bluuebunny/crossref_metadata_2025_split huggingface dataset:
60 Comparison of Comorbidities and Need for Further Surgery of Adolescent and Adult Patients Who Undergo Carpal Tunnel Release
Authors: Bapty J , Riyat H , Johnson N 
Published: November 2022

Abstract

Aim
To compare the presenting comorbidities and need for further surgery following carpal tunnel release (CTR) surgery between the adolescent and adult populations.

Method
36 consecutive patients under 25 years old who underwent CTR in a single centre were identified (43 hands). Comorbidities and further surgery in the follow up period were recorded from electronic medical records. The same data was collected from 100 randomly selected adult patients who underwent CTR in the same centre aged within one standard deviation of the mean. Outcomes included: comorbidities pre-and post-surgery, further operations and follow up in the region. Data for both cohorts were compared.

Results
Mean follow up was 13.3 years for adolescents and 8.6 years for adults. Adolescent patients undergoing CTR surgery were associated with higher rates of obesity (22%), mental health problems (19%) compared with the adult CTR population (11% and 7% respectively). 47% of the adolescents required at least one further nerve decompression surgery compared with 41% in adults. This was most likely to be a contralateral CTR in both patient groups. The revision rate of CTR was higher in adolescents (11%) than in adults (4%).

Conclusions
Mental health problems were significantly higher in younger patients undergoing CTR. Rate of further nerve decompression surgery is high in both groups. Adolescents especially should be informed of the risk of requiring future surgery following a CTR. Given the likelihood for further surgery in both cohorts, patients undergoing CTRs should be advised to reduce their modifiable risk factors for nerve entrapments.
104 Our Management of Distal Femoral Comminuted Fractures with Femoral Defects
Authors: Zhou A , Jou E , Patel S , Lu V , Zhang J , Krkovic M 
Published: November 2022

Abstract

Aim
Distal femoral fractures account for 3–6% of all femoral fractures. Current management of distal femoral fractures involve reducing bone fragments and placing a locking plate against it. In this study, the surgeon used a ‘selective approach’, whereby only key bone fragments in the comminuted fracture were reduced and fixed whilst the rest were either removed or left unreduced/unfixed.

Method
All patients underwent AxSOS plate/less invasive stabilisation system (LISS) surgery after adopting the “selective approach” during pre-surgical planning. A significant proportion of patients had a degree of bone defect, and most had open fractures. Primary outcomes included post-operative functional ability, quality of life assessed using EQ-5D-5L, Oxford Hip Score (OHS), Oxford Knee Score (OKS), range of movement.

Results
Average OKS and OHS for our cohort (n=10) is 23 and 35, respectively, with a mean knee-flexion of 86° (45°-120°). Average EQ-5D- 5L index value is 0.551; the most common response for mobility, self-care, usual activities, pain/discomfort, and anxiety/depression was moderate. 20% developed pin site infections, 40% reported significant knee stiffness.

Conclusions
Despite having a complex cohort where many of the patients had bone defects, and 80% had open fractures, the “selective approach” adopted in the present study achieved comparable outcomes to other studies with less-severe fracture characteristics, with similar operation times and range of knee-flexion. These results suggest that this alternative should be considered as a potential treatment option, although more studies on a similar cohort of patient to ours is needed to allow better comparison of the surgical approaches.
387 Minimally Invasive TTC Arthrodesis - Novel Arthroscopic Assisted Hindfoot Nailing
Authors: Lingnau L , Morris R , Cheruvu MS , Mumtaz H 
Published: November 2022

Abstract

Aim
Tibiotalocalcaneal arthrodesis is a salvage procedure for advanced primary degenerative joint disease of the hindfoot and ankle, failed primary fixation, post-traumatic osteoarthritis, or Charcot disease. Hindfoot nailing has been associated with complications in up to 40% of cases. There is limited literature on arthroscopic arthrodesis, as an advanced and minimally invasive technique.
Our aim is to evaluate this pioneering minimally invasive procedure in terms of radiological and operative outcomes.

Method
We conducted a retrospective analysis of all patients who underwent this procedure at a single centre by a specialist foot and ankle service. We noted procedure indication, post-operative complications, and post-operative outcome in all patients. Outcomes include wound defects or infection, radiographic evidence of fusion, fixation failure, venous thromboembolism (VTE), and reoperation.

Results
A total of 12 patients underwent surgery with an average age of 75± 22 years. Indication for surgery included: 2 patients requiring fusion for severe primary osteoarthritis, 3 patients underwent primary arthrodesis following trauma and 7 patients underwent arthrodesis as a salvage procedure following failed primary fracture management.
No patients had post-operative wound complications that required re-admission or a return to theatre, no VTE events, no fixation failures and 1 removal of screw for prominence. 6 patients have clinical and radiographic evidence of fusion, with the remaining 6 patients still under active follow-up and all still within 4 months of their fusion surgery.

Conclusions
Our current experience suggests that arthrodesis is achievable with this novel minimally invasive approach, which is a safe and reproducible procedure without increase in operative complications.
905 Improving Confidence in Plastering Across Specialties: A Hands-on Approach
Authors: Sambhwani S , Baba M , Hirschowitz D , Shrestha S , Khairandish H 
Published: November 2022

Abstract

Aim
Plaster of Paris casts form one the most basic yet effective treatment for acute orthopaedic fractures and often form a permanent treatment methodology. Patients with fractures present at all times of the day to acute services and require prompt stabilisation. Casts however do present some risks including compartment syndrome and skin ulcerations. Our quality improvement aimed to improve confidence in healthcare providers across different specialities in managing plasters.

Method
Focussed workshops conducted by expert plaster technicians under the supervision of an experienced orthopaedic consultant were conducted for upper and lower limb injuries. Additional workshops encompassing plaster safety and other trauma splints were delivered. Candidates ranged across different grades and included nurse practitioners and qualified doctors.
Confidence scores (out of five) measured on a Likert scale were obtained from 25 participants.

Results
Knowledge about plasters including type of plaster matched to injury improved from a mean score of 3 to 4.5. Confidence in applying upper limb plasters improved from a mean score 3 to 4.7 and applying lower limb plasters improved from a mean score of 3.25 to 4.8. Confidence in plaster safety including acute conditions and safe removal improved from a mean score of 2 to 4.6. Confidence in applying acute splints improved from a mean score of 1.5 to 4.3.

Conclusions
Our quality improvement project improve the confidence in practitioners managing acute orthopaedic patients with an emphasis on plaster safety and acute splints. It has been formally adopted on a regular basis as a teaching program.
948 Traumatic Native Hip Dislocation Without Associated Fracture: A Case Series of 13 Patients Over 9 Years
Authors: Varma J , Jones C , Fowler T , Chesser T , Ward A , Acharya M 
Published: November 2022

Abstract

Aim
Traumatic native hip dislocation (NHD) is rarely without an associated fracture or due to low energy trauma. Posterior dislocation is the most common pattern of hip dislocation. In most cases, closed reduction is successful, but occasionally open reduction is required to achieve appropriate reduction. The aim of our study was to present the 9-year experience from our institution of this rare injury pattern and to comment on how our experience correlates with the current literature.

Method
This is a retrospective case series of all adult patients (&gt; 16 years old) with a traumatic NHD without fracture presented and/or treated at our institution, between the 1st of January 2012 and 22nd June 2021.

Results
Thirteen cases of traumatic NHD were identified (38.4% female). The mean age was 26.5 years. Typically, younger patients were involved in lower energy injuries. The direction of hip dislocation was posterior in 10 cases. Associated injuries were seen in 3 patients. 12 cases underwent successful closed reduction, and 1 case was operatively managed. 3 cases had a previous hip pathology including femoroacetabular impingement, cam lesion and childhood slipped upper femoral epiphysis.

Conclusions
Traumatic NHD without associated fracture is a rare injury pattern, most commonly occurring in patients under the age of thirty. A target of 6 hours for reduction should be employed as this will reduce the risk of AVN in those who have not permanently damaged the vessels at the time of injury.
157 Stent Encrustation and Indwelling Stent Times
Authors: Debo-Aina A , Datta S , Rix G , Keoghane S , Maan Z 
Published: November 2022

Abstract

Introduction
A pathways streamlining stone management identified four rate-limiting processes causing delay and affecting outcome. Key performance indicators (KPI) with set targets were created to address them. These are:
Ureteric-stents cause morbidity if left in-situ long-term. This includes bacterial colonization and encrustation.
Methods:

Aim
a) identify IDST during pre-COVID and COVID periods, b) review encrusted-stents removed within the study timeframe and c) root-cause for delayed stent removal and encrustation.
Stent register reviewed between Jan-2019 and Mar-2021. Mean IDST pre- and post-COVID calculated. Information on indication, insertion date and removal retrieved from register and clinical-notes. Root-cause analysis to identify factors influencing delayed removal and encrustation.

Results
841 stents inserted within study timeline; 436 pre-COVID and 405 during COVID. Identical stent-times for both periods, 86% cases pre-COVID and 85% during COVID having IDST &lt;12 weeks. Average IDST of 6 weeks and 5 weeks in pre-COVID and COVID periods respectively. 11 encrusted-stents removed (7 pre-COVID, and 4 COVID), with average encrusted-stent duration of 29 weeks pre-COVID and 16 weeks during COVID. Factors involved in encrustation and delayed removal include systems and patient-related factors, failed initial removal, complex surgical planning, ESWL and dissolution therapy.

Discussion & Conclusions
No difference in IDST during pre-COVID and COVID periods. A lowered encrusted IDST during COVID, likely attributed to departmental prioritisation of stone-pathway, stent register, and use of a green-listed operative site.
488 TULA for Bladder Tumours in a University Teaching Hospital: Outcomes Over a 2-Year Period
Authors: Harrison N , Bashir J 
Published: November 2022

Abstract

Aim
TULA (Transurethral laser ablation) of bladder tumours is a relatively non-invasive procedure that is carried out on a day-case basis under local anaesthesia, providing an attractive option for treating recurrent non-muscle invasive bladder cancer (NMIBC). However, data describing efficacy rates are limited.

Method
We carried out a retrospective audit of all TULA procedures carried out for bladder lesions between January 2018 and December 2019. Patients were identified using clinical coding and data collected using electronic case note data. Analysis was performed using Microsoft Excel.

Results
48 patients were identified, 75% were male and the average age was 77. Performance status (PS) was formally documented in 6 patients, with a median of 2.5. A total of 77 TULA procedures were identified. 7 patients had TULA as primary treatment, all but one of these patients had significant co-morbidities.
Biopsies were taken in 83% of procedures. Recurrence rate at 3 months was 29% (n=14). 18% (n=8) of patients went on to have repeat TULA and the remainder went on to have TURBT or biopsy and cystodiathermy. Of those patients with recurrence, 18% had disease progression. 1 patient required catheterisation and irrigation overnight, all other patients were discharged the same day. No patients required re-admission.

Conclusions
TULA is a safe, well tolerated procedure to treat low-grade, recurrent bladder tumours. It can also be used as a palliative procedure for high-grade lesions in patients with multiple co-morbidities. Future work includes collection of objective data on tolerance in the form of VAS pain scoring.
361 Carotid Endarterectomy Pathway at a Hub Site – the Impact of COVID-19
Authors: Alawattegama LH , Siddiqui M 
Published: November 2022

Abstract

Aim
NICE Guidelines recommend that all patients who suffer from a TIA or non-disabling stroke are rapidly assessed and imaged. Patients suspected of having symptomatic carotid stenosis should be referred to a Vascular Centre for consideration of urgent carotid endarterectomy (CEA) within two weeks.
Our aim was to assess the current referral-to-treatment timeline for carotid surgery in our Vascular Centre against these standards and explore the impact of the COVID-19 Pandemic on this.

Method
We retrospectively interrogated the National Vascular Registry to identify patients undergoing CEA “pre-pandemic” (Jan – Dec 2019) and in a “contemporary period” (Jan – Sept 2021)

Results
A total of 129 patients underwent CEA in the defined periods, including pre-Pandemic (80 patients) and contemporary (49 patients) periods. One patient had to be excluded due to inability to identify date of first symptoms.
2019 Data: The times (median) from symptoms to surgery were 10 days (interquartile range (IQR) 23 days), from imaging-to-referral, one day and from vascular review to surgery, two days.
2021 Data: The times (median) from symptoms to surgery were 10 days (IQR 12 days), from imaging-to-referral, two days and from vascular review to surgery, one day.

Conclusions
The median time from symptoms to surgery has remained the same from pre-Pandemic data, though there is a decrease in IQR in current practice. We recommend creating a CEA Pathway to optimise the carotid service.
528 A Single-Centre Retrospective Study in a Large Tertiary Renal Centre on the Management of Infected Arteriovenous Grafts
Authors: Chow BJ , Chowdary P , Khurram M A , Mohamed IH 
Published: November 2022

Abstract

Aim
Prosthetic arteriovenous grafts (AVGs) are often used as tertiary vascular access for haemodialysis in patients with exhausted autogenous options. AVGs are associated with an increased risk of infection which can lead to excess morbidity and life-threatening complications. Infected AVGs are challenging to manage, and the current evidence remains unclear on optimal strategy with arguments for conservative management, salvaging with revision or surgical excision (subtotal or total). This study sought to evaluate the management of infected AVGs by examining the clinical outcomes of patients with infected AVGs managed in our institution.

Method
We conducted a single-centre retrospective study of all AVG infections managed (conservative management via antibiotics; graft revision; surgical excision) in a large tertiary renal centre between June 2016 to May 2021. Primary outcome was mortality at 1 year. Secondary outcome was functional vascular access at 6 months and 1 year. Data were extracted from electronic patient records, radiology imaging and reporting.

Results
34 patients were included in our study (14.7% conservatively managed; 14.7% revision; 70.6% surgical excision) with a mean age of 60.4 ± 14.4 years (67.6% males). Average time from AVG placement to presentation was 11.8 months. 1 year mortality was 14.7%. Functional vascular access at 6 months in the three groups was 60%, 60% and 10% and 1-year functional vascular access was 60%, 75% and 42% respectively.

Conclusion
Surgically excised infected AVGs are associated with poor 6-month and 1-year vascular access outcomes. The findings suggest that conservative management and/or revision are more prudent given their higher probability of subsequent functional access.
586 Case Series: Neurostimulation - a Promising Option for Treatment of Chronic Peripheral Arterial Disease When Revascularization and Conservative Management Are Unsuitable
Authors: Singhania A , Quddus A 
Published: November 2022

Abstract
Parasympathetic stimulation has been implicated in improving circulation in the extremities by causing arteriolar dilatation, which could plausibly be useful in patients with peripheral arterial disease (PAD).
Herein, we illustrate 5 cases (4 males and 1 female, age 40–75) of chronic disabling intermittent limb claudication without any ischaemic rest pain who were offered Neurostimulation since conservative treatment did not help and no other revascularization options were deemed suitable.
Each of these patients had a pre-neurostimulation arterial duplex scan to depict the extent of occlusion; measure diameter of vessels and their blood flow, ABPI and absolute ankle pressure. Pain score, claudication distance and impact on quality-of-life pre-stimulation were recorded in the patient clinic notes. Non-invasive Ducest Neurostimulator was implanted in the auricular fossa triangularis for two sessions of 3 weeks treatment. Post-neurostimulation arterial duplex scan was repeated to compare any changes in the vessel diameter, blood flow and ABPI.
Significant improvement in the symptoms of PAD was noted in all the cases. Post-treatment, the patients felt much more comfortable- their pain score reduced significantly (to 0 in 2 of the cases); and 2 to 16-fold increase in their walking distance as compared to pre-treatment. Remarkable symptomatic relief was in line with profound (2–8 times) improvement in blood flow which was quantified using vessel diameter, tibial flow volume, and hand-held doppler signal. ABPI and absolute pressure either remained near unchanged or increased post treatment.
This series strongly suggests a beneficial role of neurostimulation in the symptomatic treatment of PAD in selective cases.
938 Opportunity Knocks - Reducing Cardiovascular Risk in Patients Undergoing AAA Surveillance
Authors: Evans E , Turner J , Meldrum A 
Published: November 2022

Abstract

Aim
Secondary prevention medication is recognised to reduce cardiovascular events in patients with established atherosclerotic disease; in the form of antiplatelet and lipid-lowering therapy. Yet a lack of consensus between the European Society of Vascular Surgery (ESVS) (Wanhainen et al., 2019) and NICE guidelines (NICE, 2021b; a) is recognised (Saratzis et al., 2017). Abdominal aortic aneurysm (AAA) is a manifestation of peripheral arterial disease, and medical optimisation should be considered for those diagnosed (Wanhainen et al., 2019; NICE, 2021b). Compliance of secondary prevention in this patient group was assessed in our unit which serves over 1.4 million patients across the West of Scotland. The secondary aim was to optimise those identified.

Method
Data was collected systematically, analysed, and results held to the standard set by ESVS, NICE and current literature. Current medication information was obtained through Community Pharmacy Scotland.

Results
Out of 632 patients, 74.1% were on an antiplatelet, 75.6% on a statin, and 64.7% on both. 71.2% of these patients were male, mean age was 73.9 years. Circumstances that outweigh the introduction of such medications were explored, and changes have been recommended to patients and general practitioners where appropriate. Preliminary data on second cycle shows increased uptake in the recommended medications.

Conclusions
Studies have shown significantly improved survival rates for AAA patients with prescribed secondary prevention therapy (Bahia et al.,2016; Cheng et al.,2019). This study has identified 32.8% whose cardiovascular health can be optimised, and realised through liaison with general practitioners, thus protecting these patients from adverse cardiovascular outcome and death.
Medical Student Debt and the US Infectious Diseases Workforce
Authors: Mohareb Amir M , Brown Tyler S 
Published: November 2022

Abstract
Student debt in the United States is at historically high levels and poses an excessive burden on medical graduates. Studies suggest that financial limitations dissuade some medical trainees from pursuing careers in infectious diseases (ID) and other cognitive specialties, despite their interest in the subject matter. Addressing student debt may have a transformative impact on ID recruitment, diversification of the ID workforce, and contributions of ID physicians to underserved public health needs. Relief of student debt also has the potential to narrow the racial wealth gap because nonwhite students are more likely to finance their postsecondary education, including medical school, with student loans, yet they have a lower earning potential following graduation. An executive order from the Biden-Harris administration announced in August 2022 presents a first step toward student debt relief, but the policy would need to be expanded in volume and scope to effectively achieve these goals.
“Care for Me, Too”: A Novel Framework for Improved Communication and Support Between Dementia Caregivers and the Home Health Care Team
Authors: Burgdorf Julia G , Reckrey Jennifer , Russell David 
Published: November 2022

Abstract

Background and Objectives
Identifying and meeting the needs of family and unpaid caregivers (hereafter, “caregivers”) during home health (HH) can improve outcomes for patients with Alzheimer’s Disease and Related Dementias (ADRD). However, little is known regarding ADRD caregivers’ perspectives on communication and support from the HH care team. The study objectives were to identify ADRD caregivers’ common support needs during HH and preferences for addressing these needs, to inform future development of an assessment and support intervention.

Research Design and Methods
We conducted semistructured key informant interviews with caregivers who had recently assisted a HH patient with ADRD (n = 27). Interview transcripts were analyzed using directed content analysis.

Results
Caregivers identified four major support needs: assistance navigating insurance and service coverage, training on nursing tasks, referral to respite care, and information regarding ADRD disease progression. Caregivers described major barriers to communicating these needs, including never being directly asked about their needs and information discontinuity within the HH care team. Incorporating caregiver recommendations, we propose a new model of assessment and support in which the HH care team (a) proactively asks about caregiver needs, (b) presents available supportive resources, (c) solicits information regarding the patient’s needs and routine, and (d) stores and shares this information within the medical record.

Discussion and Implications
Findings reveal critical gaps in current patterns of support for ADRD caregivers during HH and suggest directions for an assessment and support intervention that explicitly queries caregivers on their capacity and needs, with content tailored to the HH setting.