bluuebunny/crossref_metadata_2025_split huggingface dataset:
421 Migratory Foreign Bodies in Theaero-Digestive Tract: The Importance of Computerised Tomography (CT) Imaging
Authors: Hussain S. , Muhammad A. , K K A. , Khan M. 
Published: February 2022

Abstract

Aim
We discuss this case to stress the role of computerized tomography imaging in diagnosis of foreign bodies of the upper aerodigestive tract and propose an algorithm for management of such cases.

Case Presentation
A 35-year-old male presented with dysphagia and swelling in the left lower part of the neck for 2 days. He gave a history of suspected fish bone ingestion one week prior, followed by pain and discomfort in the throat. Patient underwent upper gastrointestinal endoscopy, which was inconclusive. The patient was reassured and sent home.
Examination showed 3 x 4cm soft tender swelling in the left lower part of the neck. Computed tomography showed heterogeneously enhancing soft tissue density with multiple air shadows in the left para-pharyngeal space [fig 1]. Long, narrow, calcified lesion was present in the midst of the soft tissue density, suspected to be a fish bone [fig 2].
Vertical incision was made along the anterior border of the left sternocleidomastoid muscle and 20 ml pus was drained. Carotid sheath was identified and was swollen, surrounded by extensive granulation tissue. Fish bone was found adjacent to the thyroid lobe [Fig 3], was removed - it was serrated and four cm in length [Fig 4]. Repeat endoscopy and a barium meal showed no leak. He was discharged with oral antibiotics for two weeks with no further follow up.

Conclusions
Accidental fish bone ingestion is a very common situation in otarhynological emergencies. The role of CT imaging in the management of rare instances like perforation and migration of foreign bodies can prevent serious and life-threatening complications.
5 Cervical Spine Pedicle Screw Accuracy in Open Fluoroscopic, Navigated and Template Guided Systems- a Systematic Review
Authors: Mahmoud A. , Aly M. , Shanmuganathan K. , Rocos B. , Sedra F. , Montgomery A. , Aftab S. 
Published: February 2022

Abstract

Aim
Pedicle screws provide excellent fixation for a wide range of indications; their adoption in the cervical spine has been slower than in the thoracic and lumbar spine, largely due to the smaller pedicle sizes and proximity to neurovascular structures in the neck. Recent years have seen the development of technology to improve accuracy and thereby safety in cervical pedicle screw placement over traditional fluoroscopic techniques, including intraoperative 3D navigation, computer assisted systems and physical templates with screw guides. We have performed a systematic review into the accuracy rates of the various systems.

Method
PubMed and Cochrane Library databases were searched; keywords "pedicle screw cervical spine" were searched; 9 valid papers involving 1427 screws were found.

Results
Accuracy rates were 80.6% for fluoroscopy, 91.4% for navigation methods, and 96.7% for templates.

Conclusions
Superior results for templates are complemented by reduced radiation exposure to patient and surgeon; however, the technology requires prolonged pre-operative planning to create the bespoke template, and the development of an infrastructure to allow for their rapid production and delivery is needed before they become more widely available.
Two broad methods of navigation currently exist: intraoperative CT scanning providing real-time 3D navigation and preoperative CT registration in relation to a fixed reference with intraoperative computer assistance. At present, these methods are more commonly used, due to their proven improved accuracy rates over fluoroscopy, availability in emergencies and alongside minimally invasive techniques.
Despite their novelty and limitations, templates provide promising accuracy scores, although practical considerations may inhibit their proliferation.
43 The Value of Endoscopic Ultrasound (EUS) in the Investigative Pathway of Acute Idiopathic Pancreatitis (AIP)
Authors: Bhatti S.l , Evans L. , Kumar B. 
Published: February 2022

Abstract

Introduction
The British Society of Gastroenterology (BSG) guidelines on the management of acute idiopathic pancreatitis (AIP) state the incidence of idiopathic cases to be no more than 30%. However, before a firm diagnosis of AIP is made, Endoscopic Ultrasound (EUS) may be used to determine occult causes. This approach may help prevent recurrent attacks which may evolve into chronic pancreatitis.

Method
Retrospective analysis over a one-year period of cases of AIP in a tertiary referral centre was performed to see the incidence of AIP and the role of EUS. Patients with an identifiable cause for pancreatitis were excluded, leaving only those who had received a diagnosis of AIP and the diagnostic value of EUS was examined.

Results
Of the 101 patients diagnosed with AIP, 19% (n=19) underwent an EUS successfully. 79% (n=15) had no underlying cause of pancreatitis identified on EUS. In the remaining 21% of cases (n=4), microlithiasis, ductal stones, and pus requiring drainage were common findings. Of these patents, only 1 was referred for surgery. In the patient group with negative findings on EUS, 4% were unaffected, 2% were referred for surgery, 2% died and 7% had recurrent episodes of pancreatitis.

Conclusions
The results of this study show that EUS is a valuable modality in patients with suspected AIP, with a positive diagnostic rate of 21%. Therefore, we propose EUS needs to be included in the investigative pathway of all suspected AIP. Although EUS is a relatively scarce resource, further research is required to establish guidelines for the investigation of suspected AIP.
58 Introduction of a Basic Trauma Course and an Observational Study of Attitudes to Open Fractures in a Rural Region of Sierra Leone
Authors: Gabbott B. , Mistry R. , McKnight G. , Sinclair P. , David J. 
Published: February 2022

Abstract

Introduction
Sierra Leone ranks in the bottom quartile of the ‘Least Developed Countries’ across the world. ‘Injury’ is responsible for an estimated 325,000 deaths per annum. Kambia is a rural district in the northwest of the country with an approximate population of 340,000 people.
We were invited to teach the regions community health care officers (CHO) the first ever trauma skills course. Our secondary aim while in Kambia was to investigate the barriers to safe open fracture care in the region.

Method
A 4day teaching course was created and co-ordinated. Questionnaires examining candidate’s trauma knowledge, were utilised. Feedback sheets were collected to assess the courses local acceptability. Three senior CHOs were invite for a semi-structured interview exploring Open Fractures. This was recorded and a thematic analysis was performed on the results.

Results
The mean pre course questionnaire score was 9.0 (SD 3.45), and post course score 19.7(SD 3.8). This gave a mean difference of 10.7(CI 9.5 – 11.8, p value 0.01). All feedback collected was positive, with 15/23 candidates reports ‘Primary Survey’ the most useful teaching session. The reported boundaries to open fracture care included local beliefs, Lack or resources and services, Lack of finances.

Conclusions
Our basic trauma course provided an effective method of teaching trauma skills to the CHO’s of Kambia. It offered a widely accepted teaching structure and was enjoyed by the local medical community. We also identified barriers to optimal open fracture care in the region of Kambia, which can be targeted for further work.
84 Morbidity and Mortality in Elderly Head Injured Patients on Pre-Injury Antithrombotics: A Systematic Review
Authors: Ogbu I. 
Published: February 2022

Abstract

Objectives
The main objectives of this systematic review were to synthesize the available research on outcomes in elderly patients who had experienced traumatic brain injury while using antithrombotic therapy (ATT) to determine the difference in outcome compared to non-use as well as compare outcomes in different ATT types.

Design
A systematic review whose protocol is on the International prospective register of systematic reviews (PROSPERO). The review included all English language studies conducted between 2000 and 2021.

Subjects
All studies which evaluated mortality (at any time point following the injury) and morbidity in all anticoagulated head-injured patients &gt; 64 years.

Method
We searched all the major databases that index biomedical journals for articles that fit the inclusion criteria using pre-piloted search terms. Study screening for inclusion was done using Covidence®. Data were extracted into Excel and quality assessment was done with the ROBINS-I tool.

Results
15 of 5,644 studies, all of which were conducted in high-income countries, were included. The estimated odds of mortality were 2.32 (1.66–3.25) in favour of non-use of ATT. Mortality rates were 2–38% versus 0–23% in the ATT versus non-ATT groups respectively. There were significantly higher odds of mortality with VKA use– up to 5.18 vs 1.60 with other ATT agents. The odds of mortality were higher among individuals with therapeutic INR – 4.48 versus 1.28. Morbidity was worse with ATT use compared to non-ATT use.

Conclusions
Outcomes in head-injured elderly patients seem to be worse with the use of certain ATT agents—especially VKAs compared to other ATT groups.
157 Diagnostic Test Accuracy of Artificial Intelligence Models Used in Cross-Sectional Radiological Imaging of Surgical Pathology in the Abdominopelvic Cavity: A Systematic Review
Authors: Fowler G.E. , Blencowe N.S. , Hardacre C. , Callaway M.P. , Smart N.J. , Macefield R.C. 
Published: February 2022

Abstract

Introduction
Medical imaging is important for diagnostic, prognostic, and management decisions. It is reliant on an increasingly limited number of interpreters. A developing interest has explored how artificial intelligence (AI) research in medical imaging can support clinicians and provide greater efficiency in clinical care. Reviews exist for thoracic and endoscopic imaging, but one is lacking for the abdominopelvic cavity. This could benefit several specialities which use this modality of imaging to guide their clinical decision making. This systematic review examines and critically appraises the application of AI models to identify surgical pathology from cross-sectional radiological images of the abdominopelvic cavity, to identify current limitations and inform future research.

Method
Systematic database searches (Medline, EMBASE, Cochrane Central Register of Controlled Trials) to identify relevant studies were performed, adhering to the PRISMA-DTA guidelines. Study characteristics and outcomes assessing diagnostic performance were extracted. A narrative synthesis was performed in accordance with the Synthesis Without Meta-analysis guidelines.

Results
10 retrospective studies were included, comprising 3,096 and 1,432 patients for AI training and test sets, respectively. There was diversity in the speciality, intention of the AI applications and the reporting, which was unstandardised. Diagnostic performance of models varied (range: 70–95% sensitivity, 73.7%-98% specificity). Only one study used a comparator, in which AI (AUC=0.920) outperformed both senior and junior radiologists (AUC=0.791 and 0.780, respectively).

Conclusions
AI application in this field is diverse and adherence to new and developing reporting guidelines is warranted. With finite healthcare resources and funding, future endeavours may benefit from prioritising clinical need, rather than scientific inquiry.
180 Systematic Review and Meta-Analysis of Exercise Therapy for Venous Leg Ulcer Healing and Recurrence
Authors: Turner B.R.H. , Jasionowska S. , Machin M. , Onida S. , Webster C. , Davies A.H. 
Published: February 2022

Abstract

Aim
National guidelines recommend regular exercise for individuals with venous leg ulceration, yet data for the effect of exercise on ulcer healing and recurrence are sparse. This study aimed to quantify the evidence for exercise in venous ulcer healing with the primary outcomes of proportion of healed ulcers and rate of ulcer recurrence. Secondary outcomes were compliance and adverse events.

Method
The review followed PRISMA guidelines using a registered protocol (CRD42021220925). Medline, Embase and Cochrane Databases were searched on 15th March 2021 and included articles comparing exercise to compression therapy. Meta-analysis was performed to pool the data.

Results
After screening 994 articles, six reports were included with 109 participants allocated to exercise and 113 to compression. All articles were randomised-controlled trials and reported ulcer healing at 12 weeks, with a pooled relative risk of 1.35 ulcers for exercise versus compression (95% CI 1.07 – 1.71). Only one article reported on recurrence and data pooling was not performed, but no difference between exercise and usual care was demonstrated. Adverse events were inadequately reported and seen to be more frequent in the exercise arm. Compliance with exercise ranged from 33–81%.

Conclusions
There is increasing evidence for exercise as an adjunct to ulcer healing, however, trials were low quality with high risk of bias. This is a crucial innovation as many ulcers recur or fail to heal in spite of surgical correction of underlying venous insufficiency. There is paucity of evidence examining leg ulcer recurrence after exercise programmes and currently no evidence of benefit.
217 Can Virtual Reality Enhance the Patient Experience During Awake Invasive Procedures? a Systematic Review and Meta-Analysis of Randomised Controlled Trials
Authors: Boyce L. , Jordan C. , Sivaprakasam R. 
Published: February 2022

Abstract

Aim
Procedural anxiety and pain negatively impacts surgical outcomes and contributes towards patient non-attendance for awake, invasive procedures (AIPs). Providing patients with virtual reality (VR) headsets may optimise their intraprocedural experience. This meta-analysis assesses the effect of VR on subjective pain, anxiety and satisfaction scores, and patient requirements for sedative and analgesic medication during AIPs.

Method
This review was performed according to PRISMA guidelines. PubMed, EMBASE, CENTRAL, and medrxiv databases were systematically searched for randomised controlled trials investigating the use of VR to enhance the patient experience in adults during AIPs. Meta-analyses were conducted for patient-reported anxiety (n=7), pain (n=7) and satisfaction (n=3) scores, and for total doses of sedative (n=3) and analgesic (n=3) medication administered to patients.

Results
9 studies were included. Patients underwent endoscopic diagnostic procedures (n=5), minimally invasive surgery (n=2) or orthoplastic operations (n=2), under local (n=4) or regional anaesthesia (n=2), conscious sedation (n=2) or simple analgesia alone (n=1). Meta-analysis revealed a significant effect in favour of using VR to alleviate procedural anxiety (SMD: -0.51, 95%CI: -0.85 to -0.16, p=0.004), when one study was omitted. Sub-group analysis of studies where AIPs was performed without anaesthesia, showed a significant reduction in pain scores for VR cohorts (MD: -1.33, 95%CI: -2.57 to -0.09, p=0.04). No significant differences between groups were found for patient satisfaction or requirements for sedative and analgesic medication.

Conclusions
This review supports using VR to reduce procedural anxiety and attenuate pain during AIPs performed without anaesthesia. The effect of VR on patient satisfaction and requirements for sedative and analgesic medications remains unclear.
222 Robotic Surgery: Public Perceptions and Current Misconceptions
Authors: Arshad S. , Brar G. , Xu S. , Ramesh N. , Talajia K. , Anwar M. , ter Wal A. 
Published: February 2022

Abstract

Aim
While surgeons and robotic companies are key stakeholders involved in the adoption of Robotic Surgery (RS), the public's role is often overlooked. However, given that patients hold ultimate power over their healthcare decisions, public acceptance of RS is crucial. This study aims to identify public understanding, opinions and misconceptions on RS and present solutions to facilitate its wider integration.

Method
An online questionnaire distributed via social media platforms between February and May 2021 identified the views of UK adults on RS. The data was evaluated using thematic analysis, descriptive statistics, and statistical analysis. Statistical differences in age, gender, education level, and presence in the medical field were also sought.

Results
263 responses were obtained, with 216 (82.1%) analysed. Demographic differences provided significantly different results. Participants were relatively uninformed about RS, with a median knowledge score of 4.00(2.00–6.00) on a 10-point likert scale. Fears surrounding increased risk, reduced precision and technological failure were identified, alongside misconceptions on what RS entails, including it being autonomous. However, providing factual information in the survey about RS statistically increased participant comfort (p=&lt;0.0001). Most (61.8%) participants believed robot manufacturers were responsible for malfunctions, but doctors were held accountable more by older, less educated, and non-medical participants.

Conclusions
This study highlights the role of negative and inaccurate public perceptions surrounding RS in impeding its widespread adoption. Greater emphasis must be placed on patient education in RS to mitigate misconceptions and ensure greater diffusion of its benefits
31 Quality or Quantity? An Analysis of the Colorectal Cancer Resection Volume-Outcome Relationship From the 2019 National Bowel Cancer Audit Data
Authors: Gujjuri R. , Kawka M. , Murphy J. 
Published: February 2022

Abstract

Aim
Despite increasing evidence supporting cancer services centralisation, no consensus exists in the association between high-hospital or high-surgeon volume and mortality following colorectal cancer surgery. This study aimed to identify and characterise a volume-outcome relationship in colorectal cancer.

Method
National Bowel Cancer Audit (NBOCA) dataset was combined with the Association of Coloproctology of Great Britain and Ireland (ACPGBI) Clinical Outcomes Publication (COP) 2019 report. Adjusted 90-day and 2-year mortality were derived from patients included in the 2018 and 2016 datasets, respectively. The impact of centre volume, surgeon volume and ACPGBI membership rates on outcomes was assessed. Cumulative sum (CUSUM) analysis was performed to identify the centre and surgeon volume threshold.

Results
144 hospitals were included, with 17,235 and 17,703 patients from the 2018 and 2016 datasets, respectively. 781 surgeons were identified, with 478 holding ACPGBI memberships. No significant difference was found between centre or surgeon volumes for adjusted 90-day and 2-year mortality. High ACPGBI membership rates were significantly associated with a reduced 90-day (p=0.006), but not 2-year mortality (p=0.198). CUSUM analysis found 36 per year as threshold centre volume (p=0.003) and 15 surgeries per year as the threshold surgeon volume (p=0.241).

Conclusions
The high degree of existing centralisation for cancer services in the UK limits the number of true low-volume centres compared to other countries. Surgeon volume may be a better predictor of colorectal cancer surgery outcomes than centre volume. More granular data is needed to improve the current understanding of the association between surgeon volume, ACPGBI membership and outcomes in colorectal surgery.
59 Robotic-Assisted Knee Replacement Surgery & Infection: A Systematic Review and Meta-Analysis
Authors: Kwakye M.A. , Raj S. , York T. 
Published: February 2022

Abstract

Aim
An increasing proportion of knee arthroplasties are performed using robotic-assisted surgical techniques. While these techniques are associated with shorter lengths of stay, better patient outcomes and lower revision rates, the increase in intra-operative time and requirement for extra instrumentation, such as array pins, may lead to an increased risk of infection. Therefore, this review reports summary rates of surgical site infection (SSIs) in robotic-assisted knee arthroplasties.

Method
The protocol for this review was prospectively registered on PROSPERO. Embase, PubMed/MEDLINE, Cochrane and CINAHL databases were searched from 2004 to November 2020 to reflect modern robotic surgical practice. The primary outcome was overall number of SSIs that occurred within one year of the primary operative procedure, which was sub-classified into either deep or superficial and pin-site infections. Risk of bias was assessed via the Cochrane RoB2 tool. Conventional Q and I2 tests for heterogeneity were performed with subsequent meta-analysis using a DerSimonian-Laird random-effects model.

Results
From 1052 studies identified, 17 were included, of which 13 were deemed to have an overall ‘low’ risk of bias. This review included 4400 unicompartmental and 1883 total knee arthroplasties. The summary rate of overall SSIs within one year of primary robotic knee arthroplasty was 0.568% (SE=0.183, 95% CI=0.209–0.927). This rate fell to 0.154% (SE=0.069, 95% CI=0.018–0.290) for deep infections and 0.347% (SE=0.109, 95% CI=0.133–0.561) for superficial and pin-site infections.

Conclusions
The rates of surgical site infection were found to be low in robotic knee arthroplasty, however, further research is required to compare outcomes with conventional knee arthroplasty.
Difference Between the ICJ and the CERD Committee: A Comment on the Application of the International Convention on the Elimination of All Forms of Racial Discrimination (Qatar v. United Arab Emirates) Case
Authors: Pan Kaijun 
Published: February 2022

Abstract
In the Qatar v. UAE case, the Court reached, without giving much explanation, an interpretation different from that of the CERD Committee over the phrase “national origin” in the International Convention on the Elimination of All Forms of Racial Discrimination. This, in fact, marks a deviation from the Court’s previous case law. Through a close reading of the Court’s judgment and the Committee’s decision, this comment argues that their diverging interpretations bring to the surface the structural differences between these two institutions. These differences had been obscured in the Court’s jurisprudence, and a more principled approach towards human rights treaty bodies is needed for the Court in the future.
Local Politics and Fluctuating Engagement with China: Analysing the Belt and Road Initiative in Maritime Southeast Asia
Authors: Wang Zhaohui , Fu Yuheng 
Published: February 2022

Abstract
The past few years have witnessed that the success (or failure) of the Belt and Road Initiative (BRI) depends to a large extent upon engagement with and responses from recipient countries. The article explores the impact of Southeast Asian countries’ domestic socio-political factors on their foreign policymaking and BRI projects in Southeast Asia. Based on comparative political sociology, the article develops a conceptual typology of foreign policymaking and an explanatory typology of socio-political risks, both of which are further applied to studying the socio-political risks that BRI projects entail in the four maritime Southeast Asian countries of Malaysia, Indonesia, the Philippines, and Singapore. The empirical study suggests that the Philippines’ ‘populist’ type of foreign policymaking creates the highest level of risks—both political and societal—for BRI projects and that Singapore’s ‘procedural’ type produces the lowest. Malaysia’s ‘arbitrary’ type and Indonesia’s ‘democratic’ type, meanwhile, generate medium-level political or societal risks. These findings have important policy implications for Chinese-funded overseas projects.