bluuebunny/crossref_metadata_2025_split huggingface dataset:
392 Outcomes of Anatomical Custom Patient-Specific Implants After 3D CT Pre-Operative Planning for Complex Hip Conditions
Authors: Petohazi A. , Musbahi O. , Akilapa O. , Gee M. , Harnett P. 
Published: February 2022

Abstract

Aim
Primary THA in complex hip conditions presents a challenge for an orthopaedic surgeon. Often, the anatomical restoration is less than ideal with an “off the shelf” implant. The use of 3D planning with customized implants is an emerging technology to meet this challenge. However, patient outcomes are unknown. In this study, we present the 1-year results of patients with complex hip conditions undergoing custom implants and 3D pre-operative planning.

Method
We conducted a retrospective review of all patients that underwent 3D planning and custom Total Hip Arthroplasty implant. Demographic data and indications were collected. Operative details and postoperative complications were reviewed. Post-operative radiographic assessment and measurements were reviewed. Oxford Hip scores at 1 year were compared with national standards.

Results
Sixteen patients underwent Total Hip Replacement after Symbios 3D Preoperative planning with custom made implants at 1 Major Trauma Centre. The mean age was 43 consisting of 8(50%) females and 8 males. The most common indication was hip dysplasia(5/16). Mean Operative time was 114mins(range80–200mins). Mean operative blood loss was &lt;500ml and length of stay were 3 days. Mean Oxford Hip Scores at 1 year was 45/48. There were no signs of radiographic loosening or dislocation.

Conclusions
Custom implants after 3D planning is an effective treatment for restoring anatomy and improving functional outcomes. Outcomes were comparable to national standards to patients undergoing primary total hip arthroplasty for osteoarthritis.
403 The Difficulties of Managing Trauma in Elderly Patients in a West of Scotland Trauma Unit
Authors: Nair G. , Silverwood R. , Jeyakumar G. , Davison M. , Bailey O. 
Published: February 2022

Abstract

Aim
An increasing number of elderly patients require admission to Trauma & Orthopaedic units throughout Scotland with admissions often complex and lengthy. We aimed to assess the current standard of care within a west of Scotland trauma unit against the 2019 British Orthopaedic Associations Standard of Care (BOAST) - “The care of the older or frail orthopaedic trauma patient” and devise a multi-disciplinary quality improvement strategy.

Method
All patients over the age of 65 admitted to the Trauma & Orthopaedic department of the University Hospital Wishaw between the 1st-14th of August 2020 were included. Online medical records were assessed and compared to the BOAST guideline. Results were presented to Orthopaedic and Care of the elderly (COTE) team and postgraduate teaching before being re-audited from 1st-14th May 2021. Data was analysed using Chi- Squared test.

Results
Cycle one vs Cycle two:
Falls risk assessment was carried out in 50/57(87.7%) vs 49/57(86.0%); Nutritional assessment carried out in 53/57(93.0%) vs 50/57(87.7%); Delirium assessment carried out in 54/57(94.7%) vs 47/57(82.5%). More patients were reviewed by Acute Care of the Elderly nurses 24/57(42.1%) vs 30/57(52.6%). No significant improvement was seen in the percentage of patients reviewed by a COTE consultant:15/57(26.3%) vs 17/57(29.8%) (P = 0.68).

Conclusions
Both cycles show good concordance with the BOAST criteria, including physiotherapy reviews, falls and delirium assessment, however significant deficiencies exist, including the provision of COTE input. This has prompted a reconfiguration of orthogeriatric input for trauma patients, with significant investment in the recruitment of COTE medical staff.
406 SARS-CoV-2 Vaccination Modelling for Safe Surgery to Save Lives: Data from an International Prospective Cohort Study
Authors: Gohar M. , Simoes J. , Nepogodiev D. 
Published: February 2022

Abstract

Aim
Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling.

Method
The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty.

Results
NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year.

Conclusions
As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.
416 Venous Thromboembolism Prophylaxis in Emergency Surgical Admission: The Power of a Checkbox in Reducing Errors. a Closed Audit
Authors: Dhannoon A. , Hogan A. 
Published: February 2022

Abstract

Introduction
Hospital-acquired venous thromboembolism (VTE) is considered a significant cause of morbidity and mortality in all inpatients. It is potentially preventable with adequate thromboprophylaxis. All surgical patients should be assessed and commenced on an appropriate dose of anticoagulant agent.
Drug charts of 40 patients admitted under general surgery teams at Galway University Hospital were reviewed and audited against the Irish VTE prophylaxis guidelines release in 2019.

Results
A total of 40 (21 M, 19 F) patients were included, 2 out of the 40 patients (30%) were adequately assessed not suitable for chemoprophylaxis, two patients were not missed in the absence of risk factors of bleeding. Of the remaining 36 patients, 29 were adequately treated with chemoprophylaxis and 7 patients were undertreated or overtreated by doses inadequate to their weight and renal clearance. 35 out 40 patients were charted for TED stockings this falls under the 100% standard.
Intervention: An educational presentation, along with collaborative agreement with the pharmacy department to add two checkboxes on the prophylactic anticoagulant page of the carder to highlight the renal function and the weight to the prescriber.
Re-audit: On re-auditing the data, 40 patients were included, 2 patients have contraindications factors for anti-coagulant. out of 38 patients remaining, 37 of them received weight and renal function-adjusted doses of prophylactic anticoagulants. All 40 patients received TED stockings.

Conclusions
Check boxes on the prescription sheet act as effective reminders for the busy junior doctor prescriber to highlight the importance of weight and renal function when prescribing anti-coagulants.
1 Mobile Health Apps in Burns: Where Is the Quality Control?
Authors: Patel B. , Edwards T. , Schrire T. , Senn S. 
Published: February 2022

Abstract

Aim
High quality mobile health applications (mhealth apps) have the potential to enhance the prevention, diagnosis, and treatment of burns. The primary aim of this study was to evaluate whether the quality of mhealth apps for burns care is being adequately assessed. The secondary aim was to determine whether these apps meet UK regulatory standards.

Method
We searched AMED, BNI, CINAHL, Cochrane library, Embase, Emcare, Medline and PsychInfo to identify studies assessing mhealth app quality for burns. The PRISMA reporting guideline was adhered to. Two independent reviewers screened s to identify relevant studies. We analysed whether seven established domains of mhealth app quality were assessed: design, information/content, usability, functionality, ethical issues, security/privacy, and user-perceived value.

Results
Of the 28 included studies, none assessed all seven domains of quality. Design was assessed in 4/28 studies; information/content in 26/28 studies; usability in 12/28 studies; functionality in 10/28 studies; ethical issues were never assessed in any studies; security/privacy was not assessed; subjective assessment was made in 9/28 studies. 17/28 studies included apps that met the definition of ‘medical device’ according to MHRA guidance, yet only one app was appropriately certified with the UK Conformity Assessed (UKCA) mark.

Conclusions
The quality of mHealth apps for burns are not being adequately assessed. The majority of apps should be considered medical devices according to UK standards, but only one was appropriately certified. Regulatory bodies should support mhealth app developers, so as to improve quality control whilst simultaneously fostering innovation.
44 Early and Long-Term Outcomes of Re-Sternotomy Aortic Valve Replacement (AVR) With Previous Coronary Artery Bypass Grafts (CABG)
Authors: Okorocha C. , Sarvananthan S. , Malvindi P. , Luthra S. , Ohri S. 
Published: February 2022

Abstract

Introduction
With the wider use of biological prosthetic valves and increasing life expectancy, the number of patients requiring redo surgery for aortic valve replacement (AVR) is increasing. This carries its own risks particularly in those with previous cardiac surgery - from graft injury and myocardial jeopardy. Transcatheter valve replacement provides a safer option for high-risk patients that do not require any additional cardiac surgery. This project aims to evaluate the early and long-term outcomes of redo-sternotomy AVR after previous CABG.

Method
Retrospective study of patients that underwent redo sternotomy AVR with (Group 1) or without (Group 2) concomitant cardiac procedure(s) from 2000–2019. Pre-operative, operative and post-operative data collected for each patient. Statistical analysis done with significance p-value &lt;0.15.

Results
178 patients included during this time-period (Group 1 = 90 and Group 2 = 88). Mean age of 75 years and EuroSCORE of 17. In hospital-mortality was 7.8% with key contributing factors of heart failure (NYHA III-V), perioperative IABP insertion and cardiovascular injury - 12% of cases and most commonly effecting the left internal mammary artery (LIMA). Survival at 5 years in both groups is significantly worse for patients with post-operative complications and cardiovascular injury. However, long-term survival is better in Group 1 than in Group 2.

Conclusions
Risk of injury to LIMA increases operative mortality. Peripheral cannulation and pre-sternotomy cardiopulmonary bypass can help manage this - although numbers in this study too small. Alternatives to redo valve surgery are to be considered in high-risk patients and a multidisciplinary approach continued to be adopted for each case.
52 Evaluating the Outcomes of Anal Squamous Cell Carcinoma with Curative Intent- a 10-Year Experience
Authors: Noureldin K. , Ayantunda A. , Issa M. , Jones L. 
Published: February 2022

Abstract

Background
Our 10-year experience in treating anal squamous cell carcinoma (ASCC) with curative intent.

Method
Clinical and pathological data were analysed between January 2011 and December 2019. All patients underwent the standard workup and treated accordingly. Patients were followed up according to the network protocol. The outcome measures were clinicopathological characteristics, treatment modalities, response, recurrence, disease-free and overall survival.

Results
117 patients followed up over the 10-year. 26 patients treated palliatively, 11 patients with adenocarcinoma, 1 melanoma, 1 Paget disease and 1 carcinoid tumour were excluded. Median age was 65 (38–90) years with male to female ratio of 1:1.9. 3 patients were HIV+ve and 52% of the patients had AIN of varying degree of dysplasia. AJCC stages were I (16), II (18), IIIA (19), IIIB (9) and IV (15). 88.3%% of the patients had radical chemoradiotherapy while 9 patients with tumour ≤2cm underwent wide local excision. 81.8% of the patients treated with radical chemoradiotherapy had complete response while (5/77) had partial response.4 patients with incomplete response underwent salvage APER. Recurrence rate was 13%.
The overall mean survival time was 99.82 (95% CI 88.87–110.77) months with 5-year survival rate 78.0%. Overall recurrence rate was 13.0%. Mean disease-free survival time in 77 patients was 111.82 (95% CI 102.38–121;26) months. 75.3% of the patients were alive at the end of the study with an overall mortality rate was 24.7% and disease-specific mortality was 15.6%.

Conclusions
Recurrent anal SCC occurred in 1 in 10 after radical chemo-radiotherapy with disease-specific mortality of 26%.
126 The Theatre Training Checklist: A Toolkit to Improve Operative Training
Authors: Aldoori J. , Burke J. , Robson A. , Al-Attar A. , Giwa L. , O'Regan D. , Peter M. 
Published: February 2022

Abstract

Aim
The operating theatre is expensive, costing approximately £1200 per hour to run. It is a crucial learning environment for many different trainees: anaesthetists, surgeons, operation department practitioners, etc. For individuals to achieve their training requirements, the operating theatre as a training environment must be shared between all trainees, requiring excellent teamwork and leadership. This could be improved by the adoption of innovative training strategies.

Method
The Theatre Training Checklist is a simple framework that aims to facilitate awareness, understanding, coordination and cooperation of training for all team members. It is a practical strategy that can be adopted in any setting. Usually, trainers discuss informally with their trainees about their individual skills, experience, expectations and what is achievable in a theatre list. However, there is currently limited opportunity to discuss this between different disciplines and the wider team. This tool aims to refine communication, optimize training, manage expectations, and ensure equity across the board.

Results
The checklist is completed at the start of the list during the theatre brief. It identifies all trainees and their specific needs within the operating theatre session to the whole team. An agreed strategy is developed on how to achieve identified training goals. Feedback undertaken from the MDT after local trailing of the checklist has been positive.

Conclusions
The toolkit is available for use and consists of the checklist tool and an instructional video. The checklist is being piloted in some centres and we hope to have the opportunity to present some early findings to the ASiT Innovation Summit.
150 Muscle Quantity at C3 And/or L3 on Routine Trauma Series Computed Tomography Correlate with Brain Frailty and Clinical Frailty Scale: A Cross-Sectional Study
Authors: Gomindes A. , Welch C. , Chugh R. , Appleton J. 
Published: February 2022

Abstract

Background
Sarcopenia is increasingly recognised to impact the quality of life and patient outcomes. The relationship with brain frailty is unknown.

Objectives
Assess if muscle mass at C3 correlates with muscle mass at L3 on routine trauma imaging. Assess for associations between muscle-mass, brain-frailty, and Clinical Frailty Scale (CFS) on routine trauma imaging.

Method
Routine trauma-series CT scans were retrospectively analysed for patients aged ≥16-years-old admitted to Queen-Elizabeth-Hospital in January2020. Paravertebral, sternocleidomastoid, and total muscle cross-sectional-area (CSA) at C3 (C3-SMM), and total psoas muscle CSA (TPA), total muscle CSA (L3-SMM), and total adipose CSA at L3 were calculated. Brain-frailty scores were calculated assessing for leukoaraiosis, cerebral atrophy, and old vascular lesions/infarcts. CFS was calculated retrospectively from clinical notes. We assessed for correlation against age, CFS, muscle-mass, and brain-frailty using Pearson’s correlations.

Results
We included 111 patients in this study (mean age 49, SD 25.6; 65.8% female). C3-SMM strongly correlated with L3-SMM (r=0.746, p&lt;0.001). Paravertebral and sternocleidomastoid CSA correlated with C3-SMM (paravertebral: r=0.814, p&lt;0.001; sternocleidomastoid: r=0.814, p&lt;0.001). TPA strongly correlated with L3- SMM (r=0.800, p&lt;0.001). Sternocleidomastoid CSA and TPA both negatively correlated moderately with age (sternocleidomastoid: r=−0.460, p&lt;0.001; TPA: r=−0.468, p&lt;0.001), CFS (sternocleidomastoid: r=−0.414, p&lt;0.001; TPA: r=−0.431, p&lt;0.001), and brain frailty (sternocleidomastoid: r=−0.395, p&lt;0.001; TPA: r=−0.436, p&lt;0.001). Adipose CSA at L3 did not correlate with age, CFS, brain-frailty, or muscle-mass.

Conclusions
Muscle-mass at C3 relates to muscle-mass at L3. Muscle-mass on routine trauma-imaging is negatively associated with age, CFS, and brain-frailty.
176 Did Hand Washing and Use of Personal Protective Equipment (PPE) Reduce Transmission of Surgical Site Infections During the SARS-CoV-2 Pandemic?
Authors: Hunt A. , Nasr H. , Willmott H. , Patel P. 
Published: February 2022

Abstract

Aim
A retrospective case-control study comparing Surgical Site Infections (SSIs) following primary hip and knee arthroplasty before and during the SARS-CoV-2 pandemic across East Sussex NHS Trust (ESHT). The aim of this study was to evaluate whether the government advice relating to increased vigilance surrounding hand hygiene and use of personal protective equipment (PPE) reduced SSIs following elective arthroplasty.

Method
Data was obtained from Public Health England website relating to SSIs following primary hip and knee arthroplasty between April 2019 and March 2020 (pre-pandemic) performed at ESHT and compared to April 2020 to March 2021 (pandemic).

Results
A total of 454 patients underwent a total hip replacement (THR) during the pre-pandemic period with 12 patients developing an SSI (2.6%). Comparatively, during the pandemic period, 146 patients underwent a THR with 4 reporting an SSI (2.7%). A total of 449 patients underwent a total knee replacement (TKR) during the pre-pandemic period with 11 reporting an SSI (2.5%). In contrast, 9 of the 138 patients undergoing a TKR during the pandemic group developed an SSI (6.5%).

Conclusions
As the data shows, there was no significant difference observed between SSIs following THR performed at ESHT prior to and during the pandemic. Surprisingly, there was a 2.6-fold increase in SSI following TKR during the pandemic period compared with pre-pandemic. Both of these findings seemingly reject the null hypothesis that increased vigilance to hand hygiene and use of PPE mandated by the government and echoed by healthcare trusts during this time would reduce transmission of infections.
276 Safety of Maintaining Elective and Emergency Surgery During the COVID-19 Pandemic with the Introduction of an Innovative Protected Elective Surgical Unit (PESU): A Cross-Specialty Evaluation of 30-Day Outcomes in 9925 Patients Undergoing Surgery in a University Health Board
Authors: Minto T. , Abdelrahman T. , Jones L. , Shivakumar N. , Wheat J. , Ansell J. , Seddon O. , Cronin A. , Tomkinson A. , Theron A. , Trickett R. , Kynaston H. , Sagua N. , Sultana S. , Clark A. , McKay E. , Johnson A. , Behera K. , Towler J. 
Published: February 2022

Abstract

Aim
High quality mobile health applications (mhealth apps) have the potential to enhance the prevention, diagnosis, and treatment of burns. The primary aim of this study was to evaluate whether the quality of mhealth apps for burns care is being adequately assessed. The secondary aim was to determine whether these apps meet UK regulatory standards.

Method
We searched AMED, BNI, CINAHL, Cochrane library, Embase, Emcare, Medline and PsychInfo to identify studies assessing mhealth app quality for burns. The PRISMA reporting guideline was adhered to. Two independent reviewers screened s to identify relevant studies. We analysed whether seven established domains of mhealth app quality were assessed: design, information/content, usability, functionality, ethical issues, security/privacy, and user-perceived value.

Results
Of the 28 included studies, none assessed all seven domains of quality. Design was assessed in 4/28 studies; information/content in 26/28 studies; usability in 12/28 studies; functionality in 10/28 studies; ethical issues were never assessed in any studies; security/privacy was not assessed; subjective assessment was made in 9/28 studies. 17/28 studies included apps that met the definition of ‘medical device’ according to MHRA guidance, yet only one app was appropriately certified with the UK Conformity Assessed (UKCA) mark.

Conclusions
The quality of mHealth apps for burns are not being adequately assessed. The majority of apps should be considered medical devices according to UK standards, but only one was appropriately certified. Regulatory bodies should support mhealth app developers, so as to improve quality control whilst simultaneously fostering innovation.
280 IRT30 [Inadvertent Returns to Theatre Within 30 Days]: Highlighting the Value of This Novel Metric as a Measure of Surgical Performance
Authors: Kakos C. , Clements J.S. , Clements B.W.D. 
Published: February 2022

Abstract

Introduction
Unplanned return to theatre is commonly associated with a problem at the original operation. IRT30 is a potentially valuable but underutilised metric. Use of this metric in Governance Meetings allows for standardisation of the selection of patients, objective assessment of morbidity & mortality, and can facilitate an improvement in surgical performance and ultimately outcome.

Method
The complications associated with IRT30 can be graded from Type I to V ranging from Avoidable/Understandable/Major/Serious through to ‘Never events’. We reviewed all emergency procedures prospectively from February to April 2021. Planned returns and returns after 30 days from index operation were excluded. Patients’ notes were individually reviewed, and cases were grouped by subspecialty [Colorectal, Upper Gastrointestinal (UGI) and General] and ‘IRT30 graded’ accordingly.

Results
A total of 486 cases were performed. 20 were unplanned returns to theatre (4.3%). The majority of cases were Colorectal [75% (15/20)] with 20% UGI (4/20)]. There were 3 Type 1, 6 Type 2 and 11 Type 3 IRT30. 4 patients with perianal sepsis required further surgery (Type 2). Bleeding, ischaemia, and anastomotic leak were most commonly associated with IRT30. No ‘serious’ or ‘never’ events were recorded.

Conclusions
IRT30 is an underutilised useful objective metric that can be employed routinely in Governance meetings to improve surgical performance and outcomes. Perianal sepsis requires experienced involvement at the index operation. Bile leaks are more frequent than perhaps we expect following laparoscopic cholecystectomy, but a proactive approach should be encouraged.