COVID-19 has led to unprecedented waiting times for elective surgery. Optimising patient pathways is paramount in tackling the backlog. Length of hospital stay (LOS) is an accepted surrogate for successful elective surgery.
The aims of our study were: 1) report on changes in LOS after restarting our elective THA service; 2) identify barriers to early discharge, 3) investigate effectiveness of implemented changes.

Method
A retrospective review of consecutive patients undergoing elective THA, comparing three groups: 1) enhanced care pathway (n=96; 09/2019–12/2019); 2) COVID group (n=56; 03/2021–04/2021); 3) intervention group (n=96; 05/2021–08/2021).

Results
LOS in the enhanced care pathway group was 2.6 ±2.1 days. During initial resumption of elective operating (COVID group) the LOS was 4.8 ±4.5 days (statistically significant increase; p=0.011). Factors affecting LOS included reduced physiotherapy provision; lack of pre-operative occupational therapy review; loss of educational classes and worse pre-operative functional status.
To address these our department employed three new physiotherapists, introduced training for nursing staff and created a post-operative proforma. The LOS subsequently reduced to 3.7 ±4.6days (p=0.166).
Subgroup analysis of the intervention group showed age &lt;75 (p&lt;0.001) and ASA1–2 (p=0.036) were associated with reduced LOS (2.1±1.5 days). Other variables analysed did not significantly affect LOS.

Conclusions
COVID-19 has had a significant effect on LOS, which is still not reversed. For effective resumption of THA services, pre-pandemic enhanced care pathways should be reinstated. With current restrictions preventing face-to-face classes, online educational sessions could be offered. Those younger than 75 years and ASA1–2 are most likely to be discharged without delay.