bluuebunny/crossref_metadata_2025_split huggingface dataset:
49 DCM-Related Degenerative Spinal Changes in the Healthy: Meta-Analysis & Comparison to a Symptomatic Cohort
Authors: Banerjee Arkaprabha , Mowforth Oliver , Nouri Aria , Budu Alexandru , Newcombe Virginia , Kotter Mark , Davies Benjamin 
Published: November 2022

Abstract

Aim
Degenerative cervical myelopathy (DCM) is a progressive cervical spinal cord injury brought about by mechanical stress from degenerative changes in the cervical spine. It is typically diagnosed on clinical symptoms, examination findings together with MRI findings. The objective was to determine the significance of category of degenerative pathology (identified in Nouri et al, 2017) to onset of DCM, by comparing symptomatic and asymptomatic populations.

Method
A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines, cognizant of their adaptation for epidemiological studies. A search strategy was used to identify original research carrying out MRI screening of cervical spines of asymptomatic patients in MEDLINE and Embase from 1985 to the present day.

Results
The search yielded a total of 1,098 studies of which 17 were included in this meta-analysis, covering a total of 5,059 patients. Ossification of posterior longitudinal ligament (pooled asymptomatic prevalence of 0.4%), enlargement of ligamentum flavum (pooled asymptomatic prevalence of 11.8%) and degenerative multilevel disc pathology (pooled asymptomatic prevalence of 64.5%, I2 100%) were found to be significantly lower in asymptomatic populations (factor of 25 times, 4 times and 1.5 times respectively), and thus associated with DCM.

Conclusions
Ossification of posterior longitudinal ligament and enlargement of ligamentum flavum were found to be markedly lower in asymptomatic populations, possibly significantly implicating ligamentous pathology in the onset of DCM. Understanding the natural history of DCM is a recognised research priority, and whilst these perspectives require further evaluation, they may be of significance to the evolving biomechanical understanding of the disease.
671 The Effect of Supplementary Simulation-Based Procedural Training: The SIMULATE Randomised Controlled Clinical and Educational Trial
Authors: Aydin Abdullatif , Ahmed Kamran , Raison Nicholas , Abe Takashige , Brunckhorst Oliver , Van Hemelrijck Mieke , Ahmed Hashim , Shinohara Nobuo , Zhu Wei , Zeng Guohua , Sfakianos John , Tewari Ashutosh , Gözen Ali , Rassweiler Jens , Skolarikos Andreas , Kunit Thomas , Knoll Thoman , Moltzahn Felix , Thalmann George , Powers Andrea Lantz , Chew Ben , Khan Muhammad Shamim , Dasgupta Prokar 
Published: November 2022

Abstract

Aim
To evaluate whether surgical trainees undergoing additional simulation, compared to conventional training, are able to achieve proficiency sooner with better patient outcomes.

Methods
This international, multicentre randomised controlled superiority trial recruited urology trainees (n=94) who had performed ≤10 ureterorenoscopy (URS) cases, as a selected index procedure, with no prior simulation experience. Recruits were randomised to simulation-based training or non-simulation-based training groups, the latter of which is the current standard of training. Training sessions were conducted for the simulation arm, utilising an expert-developed multi-modality training curriculum. The primary outcome was the number of procedures required to achieve proficiency, defined as achieving a score of ≥28 on an OSATS scale, on 3 consecutive operations, without complications. Inpatient surgical complications were also recorded. All participants were followed up for 25 procedures or over 18 months.

Results
A total of 1140 cases were performed by 65 participants where proficiency was achieved in 21 simulation and 18 conventional participants over a median of 8 and 9 procedures, respectively (HR: 1.41 [95% CI 0.72–2.75]). More participants reached proficiency in the simulation arm in flexible ureterorenoscopy, requiring fewer number of procedures (HR 0.89 [95% CI 0.39–2.02]). Significant differences were observed in overall comparison of OSATS scores between groups (mean difference 1.42 [95% CI 0.91–1.92]; p&lt;0.001), with fewer total complications (15 vs 37; p=0.003) and ureteric injuries (3 vs 9; p&lt;0.001) in the simulation group.

Conclusions
Simulation-based training demonstrated higher overall proficiency and fewer procedures were required to achieve proficiency in the complex form of the index procedure with surgical complications.
898 The Fragility Fracture Post-Operative Mobilisation (FFPOM) Study – a UK-Wide Audit of Lower-Limb Fragility Fractures
Authors: Zargaran Alexander , Bretherton Christopher , Richardson Charlotte , Raza Mohsen , Eardley William , Trompeter Alex 
Published: November 2022

Abstract

Aim
This study quantifies the epidemiology and weight-bearing practice of operatively managed fragility fractures of the lower limb in the National Health Service.

Method
A multicentre audit of all adult patients aged 60 and over receiving surgery for a fragility fracture of the lower limb between 01/01/2019–30/06/2019 and 01/02/2021–14/03/2021 was conducted. The British Orthopaedic Association (BOA) guidance was used as the standard.

Results
430 collaborators from 84 hospitals submitted data from 20193 patients. 19557 patients with a median age of 83 (70.4% female) were included in the analysis. Data from 16241 hip fracture patients and 3316 non-hip fracture patients were analysed. In the non-hip fracture population, the most common fractures were of the foot and ankle (45.1%). 15543 (95.7%) of hip fracture and 1071 (32.3%) non-hip fracture patients were allowed to weight-bear immediately post-operatively. Despite being demographically similar, the proportion of patients instructed to weight-bear without restriction following operative fixation of the shaft (47.8%) and distal (64.6%) femur was lower than patients receiving surgery for a proximal femoral fracture (95.7%). 45.6% of distal femur and 44.2% of femoral shaft fractures were periprosthetic compared to 2.2% of proximal femur fractures.

Conclusions
This UK-wide collaborative study of over 19,000 patients demonstrates a significant disparity in weight-bearing restrictions placed on patients with fragility fractures despite the publication of a national guideline. Surgeons intentionally restrict post-operative weight-bearing in the majority of fractures outside the hip, but by contrast are content with unrestricted weight-bearing following operations for hip fracture.
174 The EXTEND Trial: EXTENDed Antibiotics to Improve Outcomes in Patients with Complicated Intra-Abdominal Infection
Authors: O'Connor Olivia , Kirby Andrew , Ahmed Shadia , Harmston Rebecca , Hewitt Catherine , Knowlson Catherine , Pinkney Thomas , Szakmany Tamas , Tharmanathan Puvan , Vargas-Palacios Armando , Welch Charlie , Burke Dermot 
Published: November 2022

Abstract

Introduction
Complicated intra-abdominal infections (cIAI) pose a major challenge in surgical patients. Despite the heterogenous aetiology they have a common disease process, which is bacterial infection of the peritoneal space. Hence, all cIAIs are managed with source control, plus antibiotic therapy. However, there is uncertainty regarding the optimal antibiotic treatment strategy in order to prevent relapse or extra-abdominal spread of infection1. At present, there is no UK guidance on the management of cIAIs2. For other serious infections outside the abdomen microbiologists often advise at least 28-days of antibiotic therapy. Currently the effectiveness of extended duration antibiotics in patients with cIAI is unknown. This trial aims to compare the clinical and cost effectiveness of 28-day duration antibiotics with standard care with respect to rate of treatment failure in patients with cIAIs. Secondary outcomes include complications and quality of life.

Trial Design
A multicentre, open label, two-arm, parallel group, pragmatic, randomised controlled trial with internal pilot. 1166 consenting adult patients with cIAI will be recruited over 3 years and randomised on a 1:1 basis between 28-days antibiotic course and standard care antibiotics, based on local protocol and clinical assessment. Patients will be recruited from ICUs and hospital in-patient wards across 30 sites.

Trial management and funding
EXTEND is sponsored by University of Leeds, hosted by York Trials Unit and funded by NIHR. The Trial Management Group will oversee design and running of the trial. Each site will have a Principal Investigator (PI) with local responsibility. The NIHR Associate PI scheme will enable trainees to participate in the trial.
408 Audit - Diagnostic Pathways in Suspected Renal Colic
Authors: Siddique MH , Rauf M , Klair A , Mohsin S , Pearce S , Ali D , Anwar A 
Published: November 2022

Abstract

Introduction
Ureteric colic is common clinical condition but has significant morbidity. Prompt diagnosis and treatment are key to overcome. Therefore, both BAUS and NICE have produced similar guidance which forms the audit standards below

Aim
Audit of local practice to national and aspirational guidelines

Standards

Method
Perform a retrospective review of consecutive 705 patients with suspected ureteric colic who had CT-KUB

Data collection tool

Conclusion
705 patients only 335 patients had CT KUB in 14 hours. Calcium checked was of 305 out 636 patients. Urate being the lowest only 2.6% that's 14 out of 523 patients was checked. Lastly NSAID's 67 patients out of 200 have received it as initial pain management. Summary as follows

Recommendations
708 An Audit of Blood Transfusion Prescription in Peri-Operative Orthopaedic Patients for Those with and Without a Coronary History
Authors: Wauchope E , Letch E 
Published: November 2022

Abstract

Aim
Correct prescription of red blood cells (RBCs) is essential for treatment of peri-operative anaemia and preventing complications to post-operative recovery. However, over prescription is costly, inefficient, and not free of complication. We compared the threshold and targets for the prescription of RBCs in a secondary care orthopaedic department to the NICE Blood Transfusion Guidance (2015) and whether altered thresholds were used or if iron was prescribed.

Method
Retrospective analysis of all surgically managed orthopaedic patients over a 3-month period receiving peri-operative RBCs in 2020. Pre and post transfusion haemoglobin (Hb) levels, concurrent prescription of iron and documented reasons for altered transfusion thresholds were collected. Exclusions included major trauma, major haemorrhage, or intra-operative transfusion.

Results
62 patients were transfused on average 1.5 units post-operatively. 21.4% were transfused in line with the NICE threshold (Hb&lt;70g/dL) and targets (Hb70–90g/dL.) Average Hb threshold was 75.5g/dL (range 60–110). 0% had an ACS on the day of RBC transfusion. In 54.2% 1 unit was prescribed at a time. Iron deficiency anaemia was identified in 11.4% and treated in 7% pre-operatively.

Conclusions
RBCs are being prescribed out of line with NICE guidance with a 21.4% compliance to the standard. The most common reason was a ‘coronary history’ which was inconsistently defined with no patients having an acute coronary syndrome - the only reason given by NICE for changing this threshold. Departmental education, identification of pre-operative anaemia and a protocol explaining the use of oral and intravenous iron peri-operatively may reduce the amount of erroneous blood transfusion prescribing in this cohort.
896 The Effect of a Simple Intervention on Emergency Department Breaches in Trauma and Orthopaedics Patients: A Multi-Cycle Audit in a District General Hospital
Authors: Burnett-Jones L , Greenwood K , Mead A , Eltagy H , Elashry S 
Published: November 2022

Abstract

Aim
We present a re-audit of Emergency Department (ED) waiting times following an intervention to improve surgical bed flow with the aim of further reducing the number of Trauma and Orthopaedics (T&O) patients that breached the four-hour wait target.

Method
An initial two-cycle closed-loop audit of ED waiting times of patients admitted under T&O was undertaken. Protocols were updated and new guidelines were synthesised and implemented in collaboration between the ED and T&O departments. This intervention reduced the number of patients that breached in ED and identified bed availability as the primary cause of these breaches. A third cycle was done. Posters were placed in key prescribing areas of the T&O department, detailing the need for ‘to take-out’ (TTO) prescriptions ‘to be completed before 15:00 as after this time pharmacy will not dispense the prescription’. Data was collected retrospectively from clinical e-documentation. P-values were calculated by Fishers Exact test.

Results
57 patients were included in cycle 1 and 51 patients in cycle 2. ED breaches reduced from cycle 1 to cycle 2: 86% to 65% respectively (p &lt; 0.05). In cycle 3, 42 patients were included, and breaches increased to 67% of patients, representing no significant change from cycle 2 (p &gt; 0.05). The number of breaches due to a shortage of hospital beds increased from 45% in cycle 2 to 75% in cycle 3 (p &lt; 0.05).

Conclusion
Bed shortages remained the main cause for T&O admissions to breach in ED. Earlier completion of TTO prescriptions did not solve the problem.
958 Enoxaparin Venous Thromboembolism Prophylaxis in Bariatric Surgery: A Best Evidence Topic Update
Authors: Pathmaraj B , Sufi P 
Published: November 2022

Abstract

Aim
To examine the literature and identify the best dosing regimen of enoxaparin for perioperative venous thromboembolism (VTE) prophylaxis in patients undergoing bariatric surgery. This presentation reviewed publications from 2015 to 2021 to determine whether previous recommendations based on a similar examination of evidence conducted in 2015 needed to be updated, considering new evidence.

Method
A literature search was conducted in accordance with a structured format. One hundred and one papers were identified using a standardised literature search from 2015 to 2021 on Medline and EMBASE using the same search terms “bariatric surgery” AND “venous thromboembolism” AND “enoxaparin”. The author, date and country of publication, patient groups and VTE prophylaxis strategy, level of evidence, outcomes, key results, and study weaknesses were tabulated.

Results
Three studies were selected as the best available evidence to answer the question. All three articles were non-randomised cohort studies analysing VTE and major bleeding rates following different bariatric thromboprophylaxis regimens. There was still no level 1 evidence available to answer this question.

Conclusion
Enoxaparin 40mg/day starting 12 hours after the operation, continuing for at least one-week post-discharge may be the best enoxaparin dosing regimen for VTE prophylaxis in bariatric surgery patients based on the best evidence available to 2021. New evidence suggests that the previously recommended 40mg enoxaparin twice daily for in-hospital patients may increase major bleeding risk. A Randomised Controlled Trial would probably require 3500 patients in each arm to identify the best enoxaparin dosing regimen.
266 Breast Cancer in Women Under 30: A Multidisciplinary Approach in a Unique Cohort
Authors: Khan S , Shaker H , Shrestha D , Shaw S , Wilson R , Abbas A , Ntanos I , Williams K , Wright C , Absar MS , Nasir N 
Published: November 2022

Abstract

Aim
Breast cancer in younger women is relatively rare, tends to be more aggressive and is associated with unique challenges. We sought to examine our practice in managing cancer in patients under 30.

Method
A retrospective case-note review was performed on patients under 30 years of age diagnosed with invasive breast through our pathology database since 2007. Clinical and pathological data was collected on patients’ cancers, management and follow up as well family history, genetic testing, and fertility management.

Results
Forty-five patients were identified. Median age was 28 years (range 20 to 30). Mean tumour size was 30mm (range 4–65mm). Seventeen (38%) of cancers were ER negative, 16 (36%) were HER2 positive.
Twenty-three patients (51%) had positive lymph node metastases. SIx patients (13%) had a strong family history and 9 (20%) were BRCA 1 or 2 gene positive. Seven patients (15%) underwent contra-lateral risk-reducing mastectomy. Twenty-5 patients (55%) had no children at diagnosis. Fertility management was discussed with &gt;90% of patients and 12 patients (26%) underwent ovum or embryo preservation.
Over a median follow up of 40.5 months (range 4.5 to 128 months), 8 patients (18%) developed local or distant recurrence and 6 patients (13%) died (due to metastasis).

Conclusion
In our experience, breast cancer patients under 30 had more aggressive cancers with a relatively high rate of axillary metastases at presentation. Young patients with breast cancer face unique management challenges such as fertility, genetic testing and survivorship issues that are best addressed in a multidisciplinary setting.
267 Axillary Recurrence Following Negative Sentinel Lymph Node Biopsy for Symptomatic Invasive Breast Cancer: A Ten-Year Review
Authors: Khan S , Shaker H , Evans S , Wilson R , Abbas A , Nasir N , Ntanos I , Williams K , Wright C , Absar MS 
Published: November 2022

Abstract

Aim
Sentinel node biopsy (SNB) became established as the standard approach (versus axillary clearance) for axillary staging in the 2000s. This was based on studies showing reductions in short-term morbidity. Symptomatic cancers are biologically more aggressive than screen-detected cancers and are more susceptible to late loco-regional recurrence. Few studies have examined long-term axillary recurrence following SNBs in this subgroup.

Method
A retrospective case-note review was performed on 82 symptomatic breast cancer patients who had a negative SNB between 2009 and 2010. Clinicopathological data was collected on cancers, axillary nodal pathology, recurrence, and survival.

Results
Median age was 57 years (range 23–87). Mean tumour size was 20mm (range: 5–50). Fourteen cancers (17%) were ER negative, 11 (19.3%) HER2 positive and 30 (36.3%) were grade 3. Sixty-one (74%) patients had breast-conserving surgery and 21 patients (26%) underwent a mastectomy.
After a median follow up of 11.8 years, 3 (3.7%) local, 1 (1.2%) axillary and 10 (12.2%) distant recurrences were seen. Twenty patients (25%) died. The median OS was 11.64 years (range: 1.20–12.47) and median DFS was 11.50 years (range: 1.14–12.47). Axillary recurrence rates were comparable to other studies that contained predominantly screening cancers (0.7–1.6%).

Conclusion
The risk of axillary recurrence and remains low at 10-year follow up after a negative SNB in symptomatic patients. This is comparable to that of follow up studies in mixed (screening and symptomatic) cohorts demonstrating equivalent long-term oncological safety in this biologically more aggressive cohort.
817 Our Experience of Management of Nipple Discharge
Authors: Khitab N , Hudson-Phillips S , Joshi S , Vig S 
Published: November 2022

Abstract

Aim
Evaluation of nipple discharge is a multidisciplinary practice requiring careful evaluation of the patient, their age and history. This study considers whether smoking is a contributory factor and if microdochectomy or Hadfield's procedure offered any additional benefit.

Method
A retrospective analysis of all patients undergoing microdochectomy or a Hadfield's procedure for nipple discharge over the last three years (2019–2021) at a DGH breast unit was undertaken. Patient demographics, smoking history, pre-operative imaging, and histopathological findings were accessed from the patient electronic records.

Results
38 patients were included in this study, 29 patients undergoing a Hadfield's procedure, and 9 a microdochectomy. 82% of patients were non-smokers (n=31), 8% (n=3) were ex-smokers, 3% (n=1) heavy smokers, and 8% of records were not available. 45% (n=17) presented with bloody discharge.
Histologically the main diagnoses were duct ectasia found in 29% (n=11) of patients, papilloma in 47% (n=18), combined duct ectasia and papilloma in 5% (n=2), benign breast changes in 13% (n=5), duct ectasia and squamous metaplasia of lactiferous ducts (SMOLD) in 3% (n=1) and focal apocrine metaplasia in 3% (n=1). In 5% (n = 2) there was a small focus of low-grade DCIS which needed further wide local excision.

Conclusion
Smoking was not found to be a major contributing factor in the aetiology of nipple discharge. Although less surgically invasive options such as microdochectomy should be considered, the duration and age of a patient should be considered to reduce the small risk of missing non-calcifying DCIS, not visible on preoperative imaging mammogram.
100 Triaging Two Week Wait Referrals According to ABS Guidelines Established During the COVID-19 Pandemic Is Safe Practice
Authors: Sadik N , Rutherford C , Ledwidge S , Johnson L 
Published: November 2022

Abstract

Aim
CoVid-19 has affected healthcare globally, disrupting cancer care. Two weeks wait (2ww) breast cancer referrals were triaged according to Association of Breast Surgery (ABS) guidelines with patients with no red flag symptoms deemed low risk and able to be discharged back to their GP. This study aimed to assess the safety and efficacy of implementing these guidelines.

Method
A database was established to prospectively collect 2ww breast cancer referrals from the outset of CoVid-19. Two Consultants triaged the referrals and if there was disagreement, a third Consultant arbitrated. Data were recorded for patient age, gender, presenting complaint, assessment, investigations, diagnosis, and outcome and also time from initial referral to discharge letter to the GP.

Results
188 patients were referred via the 2ww pathway to St Bartholomew's Hospital from 22/03/2020 to 08/04/2020. 43 (22.9%) were discharged with a median age of 34 (22–83 years) at the time of referral. The mean time from referral receipt to response was 12.1 (0 – 60 days). 15 (34.9%) patients were subsequently re-referred. Mean time from re-referral to one-stop clinic assessment was 9.1 (2 – 22 days), in keeping with NICE two week wait criteria. Of the patients re-referred, all patients underwent imaging in the form of mammogram and/or ultrasound scan. No patients were found to have pre-invasive or invasive disease.

Conclusions
Triaging patients based on GP referrals is a safe way of streamlining low risk patients. This has the potential to become standard practice worldwide but requires larger multi-centre studies prior to implementation.