Publications

Letter to the editor re: clinical features in Parkinson’s disease—characterization of urinary symptoms according to Parkinson disease subtype by Gubbiotti et al

Okeke, CJ; Siddique, S; Khadr, RN; Floyd Jr, MS. (2025). Letter to the editor re: clinical features in Parkinson's disease-characterization of urinary symptoms according to Park. International Urology and Nephrology. Pub online 17 April. [Online]. Available at: https://doi.org/10.1007/s11255-025-04506-1 [Accessed 24 April 2025].  

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Digital Assessment of Wellbeing in New Parents (DAWN-P): protocol of a randomised feasibility trial comparing digital screening for maternal postnatal depression with usual care screening.

Abstract: Background: Meta-analyses indicate that 17% of mothers experience postnatal depression (PND) in the year following childbirth, with suicide the leading cause of direct maternal death between 6 weeks and 12 months postpartum. The consequences and costs of PND are particularly high due to impacts on infants as well as parents. If detected,..

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Atlas of patient-reported outcome measures, nomograms and scoring systems used in simple and complicated urinary tract infections: a systematic review

Background Urinary tract infections (UTIs) are common and result in a significant impact on quality of life (QoL). Despite their prevalence, there seems to be a lack of evidence around patient-reported outcomes and measuring tools such as scoring systems and nomograms in UTIs. Patient-reported outcome measures (PROMs) help us measure..

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Qualitative study exploring stakeholder perspectives on the use of early MRI in wrist injury pathways in the UK NHS

Objectives Early MRI use varies in the management of acute wrist injuries in the UK, with only a minority of National Health Service (NHS) centres being able to offer this to patients. In this study, we aim to explore the perspectives of staff and patients on the use of early..

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Letter to the Editor: LigaSure Versus Conventional Milligan MORGAN Hemorrhoidectomy in Nigerian Patients With Symptomatic Hemorrhoids.

Ali, S; O'Connor Manson, M; Et al. (2025). Letter to the Editor: LigaSure Versus Conventional Milligan MORGAN Hemorrhoidectomy in Nigerian Patients With Symptomatic Hemorrhoids. World Journal of Surgery. (Ahead of Print) [Online]. Available at: doi.org/10.1002/wjs.12572 [Accessed 16 April 2025].  

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ChatGPT for speech-impaired assistance

Background: Speech and language impairments, though often used interchangeably, are two very distinct types of challenges. A speech impairment may lead to impaired ability to produce speech sounds whilst communication may be affected due to lack of fluency or articulation of words. Consequently this may affect a person's ability to..

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Ultrasound Guided Perineural and Extensor Carpi Ulnaris Tendon Sub-Sheath Hydrodissection in Management of Symptomatic Dorsal Cutaneous Branch of Ulnar Nerve Impingement

Ulnar-sided wrist pain is a common presenting clinical complaint and can present a diagnostic challenge for the treating physicians. Though individual pathologies of the dorsal cutaneous branch of ulnar nerve (DCBUN) and extensor carpi ulnaris (ECU) tenosynovitis can give rise to ulnar side wrist pain, we report an unusual distal..

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Examining the role of bullying victimization in predicting psychopathology among in-school Nigerian adolescents

Purpose This paper aims to examine the role of bullying victimization in predicting psychopathology, encompassing post-traumatic stress disorder (PTSD), risk of developing prodromal psychosis and emotional and behavioural problems, among in-school Nigerian adolescents. Design/methodology/approach A total of 351 junior secondary students (n = 173 males, 178 females; age range: 9–17 years) were recruited..

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Economic Evaluation of Inguinal Versus Ilio-inguinal Lymphadenectomy for Patients with Stage III Metastatic Melanoma to Groin Lymph Nodes: Evidence from the EAGLE FM Randomized Trial.

Abstract Purpose: We compared health outcomes and costs of inguinal lymphadenectomy (IL) versus ilio-inguinal lymphadenectomy (I-IL) for removal of metastatic melanoma to lymph nodes of the groin in adults with stage III melanoma. Methods: A within-trial cost-utility analysis was performed alongside an international randomized trial (EAGLE-FM) with 36 months follow-up from..

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Comparative Analysis of Effectiveness of Traditional Lead Aprons versus Newer Generation Lead-free Aprons in Radiation Protection

The comparative effectiveness of traditional lead aprons versus newer generation lead-free alternatives in radiation protection is a critical area of investigation in medical safety. While lead aprons have long been the standard, concerns over weight and mobility have spurred interest in lead-free options, which incorporate materials such as antimony, bismuth,..

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Exploring the quadrilateral space: Clinical anatomy, pathology, and imaging insights

Quadrilateral Space Syndrome (QSS) is a rare clinical entity characterised by neurovascular compression within the quadrilateral space, a confined anatomical region bounded by the teres minor, teres major, long head of the triceps brachii, and the surgical neck of the humerus. The syndrome primarily affects the axillary nerve and posterior..

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A unique case of reactive perforating collagenosis secondary to upadacitinib treatment in severe atopic eczema

No abstract available. Morrison, E; Low SE et al. (2025). A unique case of reactive perforating collagenosis secondary to upadacitinib treatment in severe atopic eczema. Clinical and experimental dermatology. llaf122(Online ahead of print) [Online]. Available at: https://academic.oup.com/ced/advance-article-abstract/doi/10.1093/ced/llaf122/8075112?redirectedFrom [Accessed 19 March 2025].

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Imaging Features of Anal Carcinoma after Chemoradiation.

Anal cancer is a rare malignancy that is primarily treated with chemoradiation therapy (CRT). Clinical examination of the anal canal after CRT is often limited owing to the patient's discomfort. Therefore, radiologic surveillance plays a fundamental role in treatment response assessment. Currently recommended imaging modalities for posttreatment follow-up include pelvic..

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Ethical considerations in AI for child health and recommendations for child-centered medical AI.

There does not exist any previous comprehensive review on AI ethics in child health or any guidelines for management, unlike in adult medicine. This review describes ethical principles in AI for child health and provides recommendations for child-centered medical AI. We also introduce the Pediatrics EthicAl Recommendations List for AI (..

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Factors influencing UK arthroplasty surgeons' decision-making between total and medial unicompartmental knee surgery: A vignette-based behavioural experiment

Purpose Surgical options for end-stage knee osteoarthritis (OA) include total and medial unicompartmental knee replacement (TKR and UKR). Deciding which surgery to perform is complex and ill-defined, yet it has important implications for patients and the health service. The study aimed to identify clinical and surgeon factors predicting surgeons' preferences...

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Unveiling Guyon's Canal: Insights into Clinical Anatomy, Pathology, and Imaging

Guyon's canal, or the ulnar tunnel, is a critical anatomical structure at the wrist that houses the ulnar nerve and artery, making it susceptible to various pathological conditions. Pathologies affecting this canal include traumatic injuries, compressive neuropathies like ulnar tunnel syndrome, and space-occupying lesions such as ganglion cysts. Ulnar tunnel..

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Suture choice when securing central lines: an update in the light of NICE surgical guidance.

Abstract: Despite substantial advances in care packages to reduce central venous catheter-related blood stream infections, silk sutures are used widely to secure lines. This may be due to the opening on to sets or as part of pre-arranged procurement processes, likely originating from the very easy handling characteristics of a..

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Spine Trauma Classifications: Historical, Current, and Emerging Perspectives for Radiologists

The spine serves as a protective, load-bearing, and stabilizing axis for the body. Trauma can cause significant damage to spinal structures, potentially resulting in severe neurological dysfunction and disabilities such as paraplegia or quadriplegia. Early and accurate diagnosis of these injuries is important, with computed tomography and magnetic resonance imaging..

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A Rare Case of Prosthetic Mitral Valve Endocarditis With Atrial and Ventricular Lead Infections

This is the case of a patient in their 30s who is known to have a prosthetic mitral valve replacement and a cardiac pacemaker that presented to the hyper-acute stroke unit with collapse, left-sided dense weakness, back pain, dyspnea, and hypoxia. Investigations showed bilateral areas of intracerebral haemorrhage. Transthoracic echocardiogram (..

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Prevalence of psychiatric disorders among children and adolescents in Nigeria since 2010: A systematic review and meta-analysis.

Abstract Background: Psychiatric disorders significantly impact pediatric populations globally, affecting individual development, education and societal integration. In Nigeria, where nearly half of the population is under the age of 15, there remains a substantial gap in our understanding of the burden of these disorders within this demographic. This systematic review was..

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Readability of paediatric participant information leaflets in research studies

Abstract:  Background Information leaflets in research studies should be age-appropriate to be understood, however the formal readability of children’s participant information leaflets (PILs) for research studies has not been assessed. Methods A single-centre cross-sectional study assessing paediatric PILs. Six readability tests were applied (Gunning Fog Index (GFI), Simple Measure..

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Association between diabetes self-management education attendance, hospital admissions and mortality in type 2 diabetes: A cohort analysis protocol.

Lewis, Gemma; Hardy, K; Et al. (2025). Association between diabetes self-management education attendance, hospital admissions and mortality in type 2 diabetes: A cohort analysis protocol. Diabetes, Obesity and Metabolism. Pre-Publication(1), p.1. [Online]. Available at: https://doi.org/10.1111/dom.16257 [Accessed 6 March 2025].  

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The Incomplete V-Y Flap: A Useful Design Modification of the Conventional V-Y Flap Exampled With a Case Series of Pilonidal Sinus Excision Defects

Pilonidal disease is relatively common and can be particularly comorbid for patients, especially in circumstances of chronic abscess or sinus formation. Excision of such disease can require flap reconstruction, one of the most common types being V-Y advancement flap. We present a modification of the V-Y flap that leaves incompletely..

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The Promise of Radiotherapy in High-Risk Non-Muscle Invasive Bladder Cancer.

Abstract:  Global shortages, toxicities, and high levels of incomplete treatment with Bacillus Calmette Guerin (BCG) for non-muscle invasive bladder cancer has resulted in increasing interest in alternative treatments. Radiotherapy is not the standard of care for non-muscle invasive bladder cancer (NMIBC), despite being routinely used in muscle invasive bladder cancer...

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Mechanisms underpinning the effect of exercise on the non-alcoholic fatty liver disease

Abstract Non-alcoholic Fatty Liver Disease (NAFLD) – whose terminology was recently replaced by metabolic liver disease (MAFLD) - is an accumulation of triglycerides in the liver of >5 % of its weight. Epidemiological studies indicated an association between NAFLD and reduced physical activity. In addition, exercise has been shown to improve NAFLD independently..

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Letter to the Editor Re: Low-frequency bladder vibration for the treatment of urinary tract infections in spinal cord injury patients with neurogenic bladder by Zhang et al

No abstract available. Okeke, C.J. et al. (2025). Letter to the Editor Re: Low-frequency bladder vibration for the treatment of urinary tract infections in spinal cord injury patients with neurogenic bladder by Zhang et al. International Urology and Nephrology. Online ahead of print [Online]. Available at: https://link.springer.com/..

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GRASS-UK: The Global Register of Alopecia areata disease Severity and treatment Safety- United Kingdom: importance of real-world data in alopecia areata

No abstract available. Harries, M.; Meah, N. et al. (2025). GRASS-UK: The Global Register of Alopecia areata disease Severity and treatment Safety- United Kingdom: importance of re. Clinical and Experimental Dermatology. .(.), p... [Online]. Available at: https://academic.oup.com/ced/advance-article-abstract/doi/10.1093/ced/llaf055/7994561?redirectedFrom [Accessed 6 February 2025].

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A Systematic Review of Interventions for the Transition to Adult Healthcare for Young People with Diabetes

Purpose of Review The transition to adult healthcare is difficult for young adults with diabetes, with declining glycemic control and reduced healthcare utilization. Efforts are needed to facilitate an effective transfer of care. Our study aimed to systematically review the literature and identify studies evaluating the effectiveness of interventions designed..

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Maternal views on RSV vaccination during the first season of implementation in England and Scotland

No abstract available. Williams, T.C. et al. (Collaborators : Gardner, S; O'Leary, C; Bowness, K; Morrison, M). (2025). Maternal views on RSV vaccination during the first season of implementation in England and Scotland. The Lancet Infectious Diseases. Online first (January 29, 2025) [Online]. Available at: https://www.thelancet.com/journals/laninf/article/PIIS1473..

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Hypospadias: The lay of the land

Introduction Hypospadias surgery is uniquely split across the specialities of paediatric surgery urology and plastic surgery. The division may restrict best practice as there is a paucity of cross-speciality forum for discussion and dissemination. Separately achieving training competence is a challenge. The authors present a travelling fellowship as a template..

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Pictorial Review of Paediatric Limp.

Abtract:  A limp is an abnormal, uneven or laboured gait typically resulting from pain, weakness, or structural deformity involving the hip, lower limb, spine or abdominopelvic abnormalities. Limps in children are common and have diverse causes that can be benign to life-threatening including trauma, congenital malformations, and neoplastic diseases. Diagnosis..

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Integrated care management for patients following acute stroke: a systematic review

Background Contemporary stroke care is moving towards more holistic and patient-centred integrated approaches, however, there is need to develop high quality evidence for interventions that benefit patients as part of this approach. Aim This study aims to identify the types of integrated care management strategies that exist for people with..

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National Trends in U.S Hospitalizations and Outcomes of Thyrotoxicosis With and Without Thyrotoxic Storm, 2016-2020.

Abstract: The foundation of AWR is posterior component separation by Rives-Stoppa (RS) retro-rectus sublay mesh repair, and transversus abdominis release (TAR). Traditional teaching dictates an initial laparotomy with full adhesiolysis to enable fascial closure and an intraperitoneal approach to component separation. We describe a novel extraperitoneal AWR approach, performing posterior..

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Journal Club

Willis, J. (2025). Journal Club. Thorax. 80(2), p.122. [Online]. Available at: https://doi.org/10.1136/thorax-2024-222888 [Accessed 29 January 2025]  

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Follicular Lymphoma Detected in a Patient Undergoing Mohs Surgery: A Case Report

Abstract Mohs surgery is performed by surgeons trained in detecting specific cutaneous malignancies, including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and dermatofibrosarcoma protuberans (DFSP). Mohs-trained surgeons are typically not holistic pathologists and may, when working in isolation, fail to identify lesions that are not of cutaneous origin. The..

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Imaging of Peripheral Intraneural Tumors: A Comprehensive Review for Radiologists

Background/Objectives Intraneural tumors (INTs) pose a diagnostic challenge, owing to their varied origins within nerve fascicles and their wide spectrum, which includes both benign and malignant forms. Accurate diagnosis and management of these tumors depends upon the skills of the radiologist in identifying key imaging features and correlating them..

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Trends of publications on primary sarcomas of bone: A bibliometric analysis

Introduction Sarcomas are a large group of malignant mesenchymal tumors. Despite being rare diseases, the disease burden of these malignant tumors on the existing healthcare infrastructure is substantial. Although previous bibliometric studies have analyzed the trends of publications on osteosarcoma and Ewing's sarcoma, no such major analyses encompassing all primary..

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Exploring Rhinophyma treatment: An observational study comparing the results of the cold blade technique and ablative fractional CO2-laser

Dear Editor We read with interest the retrospective single-centre observational study by Amiri et al.1 which compares the use of cold blade technique to ablative fractional CO2 laser in the treatment of 15 patients with rhinophyma over a six-year period. The study reports that both modalities are effective, but the cold..

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Developing and applying a training needs analysis tool for healthcare workers managing snakebite envenoming: A cross-sectional study in Eswatini

A considerable number of patients present to hospitals in Eswatini each year following bites by venomous snakes. Effectively diagnosing and treating patients with snakebite envenoming requires healthcare workers to have a variety of generic and snakebite-specific medical skills. In several countries, however, healthcare workers have been found to have limited..

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Strategies for preventing anterior cruciate ligament injuries in athletes: Insights from a scoping review

Background and aims Anterior cruciate ligament (ACL) injuries significantly impact young athletes, leading to long-term physical, psychological, and socioeconomic consequences. There is an urgent need to develop effective preventive strategies. This scoping review aims to evaluate modifiable and non-modifiable risk factors for ACL injuries and assess existing preventive strategies. Methods..

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An Audit Cycle of Gynecological History Documentation in Emergency Surgical Admissions of Female Patients of Childbearing Age Presenting with Acute Abdominal Pain at a District General Hospital

Background Ectopic pregnancy (EP) is a significant cause of maternal morbidity and mortality. Accurate and timely diagnosis is crucial, particularly in women of reproductive age presenting with acute abdominal pain. This audit aimed to assess the completeness and accuracy of gynecological history documentation, including pregnancy status, in female patients admitted..

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Assessing Chat Generative Pre-training Transformer’s Proficiency in Identifying, Diagnosing, and Managing Orthopedic Fractures

Background: The exploration of Chat generative pre-training transformer’s (GPT’s) applications in medicine is gaining momentum, with artificial intelligence, particularly ChatGPT, showing promise in enhancing orthopedic care. ChatGPT can assist clinicians by providing relevant information based on patient symptoms, medical history, and radiological findings, aiding in differential diagnosis, and..

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Relationship between the Articular Cartilage Thickness of the Patella and Trochlea in Trochlear Dysplasia Compared to Normal Knees

Introduction: Anterior knee pain is not an uncommon problem. A plethora of pathologies can cause anterior knee pain. Patellofemoral maltracking (trochlear dysplasia) is not an uncommon cause of anterior knee pain in adolescents and young adults.  Aim: We hypothesize that there is an alteration of articular cartilage of the patella..

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A novel approach to identifying C2 and C3 block vertebrae

Abstract Background: Congenital block vertebrae (BV) is a common condition resulting from segmentation disorders during embryonic development, leading to the fusion of adjacent vertebrae. BV at C2–C3 (cervical vertebrae 2nd–3rd) level is the most common segmentation anomaly. Labeling this correctly is the requirement for exact labeling of the..

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A novel approach to identifying C2 and C3 block vertebrae

Abstract Background: Congenital block vertebrae (BV) is a common condition resulting from segmentation disorders during embryonic development, leading to the fusion of adjacent vertebrae. BV at C2–C3 (cervical vertebrae 2nd–3rd) level is the most common segmentation anomaly. Labeling this correctly is the requirement for exact labeling of the..

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Beyond the Usual Suspects: Appendiceal Bleeding as the Surprising Cause of Lower Gastrointestinal (GI) Bleeding.

Abstract: Lower gastrointestinal bleeding (LGIB) is a common clinical condition typically associated with diseases like diverticular disease, inflammatory bowel disease, and cancer. However, rarer etiologies such as appendiceal hemorrhage can present similarly, complicating diagnosis and management. This case report discusses a 42-year-old male who presented with severe rectal bleeding. Despite..

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Determinants of physical function, as measured using PROMIS PF-10a, in patients with rheumatoid arthritis: results from the international COVID-19 Vaccination in Autoimmune Diseases (COVAD) study

Objectives Physical function in RA is largely influenced by multiple clinical factors, however, there is a growing body of evidence that psychological state and other comorbidities also play an essential role. Using data obtained in the COVID-19 Vaccination in Autoimmune Diseases study, an international self-reported e-survey, we aimed to explore..

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Musculoskeletal infection, diagnosis and management

Musculoskeletal (MSK) infection is not an uncommon problem in Trauma and Orthopaedic surgery. However early, accurate diagnosis and management of orthopaedic infection is critical to reduce morbidity, disability, economic burden and mortality. Jain, VK.; Iyengar, KP. (2025). Musculoskeletal infection, diagnosis and management. Journal of Clinical Orthopaedics and Trauma. 62, p.102898. [Online]. Available..

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The Impact of Age and Sex on Fasting Plasma Glucose and Glycated Haemoglobin (HbA1c) in the Non-diabetes Population

Introduction: We previously reported sex differences in the distribution of glycated haemoglobin (HbA1c) for men/women aged < 50 years vs older individuals, with implications for delayed diabetes diagnosis. Here, we explored whether this pattern was also seen in matched fasting plasma glucose (FPG) levels.  Methods: We extracted data on same-day,..

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Clinical emergencies in inpatient hospice: simulation-based training to improve nursing confidence

Objectives: This study aims to assess whether a simulation-based training programme focusing on palliative care emergencies conducted in a hospice setting could improve the self-reported confidence and competence of nursing staff. Methods: A training programme was developed to enable nursing professionals to practice clinical skills necessary for recognising and managing..

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Exploring the prognostic impact of triglyceride-glucose index in critically ill patients with first-ever stroke: insights from traditional methods and machine learning-based mortality prediction

Background The incidence and mortality of first-ever strokes have risen sharply, especially in the intensive care unit (ICU). Emerging surrogate for insulin resistance, triglyceride-glucose index (TyG), has been linked to stroke prognosis. We aims to explore the relationships between TyG with ICU all-cause mortality and other prognosis, and to develop..

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Assessing the Reliability of YouTube Content for Plastic Surgery Patient Information in Africa With the Modified DISCERN and JAMA Scores

Introduction YouTube has become a popular source of health information, including plastic surgery. Given the platform's wide reach and potential influence on patient decisions, this study aimed to assess the quality of information available on YouTube for African audiences seeking plastic surgery procedures. Methods This cross-sectional study extracted data from..

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CO184 Reducing the Environmental Impact of Anesthetic Gases in England Without Worsening Clinical Outcomes for Patients or Increasing Resource Use

Abstract Desflurane has a higher global warming potential than other general anaesthetic agents. NHS England (NHSE) aims to be carbon neutral by 2045, acknowledging the link between planetary and human health. In 2023, NHSE, the Royal College of Anaesthetists (RCoA) and the Association of Anaesthetists (AoA) announced the decommissioning of desflurane for..

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Appendicular intussusception mimicking caecal polyp: A case report.

Pereira, C; Babu, H. (2024). Appendicular intussusception mimicking caecal polyp: A case report.. The Surgeon. [Online]. Available at: doi.org/10.1016/j.surge.2024.12.002 [Accessed 20 December 2024].

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Considerations for β-lactam antimicrobial continuous infusion. Authors' reply to Massart et al. and Marzaroli et al

Barton, G; Et al. (2024). Considerations for β-lactam antimicrobial continuous infusion. Authors' reply to Massart et al. and Marzaroli et al. Intensive Care Medicine.[Online]. Available at: http://dx.doi.org/10.1007/s00134-024-07724-w [Accessed 19 December 2024].

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Considerations for beta-lactam antimicrobial continuous infusion. Authors' reply to Massart et al. and Marzaroli et al.

Barton, G; Et al. (2025). Considerations for beta-lactam antimicrobial continuous infusion. Authors' reply to Massart et al. and Marzaroli et al. Intensive Care Medicine. 51(1), pp.230-231. [Online]. Available at: https://dx.doi.org/10.1007/s00134-024-07724-w [Accessed 6 March 2025].

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Relaxin agonists under preclinical and early clinical investigation for the treatment of heart failure

Introduction Acute failure is a critical condition, encompassed by the sudden or progressive onset of symptoms or signs of congestion. The treatment strategies available are mainly supportive and do not improve mortality or long-term outcomes. Therefore, there is a need for alternative novel treatment strategies. In this narrative review, we..

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Conduction system pacing versus biventricular pacing in heart failure with reduced ejection fraction and electrical dyssynchrony

Abstract Biventricular pacing (BiVP) has been the cornerstone of cardiac resynchronization therapy (CRT) in the management of symptomatic heart failure patients with reduced ejection fraction (HFrEF) and electrical dyssynchrony despite guideline-directed medical therapy (GDMT). However, BiVP has some limitations, including technical difficulties and high non-response rates. Conduction system pacing encompassing..

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Mortality Risk in Patients With Cardiac Complications Following Ischemic Stroke: A Report From the Virtual International Stroke Trials Archive

Background: Cardiac complications may occur in patients following ischemic stroke (stroke-heart syndrome [SHS]). We investigated the mortality risk in patients with SHS and across the SHS manifestations. Methods and results: Data were sought from the VISTA (Virtual International Stroke Trials Archive), an international repository of clinical trials data. We reviewed..

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“Small but mighty” — A radiologists’ primer for ultrasound imaging of the smaller peripheral nerves

Abstract Peripheral nerve imaging is a powerful tool in evaluating peripheral neuropathy. This review aims to provide an overview of the anatomy, clinical significance and pathologies of small peripheral nerves, typically less than 2 mm in diameter. High frequency ultrasound probes offer the best assessment of these nerves whilst permitting real-time..

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Management of Scapula Fractures at a Level 1 Trauma Centre in the United Kingdom.

Abstract: Scapular fractures, an uncommon injury that can be brought on by a high-energy mechanism because of its proximity to the pectoral and shoulder muscles, are frequently linked to fatal injuries. This study aimed to compare surgical versus conservative treatment of scapular fractures and the results of treated patients. Khan,..

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Vitamin D and cardiovascular outcomes in multiple sclerosis

Abstract:  BACKGROUND: Vitamin D (25(OH)D) deficiency is linked to increased cardiovascular disease (CVD) risk in the general population, but its implications for people with multiple sclerosis (pwMS) remain unexplored. This study aimed to evaluate the association of 25(OH)D with long-term CVD outcomes in pwMS and the impact of..

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The National Joint Registry Data Quality Audit of elbow arthroplasty

Aims: The aim of this audit was to assess and improve the completeness and accuracy of the National Joint Registry (NJR) dataset for arthroplasty of the elbow. Methods: It was performed in two phases. In Phase 1, the completeness was assessed by comparing the NJR elbow dataset with the NHS England..

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Unravelling Kikuchi-Fujimoto Disease: A Unique Presentation of Recurrent Aseptic Meningitis in a District Hospital Setting.

Abstract: Kikuchi-Fujimoto disease (KFD) is a rare, self-limiting, and ultimately benign condition characterised by localised lymphadenopathy. The association of KFD with aseptic meningitis is even more uncommon. We report a case of KFD accompanied by aseptic meningitis in a 31-year-old male who initially presented with lethargy, night sweats, axillary lymphadenopathy,..

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Use of Therapy Outcome Measures (TOMs) and Australian Therapy Outcome Measures (AusTOMs) in community physiotherapy and community occupational therapy services: a scoping review

Purpose: Outcome measures enable benchmarking within and between services, which is essential for ensuring best practice standards. There is limited consensus regarding which outcome measures should be utilised within the community. Therefore, the aim of this scoping review is to provide an overview on the Therapy Outcome Measures (TOMs) and..

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Current trends on clinical audit on surgical record keeping

The aim of this audit was to evaluate compliance with the local surgical record-keeping policy, identify areas of non-compliance and recommend improvements. A retrospective review was conducted using 30 randomly selected inpatient records from the surgical department, audited over two quarters (Q1 and Q2 of 2023). Data were extracted via the Electronic..

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Understanding inequities in access to diabetes technologies in children and young people with type 1 diabetes: Qualitative study of healthcare professionals' perspectives and views

Aims: We explored healthcare professionals' perceptions and understandings of the factors and considerations underlying inequities in technology access in children and young people (CYP) with type 1 diabetes. Methods: We interviewed (n = 29) healthcare professionals working in paediatric diabetes in England recruited from (n = 15) purposively selected sites. We analysed data thematically. Results:..

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Are trauma and orthopaedic consultant posts decreasing in frequency and increasing in subspecialisation?

Background The needs of the population and changes to the configuration of the NHS affect the role of the Trauma & Orthopaedic (T&O) surgeon. This impacts training and the number of consultant posts available at Certificate of Completion of Training. Aim of this study was to review advertised T&O..

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A Rare Case of Scrotal Swelling: Prostate Cancer Metastasis Masquerading as a Complicated Hydrocele

Abstract Metastasis of prostate cancer to the testes is exceptionally rare. We report the case of a 67-year-old male with a 10-year history of high-risk prostate cancer, previously treated and currently in remission, who presented with left scrotal swelling. The swelling was clinically and radiologically diagnosed as a hydrocele and..

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What impact does widening participation to medicine have on the medical workforce in the UK: a scoping review

Purpose: Widening participation in medicine refers to the recruitment policy of encouraging those who are traditionally under-represented in medical school. Whilst research in the UK has investigated the processes around improving participation through recruitment and selection to medical schools, there is less focus around the period after medical school and..

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Autologous faecal microbiota transplantation via double barrel stoma to treat chronic diversion colitis

Diversion colitis is a common phenomenon affecting patients after defunctioning ileostomy. We present a complex case of diversion colitis where the patient was deemed unsuitable for restorative surgery due to multiple areas of stricturing in a long defunctioned colonic segment. Despite initial treatments with rectally administered topical mesalazine, butyrate enemas..

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Anatomy and Pathologies of the Spinous Process

Abstract The spinous processes act as a lever for attachments of muscles and ligaments. Spinal imaging is commonly performed as a diagnostic test for pain and radiculopathy. A myriad of incidental or unexpected findings, both potentially asymptomatic and symptomatic, may be encountered during the interpretation of these images, which commonly..

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Placental mesenchymal dysplasia: a rare case associated with second trimester fetal growth restriction

Background Placental mesenchymal dysplasia (PMD) is a rare, benign, placental disorder characterised macroscopically by an enlarged multi-cystic placenta. It is a condition associated with a range of reported clinical outcomes and can be misdiagnosed as a molar or partial molar pregnancy given the similarities in clinical presentation. We present an..

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An Algorithmic Approach to use Extended Spreader Grafts in Deviated Noses

Background: Restoration of a straight and adequately wide nasal dorsum is challenging in patients with deviated noses. Supporting a reformed septum with an extended spreader graft (ESG) is important for maintaining position. Objective: The study aimed to describe different types of ESG and propose a comprehensive algorithm for using specific..

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Reply to Lee et al.: Endovascular Forceps Biopsy of Pulmonary Artery Intimal Sarcoma, A Safer Approach

NA Petrarulo, S; Paul, S et al. (2024). Reply to Lee et al.: Endovascular Forceps Biopsy of Pulmonary Artery Intimal Sarcoma, A Safer Approach. American Journal of Respiratory and Critical Care Medicine. Online ahead of print [Online]. Available at: https://www.atsjournals.org/doi/10.1164/rccm.202410-1948LE?url_ver=Z39.88-2003&..

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Prognostic effects of glycaemic variability on diastolic heart failure and type 2 diabetes mellitus: insights and 1-year mortality machine learning prediction model

Background: Diastolic heart failure (DHF) and type 2 diabetes mellitus (T2DM) often coexist, causing increased mortality rates. Glycaemic variability (GV) exacerbates cardiovascular complications, but its impact on outcomes in patients with DHF and T2DM remains unclear. This study examined the relationships between GV with mortality outcomes, and developed a..

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Effect of Micronutrients on HIV-Related Clinical Outcomes Among Adults Living With HIV on Antiretroviral Therapy: Systematic Review and Meta-analysis

Context: Micronutrient deficiencies are common and frequently co-occurring among people living with HIV (PLHIV) globally, with consequences for their health and clinical outcomes. Previous reviews of the influence of micronutrient supplementation on HIV outcomes were conducted in the pre-highly active antiretroviral therapy (pre-HAART) era or included both HAART-naive and HAART-experienced..

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P-154 Palliative upper gastrointestinal (UGI) cancer health and wellbeing – a place for support and preparation

Background Upper GI cancer is one of the most complicated groups of patients to manage, due to complex needs of the disease at presentation. Often with >70% palliative on presentation with poor prognosis, as symptoms are frequently vague and non-specific. (Local Trust UGI service review, 2019) Aim To form collaborations with local..

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P-134 Virtual vigilance: palliative virtual ward to avoid unneeded admissions and ensure timely escalation

Background Community palliative care complexities are increasing, with more patients choosing home as their final place of care (Vernon, Hughes, Kowalczyk. Soc Sci Med. 2022; 296:114731). NHS England has directed Integrated Care Systems to expand or introduce Virtual Ward models, proven to substantially reduce unnecessary hospital admissions (NHS England. Supporting information for..

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Low-Dose Oral Minoxidil Initiation for Patients With Hair Loss: An International Modified Delphi Consensus Statement

Importance: The results of small studies suggest that off-label use of low-dose oral minoxidil (LDOM) may be safe and effective for patients with hair loss, but larger trials and standardized guidelines are lacking. Objective: To create an expert consensus statement for LDOM prescribing for patients with hair loss. Evidence review:..

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Initiation of therapeutic hypothermia in neonates with hypoxic ischaemic encephalopathy

The authors present a comparative study on initiation of active and passive therapeutic hypothermia in neonates with hypoxic ischaemic encephalopathy grade 2-3 within a level 2 neonatal unit and a non-cooling centre. Bhatia, C; Balraj, A; Seenivasan, A. (2024). Initiation of therapeutic hypothermia in neonates with hypoxic ischaemic encephalopathy. Infant. 20(6). [Online]. Available..

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Calcific Enthesitis of Lateral Patellofemoral Ligament: A Rare Cause of Anterolateral Knee Pain

Abstract Hydroxyapatite deposition disease is a common musculoskeletal pathology that often affects rotator cuff tendons in the shoulder joint. Here, we present the first documented case of acute calcific enthesitis involving the lateral patellar retinaculum, specifically the lateral patellofemoral ligament (LPFL). A 35-year-old male presented with insidious onset atraumatic pain..

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Machine learning for stroke in heart failure with reduced ejection fraction but without atrial fibrillation: A post-hoc analysis of the WARCEF trial.

Abstract:   Background: The prediction of ischaemic stroke in patients with heart failure with reduced ejection fraction (HFrEF) but without atrial fibrillation (AF) remains challenging. Our aim was to evaluate the performance of machine learning (ML) in identifying the development of ischaemic stroke in this population. Methods: We performed a post-hoc..

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Recurrence of Retinopathy of Prematurity Following Anti-vascular Endothelial Growth Factor (Anti-VEGF) Therapy: A Systematic Review and Meta-Analysis.

Abstract: Retinopathy of prematurity (ROP) is a neovascular disorder which affects premature infants and can lead to childhood blindness. Treatment includes laser photocoagulation and intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections, both effective options. However, laser photocoagulation can lead to refractive errors, while anti-VEGF therapy can result in disease recurrence...

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COVID-19 vaccination-related delayed adverse events among people with rheumatoid arthritis: results from the international COVAD survey

This study aimed to assess COVID-19 vaccination-related AEs in patients with rheumatoid arthritis (RA), in the COVID-19 Vaccination in Autoimmune Diseases (COVAD)-2 study. An online international cross-sectional survey captured self-reported data on COVID-19 vaccination-related adverse events (AEs) in people with RA, autoimmune diseases (AIDs; rheumatic [r] and non-rheumatic [nr])..

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A Systematic Review of the Learning Curves of Novices and Trainees to Achieve Proficiency in Laparoscopic Skills: Virtual Reality Simulator Versus Box Trainer

Abstract Laparoscopic surgery, established in the 1980s, has become a primary treatment method across various surgical specialities due to its advantages over open surgery, including shorter recovery times and fewer complications. Mastery of laparoscopic skills is essential for novice and junior trainees, who must develop hand-eye coordination, depth perception, and..

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Incident dementia in ischaemic stroke patients with early cardiac complications: A propensity-score matched cohort study

Introduction The risk of dementia in patients with stroke-heart syndrome (SHS) remains unexplored. Patients and methods Retrospective analysis using the TriNetX network, including patients with ischaemic stroke from 2010 to 2020. These patients were categorised into two groups: those with SHS (heart failure, myocardial infarction, ventricular fibrillation, or Takotsubo cardiomyopathy within 30 days..

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UK Foot and Ankle Thromboembolism (UK-FATE).

Abstract Aims: Venous thromboembolism (VTE) is a potential complication of foot and ankle surgery. There is a lack of agreement on contributing risk factors and chemical prophylaxis requirements. The primary outcome of this study was to analyze the 90-day incidence of symptomatic VTE and VTE-related mortality in patients undergoing foot..

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Effect of GLP-1 receptor agonists on weight and cardiovascular outcomes: A review.

Abstract: Diet and lifestyle modifications remain the foundation of obesity treatment, but they have historically proven insufficient for significant, long-term weight loss. As a result, there is a high demand for new pharmacologic treatments to promote weight loss and prevent life-threatening diseases associated with obesity. Researchers are particularly interested in 1..

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Initial blood pressure and adverse cardiac events following acute ischaemic stroke: An individual patient data pooled analysis from the VISTA database

Background Adverse cardiac events following ischaemic stroke (stroke-heart syndrome, SHS) pose a clinical challenge. We investigated the association between initial blood pressure at stroke presentation and the risk of SHS. Methods We utilised data from the Virtual International Stroke Trials Archive (VISTA). We defined SHS as the incidence of cardiac..

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Nanomaterials in point-of-care diagnostics: Bridging the gap between laboratory and clinical practice.

Abstract The integration of nanomaterials into biosensing technologies represents a paradigm shift in medical diagnostics and environmental monitoring, marking a significant advancement in the field. This comprehensive review examines the role of nanomaterials, such as gold nanoparticles, carbon nanotubes, graphene, and quantum dots, in enhancing the performance of biosensors. These..

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Nanomaterials in point-of-care diagnostics: Bridging the gap between laboratory and clinical practice.

Abstract The integration of nanomaterials into biosensing technologies represents a paradigm shift in medical diagnostics and environmental monitoring, marking a significant advancement in the field. This comprehensive review examines the role of nanomaterials, such as gold nanoparticles, carbon nanotubes, graphene, and quantum dots, in enhancing the performance of biosensors. These..

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Cerebral Venous Sinus Thrombosis Following Varicella Infection: A Case Report

Abstract A 38-year-old man presented to the emergency department with a severe frontal headache, which began three days prior without visual, speech, or balance disturbances. His past medical history was unremarkable, apart from raised cholesterol. He confirmed a recent primary Varicella-zoster virus infection (chicken pox) two weeks prior. Clinical examination..

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Eosinophilic Dermatosis of Haematological Malignancy

Nallathamby, K; Moss, K et al. (2024). Eosinophilic Dermatosis of Haematological Malignancy. Clinical and Experimental Dermatology. Pub online 25 Oct, p.llae469. [Online]. Available at: https://doi.org/10.1093/ced/llae469 [Accessed 31 October 2024]  

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Outcome Measures in intellectual disability: A Review and narrative synthesis of validated instruments.

Abstract: Background: Outcome measurement is essential to determine the effectiveness of health interventions and improve the quality of services. The interplay of social, individual, and biological factors makes this a complex process in the psychiatry of people with intellectual disability (PwID). Aim: Review of outcome measures which are validated in..

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Navigating dual challenges: a qualitative study of adolescents and caregivers perceptions in managing type 1 diabetes and neurodiversity.

Quinn M.; Padi D.; Day H.; Hubbard R.; Finnigan L.; Rowe L.; Kyprios H.; Unsworth L.; Pintus D.; McCaffrey L.; Bray D.; Ng S.M. (2024). Navigating dual challenges: a qualitative study of adolescents and caregivers perceptions in managing type 1 diabetes and neurodiversity. Hormone Research in Paediatrics. p.1. [Online]. Available at:..

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Context, clarity and conversation: Spotting the Signs updated toolkit

No abstract available Daurat JL, Ashby J, Thomson-Glover R. Context, clarity and conversation: Spotting the Signs updated toolkit. Sex Transm Infect. 2024 Oct 17;100(7):474. doi: 10.1136/sextrans-2024-056213. PMID: 39419514.

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Parkinson's families project: a UK-wide study of early onset and familial Parkinson's disease.

Abstract: The Parkinson’s Families Project is a UK-wide study aimed at identifying genetic variation associated with familial and early-onset Parkinson’s disease (PD). We recruited individuals with a clinical diagnosis of PD and age at motor symptom onset ≤45 years and/or a family history of PD in up to..

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Challenging anticoagulation decisions in atrial fibrillation: a narrative review

Abstract Atrial fibrillation (AF) is common and warrants consideration of oral anticoagulant (OAC) medication. Usually, the decision is straightforward, following the pathway outlined in the European Society of Cardiology’s guideline; however, certain situations fall outside of this evidence base – such as a diagnosis of subclinical AF made via implanted..

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Provision of medical Same Day Emergency Care services within the UK: analysis from the Society for Acute Medicine Benchmarking Audit

Aim To evaluate current provision of medical Same Day Emergency Care (SDEC) services within the UK, and current utilisation of these pathways in the assessment of unplanned medical attendances.  Design Survey data was used from the Society for Acute Medicine Benchmarking Audit (SAMBA), including anonymised patient-level data collected annually using..

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Anatomy and pathology of adductor canal (Hunter’s canal)

Abstract Adductor canal (Hunter’s canal) pathologies are often underdiagnosed, with the saphenous nerve being the most commonly affected. While uncommon, involvement of the femoral artery and vein can cause severe and irreversible complications if not detected early. Significant attention must be given to adductor canal pathologies because the musculoaponeurotic..

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Stroke-heart syndrome and early mortality in patients with acute ischaemic stroke using hierarchical cluster analysis: An individual patient data pooled analysis from the VISTA database

Background The patient clinical phenotypes at particularly high risk for early cardiac complications after a recent acute ischaemic stroke (AIS), that is, stroke-heart syndrome (SHS), remain poorly defined. We utilised hierarchical cluster analysis to identify specific phenotypic profiles associated with this risk. Methods We gathered data on patients with AIS..

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Establishing postgraduate education in urology for nurses and the non-medical workforce using a partnership model

  Phillips, E. (2024). Establishing postgraduate education in urology for nurses and the non-medical workforce using a partnership model. British Journal of Nursing. 33(18), pp.S28-S29. [Online]. Available at: https://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2024.0352 [Accessed 17 October 2024]  

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Transition readiness interventions improve some diabetes outcomes and engagement of young people following transition to adult services: an NHS England transition pilot.

Abstract: Transition from paediatric to adult diabetes services is a critical period influencing health outcomes. Ensuring a smooth transition process has been a significant challenge, often associated with a high rates of disengagement and DKA admissions, and clinic non-attendance once the young person is transferred to adult services. Objective(s):..

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Eccentric ripple sign of BAARISh - a new sign of venous pseudoaneurysm

Abstract Superficial venous pseudoaneurysm is rare. Prompt diagnosis is essential to formulate management plan and decrease morbidity. We describe a novel Eccentric Ripple sign of BAARISh for diagnosing venous pseudoaneurysm.   Kanani, A; Iyengar, KP et al. (2024). Eccentric ripple sign of BAARISh - a new sign of venous pseudoaneurysm. Journal of..

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Anatomical Variations of the Bifurcation Levels of the Common Carotid Artery and Superior Thyroid Artery

Background Variations in the carotid arterial system significantly impact atherosclerosis's clinical and surgical management, which predominantly occurs at arterial bifurcations. Objectives This study aimed at evaluating anatomical variations in the bifurcation levels of the common carotid artery (CCA) and the superior thyroid artery (STA), emphasizing clinical relevance. Methods This was..

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Intraosseous regional antibiotic prophylaxis in total joint arthroplasty (TJA): Systematic review and meta-analysis

Background A major catastrophic adverse event after total joint arthroplasty surgery (TJA) is the periprosthetic joint infection (PJI). In the recent years, regional antibiotic prophylaxis has gained momentum as a novel infection control strategy in total knee arthroplasty (TKA), with different purported benefits over systemic administration. The current article was..

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Age, anticoagulants, hypertension and cardiovascular genetic traits predict cranial ischaemic complications in patients with giant cell arteritis

Objectives This project aimed to determine whether cranial ischaemic complications at the presentation of giant cell arteritis (GCA) were associated with pre-existing cardiovascular (CV) risk factors, CV disease or genetic risk of CV-related traits. Methods 1946 GCA patients with clinicodemographic data at GCA presentation were included. Associations between pre-existing CV-related traits (..

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Incidence and Outcomes of Patients With Early Cardiac Complications After Intracerebral Hemorrhage: A Report From VISTA

Background The incidence and outcomes of early cardiac complications in patients with intracerebral hemorrhage (ICH) are poorly understood. These cardiac complications may be part of the so-called stroke-heart syndrome in patients with ICH. We investigated this issue in an individual patient data pooled analysis from an international repository of clinical..

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Dapagliflozin's Role in Heart Failure: An Overview of Clinical Trial Evidence

Heart failure (HF) has become a global health threat, necessitating the development of novel treatment options to address this crisis. Sodium-glucose co-transporter-2 (SGLT2) inhibitors, such as dapagliflozin, may offer significant advantages in the treatment of HF, particularly in patients with reduced ejection fraction (HFrEF). This systematic review combines the findings..

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Pelvic Stress Fractures Following Resection and Reconstruction of Pelvis Tumours—An Observational Study.

Abstract Background and Aims: Pelvic bone tumours are rare, with a guarded prognosis despite advances in radiological imaging and surgical techniques. Despite this, limb salvage surgery has become the mainstay treatment for patients presenting with primary bone sarcomas, especially those with low histological grade variants. However, the rate of peri-operative-associated..

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Residual Risks of Thrombotic Complications in Anticoagulated Patients with Atrial Fibrillation

Background Assessment of residual thromboembolic risk in patients with atrial fibrillation (AF) prescribed oral anticoagulants (OACs) remains unexplored. We performed hierarchical cluster analysis to identify phenotypic profiles of these patients and their risks of residual thromboembolic events. Methods We utilised data from non-valvular AF patients on OACs, as documented in..

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The impacts of climate change on health in persons with Spinal Cord Injuries (SCI)

The poster is available as a PDF https://www.knowledge-nw.nhs.uk/media/StaffPublications/ISCoS2024/1.%20Poster_%20Yannis       Dionyssiotis, Y; Lennon, A; Alexander, M; Silva, C; Uddin, T (2024, September 24). Climate Change and Spinal Cord Injuries: Developing an informed action plan: The impacts of climate change on health in persons with Spinal..

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The emotional toll of climate change for persons with spinal cord injury

The poster is available as a PDF https://www.knowledge-nw.nhs.uk/media/StaffPublications/ISCoS2024/2.%20Poster_%20Aisling       Lennon, A; Dionyssiotis Y; Alexander, M; Silva, C; Uddid T (2024, September 24). Climate Change and Spinal Cord Injuries: Developing an informed action plan: The emotional toll of climate change for persons with spinal cord..

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How does health care contribute to climate change and what can we do about it?

The poster is available as a PDF https://www.knowledge-nw.nhs.uk/media/StaffPublications/ISCoS2024/3.%20Poster_%20Carla       Silva, C; Dionyssiotis, Y; Lennon, A; Alexander, M; Uddin, T (2024, September 24). Climate Change and Spinal Cord Injuries: Developing an informed action plan: How does health care contribute to climate change and what can..

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P075 Awake upper limb plastic surgery list – evaluation of a well established service shows good patient satisfaction and time efficiency

Background and Aims Undertaking procedures under regional anaesthesia (RA) avoids the risks, side effects and longer recovery associated with general anaesthesia (GA). There is a regular upper limb plastic surgery list at Whiston Hospital where patients have procedures under RA alone with no sedation, predominantly a brachial plexus block plus..

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EP058 Sonoclub North West – Improving the provision of regional anaesthesia skills of trainee anaesthetists

Background and Aims Regional anaesthesia is a core element of the Royal College of Anaesthetists curriculum and a key component as part of an independent anaesthetists practice (1,2). In our region, provision of regional anaesthesia training can be variable, therefore we created Sonoclub North West, targeting UK anaesthesia trainees aiming to..

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EP056 Introduction of a thoracic trauma protocol including implementation of an erector spinae plane (ESP) catheter service in a busy district general hospital

Background and Aims Following a previous audit into the management of rib fracture patients over 12 months (Jan-Dec 2021) an updated thoracic trauma protocol was introduced including offering a new ESP catheter service. We completed a re-audit of all rib fracture patients over a 12 month period to assess the impact, with audit..

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OP070 Greenhouse emissions associated with general or regional anaesthesia for open reduction and internal fixation of distal radius fractures

Background and Aims Total intravenous anaesthesia (TIVA) and regional anaesthesia (RA) have been touted as environmentally preferable alternatives to volatile anaesthesia, however few studies have investigated the relative environmental impact of these anaesthetic techniques. Methods A retrospective observational database study was conducted, in which theatre billing records were obtained. For..

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The “Mustache sign:” An ancillary radiological sign for detecting L5/S1 spondylolisthesis

Introduction and Aims Grade 1 spondylolisthesis can be challenging to detect on magnetic resonance imaging (MRI), particularly for spinal surgeons and radiologists with limited experience interpreting spinal MRIs. This study aims to describe a unique sign described as a “mustache sign,” which may assist in detecting subtle Grade I spondylolisthesis on..

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Lumbar offset distance: A simplified metric for evaluation of the lumbar spine alignment

Background A healthy lower back is essential for optimal spinal function and overall wellness. Magnetic resonance imaging (MRI) has become the gold standard in assessing lumbar spine disease. This article aims to evaluate the precision and efficacy of the lumbar offset distance (LOD) as a novel MRI parameter designed to..

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Identifying Research Priorities in Limb Reconstruction Surgery in the United Kingdom

Introduction Limb reconstruction surgery (LRS) has a wide range of clinical applications within orthopaedic and trauma surgery. We sought a consensus view from limb reconstruction healthcare practitioners across the United Kingdom to help guide research priorities within LRS. Our aim is to guide future clinical research in LRS, and assist..

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Continuous infusion of beta-lactam antibiotics in critically ill patients with sepsis: implementation considerations

No abstract available Barton, G., Rickard, C.M. & Roberts, J.A. Continuous infusion of beta-lactam antibiotics in critically ill patients with sepsis: implementation considerations. Intensive Care Med (2024). https://doi.org/10.1007/s00134-024-07650-x

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Calcific Myonecrosis of the Leg: A Clinical and Diagnostic Dilemma

Background:  Calcific myonecrosis (CMN) is a rare condition, often considered to be a late sequela of antecedent trauma. Case Report:  We describe here our experience in managing a 56-year-old male referred with a painless swelling on the lateral aspect of the left lower leg with a suspicion of a tumour...

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1076O Primary analysis of the EORTC 1208 Minitub trial: Prospective registry of sentinel node (SN) positive melanoma patients with minimal SN tumor burden

Background Retrospective studies have shown the prognostic value of SN tumor burden (van der Ploeg et al. JCO 2011). There are different ways to assess SN tumor burden, e.g. as the microanatomic location (Dewar et al. JCO 2004) or the diameter of the largest deposit (van Akkooi et al. Ann Oncol 2006)...

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Use of a Dedicated Questionnaire to Assess Buccal Mucosal Graft Morbidity in Urethral Reconstruction

Introduction Buccal mucosa grafts (BUMG) are used in urethral reconstruction. Although 1st described in 1894 it has only become popular since the early 90s. It easy to harvest with ideal graft properties. Potential complications associated with donor site harvest include oral numbness, delayed mouth opening and pain. Methods All urethral reconstruction..

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Perineal Urethrostomy

Introduction Perineal urethrostomy represents an excellent option for patients with pan urethral stricture disease who are unfit for major reconstruction. Methods With the scrotum sewn up, the base and ischial tuberosities are marked. Methylene blue is injected and massaged down the urethra. An inverted U-shaped incision is made along the..

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Outcomes of Staged Urethroplasty for Distal Urethral BXO: The Whiston Hospital Experience

Introduction Distal urethral disease due to balanitis xerotica obliterans is managed by staged urethroplasty. The first stage involves urethrectomy and replacement of the diseased urethral plate with a buccal graft. The second stage involves tubularisation and reconstructing the urethra. The purpose of this study was to analyse the final outcomes..

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Letter to the Editor: Low-dose oral minoxidil for the treatment of monilethrix: A retrospective review

Darchini-Maragheh, E; Meah, N et al. (2024). Letter to the Editor: Low-dose oral minoxidil for the treatment of monilethrix: A retrospective review. JEADV: Journal of the European Academy of Dermatology & Venereology. pub online 18 Sep. [Online]. Available at: https://doi.org/10.1111/jdv.20329 [Accessed 2 October 2024]  

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Tales from the community menopause clinic

Rook, D; Temple, R et al. (2024). Tales from the community menopause clinic. Post Reproductive Health. pub online 18 Sep. [Online]. Available at: https://doi.org/10.1177/20533691241285637 [Accessed 2 October 2024].  

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Adapting the WHO hand hygiene ‘reminders in the workplace’ to improve acceptability for healthcare workers in maternity settings worldwide: a mixed methods study

Introduction Hand hygiene is key in preventing healthcare-associated infections, but it is challenging in maternity settings due to high patient turnover, frequent emergencies and volume of aseptic procedures. We sought to investigate if adaptions to the WHO hand hygiene reminders could improve their acceptability in maternity settings globally, and use..

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Subarachnoid haemorrhage in the emergency department (SHED): a prospective, observational, multicentre cohort study

Background People presenting to the ED with acute severe headache often undergo investigation to exclude subarachnoid haemorrhage (SAH). International guidelines propose that brain imaging within 6 hours of headache onset can exclude SAH, in isolation. The safety of this approach is debated. We sought to externally validate this strategy and evaluate..

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Outcomes with single-agent gilteritinib for relapsed or refractory FLT3-mutant AML after contemporary induction therapy

Abstract Gilteritinib is the current standard of care for relapsed or refractory FLT3-mutated AML in many countries, however outcomes for patients relapsing after contemporary first-line therapies (intensive chemotherapy with midostaurin, or non-intensive chemotherapy with venetoclax) are uncertain. Moreover, reported data on toxicity and healthcare resource use is limited. Here..

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Assessing the current role of AP and Bernageau view radiographs in measurement of glenoid bone loss in patients with recurrent shoulder dislocation...

Background Evaluation of glenoid bone loss following recurrent anterior shoulder dislocations is normally performed using cross sectional imaging. Objectives To assess how anteroposterior (AP) and Bernageau view radiographs compare to computed tomography (CT), magnetic resonance imaging (MRI) and arthroscopy for evaluating glenoid bone loss in patients with recurrent anterior shoulder..

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Decoding the hidden realm: Molecular pioneering unravelling osteoarticular tuberculosis diagnosis

Abstract Osteoarticular tuberculosis (TB), a form of extrapulmonary tuberculosis, refers to the involvement of Mycobacterium tuberculosis (M.tb) in the bones and joints. While pulmonary tuberculosis is the most common form, osteoarticular TB represents a relatively rare but significant manifestation, accounting for approximately 1–3% of all TB cases. Accurate and timely..

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Early statin use is associated with improved survival and cardiovascular outcomes in patients with atrial fibrillation and recent ischaemic stroke...

Introduction Statins reduce recurrent stroke and cardiovascular events in patients with non-cardioembolic stroke. The benefits of statins in patients with AF and recent IS remain unclear. We aimed to investigate the benefits of statins in patients with AF and recent IS. Patients and methods This retrospective, cohort study was conducted..

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Management of paediatric elbow injuries, where is the equipoise? A UK and Ireland wide international survey of practice

No abstract available. Aldridge P, Rout R, Parish R, Roland D, Perry DC, Lyttle MD; Paediatric Emergency Research in the United Kingdom & Ireland (PERUKI). Management of paediatric elbow injuries, where is the equipoise? A UK and Ireland wide international survey of practice. Arch Dis Child. 2024 Sep 10:archdischild-2024-327051. doi: 10.1136/archdischild-2024..

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EP366 A single surgeon experience of total extraperitoneal inguinal hernia repair in a district general hospital

Methods This was a retrospective review of a prospectively collected and maintained data on elective TEP hernia repairs. All theatre list has been collected prospectively. All patient who had inguinal hernia repair between 2004 and 2021 has been identified from the list. The notes of all Patients who had laparoscopic hernia repair..

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Evaluating the impact of differing completion rates of a face-to-face DIABETES self-management education programme on Patient Reported Outcome measures (DIABETES PRO): A feasibility trial protocol

Introduction: Structured diabetes self-management education (DSME) is internationally recommended for people with type 2 diabetes to support self-management and to prevent associated long-term complications. 'Attendance' at DSME is currently benchmarked as having completed a registration form and at least one active engagement with programme content, and 'completion' measured against ≥60% completion, despite..

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The SAInT study: a protocol for a randomized controlled trial of steroid injection for subacromial pain syndrome using the anterolateral versus posterior approach

Aims: Steroid injections are used for subacromial pain syndrome and can be administered via the anterolateral or posterior approach to the subacromial space. It is not currently known which approach is superior in terms of improving clinical symptoms and function. This is the protocol for a randomized controlled trial (RCT)..

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GESTATIONAL DIABETES MELLITUS PREVENTION: A COMMENTARY.

Abstract: Gestational diabetes mellitus (GDM) poses a significant global health challenge. Well-established risk factors include a body mass index (BMI) above 30, maternal age over 40, previous GDM instances, a history of delivering babies weighing over 4.5kg, and specific ethnic backgrounds. This commentary discusses the Cochrane umbrella review by Griffith, et al., (2020)..

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Painful Ankle due to Impingement Between the Medial Malleolus and Navicular

Introduction:  A plethora of pathologies can cause medial ankle pain. Material and methods:  We present a case of 66-year-old male with medial ankle pain. Result:  Bilateral CTEV (Congenital talipes equino varus) with impingement between the navicular and medial malleolus was present, which was contributing to medial ankle pain. Conclusion:  One..

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Optimizing scapulothoracic injections: the role of hand positioning in enhancing procedural ease.

Abstract Introduction: Pathologies of the scapulothoracic articulation may lead to painful symptoms such as crepitus and bursitis. While conservative treatments are preferred, persistent symptoms may require image-guided injections. This study aims to determine the optimal hand positioning during ultrasound to maximize the distance between the scapula and thoracic wall, and..

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Construction of a decision model for donor testing in cases of suspected antibody-mediated transfusion-related-acute-lung-injury

Abstract Objective: To propose a rational basis for donor testing in cases of suspected antibody-mediated transfusion-related lung injury (AMT). Background: Anti-leukocyte antibodies in donated blood are established causes of transfusion-related lung injury (TRALI). However, the question of whether to test donors for antibodies is not identical to whether the case..

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Impact of bridging thrombolysis versus endovascular thrombectomy alone on outcomes in anticoagulated patients with atrial fibrillation and acute ischaemic stroke

Background and purpose The impact of bridging thrombolysis prior to endovascular thrombectomy (EVT) compared to EVT alone on intracerebral haemorrhage (ICH), subarachnoid haemorrhage (SAH), and death in anticoagulated atrial fibrillation (AF) patients with acute ischaemic stroke (AIS) is not well defined.  Methods   A retrospective study was conducted using data from..

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BAASIK technique: an innovative single needle technique of performing shoulder corticosteroid injections

The novel BAASIK (B-Botchu,Bipin, A-Agrawal, A-Ankit, S- Sindhura, I-Iyengar, K- Kapil) technique is a combined ultrasound-guided injection into the subacromial-subdeltoid (SASD) bursa and the biceps tendon sheath to treat shoulder pain associated with biceps tendonitis/tendinopathy, subacromial bursitis, rotator cuff impingement or to determine the source of shoulder pain...

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The management of acute complete ruptures of the ulnar collateral ligament of the thumb

Aims: Complete ruptures of the ulnar collateral ligament (UCL) of the thumb are a common injury, yet little is known about their current management in the UK. The objective of this study was to assess the way complete UCL ruptures are managed in the UK.  Methods: We carried out a..

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Felty Syndrome Presented With Candida albicans Lung Abscess Without Arthritis: A Case Report

Abstract Felty syndrome (FS) is a late manifestation of severe active rheumatoid arthritis (RA). A high index of suspicion or FS is needed in patients who present with neutropaenia and splenomegaly with no initial or obvious identifiable cause. We present the case of a 52-year-old who presented with a one-week..

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Uncommon Expression of Osteochondroma in the Wrist: A Case Report

Introduction Osteochondroma (OC) is a common benign bone tumor that usually arises from the metaphyseal region of long bones. Rarely, it can present in atypical locations such as the wrist and posing diagnostic challenges. Case Report We present a 42-year-old female with an incidental finding of OC on the volar..

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Painful Os Peroneum Syndrome Secondary to Hydroxyapatite Deposition Disease

Abstract Painful os peroneum syndrome (POPS) is one of the uncommon causes of lateral foot pain in orthopaedic practice. POPS encompasses a spectrum of pathologies such as an acute or a chronic fracture, peroneus longus tenosynovitis, and attrition or partial rupture of the peroneus longus tendon. Herein, we reported the..

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Breakthrough SARS-CoV-2 infection in fully vaccinated patients with systemic lupus erythematosus: results from the COVID-19 Vaccination in Autoimmune Disease (COVAD) study

Objective To determine the occurrence of breakthrough COVID-19 infections (BIs) in patients with systemic lupus erythematosus (SLE) compared with patients with other rheumatic autoimmune diseases (rAIDs), patients with non-rheumatic autoimmune diseases (nrAIDs), and healthy controls (HCs). Methods The study was based on data from 7035 fully vaccinated respondents to the online..

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Coccygeal Tumors Unveiled: Retrospective Cohort Analysis from a Tertiary referral Centre

Background Isolated tumours affecting the coccyx are infrequent, with only a handful of documented cases in the literature. Herein, we highlight the most extensive consecutive case series involving various isolated coccyx tumours with varied clinical presentations and imaging features. Material and Methods A retrospective search of our tertiary Orthopaedic oncology..

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Causes of sudden unexpected death in infants with and without pre-existing conditions: a retrospective autopsy study

Objective: We investigated sudden unexpected death in infancy (SUDI) autopsy data from 1996 to 2015 inclusive, comparing findings from infants with and without pre-existing medical conditions.  Design: Large, retrospective single-centre autopsy series.  Setting: Tertiary paediatric hospital, London, UK.  Methods: Non-identifiable autopsy findings were extracted from an existing research database for infants older..

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Unveiling the spiral groove: a journey through clinical anatomy, pathology, and imaging

Aim To review the anatomy of the spiral groove, its clinical significance, and the imaging characteristics of common pathologies affecting this area, highlighting the strengths of different imaging modalities. Materials and methods A comprehensive review of the spiral groove anatomy and its clinical implications and an evaluation of various imaging..

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Use and impact of virtual resources for peer support by young adults living with cancer: A systematic review.

Abstract: Background: Young adults (YA) with cancer often have unmet psychosocial needs. The impact of peer support delivered in an online format to fulfil these needs in the populations of YA with cancer has not been thoroughly examined. Methods: We searched Cochrane Central Register of Controlled Trials, CINAHL, Embase, and..

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Prognostic factors for outcomes following surgical stabilization of rib fractures: A review of the literature

Abstract Rib fractures are a common injury following blunt thoracic trauma, often resulting in high levels of morbidity and mortality. With the ageing global population, the incidence of rib fractures is expected to increase, posing a significant burden on healthcare systems worldwide. With advancements in surgical techniques and pioneering research..

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Revisiting surgical margins for invasive breast cancer patients treated with breast conservation therapy - Evidence for adopting a 1 mm negative width

Clinical trials have demonstrated conclusively the non-inferiority of breast-conserving surgery followed by breast radiation therapy (BCT) compared with mastectomy for the treatment of early-stage invasive breast cancer (BC). The definition of the required surgical margin to ensure adequate removal of the cancer by BCT to obtain an acceptable low local..

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Revisional bariatric surgery following sleeve gastrectomy: a meta-analysis comparing Roux-en-Y gastric bypass and one anastomosis gastric bypass

Abstract: Introduction: The number of bariatric operations is increasing each year. Sleeve gastrectomy is the most popular procedure; however, it often requires revision surgery because of insufficient weight loss, weight regain or gastro-oesophageal reflux disease (GORD). The most popular revisional procedures are Roux-en-Y gastric bypass (RYGB) and one anastomosis gastric..

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Stroke-heart syndrome: Incidence and clinical outcomes of cardiac complications following intracerebral haemorrhage

Introduction Newly diagnosed cardiovascular complications following an ischaemic stroke, termed stroke-heart syndrome, are common and associated with worse outcomes. Little is known regarding stroke-heart syndrome in relation to intracerebral haemorrhage (ICH). This study aimed to investigate the incidence and 5-year major adverse cardiovascular events (MACE; acute myocardial infarction, ischaemic stroke,..

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Transcatheter arterialization of the deep veins: 1-year outcomes of PROMISE-UK study

Abstract: Approximately 20% of the general population over the age of 55 years have peripheral arterial disease (PAD), which is the main cause of leg amputations in the UK National Health Service (NHS) and other healthcare systems1,2. An estimated 20% of those with symptomatic PAD progress to develop chronic limb-threatening ischaemia (CLTI), the..

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Breast cancer in pregnancy: a comprehensive review of diagnosis, management, and outcomes.

Conclusions: BC during pregnancy presents a complex challenge, requiring personalized diagnosis and treatment. Multidisciplinary care and timely interventions are essential for optimal outcomes for both mother and child. Ongoing research offers hope for improved strategies and outcomes in the future. Surgical management of BC during pregnancy requires a delicate balance..

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A Six-year review of deaths, a district general hospital’s experience: reflection and learning.

Abstract Objectives: Neonatal and paediatric mortality has remained a challenge worldwide, despite significant improvements in antenatal, neonatal and paediatric care. Case reviews and acting on lessons learned remain a powerful training tool in paediatrics. This is a single centre, retrospective review of all neonatal and paediatric mortality cases in order..

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Home oxygen for bronchopulmonary dysplasia – Are we safely discharging?.

Abstract Objectives: The British Thoracic Society (BTS) guidelines for home oxygen suggests that ‘Infants can be discharged from SCBU with mean oxygen saturations of >93%. The saturations should not fall below 90% for more than 5% of the recording’.1 However, the American Thoracic Society (ATS) recommend a more conservative approach, allowing less than 5%..

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6653 Embedding paediatric inequalities thinking and practice in a paediatric department – journey from a lone warrior to community of practice to improve outcomes.

Abstract Objectives: The purpose of this abstract is to detail the journey of a paediatrician/core20plus5 ambassador in embedding paediatric health inequalities (HI) thinking and practice in a hospital paediatric department. The aim is to share the learning and resources to improve success of similar endeavours. Methods: An initial..

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Isolated spontaneous non-insertional tear of the iliopsoas tendon in an elderly patient: significance of ultrasound imaging

Isolated spontaneous tears in the non-insertional portion of the iliopsoas tendon without any underlying injury are uncommon, especially among elderly individuals. We describe the case of an 88-year-old man who experienced right groin pain caused by a spontaneous non-insertional tear in the iliopsoas tendon identified through ultrasound and confirmed via..

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Chatbots and Their Applications in Medical Fields: Current Status and Future Trends: A Scoping Review

Background and Aim: Chatbots are computer programs, which are devised to simulate conversations through voice or textual interactive forms. These applications offer multiple benefits in patient education, clinical decision-making, interpersonal communication, research activities, data analysis and administrative affairs. The present scoping review aims to analyse the current role, pitfalls, challenges..

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Bone Trauma

Abstract The skeleton of the lower torso is a strong yet flexible scaffold composed of the sacrococcygeal spine, pelvic girdle, and hip joints, whose individual components can undergo a multitude of possible injuries following either low- or high-energy traumas. Plain and cross-sectional imaging play key roles in the early detection..

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Recurrent fractures in a teen with osteopetrosis

Abstract not available. Vaisha, R.; Iyengar, KP. et al. (2024). Recurrent fractures in a teen with osteopetrosis. BMJ Case Reports. 17(7), p.-. [Online]. Available at: https://doi.org/10.1136/bcr-2024-260383 [Accessed 30 July 2024].  

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Metastatic Adenocarcinoma of the Prostate Masquerading as a Splenic Flexure Colonic Polyp: A Diagnostic Conundrum

Abstract Metastasis of prostate cancer to the gastrointestinal tract is infrequently described in the literature, with only a limited number of cases reporting metastasis to the rectum. We present a rare case of a 74-year-old man initially presenting with symptomatic anemia and weight loss. A colonoscopy revealed a sessile polyp..

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GIBPS technique-a novel sequential technique of performing shoulder corticosteroid injections.

Abstract: The introduction of the xxxxxxxx (GIBPS) technique represents a patient-centric novel and innovative method of ultrasound guided corticosteroid injection targeting the Glenohumeral joint (GHJ) and the Subacromial-Subdeltoid (SASD) bursa in a sequential manner, in the same setting. By integrating the two different sites of injection into a single technique,..

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Evaluating acute medical service performance against assessment time metrics: the Society for Acute Medicine Benchmarking Audit 2023 (SAMBA23)

Abstract Performance within acute medicine services is impacted by ongoing pressures on acute care services. Data from the Society for Acute Medicine Benchmarking Audit 2023 (SAMBA23), was used to assess performance of acute medicine services compared to key clinical quality indicators, comparing performance by initial assessment location. Data was analysed for 8213..

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Global prevalence and correlates of mpox vaccine acceptance and uptake: a systematic review and meta-analysis.

Abstract Background: Vaccination has been recommended as one of the most potent ways of controlling the mpox (formerly, monkeypox) outbreak, particularly among high-risk groups. Here, we evaluated the prevalence of mpox vaccine acceptance and uptake globally. Methods: We searched multiple databases for peer-reviewed studies published in English from May 2022 to 25..

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The role of multimodality imaging in the selection and management of patients treated with cytoreductive surgery and HIPEC.

Abstract:  Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) is the mainstay of potentially curative surgical treatment for malignancies that have spread to peritoneal surfaces. This surgical procedure is however associated with high morbidity and appropriate patient selection and planning is therefore essential. Available multimodality imaging techniques include..

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Impact of SARS-CoV-2 on male reproductive system and fertility.

Abstract Objective: Evaluate the impact of SARS-CoV-2 on male fertility. Design: Comprehensive analysis of studies exploring virus presence, inflammation, and altered semen parameters. Result(s): While some studies report absence of SARS-CoV-2 in semen, others highlight testicular injury, inflammation, and potential viral orchitis. Scrotal discomfort and altered sperm parameters indicate..

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Letter to editor re: (2024) Smoking is not associated with wound complications in augmented urethroplasty: a NSQIP analysis. Int Urol Nephrol. https://doi.org/10.1007/s11255-024-04085-7 by Cahill et al.

No abstract available. Day, A.W.; Floyd, M.S. et al. (2024). Letter to editor re: (2024) Smoking is not associated with wound complications in augmented urethroplasty: a NSQIP analysis. Int Urol Nephrol. https://doi.org/10.1007/s11255-024-04085-7 by Cahill et al. International Urology and Nephrology. [Online]. Available at: https://..

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Transition between paediatric and adult diabetes healthcare services: An online global survey of healthcare professionals’ experiences and perceptions

Introduction Youth with diabetes should transition from paediatric to adult diabetes services in a deliberate, organized and cooperative way. We sought to identify healthcare professionals’ (HCPs) experiences and perceptions around transition readiness planning, policies and procedures, and the actual transfer to adult services. Methods Data were collected via an online..

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Sciatic Nerve Entrapment from Cerclage Wiring in Intramedullary Nail Fixation

Cerclage wiring may be used to optimize the stability of intramedullary nail or plate fixations in comminuted proximal femoral fractures, periprosthetic fractures, and other selected cases. In this article, we presented a novel case of iatrogenic sciatic nerve entrapment from cerclage wiring used to supplement intramedullary nail fixation. We also..

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247 Prophylactic Use of 3D Intraperitoneal Mesh in the Prevention of Parastomal Hernia in Permanent Colostomies After Rectal Cancer Resection

Background  Parastomal hernia (PSH) is the most common complication of stomas associated with significant morbidity. Prophylactic mesh in preventing PSH is less well studied, and evidence is conflicting. We compare PSH rates in patients in whom 3D intraperitoneal mesh was and was not used prophylactically in a cohort of rectal..

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Natriuretic Peptides to Classify Risk of Atrial Fibrillation Detection After Stroke: Analysis of the BIOSIGNAL and PRECISE Cohort Studies.

Background and Objectives Prolonged cardiac monitoring (PCM) increases atrial fibrillation (AF) detection after ischemic stroke, but access is limited, and it is burdensome for patients. Our objective was to assess whether midregional proatrial natriuretic peptide (MR-proANP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) could classify people who are unlikely to have..

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Luschka’s tubercle and snapping scapula syndrome: an anatomical and clinical discourse.

Snapping Scapula Syndrome (SSS) is an uncommon orthopaedic disorder characterised by audible crepitations and disrupted shoulder kinematics due to pathological interactions within the tissues between the scapula and ribcage. One rare cause of SSS is the presence of Luschka’s Tubercle, a bony prominence located on the costal surface of..

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Use of the Therapy Outcome Measure in community intermediate care: results of a service evaluation

Background/Aims Outcome measures are essential in clinical practice to demonstrate patient improvement and secure funding for services. The purpose of this service evaluation was to explore levels of patient improvement as measured by the Therapy Outcome Measure in a community intermediate care team. Methods A total of 232 patients who..

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P29 Utilising cytosponge to reduce the post-covid gastroscopy backlog

Introduction The post-Covid-19 era brought about significant challenges in relation to the waiting times for endoscopy procedures. Resources were re-directed to the front-line resulting in a temporary cessation of non-urgent endoscopy services. Delays to endoscopy provision can have a devastating effect on the prognosis of oesophagogastric cancers. Innovative test such..

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Spontaneous pneumomediastinum and surgical emphysema presenting as rhinolalia following ecstasy ingestion: a case report.

Abstract: Background: We present a unique case of rhinolalia as the first recognizable sign of spontaneous pneumomediastinum and surgical emphysema following drug use. Case presentation: This case presents a 17-year-old white male experiencing rhinolalia following ecstasy ingestion at a rave. Subsequent chest X-ray revealed extensive surgical emphysema, along with a..

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BT16 BT17 Dermatology advice and guidance: a service evaluation.

Abstract: We wish to present a service evaluation undertaken of the regional dermatology advice and guidance (A&G) service provided within our locale. As part of the national Elective Care Transformation Programme, A&G services were created, primarily as a consultant dermatologist-led service prior to referral. This was designed to..

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A global survey to assess practice of laboratory testing in alopecia areata by hair specialists.

Abstract: Alopecia areata (AA) is a common, immune-mediated, nonscarring alopecia associated with increased risk of other autoimmune conditions such as thyroid disease. Risk of cardiovascular disease in AA is contentious, but is relevant in the era of Janus kinase (JAK) inhibitor therapy. Rarely, nutritional deficiency and infective disorders, such as..

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P010 Eosinophilic dermatosis of haematological malignancy mimicking insect bite-like reaction in a patient with chronic lymphocytic leukaemia: a case report..

Abstract: We present a case of a patient presenting with severe insect bite-like reactions in her skin with underlying chronic lymphocytic leukaemia (CLL). A 71-year-old woman was diagnosed with CLL in 2017 after presenting with a low-level lymphocytosis. She has never required treatment for CLL and remains under active observation in..

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Imaging in shoulder arthroplasty: Current applications and future perspectives

Shoulder arthroplasty has become a standard surgical procedure for treating a variety of complex shoulder disorders, including those with degenerative and traumatic aetiologies. The ever-improving success rates of shoulder arthroplasty could be attributed to advancements in endoprosthesis design, improvements in the biomechanics of endoprosthetic components, and improvements in surgical techniques...

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Irreducible Complex Posterior Elbow Dislocation with Varus Posteromedial Rotary Instability – A Case Report

Introduction Elbow dislocations, particularly those associated with varus posteromedial rotary instability, are relatively uncommon. We present the case of a 25-year-old male initially managed nonoperatively for a posterior elbow dislocation, who subsequently experienced irreducible re-dislocation with characteristic fractures of the anteromedial facet and tip of the coronoid, indicative of varus..

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Reperfusion therapies in patients with acute ischaemic stroke and atrial fibrillation: data on safety and effectiveness from a multi-centre cohort study

Conclusion: Patients with AF and AIS treated with reperfusion therapies had a significantly higher rate of good functional outcome and lower rates of mortality compared to those patients with AF and AIS who had undergone conservative treatment. Cancelloni, V; Abdul-Rahim, A. H; Et al. (2024). Reperfusion therapies in patients with acute..

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Telehealth Versus In-person Musculoskeletal Physiotherapy Assessment: A Comparison of Specific Outcomes

Aim To test the hypothesis that MSK physiotherapy assessment through telehealth results in different outcomes relative to in-person assessment. Methods *This is a retrospective evaluation of two large sample groups of patients assessed within an NHS MSK service by senior and advanced practitioner physiotherapists.* To represent in-person physiotherapy assessments, 3 months..

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Development and external validation of the ‘Global Surgical-Site Infection’ (GloSSI) predictive model in adult patients undergoing gastrointestinal surgery

Background Identification of patients at high risk of surgical-site infections may allow surgeons to minimize associated morbidity. However, there are significant concerns regarding the methodological quality and transportability of models previously developed. The aim of this study was to develop a novel score to predict 30-day surgical-site infection risk after..

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Authors’ Response: The Accuracy of the Multimodal Large Language Model GPT-4 on Sample Questions From the Interventional Radiology Board Examination

Ariyaratne, S; Iyengar, KP et al. (2024). Authors’ Response: The Accuracy of the Multimodal Large Language Model GPT-4 on Sample Questions From the Interventional Radiology Board Examination. Academic Radiology. epub 20 June. [Online]. Available at: https://doi.org/10.1016/j.acra.2024.05.025 [Accessed 27 June 2024]  

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A Systematic Review to Summarise and Appraise the Reporting of Surgical Innovation: a Case Study in Robotic Roux-en-Y Gastric Bypass

Abstract Robotic Roux-en-Y gastric bypass (RRYGB) is an innovative alternative to traditional laparoscopic approaches. Literature has been published investigating its safety/efficacy; however, the quality of reporting is uncertain. This systematic review used the Idea, Development, Exploration, Assessment and Long-term follow-up (IDEAL) framework to assess the reporting quality of available..

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Advancing orthopaedic trauma care through WhatsApp: An analysis of clinical and non-clinical applications, challenges, and future directions.

Abstract: The integration of WhatsApp, a widely-used instant messaging application (IMA), into the realm of orthopaedics and trauma surgery has emerged as a significant development in recent years. This paper explores the multifaceted role of WhatsApp in orthopaedics, focusing on its clinical and non-clinical applications, advantages, disadvantages, and future prospects...

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Major burns in adults: a practice review

Abstract There are approximately 180 000 deaths per year from thermal burn injury worldwide. Most burn injuries can be treated in local hospitals but 6.5% require specialist burn care. The initial ED assessment, resuscitation and critical care of the severely burned patient present significant challenges and require a multidisciplinary approach. The management of..

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Open reduction of irreducible elbow dislocations due to varus posteromedial rotary instability may require addressing capsular interposition, ligament repair, and coronoid fixation for optimal outcome.

Abstract Introduction: Elbow dislocations, particularly those associated with varus posteromedial rotary instability, are relatively uncommon. We present the case of a 25-year-old male initially managed nonoperatively for a posterior elbow dislocation, who subsequently experienced irreducible re-dislocation with characteristic fractures of the anteromedial facet and tip of the coronoid, indicative of..

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Systematic Review and Meta‐Analysis of Prehospital Machine Learning Scores as Screening Tools for Early Detection of Large Vessel Occlusion in Patients with Suspected Stroke

Background Enhanced detection of large vessel occlusion (LVO) through machine learning (ML) for acute ischemic stroke appears promising. This systematic review explored the capabilities of ML models compared with prehospital stroke scales for LVO prediction. Methods and Results Six bibliographic databases were searched from inception until October 10, 2023. Meta‐analyses pooled..

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ISPAD Annual Conference Highlights 2023

Ng, SM; Day, H; Hubbard, R; Alexopoulou, V et al. (2024). ISPAD Annual Conference Highlights 2023. Hormone Research in Paediatrics. Pub online 11 Jun. [Online]. Available at: https://doi.org/10.1159/000539749 [Accessed 31 October 2024].  

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AB1645-PARE Disease flares in patients with rheumatoid arthritis following covid-19 breakthrough infection: result from COVAD e-survey study

Abstract: Background: COVID-19 has been suggested as a possible trigger of disease flares in patients with rheumatoid arthritis (RA). However, factors associated with disease flares remain unknown. Objectives: This study aimed to identify factors associated with disease flares in patients with RA following COVID-19. Methods: We selected patients with RA..

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POS1316 The impact of mental health comorbidities on quality of life in patients with idiopathic inflammatory myopathies: a COVAD-2 study

Abstract: Background: Idiopathic inflammatory myopathies (IIM) encompass a group of disorders characterized by muscle inflammation, weakness, and varying levels of systemic involvement. These conditions profoundly impact patients’ quality of life (QoL) due to their chronic nature, physical impairments, and accompanying mental health challenges. Recent literature has highlighted the prevalence of..

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Supraspinous Fossa: Anatomy and Pathology

Abstract Supraspinous fossa is an important location in the periscapular region, which houses important structures such as the supraspinatus muscle and the suprascapular nerve. The supraspinous fossa can be affected by pathologies involving its contents (supraspinatus muscle and suprascapular nerve), osseous boundary (scapular body, distal clavicle, and spinous process), or..

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Real-world effectiveness and safety of tofacitinib for alopecia areata: A retrospective cohort study of 202 patients

Background Alopecia areata (AA) is an autoimmune hair loss disorder characterised by collapse of hair follicle immune privilege and mediated by autoreactive CD8+ T lymphocytes and natural killer cells. Treatment is often unsatisfactory. The Janus kinase-signal transducer and activator of transcription (JAK–STAT) pathway is implicated in the pathogenesis of..

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P228 Multicentre review of lung microbiome for patients with cystic fibrosis treated with elexacaftor/tezacaftor/ivacaftor

Background Respiratory tract infections are a leading cause of morbidity in children with cystic fibrosis(CF). The introduction of the highly effective modulator elexacaftor-tezacaftor-ivacaftor (ETI) has been shown to be clinically effective in terms of improved lung function, decreased symptoms and improved CFTR function. The results on the microbiome are..

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31 North west leadership schools: inspiring and developing the healthcare leaders of the future

Introduction The North West Leadership Schools (NWLS) are an initiative of NHS England North West (NHS England NW). Each year we run a series of free, virtual evening events to inspire and develop leadership skills in medical and dental trainees of all specialties and grades across the North West region...

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Working on the Clinical Frontline During the COVID-19 Pandemic: The Perceptions and Experiences of Hospital Chaplains

Abstract: Hospital chaplaincy teams played a vital role during the COVID-19 pandemic, but the full depth of their experiences and personal impacts is not fully known. This UK study was advertised using social media platforms, local press outlets and chaplaincy professional bodies. An electronic survey was completed by 63 hospital chaplains,..

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Shining a Light in COVID-19 Darkness: The Impact of Hospital Chaplaincy Teams on Healthcare Professionals.

Abstract Introduction: The World Health Organization officially declared COVID-19 a global pandemic in March 2020, resulting in travel restrictions, closure of non-essential shops and services, and the discontinuation of elective healthcare. The escalation of the pandemic impacted on hospital healthcare professionals, who experienced the deaths of colleagues and unprecedented changes in..

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Intra-articular steroids for the treatment of coxarthrosis; a retrospective cohort study comparing three contrast techniques.

Conclusion: Air arthrogram is an effective method of confirming injection placement in hip IAS for coxarthrosis and the use of a contrast agent (e.g., Iohexol) may not be required. Non-contrast techniques may produce longer duration of symptomatic relief in non-smokers and in older patients. Kwaees, T A; Barter, R;..

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A rare cardiac mass

A new systolic heart murmur was identified in a woman in her mid-60s during a preoperative assessment (fig 1). She had completed a course of radiotherapy and chemotherapy for rectal cancer (stage T4b N1b M0), followed by uncomplicated elective robotic low anterior resection and laparoscopic ileostomy.   Ali, H;..

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Evaluation of the impact of a nephrologist led acute kidney Injury clinic in a large district general hospital.

Abstract Background and Aims: Acute kidney injury (AKI) has a significant impact on inpatient hospital admissions costing the NHS in the UK an estimated £1bn. Hospitalisation complicated by AKI results in increased length of stay and mortality and up to a fifth of discharged patients are readmitted to hospital within 30..

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Could ChatGPT Pass the UK Radiology Fellowship Examinations?.

Abstract: Rationale and Objectives: Chat Generative Pre-trained Transformer (ChatGPT) is an artificial intelligence (AI) tool which utilises machine learning to generate original text resembling human language. AI models have recently demonstrated remarkable ability at analysing and solving problems, including passing professional examinations. We investigate the performance of ChatGPT on some..

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Cubital tunnel syndrome: anatomy, pathology, and imaging.

Abstract: Cubital tunnel syndrome (CuTS) is the second most common peripheral neuropathy in the upper limb. It occurs due to ulnar nerve compression within the fibro-osseous cubital tunnel at the elbow joint. Although CuTS is typically diagnosed clinically and with electrodiagnostic studies, the importance of imaging in evaluating the condition..

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Quantifying postoperative recovery using wearable activity monitors following abdominal wall surgery: The AbTech trial

Purpose This work aimed to investigate the validity of wearable activity monitors (WAMs) as an objective tool to measure the return toward normal functional mobility following abdominal wall surgery. This was achieved by quantifying and comparing pre- and postoperative physical activity (PA). Methods A multicenter, prospective, observational cohort study was..

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Guidelines on the diagnosis and management of patent foramen ovale (PFO) after stroke

Abstract Patent foramen ovale (PFO) is frequently identified in young patients with cryptogenic ischaemic stroke. Potential stroke mechanisms include paradoxical embolism from a venous clot which traverses the PFO, in situ clot formation within the PFO, and atrial arrhythmias due to electrical signalling disruption. The purpose of this guideline is..

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An annual review of key advances in evidence-based plastic surgery, A synopsis from the leads of the BAPRAS Research & Innovation, Education, and Trainees Committees

Abstract: Understanding and practising evidence-based medicine is crucial in delivering optimal patient care in Plastic Surgery. It can be incredibly challenging for Plastic Surgeons with a demanding clinical workload to keep up to date with research and regulatory advances within the field. This is particularly difficult given the rate of..

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Guidelines on the diagnosis and management of patent foramen ovale (PFO) after stroke.

Conclusion: In patients with PFO-related stroke aged 18–60 years, PFO closure plus time-limited antiplatelet therapy is the recommended strategy for secondary prevention of recurrent stroke, with a low rate of complications. Further RCTs are required to test whether and in which patients over 60 years of age with stroke and PFO should..

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European Stroke Organisation (ESO) Guidelines on the diagnosis and management of patent foramen ovale (PFO) after stroke

Patent foramen ovale (PFO) is frequently identified in young patients with cryptogenic ischaemic stroke. Potential stroke mechanisms include paradoxical embolism from a venous clot which traverses the PFO, in situ clot formation within the PFO, and atrial arrhythmias due to electrical signalling disruption. The purpose of this guideline is to..

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Assessment of Needlestick and Sharps Injuries (NSSIs) Amongst Orthopaedic Surgeons in Clinical Practice: A Pan-India Cross-Sectional Study

Introduction Needlestick and sharps injuries (NSSIs) represent an existential occupational hazard risk to orthopaedic surgeons during their career due to the interaction with various devices, instruments and bone fragments. Consequently, NSSIs have the potential to transmit infections such as Hepatitis B (HBV), Hepatitis C (HCV) and Human Immunodeficiency Virus (HIV)..

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Beyond Face Arm and Speech Test (Beyond FAST), a predicted probability-based stroke identification scale

Poster presentation for the ESOC 2024. Full conference programme available here: https://apps.congrex.com/esoc2024/en-GB/pag/   Background and aims Despite its widespread usage in stroke identification, the FAST test exhibits modest accuracy. This study assesses the effectiveness of integrating additional clinical parameters to distinguish strokes and stroke mimics. Methods..

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Early statin use for secondary prevention in patients with atrial fibrillation and recent ischaemic stroke

Poster presentation for the ESOC 2024. Full conference programme available here: https://apps.congrex.com/esoc2024/en-GB/pag/   Background and aims We investigated the benefits of early statin use for secondary prevention of ischaemic stroke (IS) in patients with AF. Methods We conducted a propensity score matched analysis using data within..

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Left atrial appendage occlusion versus direct oral anticoagulants in the prevention of ischaemic stroke in patients with atrial fibrillation

Poster presentation for the ESOC 2024. Full conference programme available here: https://apps.congrex.com/esoc2024/en-GB/pag/   Background and aims Existing randomised controlled trials assessing the safety and efficacy of left atrial appendage occlusion (LAAO) in atrial fibrillation (AF) were of relatively small sample size, or included patients who could..

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Risk of tumour seeding in patients with liver lesions undergoing biopsy with or without concurrent ablation: meta-analysis

Abstract: Liver biopsies are fundamental for research purposes to plan personalized therapies1. Needle tract seeding is often raised as a concern during liver biopsies2. It occurs during withdrawal of a needle, where malignant cells get displaced along the needle tract. The risk of seeding associated with liver biopsies remains uncertain...

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Are relative contraindications for unicompartmental knee replacements in medial compartment osteoarthritis really contraindications?.

Conclusion: BMI maybe an important patient factor in predicting post operative OKS at 2–5 years. This is beneficial to surgeons for patient selection in medial UKR. Patellofemoral wear doesn't appear to impact on post operative functional outcomes. This supports the theory that patient who suffer from patellofemoral wear, as well as..

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Bridging the digital divide: The UNBIASED national study to unravel the impact of ethnicity and deprivation on diabetes technology disparities in the United Kingdom

Ng, SZ et al. (2024). Bridging the digital divide: The UNBIASED national study to unravel the impact of ethnicity and deprivation on diabetes technology disparities in the United Kingdom. Diabetic Medicine. epub 8 May. [Online]. Available at: https://doi.org/10.1111/dme.15346 [Accessed 17 May 2024]

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Letter to the editor RE: Management of Anterior Urethral Stricture: A survey of Contemporary Practice of Iranian Urologists

Abstract We read with interest the recent paper by Hosseini et al detailing the management practice of Iranian Urologists towards the management of anterior urethral stricture disease. Please find our letter to the editor regarding this.   Harrison, NL; Omar, AM; Floyd Jr, MS. (2024). Letter to the editor RE: Management of..

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Long-term assessment of the NHS hybrid closed-loop real-world study on glycaemic outcomes...

Abstract Hybrid closed-loop (HCL) systems seamlessly interface continuous glucose monitoring (CGM) with insulin pumps, employing specialised algorithms and user-initiated automated insulin delivery. This study aimed to assess the efficacy of HCLs at 12 months post-initiation on glycated haemoglobin (HbA1c), time-in-range (TIR), hypoglycaemia frequency, and quality of life measures among children..

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Predictors of post-operative complications following immediate implant-based breast reconstruction - a single centre experience

Introduction Post-operative complications are common in breast cancer patients who underwent immediate implant-based breast reconstruction following risk reduction mastectomy. This study aimed to determine patient and intraoperative factors that increased risk of post-operative complications. Method(s) 161 patients underwent immediate implant-based breast reconstruction at North Manchester General Hospital Breast Surgery Unit..

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The impact of body mass index on pathological complete response following neoadjuvant chemotherapy in operable breast cancer

Introduction Breast cancer being a global health concern, with an incidence and mortality rate of 11.7% and 6.9% respectively. Pathological complete response (PCR) post-neoadjuvant chemotherapy (NACT) is associated with improved survival outcomes. 63.5% of adults in the United Kingdom have an elevated body mass index (BMI). Objective(s) We aimed to compare pathological..

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The association of breast surgery ASPIRE - Breast pain pathway rapid evaluation project: Study update

Background Breast pain accounts for 20-40% of new referrals to breast units with multiple pathways for patient management. This prospective multi-centre service evaluation, supported by the ABS, aims to assess the safety and patient satisfaction of different Breast Pain-only Pathways (BPPs). Method(s) All UK breast units were invited to..

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An evaluation of a simulation-based training programme to support final-year medical students in their preparation for foundation-year prescribing practice

Introduction  Prescribing is a high-risk and error prone activity with doctors reporting a lack of preparedness for prescribing practice,[1] with potential for simulation-based training (SBT) to enhance prescribing skill development.[2] To support preparation for prescribing practice, a team-based SBT programme was developed for final-year medical students. Aim  To determine the..

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A mixed methods evaluation of the appropriateness of hospital on-call pharmacy service use

Introduction  Most English hospitals provide out-of-hours pharmacy support via an ‘on-call pharmacist’.[1] There is scant published literature characterising these services. Prior research[2] suggests a significant number of calls may be inappropriate requests for non-urgent medication or information readily available elsewhere. Delaying while the on-call pharmacist is unnecessarily contacted may avoidably..

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Clarity in the law is needed to stop physical punishment of children

Removing the “reasonable punishment” defence and prohibiting corporal punishment of children can help to reduce family violence, says Andrew Rowland.

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P046 The influence of deprivation in the outcomes of Psoriatic Arthritis within the UK - utilising Outcomes of Treatment in Psoriatic Arthritis Study Syndicate data

Background/Aims Psoriatic arthritis (PsA) is a chronic inflammatory arthropathy, which affects approximately 30% of patients with psoriasis and is associated with a high degree of morbidity. The introduction of biological disease-modifying antirheumatic drugs (bDMARDs) revolutionised treatment strategies for patients with PsA, however response is not universal. Deprivation and its associated..

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Medical photography and the reconstructive urologist: A 6-month prospective study

Abstract Medical photography has multiple, important roles. The education of medical practitioners, documentation of disease, response to treatment, research, publication, intraoperative recording and trauma documentation all rely on medical photography. Additionally, there are important medicolegal implications pertaining to medical photography across many medical disciplines. Other than specific image use to..

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The need to educate on effective reflective practice for international medical graduates

  Khan, AA; Patel, P; Rachid, A. (2024). The need to educate on effective reflective practice for international medical graduates. Medical Teacher. epub 22 Apr. [Online]. Available at: https://doi.org/10.1080/0142159X.2024.2344620 [Accessed 3 May 2024]  

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Depression mediates the relationship between exposure to stigma and medication adherence among people living with HIV in low-resource setting: a structural equation modeling approach

Abstract This study hypothesizes that depression mediates the association between exposure to stigma and medication non-adherence in people living with HIV (PLHIV). We recruited 372 PLHIV from the Stigma, health-related Quality of life, antiretroviral Adherence, and Depression among people living with HIV (SQuAD-HIV) project, a multicenter cross-sectional study conducted between October 2021..

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The diagnosis and management of systemic autoimmune rheumatic disease-related interstitial lung disease: British Society for Rheumatology guideline scope.

Abstract: Interstitial lung disease (ILD) is a significant complication of many systemic autoimmune rheumatic diseases (SARDs), although the clinical presentation, severity and outlook may vary widely between individuals. Despite the prevalence, there are no specific guidelines addressing the issue of screening, diagnosis and management of ILD across this diverse group...

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Endobronchial Ultrasound-guided Cryobiopsy of Pulmonary Artery Intimal Sarcoma

Link: https://www.atsjournals.org/doi/abs/10.1164/rccm.202309-1633IM  Petrarulo, S; Paul, S; et al. (2024). Endobronchial Ultrasound-guided Cryobiopsy of Pulmonary Artery Intimal Sarcoma. American journal of respiratory and critical care medicine. [Online]. Available at: http://dx.doi.org/10.1164/rccm.202309-1633IM [Accessed 25 April 2024].

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Effectiveness of AI-powered Chatbots in responding to orthopaedic postgraduate exam questions—an observational study

Abstract:  Purpose This study analyses the performance and proficiency of the three Artificial Intelligence (AI) generative chatbots (ChatGPT-3.5, ChatGPT-4.0, Bard Google AI®) and in answering the Multiple Choice Questions (MCQs) of postgraduate (PG) level orthopaedic qualifying examinations. Methods A series of 120 mock Single Best Answer’ (SBA) MCQs with four possible..

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Letter to editor re: Chen et al. (2024) Management of spinal cord injury patients with neurogenic lower urinary tract dysfunction...

  Day, AW; Ravichandran, S; Khadr, RN; Floyd Jr, MS. (2024). Letter to editor re: Chen et al. (2024) Management of spinal cord injury patients with neurogenic lower urinary tract dysfunction using minimally invasive and surgical therapies in Taiwan. Int Urol Nephrol 56:1205–1216. International Urology and Nephrology. epub 13 Apr. [Online]. Available at: https://link...

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Radiological angle assessment of Haglund’s deformity: validation on Magnetic Resonance Imaging

Abstract Purpose Haglund’s deformity, an abnormality at the postero-superior corner of the calcaneus is a common cause of posterior heel pain. To date numerous measurements of radiological angles related to the calcaneus have been proposed to differentiate between symptomatic and asymptomatic patients with the deformity. Traditionally, these measurements have..

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Medication-related osteonecrosis of the jaw: Shortfalls in UK-based guidance for management of established cases

Letter to the Editor. Dawar, Heather. (2024). Medication-related osteonecrosis of the jaw: Shortfalls in UK-based guidance for management of established cases. Oral Surgery. 17(4), p.393. [Online]. Available at: https://doi.org/10.1111/ors.12888 [Accessed 11 October 2024].

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Large-scale phenotyping of patients with long COVID post-hospitalization reveals mechanistic subtypes of disease

Abstract One in ten severe acute respiratory syndrome coronavirus 2 infections result in prolonged symptoms termed long coronavirus disease (COVID), yet disease phenotypes and mechanisms are poorly understood1. Here we profiled 368 plasma proteins in 657 participants ≥3 months following hospitalization. Of these, 426 had at least one long COVID symptom and 233 had fully recovered...

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Low-dose oral minoxidil improves hair length and global hair density in short anagen syndrome.

https://www.jaad.org/article/S0190-9622(24)00567-X/abstract Moussa, A; Meah, N; Et al. (2024). Low-dose oral minoxidil improves hair length and global hair density in short anagen syndrome. Journal of the American Academy of Dermatology.[Online]. Available at: https://doi.org/10.1016/j.jaad.2024.03.040 [Accessed 25 April 2024].

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Right-sided meralgia paresthetica from lateral femoral cutaneous nerve neuroma

Abstract Meralgia Paresthetica (MP) causes outer thigh discomfort, numbness, and tingling. Compression or injury to the Lateral Femoral Cutaneous Nerve (LFCN), which gives sensory innervation to outer aspect of the thigh. It frequently gets impinged beneath the inguinal ligament resulting in in sensory impairment in the distribution of LFCN. Compression..

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Neurostimulation for treatment of post-stroke impairments

Abstract Neurostimulation, the use of electrical stimulation to modulate the activity of the nervous system, is now commonly used for the treatment of chronic pain, movement disorders and epilepsy. Many neurostimulation techniques have now shown promise for the treatment of physical impairments in people with stroke. In 2021, vagus nerve stimulation..

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A practical evidence-based approach to management of type 2 diabetes in children and young people (CYP): UK consensus

Background Type 2 diabetes in young people is an aggressive disease with a greater risk of complications leading to increased morbidity and mortality during the most productive years of life. Prevalence in the UK and globally is rising yet experience in managing this condition is limited. There are no consensus guidelines..

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Cantilever Failure of Modular Uncemented Femoral Revision Stem in Patients with Poor Proximal Femoral Support; How to avoid it?

Objectives Revision hip arthroplasty is a major surgical challenge and is even more difficult in cases with a deficient proximal femur. Modular uncemented cone body revision femoral stems were introduced as a solution. They have the advantage of optimising joint kinematics by allowing the variable degrees of version, offset and..

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Clinical features of type 1 diabetes in older adults and the impact of intermittently scanned continuous glucose monitoring: An Association of British Clinical Diabetologists (ABCD) study

Aims To evaluate the clinical features and impact of flash glucose monitoring in older adults with type 1 diabetes (T1D) across age groups defined as young-old, middle-old, and old-old. Materials and Methods Clinicians were invited to submit anonymized intermittently scanned continuous glucose monitoring (isCGM) user data to a secure web-based..

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Fludarabine, Cytarabine, Granulocyte Colony-Stimulating Factor, and Idarubicin With Gemtuzumab Ozogamicin Improves Event-Free Survival...

Purpose To determine the optimal induction chemotherapy regimen for younger adults with newly diagnosed AML without known adverse risk cytogenetics. Patients and Methods One thousand thirty-three patients were randomly assigned to intensified (fludarabine, cytarabine, granulocyte colony-stimulating factor, and idarubicin [FLAG-Ida]) or standard (daunorubicin and Ara-C [DA]) induction chemotherapy, with one..

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Multiple transfusion request audit.

Abstract:  Introduction: This audit addresses practices concerning multiple blood transfusion requests of more than three units of blood, focusing on patients at Whiston Hospital, UK. Our findings highlight issues of inadequate documentation in blood transfusions, resource waste, and suggest potential process improvements. Motivation: Blood transfusions are common in hospitals but..

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Waiting Times in Prostate Cancer Diagnosis and Treatment: A Ten-Year Experience in A Nigerian Teaching Hospital

Introduction Prostate cancer is still the leading male cancer and the leading cause of cancer deaths in Nigeria, and other low- and middle-income countries (LMIC) in Sub-Saharan Africa. Early diagnosis is essential to ensuring prompt treatment and reducing morbidity and mortality. Reducing the waiting times for diagnosis and treatment is..

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Response to: ChatGPT’s limited accuracy in generating anatomical images for medical

Ajmera, P; Iyengar, KP; et al. (2024). Response to: ChatGPT’s limited accuracy in generating anatomical images for medical. Skeletal Radiology. epub 20 Mar. [Online]. Available at: https://doi.org/10.1007/s00256-024-04656-w [Accessed 19 April 2024]  

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Surgical Preparedness Index in Orthopaedics During the Coronavirus Disease 2019 (COVID-19) Pandemic.

Abstract The coronavirus disease 2019 (COVID-19) pandemic has increased the vulnerability of routine surgical procedures and elective surgery preparedness all over the world, with the suspension of most elective surgeries during the pandemic and the backlog of patients currently on waiting lists, especially in publicly funded healthcare systems. On average, at..

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Safe usage of Mini 'C'-arm in operating room environment: Implications for clinical practice

Background: Mini 'C'-arm machine is an advanced medical imaging device used primarily for intraoperative imaging during surgical, orthopaedic and emergency care procedures. Since the technology is based on ionising radiation, safe usage of Mini 'C'-arm machine is mandatory to protect patients and operating personnel. Objective: The main objective is to..

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Clinical and Immunological Profile of Systemic Lupus Erythematosus: A 5-year Retrospective Analysis from Northeast India

Objective Systemic lupus erythematosus (SLE) is a chronic inflammatory disease with a wide range of clinical manifestations having considerable variation in clinical features that are influenced by ethnic, sociocultural, and geographical factors. This disease primarily affects young women aged between 18 and 35 years. The aim of this present study was to..

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Global disparities in the treatment of idiopathic inflammatory myopathies: results from an international online survey study

Objectives: We aimed to explore current practice and interregional differences in the treatment of idiopathic inflammatory myopathies (IIMs). We triangulated these observations considering countries' gross national income (GNI), disease subtypes, and symptoms using patient-reported information. Methods: A cross-sectional ancillary analysis of the 'COVID-19 vaccination in auto-immune disease' (COVAD) e-survey containing..

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HIV-negative Kaposi sarcoma manifesting as foot lesion in a patient with diabetes mellitus: a case study

Abstract Kaposi’s sarcoma caused by Kaposi’s sarcoma-associated virus, is a rare malignancy in the general population with unique features. However, clinical presentation on the feet can mimic a diabetic foot ulcer. Here we describe the case of a 63-year-old male with type 2 diabetes, who presented with a lesion..

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Introducing the pause after the death of a patient in critical care

Abstract This article describes the implementation of holding a minute’s silence when a patient dies in Southport Critical Care Unit. It describes the rationale for the initiative, as well as the words used, and the outcomes for staff and relatives of recently deceased patients when all are given an..

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Introducing the pause after the death of a patient in critical care

Abstract This article describes the implementation of holding a minute’s silence when a patient dies in Southport Critical Care Unit. It describes the rationale for the initiative, as well as the words used, and the outcomes for staff and relatives of recently deceased patients when all are given an..

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The clinical significance of indeterminate pulmonary nodules in patients with primary bone sarcoma: a systematic review

Objective To report the incidence of indeterminate pulmonary nodules (IPN) and the rate of progression of IPNs to metastasis in patients with primary bone cancers. We also aimed to evaluate clinical or radiological parameters that may identify IPNs more likely to progress to metastatic disease and their effect on overall..

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Challenges and Clinical Relevance of Modern Breast Pathology Reporting: Your Questions Answered

Background Breast pathology reporting, especially for breast cancer, has evolved through the years, from terse succinct diagnostic conclusions with scant histological details to the current comprehensive reporting guidelines issued by major pathology colleges and bodies, including the International Collaboration on Cancer Reporting. Pathology elements included in reporting guidelines are evidence..

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Exploring the potential of ChatGPT in the peer review process: An observational study

Background Peer review is the established method for evaluating the quality and validity of research manuscripts in scholarly publishing. However, scientific peer review faces challenges as the volume of submitted research has steadily increased in recent years. Time constraints and peer review quality assurance can place burdens on reviewers, potentially..

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Teleophthalmology at a primary and tertiary eye care network from India: environmental and economic impact

Objective: To evaluate the environmental and economic impact of teleophthalmological services provided by a primary (rural) and tertiary (urban) eyecare network in India. Methods: This prospective study utilised a random sampling method, and administered an environmental and economic impact assessment questionnaire. The study included 324 (primary: 173; tertiary: 151) patients who received teleconsultations..

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An evaluation of AI generated literature reviews in musculoskeletal radiology

Purpose The use of artificial intelligence (AI) tools to aid in summarizing information in medicine and research has recently garnered a huge amount of interest. While tools such as ChatGPT produce convincing and naturally sounding output, the answers are sometimes incorrect. Some of these drawbacks, it is hoped, can be..

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Value of chemical shift imaging in the evaluation of neural foramen stenosis

Background Chemical shift Magnetic Resonance Imaging (MRI) is often routinely acquired to assess a spectrum of spinal lesions due to its ability versatility to obtain rapid sequences at the expense of spatial resolution images. It is one of the quickest sequences to acquire at the expense of spatial resolution. Objective..

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Nutrition counselling and clinical outcomes in HIV: A systematic review and meta-analysis

Background: People living with the HIV (PLHIV) are at an increased risk of various diseases due to a weakened immune system, particularly if they are naïve or poorly adherent to antiretroviral therapy (ART). Nutrients play a critical role in improving immune health, especially among this population. We systematically reviewed..

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Creating evidence-based engaging online learning resources in neuroanatomy

Online anatomical resources are rising in popularity since the COVID-19 pandemic, but the pedagogical principles and effectiveness of their use remain unclear. This article aims to demonstrate evidence-informed ways in which fellow educators can create engaging online learning resources in clinical neuroanatomy and compare the effectiveness of text-based and online..

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Acute care models for older people living with frailty: a systematic review and taxonomy

Background The need to improve the acute care pathway to meet the care needs of older people living with frailty is a strategic priority for many healthcare systems. The optimal care model for this patient group is unclear. Methods A systematic review was conducted to derive a taxonomy of acute..

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Acute care models for older people living with frailty: a systematic review and taxonomy

Background The need to improve the acute care pathway to meet the care needs of older people living with frailty is a strategic priority for many healthcare systems. The optimal care model for this patient group is unclear. Methods A systematic review was conducted to derive a taxonomy of acute..

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Internet analytics of an innovative digital educational resource of type 1 diabetes HelloType1 in local languages

Background There is minimal data of health outcomes for Type 1 Diabetes (T1D) in Southeast Asia (SEA) where government funding of insulin and blood glucose monitoring either do not exist or is limited. The full impact of Covid-19 pandemic on the national economies of SEA remain unknown. In the midst..

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Health-related quality of life following TAVI or cardiac surgery in patients at intermediate and low risk: a systematic review and meta-analysis

Abstract Recent randomised trials have shown that clinical outcomes with transcatheter aortic valve implantation (TAVI) are non-inferior to surgical aortic valve replacement (SAVR) in patients with symptomatic aortic stenosis at intermediate to low risk. Health-related quality of life (HrQoL) outcomes in these patient groups remain uncertain. A systematic search of..

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Author response to: Comment on: Will collaborative publishing with ChatGPT drive academic writing in the future?

Purpose The use of artificial intelligence (AI) tools to aid in summarizing information in medicine and research has recently garnered a huge amount of interest. While tools such as ChatGPT produce convincing and naturally sounding output, the answers are sometimes incorrect. Some of these drawbacks, it is hoped, can be..

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Author response to: Comment on: Will collaborative publishing with ChatGPT drive academic writing in the future?

Purpose The use of artificial intelligence (AI) tools to aid in summarizing information in medicine and research has recently garnered a huge amount of interest. While tools such as ChatGPT produce convincing and naturally sounding output, the answers are sometimes incorrect. Some of these drawbacks, it is hoped, can be..

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Authors’ response to the Letter to the Editor

  Ariyaratne, S; Iyengar, KP; et al. (2023). Authors’ response to the Letter to the Editor. Skeletal Radiology. 52, p.2491. [Online]. Available at: https://doi.org/10.1007/s00256-023-04418-0 [Accessed 19 April 2024]  

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Authors’ response to the Letter to the Editor

  Ariyaratne, S; Iyengar, KP; et al. (2023). Authors’ response to the Letter to the Editor. Skeletal Radiology. 52, p.2491. [Online]. Available at: https://doi.org/10.1007/s00256-023-04418-0 [Accessed 19 April 2024]  

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Association between mouth rinse use and changes in blood pressure: A systematic review and meta-analysis with trial sequential analysis

Introduction Previous randomized controlled trials have shown that the use of antiseptic mouth rinses not only eradicates oral bacteria but also disrupts their ability to convert nitrate to nitrite, which is the key molecule in regulating blood pressure (BP). Objective This study aimed to evaluate the association between the use..

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Authors’ response to the Letter to the Editor: Re-evaluating the role of AI in scientific writing: a critical analysis

  Ariyaratne, S; Iyengar, KP; et al. (2023). Authors’ response to the Letter to the Editor: Re-evaluating the role of AI in scientific writing: a critical analysis. Skeletal Radiology. 52(.), p.2489. [Online]. Available at: https://doi.org/10.1007/s00256-023-04405-5 [Accessed 19 April 2024]  

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Authors’ response to the Letter to the Editor: Re-evaluating the role of AI in scientific writing: a critical analysis

  Ariyaratne, S; Iyengar, KP; et al. (2023). Authors’ response to the Letter to the Editor: Re-evaluating the role of AI in scientific writing: a critical analysis. Skeletal Radiology. 52(.), p.2489. [Online]. Available at: https://doi.org/10.1007/s00256-023-04405-5 [Accessed 19 April 2024]  

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What’s this?

A 35-year-old lady presents to accident and emergency with a history of progressively worsening dysphagia for 8 months. Chest X-ray shows a dilated oesophagus and absence of air in the stomach. Barium swallow reveals the bird’s beak sign and oesophageal dilatation. Paracha, M; Cheema, K.T.; Et al. (2021). What’s..

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Omnipod5 Real-World Data from the First Pediatric Users' Universal Coverage Under the UK National Health Service. 

Abstract: Background: Hybrid closed-loop (HCL) systems combine continuous glucose monitoring (CGM) with insulin pumps to automate insulin delivery through specific algorithms and user input. This real-world study aimed to evaluate the effectiveness of the Omnipod5 HCL system on HbA1c, time-in-range (TIR), hypoglycemia frequency, and sensor glucose variability over 3 and 6..

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Use of Botulinum Toxin Injections in the Treatment of Cold Intolerance

Abstract There is currently no consensus on the treatment of cold intolerance in extremities in post-trauma patients. We aim to present two cases where botulinum toxin type A injections were used to improve symptoms of cold intolerance. Botulinum toxin type A (Allergan) was injected into the area around the palmar..

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Diffuse Lichen Planopilaris Masquerading as Diffuse Alopecia Areata

Introduction Lichen planopilaris (LPP) is a primary lymphocytic cicatricial alopecia that represents a form of follicular lichen planus. Case Presentation We describe a case of coexisting diffuse LPP and female pattern hair loss masquerading as diffuse alopecia areata in a 32-year-old female. Discussion In complex cases such as this, dermoscopy-guided..

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Poster 80: Developing a hospital based transition MDT in an acute teaching hospital

Introduction Moving from Paediatrics to an Adult setting is difficult for any patient and family. Having been involved with a particular young adult, I was made very aware. Moving from paediatrics palliative care to adult care is huge. Being admitted to an adult ED or AMU will be traumatic and..

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Leg Lymphoedema After Inguinal and Ilio-Inguinal Lymphadenectomy for Melanoma: Results from a Prospective, Randomised Trial

Background The Evaluation of Groin Lymphadenectomy Extent for Melanoma (EAGLE FM) study sought to address the question of whether to perform inguinal (IL) or ilio-inguinal lymphadenectomy (I-IL) for patients with inguinal nodal metastatic melanoma who have no clinical or imaging evidence of pelvic disease. Primary outcome measure was disease-free survival..

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Evaluating the utility of quantitative pupillometry in a neuro-critical care setting for the monitoring of intracranial pressure

Introduction Assessment of the pupillary light reflex (PLR) is key in intensive care monitoring of neurosurgical patients, particularly for monitoring intracranial pressure (ICP). Quantitative pupillometry using a handheld pupillometer is a reliable method for PLR assessment. However, many variables are derived from such devices. We therefore aimed to assess the..

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Carbon dioxide laser for precise and bloodless contouring of soft tissue ahead of skin grafting–A case example of technique and benefits

Abstract Scarring is a dynamic development as a result of the wound healing process. Post-burn scars are often hypertrophic in nature and thus exhibit a much thicker and firmer scar, often leading to contractures. Various strategies have been implemented by burns surgeons to endeavour to mitigate and improve such symptoms..

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How can technology be used to support communication in palliative care beyond the covid-19 pandemic

Background Developments in digital health have the potential to create new opportunities for healthcare professionals support delivery of palliative care. Globally, many palliative care professionals used digital health innovations to support communication with staff, patients and caregivers, during COVID-19 pandemic. However, there is limited data about the views of palliative..

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Accuracy of PET/CT in the diagnosis of pelvic lymph node metastases in melanoma: A subgroup analysis of the evaluation of groin lymphadenectomy extent for metastatic melanoma (EAGLE-FM) trial

Background PET/CT is widely used in the staging of patients with melanoma groin lymph node (LN) metastases. This study aims to utilise prospectively collected data to determine the accuracy of this modality in the diagnosis of pelvic metastases in those patients with known inguinal LN involvement.   Russell, M; Pritchard-Jones,..

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Albumin Levels and Risk of Early Cardiovascular Complications After Ischemic Stroke: A Propensity-Matched Analysis of a Global Federated Health Network

Background No studies have investigated the association between albumin levels and the risk of early cardiovascular complications in patients with ischemic stroke. Methods Retrospective analysis with a federated research network (TriNetX) based on electronic medical records (International Classification of Diseases-Tenth Revision-Clinical Modification and logical observation identifiers names and codes) mainly..

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The Alopecia Areata Severity and Morbidity Index (ASAMI) Study

Importance Current measures of alopecia areata (AA) severity, such as the Severity of Alopecia Tool score, do not adequately capture overall disease impact. Objective To explore factors associated with AA severity beyond scalp hair loss, and to support the development of the Alopecia Areata Severity and Morbidity Index (ASAMI). Evidence..

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Mechanical circulatory support and its implications for anaesthesia and critical care

Abstract Mechanical circulatory support is an increasingly important strategy for the treatment of a subset of patients with acute heart failure. Use of extracorporeal circuits with pumps and oxygenators to augment cardiac function can be immediately lifesaving, whereas implantable therapies can allow patients, with advanced heart disease, to resume near..

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Left Atrial Appendage Occlusion Versus Direct Oral Anticoagulants in the Prevention of Ischaemic Stroke in Patients with Atrial Fibrillation

Introduction Existing randomised controlled trials assessing the safety and efficacy of left atrial appendage occlusion (LAAO) in atrial fibrillation (AF) were of relatively small sample size, or included patients who could receive oral anticoagulant treatment after device implantation. We compared the outcomes of patients with newly diagnosed AF who received..

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Exploration of the circulating human secretome through protein quantitative trait analysis...

Background Glucocorticoid monotherapy remains the principal treatment for giant cell arteritis (GCA), yet concurrent toxicity and adverse effects highlight the need for targeted therapies and improved risk stratification. Previous work suggests that evidence of genetic association can improve success rates in clinical trials and identify biomarkers for risk assessment, particularly..

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Acceptability and feasibility of an app to prepare children for a blood test: An exploratory cohort study.

Conclusion: Xploro was reported as being a useful and engaging self-directed child-friendly information app for children having a planned blood test which helped children know what was going to happen and improved their experiences of having a blood test. Bray, L; May Ng, Sze; Pyke, L; Et al. (2024). Acceptability and..

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Ten-Year Analysis of Bacterial Colonisation and Outcomes of Major Burn Patients with a Focus on Pseudomonas aeruginosa

Abstract: A retrospective descriptive study included patients admitted with severe burns over the course of 10 years (2008–2018). Across all patients, there were 39 different species of bacteria, with 23 species being Gram-negative and 16 being Gram-positive bacteria, with also five different species of fungi cultured. Pseudomonas aeruginosa was the most commonly isolated organism, with 57.45%..

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Ibrutinib as first line therapy for mantle cell lymphoma: A multicentre, real-world UK study

Abstract During the Covid-19 pandemic, ibrutinib +/- rituximab was approved in England for initial treatment of mantle cell lymphoma (MCL) instead of immunochemotherapy. As limited data are available in this setting, we conducted an observational cohort study evaluating safety and efficacy. Adults receiving ibrutinib +/- rituximab for untreated MCL were..

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Changes in prescribing of psychotropic vs some physical health medication in primary care through the COVID-19 pandemic

Introduction The COVID-19 pandemic globally impacted healthcare provision. Prescribing changes in common medications can be used as a marker for new diagnoses. We describe how the prescribing of specific psychotropics was impacted by the pandemic. Methods Primary Care Prescribing data for different classes of drugs from March 2017 to February 2022 were..

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The importance of creating a positive learning environment for student nurses

  Thomas, V. (2023). The importance of creating a positive learning environment for student nurses: the value of good quality nurse education and the influence this has in future practice. Dermatological Nursing. 22(4), pp.29-31

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Validation of the brain injury associated visual impairment - impact questionnaire (BIVI-IQ)

Purpose The Brain Injury associated Visual Impairment - Impact Questionnaire (BIVI-IQ) was developed to assess the impact of post-stroke visual impairment. The development of the questionnaire used robust methods involving stroke survivors and clinicians. The aim of this study was to assess the validity of the BIVI-IQ in a stroke..

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Discussion: Immediate Breast Reconstruction in Skin-Reducing Mastectomy with Prepectoral Polyurethane (PU) Implant Covered with an Autologous Dermo-Adipose Flap.

Taghizadeh, R. (2024). Discussion: Immediate Breast Reconstruction in Skin-Reducing Mastectomy with Prepectoral Polyurethane (PU) Implant Covered with an Autologous Dermo-Adipose Flap. Aesthetic Plastic Surgery. 48(15), pp.2839-2841. [Online]. Available at: http://dx.doi.org/10.1007/s00266-023-03760-x [Accessed 14 August 2024].

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Social determinants of health and clinical outcomes among patients with atrial fibrillation: evidence from a global federated health research network

Abstract:  To investigate the relationship between SDoH and adverse events in a large multinational AF cohort. Design Retrospective study utilizing a global federated health research network (TriNetX). Methods Patients with AF were categorized as socially deprived defined according to ICD codes based on three SDoHs: (i) extreme poverty; (ii) unemployment;..

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Social determinants of health and clinical outcomes among patients with atrial fibrillation: evidence from a global federated health research network

Background Few studies have investigated the role of social determinants of health (SDoH) in patients with atrial fibrillation (AF). Aim To investigate the relationship between SDoH and adverse events in a large multinational AF cohort. Design Retrospective study utilizing a global federated health research network (TriNetX). Methods Patients with AF..

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Letter to the editor regarding are plastic surgery trainees accurate assessors of their own microsurgical skill?

Abstract We read with interest the article ‘Are Plastic Surgery Trainees Accurate Assessors of Their Own Microsurgical Skill?’1 as we are surgical trainees currently honing our microsurgical skills.   Masterton, G; Evans, N. (2024). Letter to the editor regarding are plastic surgery trainees accurate assessors of their own microsurgical skill?. JPRAS Open. 39,..

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Analysis from the Society for Acute Medicine Benchmarking Audit 2022 and comparison with performance 2019 - 2021

Abstract Urgent and emergency care services face increasing pressure, impacting patient care. We evaluated the performance of acute medicine services, assessing clinical quality indicators for unplanned medical admissions to acute hospital services. 152 acute UK hospital services accepting unplanned admissions to acute and general internal medicine completed a day-of-care survey incorporating..

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Do we fully understand the impact of cosmetic surgery on our NHS and are we planning for the increased burden?

Abstract We read with interest the article “Managing complications following cosmetic surgery after the COVID pandemic: A study of a year at a NHS plastic surgery unit” 1 ; given we too work within a NHS plastic surgery unit.   Masterton, G; Evans, N. (2024). Do we fully understand the impact of cosmetic surgery..

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Multi-nodal basin drainage in lower limb melanoma

Summary Lymph node status is an important factor that influences outcomes in melanoma. Whilst certain anatomical areas have multiple-nodal basin drainage, limb melanomas are thought to have more predictable lymphatic drainage patterns, with lower limb melanomas reliably draining to the corresponding ipsilateral inguinal lymph node basin with occasional popliteal drainage...

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Assessing and further developing age-appropriate information for young people about reporting suspected adverse drug reactions

Aims The Medicines and Healthcare products Regulatory Agency Yellow Card scheme (YCS) is the UK's system that collects spontaneous reports about suspected adverse drug reactions (ADRs). Reporting of suspected ADRs by young people (age

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The impact of socioeconomic deprivation on the prevalence of gestational diabetes: An observational study

Background Approximately 3.5% of pregnancies in the United Kingdom are complicated by gestational diabetes mellitus (GDM). Risk factors for this mirror those contributing to type 2 diabetes (T2DM). Though socioeconomic status (SES) is presumed to contribute to GDM, evidence in the United Kingdom is limited. In this unique study, we explored..

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Atrial Fibrillation and Stroke: State-of-the-art and future directions

Introduction Stroke is a major complication of atrial fibrillation (AF). About 25% of ischaemic stroke are cardio-embolic in origin; AF is the most common cause of those.1 Nonvalvular AF carries a 5-fold increased risk of stroke,2 while AF related to mitral stenosis increases the risk of stroke by 20-fold.3 The attributable..

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Haemorrhagic cholecystitis in a young patient, complicated by gallbladder perforation and choledocholithiasis

Abstract Haemorrhagic cholecystitis is a rare condition associated with a high risk of morbidity and mortality. Its pathophysiology is thought to be due to gallbladder wall erosion and infarction secondary to inflammation, which subsequently leads to haemorrhage into the gallbladder lumen or the peritoneal cavity. There is no current official..

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Initiation of continuous renal replacement therapy versus intermittent hemodialysis...

Background There is controversy regarding the optimal renal-replacement therapy (RRT) modality for critically ill patients with acute kidney injury (AKI). Method We conducted a secondary analysis of the STandard versus Accelerated Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial to compare outcomes among patients who initiated RRT with either..

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Small bowel obstruction secondary to phytobezoar in a patient with myotonic dystrophy

Abstract A male patient in his 30s, with myotonic dystrophy (DM), presented to the emergency department with abdominal pain and vomiting. CT imaging revealed a soft tissue lesion in the terminal ileum causing small bowel obstruction (SBO). The patient underwent diagnostic laparoscopy which allowed identification and removal of the obstructing..

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Ancient genomes illuminate Eastern Arabian population history and adaptation against malaria

Abstract The harsh climate of Arabia has posed challenges in generating ancient DNA from the region, hindering the direct examination of ancient genomes for understanding the demographic processes that shaped Arabian populations. In this study, we report whole genome sequence data obtained from four Tylos-period individuals from Bahrain. Their genetic..

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Is the Current Cut Point for Glycated Haemoglobin (HbA1c) Correct for Diagnosing Diabetes Mellitus in Premenopausal Women? Evidence to Inform Discussion

Abstract Women are on average diagnosed with diabetes mellitus at later age than men but have higher mortality. As the diagnosis of diabetes mellitus is primarily based on HbA1c, the use of a non-specific reference range and cut point for diabetes mellitus that does not account for gender differences..

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Radiology reporting of incidental osteoporotic vertebral fragility fractures present on CT studies: results of UK national re-audit

Aim To describe a UK-wide re-audit of the 2019 Royal College of Radiologists (RCR) audit evaluating patient-related data and organisational infrastructure in the radiological reporting of vertebral fragility fractures (VFFs) on computed tomography (CT) studies and to assess the impact of a series of RCR interventions, initiated to raise VFF awareness,..

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Letter to the editor: Comparison of perineal urethrostomy versus augmentation urethroplasty in anterior urethral stricture disease.

Pina, IM; Omar, A; Floyd Jr MS. (2023). Letter to the editor: Comparison of perineal urethrostomy versus augmentation urethroplasty in anterior stricture disease. Urologia Journal. Epub 23 September [Online]. Available at: https://dx.doi.org/10.1177/03915603231199809 [Accessed 04 January 2023]

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Society for Acute Medicine’s Patients: Learning from Experience Report (SAM-PLER) A service evaluation of patient reported experience in Acute Medicine – establishing the feasibility of a quality improvement collaborative

Abstract Patient reported experience measures (PREMS) are a key part of measured quality. There is no tool currently used in the UK in Acute Medicine. On the 8th of September 2022 10 units based in England, Scotland and Wales collected data for the validated PREM, alongside the EQ-5D and variables from..

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Video 2: 2nd stage Urethroplasty for distal Urethral BXO

Introduction 2nd stage Urethroplasty involves tubularising the new urethral plate over a catheter, fashioning a new meatus and closing the distal urethra. Typically, this occurs 9 months after a 1st stage BUMG replacement. Methods Meatal apposition is assessed and distal urethral calibre gauged with a sound. The inner and outer urethral..

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Demographics and Outcomes of 1st stage BUMG Urethroplasty for BXO: The Whiston Hospital experience

Abstract There is currently no consensus on the treatment of cold intolerance in extremities in post-trauma patients. We aim to present two cases where botulinum toxin type A injections were used to improve symptoms of cold intolerance. Botulinum toxin type A (Allergan) was injected into the area around the palmar..

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Anastomotic Urethroplasty: The Whiston Hospital experience

Introduction Recurrent bulbar strictures under 2 cm are treated with anastomotic urethroplasty. The purpose of this study was to analyse the aetiologies and validated outcomes of anastomotic urethroplasty in a tertiary centre Methods All anastomotic urethroplasties performed by a single Urologist were analysed. Age, prior urethrotomies, presence of a suprapubic catheter,..

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A Longitudinal Clinical Trajectory Analysis Examining the Accumulation of Co-morbidity in People with Type 2 Diabetes (T2D) Compared with Non-T2D Individuals.

Abstract Type 2 diabetes mellitus (T2D) is commonly associated with an increasing complexity of multimorbidity. While some progress has been made in identifying genetic and non-genetic risk factors for T2D, understanding the longitudinal clinical history of individuals before/after T2D diagnosis may provide additional insights. Methods In this..

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Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing..

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A second update on mapping the human genetic architecture of COVID-19

Extract Investigating the role of host genetic factors in COVID-19 severity and susceptibility can inform our understanding of the underlying biological mechanisms that influence adverse outcomes and drug development1,2. Here we present a second updated genome-wide association study (GWAS) on COVID-19 severity and infection susceptibility to SARS-CoV-2 from the COVID-19..

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Mortality from diabetic kidney disease before and during the COVID pandemic

Background and aims We have previously published 5-and 10-year audits from our UK diabetes kidney clinic reporting outcomes comparable to those in landmark trials of diabetic kidney disease in broadly similar patients. This 2023 (20-year) audit again showed practice consistent with NICE, ADA and Kidney Disease Improving Global Outcomes guidelines, but..

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Real world safety of methoxyflurane analgesia in the emergency setting: a comparative hybrid prospective-retrospective post-authorisation safety study.

Abstract Low-dose analgesic methoxyflurane (Penthrox R) was approved in Europe for emergency relief of moderate to severe pain in conscious adults with trauma in 2015. A comparative post-authorisation safety study (PASS) was conducted to assess the risk of hepatotoxicity and nephrotoxicity with methoxyflurane during routine clinical practice. Methods This was a..

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Evaluation of the 'Clicky' Hip in the Diagnosis of Developmental Dysplasia of the Hip (DDH).

Abstract Early detection of developmental dysplasia of the hip (DDH) is associated with improved outcomes of conservative treatment. Therefore, we aimed to evaluate the use of a 'clicky' hip as an indication for secondary assessment as per the British Society for Children's Orthopaedic Surgery (BSCOS) consensus statement. Method Prospective cohort..

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205 Single-Centre Review on Incisional Hernia After Laparoscopic Anterior Resection: What Is the Ideal Incision for Specimen Extraction?

Abstract Midline incision was reported as the common site of incisional hernia (IH) after hand-assisted laparoscopic anterior resection (LAR). There is no consensus on the ideal site for specimen extraction. Our aim was to compare the rate of IH at various specimen extraction sites at our institution. Method We retrospectively..

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An Audit to Evaluate the Prevalence and Efficiency of the 'Acute Abdomen Pathway' Proforma Used in a Large District General Hospital.

Abstract The 'acute abdomen pathway' was introduced with the aim of early identification of patients with an acute abdomen and once identified to increase the efficiency of imaging, senior review and if required surgical intervention. We audited how this pathway was being used by clerking doctors and its benefits to..

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The Patient Demographic Details of Referrals for Risk Reducing Breast Surgery and Reconstruction to St Helen's and Knowsley Teaching Hospitals Over a 5 Year Period.

Abstract Breast cancer is the most common cause of cancer in women affecting 1 in 7 women in the UK. Hereditary breast cancers are present in up to 10% of all cases and are most commonly related to BRCA gene mutations. Bilateral risk reducing mastectomy (RRM) +/- reconstruction is the most effective strategy..

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Handwritten Operative Note Compliance in Plastic Surgery.

Abstract Accurate and comprehensive documentation of operations is crucial to optimise patient care. Omissions may cause compromised management, or medicolegal issues. A closed-loop audit was completed at a plastic surgery centre to identify whether Royal College of Surgeons (RCS) standards were met. It aimed to identify and address limitations of..

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Incidence of Incisional Hernia Post-Colorectal Liver Metastasis Resection - a Longitudinal Radiological Cohort Study.

Abstract The aim of this study is to determine the incidence and time to development of incisional hernia (IH) in post partial hepatectomy (PH) for colorectal liver metastases (CRLM) patients to enable surgeons to prepare and accurately consent patients for the operations. Method The radiological images and reports of all..

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220 A Systematic Review on Under-Recognized Condition: Duodenogastric Reflux After Cholecystectomy

Aim Midline incision was reported as the common site of incisional hernia (IH) after hand-assisted laparoscopic anterior resection (LAR). There is no consensus on the ideal site for specimen extraction. Our aim was to compare the rate of IH at various specimen extraction sites at our institution. Method We retrospectively..

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Lack of regional pathways impact on surgical delay: Analysis of the Orthopaedic Trauma Hospital Outcomes–Patient Operative Delays (ORTHOPOD) study

Introduction Current practice following injury within the United Kingdom is to receive surgery, at the institution of first contact regardless of ability to provide timely intervention and inconsiderate of neighbouring hospital resource and capacity. This can lead to a mismatch of demand and capacity, delayed surgery and stress within hospital..

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A study to investigate genetic factors associated with weight gain in people with diabetes: analysis of polymorphisms in four relevant genes

Abstract Background Weight change is often seen in people with diabetes. We investigated the effects of genes associated with weight change/glucose handling/insulin-signalling. Materials/methods DNA from diabetes individuals and non-diabetes individuals, plus clinical data, were available from the DARE study (n = 379 individuals: T1D n = 111; T2D n = 222;..

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Hybrid Closed-Loop Therapy in Adults With Type 1 Diabetes and Above-Target HbA_1c: A Real-world Observational Study

Abstract Objective We explored longitudinal changes associated with switching to hybrid closed-loop (HCL) insulin delivery systems in adults with type 1 diabetes and elevated HbA1c levels despite the use of intermittently scanned continuous glucose monitoring (isCGM) and insulin pump therapy. Research Design and Methods We undertook a pragmatic, preplanned observational..

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Hallux Varus

Introduction Hallux varus is a clinical condition characterized by medial deviation of the great toe at metatarsophalangeal (MTP) joint. This condition may present with varying degrees of severity, causes, and symptoms. Adult acquired hallux varus deformity is commonly iatrogenic, commonly resulting from surgery for hallux valgus. A patient may have..

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Performance of admission pathways within acute medicine services: Analysis from the Society for Acute Medicine Benchmarking Audit 2022 and comparison with performance 2019 - 2021.

Abstract  Urgent and emergency care services face increasing pressure, impacting patient care. We evaluated the performance of acute medicine services, assessing clinical quality indicators for unplanned medical admissions to acute hospital services. 152 acute UK hospital services accepting unplanned admissions to acute and general internal medicine completed a day-of-care survey incorporating..

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Cohort study of short-term outcomes after ACL-reconstruction using autograft with internal brace reinforcement versus isolated autograft demonstrating no significant difference

Abstract Background The gold standard treatment for Anterior Cruciate Ligament injury is reconstruction (ACL-R). Graft failure is the concern and ensuring a durable initial graft with rapid integration is crucial. Graft augmentation with implantable devices (internal brace reinforcement) is a technique purported to reduce the risk of rupture and hasten..

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Association Between Depression and Anxiety Status With Uptake of Colorectal Cancer Screening Among US Adults: A Population-Level Study

Background Individuals with different mental disorders tend to experience higher rates of colorectal cancer (CRC)-related mortality compared to the general population. Discrepancies in CRC screening behaviors have been suggested as a potential contributing factor to this difference in mortality. However, existing evidence on this topic has been inconclusive and..

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Association Between Depression and Anxiety Status With Uptake of Colorectal Cancer Screening Among US Adults: A Population-Level Study.

Abstracts  Individuals with different mental disorders tend to experience higher rates of colorectal cancer (CRC)-related mortality compared to the general population. Discrepancies in CRC screening behaviors have been suggested as a potential contributing factor to this difference in mortality. However, existing evidence on this topic has been inconclusive and..

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Preputial advancement flap for delayed urethrocutaneous fistula of the glans following urethral insertion of an ‘AAA’ battery

Abstract Introduction Foreign body insertion associated with sexual gratification is known as polyembolokoilomania. Following removal of the foreign body, long-term complications are infrequently seen. Whilst conservative and endoscopic approaches usually suffice, in extreme cases open surgical approaches are required. We describe an unusual case of polyembolokoilomania in a 25-year-old male..

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MANAGEMENT OF OSTEOARTHRITIS AND JOINT PROBLEMS IN SEMI-RURAL INDIA.

Abstract This is a retrospective presentation of patients who were treated under the author's care in Eastern India over a period of 13 years. The aim of the this study was to identify and addressing the difficulties faced by the patients in accessing appropriate care and the obstacles in educating and..

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Carpal Tunnel Decompression Under Wide Awake Local Anaesthesia No Tourniquet Technique (WALANT): A Cost Effective and Outcome Analysis

Abstract Introduction Wide-awake local anaesthesia with no tourniquet (WALANT) technique is cost-effective, resource-friendly, and safe. This can be used as an alternative to hand surgery procedures in outpatient units. It can be performed in clinics or operating rooms. Methods We retrospectively evaluated the outcomes of WALANT for carpal tunnel decompression (..

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PP-306 An adipose derived decellularised extracellular matrix as a biomaterial for tissue engineering of soft tissue

Introduction Vascularised tissue transplants are currently used to reconstruct soft tissue defects caused by trauma, cancer or infection but is not without its limitations and risks. Decellularised extracellular matrix are tissues that have been processed to remove cellular content whilst retaining its network of structural proteins, glycoproteins and adhesion proteins,..

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Commentary on: Repair of Congenitally Defective Types of Earlobe Clefts With Residual Lobular Tissue: A Convenient and Effective Surgical Technique

Extract Innovation in surgical technique is a cornerstone of advancing surgical care. The authors describe a new surgical technique that utilizes residual lobular tissue anterior and inferior to the ear to form a new earlobe.1 The authors believe that this approach brings a number of advantages including a fuller, more..

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Stroke–heart syndrome: mechanisms, risk factors, and adverse cardiovascular events

Extract New-onset cardiovascular complications following an ischaemic stroke, hereafter termed stroke–heart syndrome, are a major medical challenge of the 21st century, yet are under-recognized and under-researched.1,2 Acutely, stroke–heart syndrome associates with poorer functional prognosis and increased mortality following stroke.3 In the long term, stroke–heart syndrome associates with..

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Machine-learning derived heart and brain age are independently associated with cognition

Cameron, A.C.; Lip, Y.H.; Abdul-Rahim, AH. (2023). Machine-learning derived heart and brain age are independently associated with cognition. European Journal of Neurology. epub 23 June(.), p... [Online]. Available at: https://doi.org/10.1111/ene.15953 [Accessed 26 June 2023]  

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P039 Adult onset Varicella zoster infection presenting as probable Mpox (Monkeypox)

  Introduction A 56 year old cis-male who has sex with men (MSM) presented to our semi-rural Genitourinary Medicine (GUM) service with fever, rigors, arthralgia, lymphadenopathy, headache and rash. He had recently returned from Gran Canaria and was triaged as a probable case of Mpox. Methods He had a past medical history..

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P165 Rates of isolated extragenital chlamydia trachomatis and neisseria gonorrhoeae in heterosexual patients attending a sexual health clinic

Abstract Introduction BASHH guidance advises offering testing at extra genital sites for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) dependant on sexual history in heterosexual males and females. We examined the roll out of offering routine additional extragenital testing in heterosexual patients attending the sexual health clinic. Methods Genitourinary Medicine..

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External validation of the Oldham composite Covid-19 associated mortality model (OCCAM), a prognostic model for death in patients hospitalised with Covid-19

Objective External validation of the Oldham Composite Covid-19 associated Mortality Model (OCCAM), a prognostic model for Covid-19 mortality in hospitalised patients comprised of age, history of hypertension, current or previous malignancy, admission platelet count < 150 × 103/µL, admission CRP ≥ 100 µg/mL, acute kidney injury (AKI), and radiographic evidence of > 50% total lung field..

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732 An audit of admission into a high-dependency unit of a large district general hospital. Is there compliance with national guidance?

Abstract Objective To audit the reasons for admission to the Paediatric high dependency unit (PHDU) using the Paediatric critical care society (PCCS) criteria for PHDU admission (1). To review the demography of children admitted and the duration of admission. Method This was a retrospective audit of children < 18 years old admitted to..

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369 The role of children’s hospitals in reducing health inequalities: a review of organisational policies

Abstract Objectives Health inequalities are ‘avoidable, unfair and systematic differences in health between different groups of people’, including differences in access to care and quality of healthcare received.1 The Children’s Hospital Alliance (CHA) is a group of English children’s hospitals, collaborating through the National Paediatric Accelerator Programme.2 This..

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P26 Standardising outpatient care for primary biliary cholangitis patients in a hospital trust

Abstract Introduction Primary biliary cholangitis (PBC) is a progressive autoimmune mediated cholangiopathy. There are well recognised treatments for both the underlying disease and symptom control highlighted by British Society of Gastroenterology (BSG) guidelines. Anecdotally, clinical practice does not reflect this. One likely reason is that patients are seen in various..

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P250 RNASeq identifies differential gene expression in colorectal and duodenal adenomas in familial adenomatous polyposis (FAP)

Abstract Introduction Familial adenomatous polyposis (FAP) is an autosomal dominant condition caused by a germline mutation in the APC gene (Campos et al., 2015). Patients develop hundreds to thousands of polyps along their intestinal tract in the second and third decades of life (Vasen et al., 2008). Without prophylactic colectomy, the lifetime..

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P40 Re-engagement of haemochromatosis service users to provide best practice

Abstract Introduction Haemochromatosis is a medical condition that causes patient to absorb too much iron from their diet. This can accumulate around the body over time, damaging many organs and eventually causing disease. Inheritance of a faulty gene is responsible for an increase in the amount of iron in the..

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Opioid use and associated factors in 1676 patients with inflammatory bowel disease: a multicentre quality improvement project

Objective Despite its association with poorer outcomes, opioid use in inflammatory bowel disease (IBD) is not well characterised in the UK. We aimed to examine the extent of opioid use, the associated factors and the use of mitigation techniques such as pain-service review and opioid weaning plans among individuals with..

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Current concepts in the management of “Terrible Triad” injuries of the elbow

Abstract Terrible triad injuries of the elbow are complex injuries which can result in long term complications and significant disability. They must be identified correctly, and managed appropriately in order to maximise functional outcomes. A clear understanding of the bony and ligamentous anatomy is essential to plan appropriate surgical reconstruction..

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1056-P: Impact of Individualized HbA1c Target Setting on Diabetes-Distress, Self-Efficacy, Well-Being, and HbA1c

Abstract American Diabetes Association guidelines emphasize the importance of individualized HbA1c target setting in glycemic management, but little is known of the impact of target-setting on patient well-being. We randomized 50 adults (type 1 or 2) to receive HbA1c targets 5 mmol/mol (0.5%) above or below current value and evaluated impact on..

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Risk of myocardial infarction and ischemic stroke in individuals with first-diagnosed paroxysmal vs. non-paroxysmal atrial fibrillation under anticoagulation

Aims There is conflicting evidence on whether the type of atrial fibrillation (AF) is associated with risk of cardiovascular events, including acute myocardial infarction (MI) and ischemic stroke. The aim of the present study was to investigate whether the risk of MI and ischemic stroke differs between individuals with first-diagnosed..

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Epilepsy-Heart Syndrome: Incidence and Clinical Outcomes of Cardiac Complications in patients with Epilepsy

Background The risks of cardiovascular events(CVEs) in people with epilepsy(PWE) are not well understood. Objectives To establish the short- and long-term burden of CVEs in PWE. Methods Electronic health records from a global federated health research network(TriNetX) were used to establish a cohort of PWE. Primary outcomes..

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P 12.018 Specialist Palliative Care at the Front Door

Background and aims At a time of significant pressure within the NHS, patients with palliative care needs often present to the emergency department in crisis. This makes the ED an important site for specialist palliative care assessment. It is widely recognised that 40 million people a year globally will require palliative..

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A COMPARISON OF AGE-BANDED AND WEIGHT-BASED ORAL PARACETAMOL DOSING IN HOSPITALISED CHILDREN.

Abstract: The British National Formulary for Children contains two dosing strategies for oral paracetamol: age-banded and weightbased. Weight-based is used in our hospital. This study compares dosing strategies in inpatients. Retrospective analysis over 4 years was undertaken in a single tertiary paediatric hospital. Data was collected from electronic patient records. Patients 3..

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Association between enteral feeding and gastrointestinal complications in children receiving extracorporeal life support...

Background Extracorporeal life support is an accepted treatment modality for children with severe cardiac and/or respiratory dysfunction. However, after a period of inadequate gut perfusion, clinicians are often reluctant to initiate enteral nutrition. Methods This was a retrospective cohort study in a single large pediatric intensive care unit in..

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Morton Neuroma

Introduction Morton neuroma is a compressive neuropathy of the forefoot interdigital nerve. Neuropathy is mainly due to compression and irritation at the plantar aspect of the transverse intermetatarsal ligament. It is not a true neuroma as the condition is degenerative rather than neoplastic. It is also referred to as Morton..

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Delayed diagnosis of a scaling genodermatosis

Description A man in his early 60s presented to the dermatology clinic with a lifelong history of dry, scaling skin. He had congenital deafness but no other medical problems. He had received a diagnosis of ichthyosis vulgaris several years ago and was treating the condition with topical emollients. Further questioning..

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642 Impact of bridging therapy vs endovascular thrombectomy alone on outcomes in anticoagulated patients with atrial fibrillation presenting with mild-moderate ischaemic stroke

Background and aims The aim was to assess the impact of bridging intravenous thrombolysis (IVT) before endovascular thrombectomy (EVT), compared to EVT alone, in anticoagulated patients with atrial fibrillation (AF) presenting with mild-moderate acute ischaemic stroke. Method(s) A retrospective analysis (01/09/2018-01/09/2022) using a global health research network was conducted...

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The Optimal Management for People with Acute Stroke and Minor Deficits: Intravenous Thrombolysis or Medical Management?

Cameron, AC and Abdul-Rahim, AH. (2023). The Optimal Management for People with Acute Stroke and Minor Deficits: Intravenous Thrombolysis or Medical Management?. Thrombosis and Haemostasis. e-pub 12 May(.), p... [Online]. Available at: https://www.thieme-connect.de/products/ejournals/abstract/10.1055/a-2077-5642 [Accessed 12 June 2023].

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O132 Preliminary results of radiofrequency ablation for haemorrhoidal disease at a district general hospital

Introduction Haemorrhoidal disease (HD) is a common perianal condition. There is still limited data on the role of minimally invasive surgery for HD. The aim of our study was to report the outcome of radiofrequency ablation of haemorrhoids under local anaesthetic (RAFAELO) at our institution. Methods 23 patients who had a..

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Use of volar distal radius plate dorsally for wrist arthrodesis in patients with upper limb spasticity: A retrospective

Summary Standard wrist arthrodesis implants are generally designed for adult joints with arthritis. They are often too big for patients with limb spasticity who generally tend to have osteopenic and smaller bones for their age, resulting in high complication rates. We previously described the novel use of volar distal radius..

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A bibliometric analysis of publication trends in UK plastic surgery

Introduction Publication is seen as the pinnacle of academia and is actively encouraged from an early stage in a junior doctor's career. It forms the bedrock of evidence-based practice, allowing clinicians and researchers to share experiences which may lead to an improvement in patient outcomes. High quality research with robust..

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P281 Impact of pre-pregnancy counselling on HbA1c level and pregnancy outcomes in women with pre-existing diabetes

Aims The aim of our study was to assess uptake of pre-pregnancy counselling and its impact on HbA1c level. We looked to establish whether lower HbA1c levels and counselling improved outcomes in pregnant women with pre-existing diabetes. Methods Electronic record of all pregnant women with pre-existing diabetes booked..

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P280 Impact of introducing an intensive support package alongside continuous glucose monitoring on neonatal outcomes and...

Aims The National Diabetes in Pregnancy Audit in 2020 demonstrated that the percentage increase of women with type 1 diabetes under our service achieving an HbA1c

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P277 Patient and public involvement (PPI) exploring the experiences of women with gestational diabetes...

Aim Gestational Diabetes (GDM) affects 1 in 23 UK pregnancies and can lead to adverse maternal & neonatal outcomes. PPI empowers those affected by a condition to influence future care. The aim of this project was to explore the experiences of GDM care for a group of women and their partners attending a..

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P137 Follow up screening for diabetes after gestational diabetes 2019 versus 2022

Aims NICE guidelines for screening state that all GDM patients should be screened for diabetes at 6 to 12 weeks postpartum. Previous published data have given a national rate of less than 20% [1]. Our previously published data showed a 45% follow up [2]. We re-reviewed our screening rate after the interventions of: discussion with and..

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A62 (P227) Risk of 12-month mortality following a severe inpatient hypoglycaemic event...

Aims At our Trust, all severe inpatient hypoglycaemic episodes in individuals with diabetes (defined as a hypoglycaemic episode requiring injectable treatment) are reported to NaDIA-Harms (National Diabetes Inpatient Audit). We conducted a detailed review of the care of all these events to improve patient safety. In this study, we assessed..

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P303 Explicit glycated haemoglobin goals improve subsequent HbA1c levels with no impact on health-related quality of life

Background National guidelines recognise the importance of individualising HbA1c targets. Many people with diabetes agree to have their targets re-evaluated in consultations in response to specific characteristics. Aims We aimed to evaluate the impact of relaxed or stretch HbA1c goals on subsequent HbA1c levels and health-related quality..

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P302 Glycated haemoglobin targets: The experiences and views of people with diabetes and diabetes healthcare professionals

Background National guidelines highlight the importance of individualising HbA1c targets. Little is known about the experiences of people with diabetes and diabetes healthcare professionals (HCPs) on the use of HbA1c targets. We explored the experiences of adults with diabetes and diabetes HCPs on the use of glycated haemoglobin..

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P300 Setting explicit glycated haemoglobin goals improves diabetes-related distress, self-efficacy and wellbeing

Background High levels of diabetes-related distress and low levels of self-efficacy and wellbeing are associated with poorer outcomes in people with diabetes. Aims We evaluated the impact of relaxed or stretch HbA1c targets on diabetes-related distress, self-efficacy and wellbeing in adults with type 1 or type 2 diabetes. Methods We randomised 50..

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A new protocol for improving immediate monitoring of skin-island free flap with near-infrared spectroscopy and ultrasound

Background Postoperative monitoring is essential for detecting early complications and improving the salvage rate of free flaps. We propose a new protocol for free flap monitoring based on the combination of near-infrared spectroscopy (NIRS) and ultrasound. Methods All free flaps with a skin paddle were included and divided into two..

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446 A qualitative exploration using focus groups, of the perceived barriers and enablers of hospital pharmacists to participating in simulation based training

Introduction The role of hospital pharmacists has changed significantly over the past decade with a need for further educational interventions to support their professional development. Simulation based training (SBT) is widely used by other healthcare professionals to enhance skill acquisition and performance (1). However, the use of SBT does not appear..

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Phalangeal and Metacarpal Fractures in Children: A 10-Year Comparison of Factors Affecting Functional Outcomes in 313 Patients

Data It is widely believed that fractures in children have excellent clinical outcomes due to their capacity to remodel. There are, however, certain fractures that require careful management to avoid long-lasting functional impairment. Functional outcomes following hand fractures in children are poorly studied. Materials and Methods We performed a retrospective..

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Switching between tofacitinib and baricitinib in alopecia areata: A review of clinical response

  Kazmi, A; Moussa, A; Meah, M et al. (2023). Switching between tofacitinib and baricitinib in alopecia areata: A review of clinical response. Journal of the American Acadamy of Dermatology. epub 05 April. [Online]. Available at: https://doi.org/10.1016/j.jaad.2023.03.041 [Accessed 28 April 2023]]  

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Bridging pre-surgical endocrine therapy for breast cancer during the COVID-19 pandemic: outcomes from the B-MaP-C study

Purpose The B-MaP-C study investigated changes to breast cancer care that were necessitated by the COVID-19 pandemic. Here we present a follow-up analysis of those patients commenced on bridging endocrine therapy (BrET), whilst they were awaiting surgery due to reprioritisation of resources. Methods This multicentre, multinational cohort study recruited 6045 patients..

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Critical care pharmacy workforce: a 2020 re-evaluation of the UK deployment and characteristics

Introduction Critical care pharmacists improve the quality and efficiency of medication therapy whilst reducing treatment costs where they are available. UK critical care pharmacist deployment was described in 2015, highlighting a deficit in numbers, experience level, and critical care access to pharmacy services over the 7-day week. Since then, national workforce..

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Stroke in Atrial Fibrillation and Other Atrial Dysrhythmias

Purpose of Review Atrial fibrillation (AF) is a major risk factor for systemic embolism and ischaemic stroke. Furthermore, AF-related strokes are associated with higher mortality, greater disability, longer hospital stays and lower rates of hospital discharge than strokes caused by other reasons. The aim of this review to summarise the..

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A Review of Emerging Factor XI inhibitors

Introduction Whilst the introduction of direct oral anticoagulants (DOACs) has improved the prevention of thromboembolic events, there is still a need for safer anticoagulants. This is particularly so, for specific populations of patients, such as those with an increased bleeding risk or those with severely reduced kidney function. People with..

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Wide-Awake Local Anesthesia No Tourniquet (WALANT) for Flexor Tendon Repairs...

Background The coronavirus disease 2019 (COVID-19) pandemic forced many changes. In our unit, there was a significant shift from traditional anesthesia (TA) which included general or regional anesthesia, to Wide-Awake Local Anesthesia No Tourniquet (WALANT) for the treatment of flexor tendon injuries. Zones I and II injuries have always been a..

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165 A NICE accredited guideline for the management of malignant ascites

Introduction Ascites is the accumulation of fluid in the peritoneal cavity, often associated with a poor quality of life and poor prognosis. There is limited national guidance on management of malignant ascites .This guideline has been produced to enable healthcare professionals to make evidence-based, patient-centred decisions about the management of..

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Long-term Management Considerations for Retinal Artery Occlusion and Cardiovascular and Cerebrovascular Mortality

Extract In this issue of JAMA Network Open, Hwang et al1 report a population-based, retrospective, cohort study using the Korean National Health Insurance Service claims database to determine the incidence of retinal artery occlusion (RAO), and its associated rate (and cause) of death compared with the general population. RAO has 2..

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Prophylactic intravenous gentamicin with sedation-free cystoscopic injection of BoNT-A

Objectives To determine whether administration of single dose prophylactic intravenous gentamicin prior to intravesical injection of botulinum toxin type A (BoNT-A) is associated with adverse extravesical neuromuscular effects in idiopathic overactive bladder syndrome. Patients and methods A retrospective analysis of 220 consecutive idiopathic overactive bladder patients following sedation-free flexible cystoscopic injection..

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Heart was the key to the diagnosis

Extract We present the case of a man in his 70s who was referred to gastroenterology with several months’ history of offensive smelling loose stools and weight loss. He underwent a standard panel of initial investigations including colonoscopy for his chronic diarrhoea. Colonoscopy was reported as normal and the results..

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The Effect of the COVID-19 Pandemic on HbA1c Testing

Introduction Studies show that the COVID-19 pandemic disproportionately affected people with diabetes and those from disadvantaged backgrounds. During the first 6 months of the UK lockdown, > 6.6 M glycated haemoglobin (HbA1c) tests were missed. We now report variability in the recovery of HbA1c testing, and its association with diabetes control..

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#217 Parallel Session - Aid Experience in the Real-World - in the United Kingdom

Abstract AID experience in the real‐world in the United Kingdom Background Hybrid closed loop (HCL) technology automates insulin delivery and improves outcomes in people living with Type 1 diabetes. We report real‐world outcomes from adults with Type 1 diabetes with raised HbA1c despite insulin pump therapy and flash glucose..

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Assessment of the effect of the COVID-19 pandemic on UK HbA1c testing

Aims The COVID-19 pandemic, and the focus on mitigating its effects, has disrupted diabetes healthcare services worldwide. We aimed to quantify the effect of the pandemic on diabetes diagnosis/management, using glycated haemoglobin (HbA1c) as surrogate, across six UK centres. Methods Using routinely collected laboratory data, we estimated the..

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Tranexamic acid use in meningioma surgery – A systematic review and meta-analysis

Abstract Tranexamic Acid (TXA) has been used in medical and surgical practice to reduce haemorrhage. The aim of this review was to evaluate the effect of TXA use on intraoperative and postoperative outcomes of meningioma surgery. A systematic review and meta-analysis was conducted in accordance with the PRISMA statement and..

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Potential Embolic Sources in Embolic Stroke of Undetermined Source in Patients with Patent Foramen Ovale: Look Harder.

ElSheikh, S; Lip, GYH; Abdul-Rahim, AH. (2023). Potential Embolic Sources in Embolic Stroke of Undetermined Source in Patients with Patent Foramen Ovale: Look Harder. Cerebrovascular Diseases. epub 7 Feb, [Online]. Available at: https://doi.org/10.1159/000529105 [Accessed 17 February 2023].

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The management of developmental dysplasia of the hip in children aged under three months

Aims A national screening programme has existed in the UK for the diagnosis of developmental dysplasia of the hip (DDH) since 1969. However, every aspect of screening and treatment remains controversial. Screening programmes throughout the world vary enormously, and in the UK there is significant variation in screening practice and treatment..

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Antiplatelet Agents and Oral Anticoagulant Use in Patients with Atrial Fibrillation and Carotid Artery Disease After First-Time Ischaemic Stroke

Introduction People with atrial fibrillation (AF) frequently have competing mechanisms for ischaemic stroke, including extracranial carotid atherosclerosis. The objective of this study was to determine associations between use of oral anticoagulants (OACs) plus antiplatelet agents (APA) after ischaemic stroke and outcomes for patients with AF and carotid artery disease. Methods..

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Accuracy of a tool to prioritise patients awaiting elective surgery: an implementation report

Study objective The objective of this study was to evaluate the accuracy of a new elective surgery clinical decision support system, the ‘Patient Tacking List’ (PTL) tool (C2-Ai(c)) through receiver operating characteristic (ROC) analysis. Methods We constructed ROC curves based on risk predictions produced by the tool and..

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Trichorrhexis nodosa improving with oral minoxidil: a case report

  McFeely, O; Meah, N; Sinclair, R; Wall, D. (2023). Trichorrhexis nodosa improving with oral minoxidil: a case report. Clinical and Experimental Dermatology. epub 19 Jan. [Online]. Available at: https://doi.org/10.1093/ced/llad019 [Accessed 21 February 2023]  

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Short And Long Term Outcomes After Surgical Resection Of Tumours Of The Splenic Flexure – A Two Institutions’ Experience

Background This study was conducted as a part of our service evaluation of colorectal resections. Our primary outcomes were 30 day mortality, 90 day mortality, complication rate and recurrence rates at 3 and 5 years. The secondary outcomes were lymph node harvest >12 and length of stay. Methodology Retrospective data collection from a prospectively maintained..

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Giant cell arteritis causing multifocal ischaemic stroke with normal erythrocyte sedimentation rate: a case report

  Introduction Giant cell arteritis (GCA), a medium-to-large-vessel vasculitis affecting the over-50s, is a rare cause of ischaemic stroke, favouring the vertebrobasilar circulation. Erythrocyte sedimentation rate (ESR) is often used to help exclude the diagnosis but this is not always reliable. We discuss a case of ischaemic stroke due to..

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A multicentre observational cohort study of cardiovascular risk and outcomes following stroke: The Liverpool-Heart And bRain Project (L-HARP)

  Introduction Improving risk prediction models for adverse outcomes following stroke, such as atrial fibrillation (AF), recurrent stroke, and cognitive impairment and dementia, would help target secondary prevention and other intervention strategies. The primary aim of the Liverpool-Heart And bRain Project (L-HARP) is to establish a prospective cohort study of adults..

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019 Nil by mouth and peri-operative medicines administration in trauma and emergency surgery patients

Background An 88-year-old woman attends theatre for dynamic hip screw (DHS) 2 days after a trip and fall, delayed due to clinical pressures. BP, usually well controlled, is through the roof and her atrial fibrillation (AF) is no longer rate controlled; her anaesthetic risk is now considerably greater than prior to..

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Improving family experience through better communication for postoperative patients

Background It is with great stress and anxiety that relatives wait until they get some news about their loved ones being back from a surgical procedure [1]. We aimed to implement a system to improve patient and relative experience through a gesture of updating the relatives about the general condition of..

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Atrial fibrillation and stroke

Introduction Stroke is one of the leading causes of mortality and morbidity globally. Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. It is set to reach epidemic proportions. AF is associated with a five-fold increase in risk of stroke. Strokes caused by AF more often are fatal or..

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Evaluation of Huawei smart wearables for detection of atrial fibrillation in patients following ischemic stroke: The Liverpool-Huawei stroke study.

Background Atrial fibrillation (AF) often remains undetected following stroke. Documenting AF is critical to initiate oral anticoagulation, which has proven benefit in reducing recurrent stroke and mortality in patients with AF. The accuracy and acceptability of using smart wearables to detect AF in patients following stroke is unknown. Methods The..

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Endovascular treatment for ischemic stroke patients with and without atrial fibrillation, and the effects of adjunctive pharmacotherapy: a narrative review

Introduction Endovascular thrombectomy (EVT) is associated with good clinical outcomes in patients with ischemic stroke, but the impact of EVT on clinical outcomes in patients with ischemic stroke with and without atrial fibrillation (AF), and the effect of adjunctive pharmacological therapies with EVT, remains unclear. Areas covered The goal of..

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Mystery of Joint Pain: Is It Rheumatoid Arthritis (RA) or Hereditary Hemochromatosis (HH)?

Abstract A 58-year-old lady with a previous diagnosis of rheumatoid arthritis (RA) was referred to Rheumatology to manage her joint pains. On evaluation, it was noted that the lady did not have any signs of synovial inflammation. The patient had a negative anti-cyclic citrullinated peptide (anti-CCP) (

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Do preoperative leukocyte and neutrophil levels have a predictive value on the complications of hypospadias repair in children?

Objective Surgeons observed that the outcomes after the same repair technique in the same type of hypospadias performed by the same surgeon may be different. There may be some indeterminate factors that influence the results such as subclinical inflammation. Our study evaluated the predictor values of inflammatory hematologic parameters on..

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Commentary on “An assessment of urethral radiation exposure in the treatment of endometrial and rectal cancers”

Abstract This retrospective cohort study was aimed at comparing urethral radiation exposure during two common radiotherapy modalities. Vaginal brachytherapy (VBT) is commonly used to treat endometrial cancer, with external beam radiation (EBRT) therapy used to treat rectal cancer. The study hypothesised that urethral radiation dose varies between these two modalities...

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Classification of Systemic Lupus Erythematosus Using Raman Spectroscopy of Blood and Automated Computational Detection Methods

Abstract The aim of this study was to explore the proof of concept for using Raman spectroscopy as a diagnostic platform in the setting of systemic lupus erythematosus (SLE). We sought to identify unique Raman signatures in serum blood samples to successfully segregate SLE patients from healthy controls (HC). In..

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O.15 Pulse dye LASER - treatments can be safely delivered without formal test patching in children

Introduction Pulse dye LASER (PDL) traditionally requires test patching prior to full treatment, to assess for efficacy and side effects. In our unit, in children under age 6, this requires a general anaesthetic. The aim of this study was to ascertain whether results of test patching change settings chosen for subsequent..

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Purpuric lesions in the large bowel

Abstract A 54-year-old woman presented with a 1-week history of a rash starting in her feet. This was associated with arthralgia and myalgia. Her bowel habit was initially unchanged; however, she developed bloody diarrhoea shortly after admission to the hospital. She had no constitutional symptoms. Her medical history included myocardial..

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Outcomes in patients with ischaemic stroke undergoing endovascular thrombectomy: Impact of atrial fibrillation

Objectives Endovascular thrombectomy (EVT) is associated with good clinical outcomes in ischaemic stroke, but the risk of intracerebral haemorrhage (ICH) and mortality remains common following ischaemic stroke. The effect of concomitant atrial fibrillation (AF) on clinical outcomes following acute ischaemic stroke in patients receiving EVT remains unclear. The aim is..

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Faricimab for treatment of diabetic macular oedema

Abstract Diabetic macular oedema (DME) is a common cause of sight impairment in people with diabetes. Twenty-seven percent of people with type 1 diabetes develop DME within nine years of the disease onset. For people with type 2 diabetes, 25.4% of insulin dependent and 13.9% of those who do not use insulin have DME...

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Development of guidance for initiation and deprescribing PPI

Abstract It is important to consider whether the risks outweigh the benefits in long term proton pump inhibitor as there has been increasing use of PPIs in hospital settings and community especially in elderly care. Data collection was done on the patients admitted to care of elderly wards in Whiston..

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Post-stroke visual impairment: how big is the problem, how do we identify it, what we can do about it, and why does it matter?

In the UK, 100,000 new strokes occur each year, with 1.3 million stroke survivors. This article will focus on post-stroke visual impairment, discussing topics of how common it is, how it can be detected, possible management options and how it impacts stroke survivors.   Hepworth, L.R. (2022). Post-stroke visual impairment: how big is..

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Cross-specialty identification of the JAK1 inhibitor trial agent filgotinib as a potential therapy for alopecia areata

  Fagan, N; Doherty, Meah, N; Sinclair, R; Wall, D. (2022). Cross-specialty identification of the JAK1 inhibitor trial agent filgotinib as a potential therapy for alopecia areata. British Journal of Dermatology. epub 25 Nov. [Online]. Available at: https://doi.org/10.1093/bjd/ljac103 [Accessed 21 February 2023]  

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Re: Do no harm: the role of perioperative heparin in urethroplasty. Lee et al. IUN (2022)

  Jones, R.E; Omar, A.M; Garth, L.E; Floyd Jr; Michael S. (2022). Re: Do no harm: the role of perioperative heparin in urethroplasty. Lee et al. IUN (2022). International Urology and Nephrology. 55(2), pp.321-322. [Online]. Available at: https://link.springer.com/article/10.1007/s11255-022-03417-9 [Accessed 20 February 2023]  

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Patient-reported outcome measures (PROMs) in stone surgery: A multi-centre study of patient experience of flexible ureteroscopy (fURS) versus extracorporeal shockwave lithotripsy (SWL)

Objectives To compare patient-reported outcome measures (PROMs) for patients with symptomatic renal stone disease treated by flexible ureterorenoscopy (fURS) and shockwave lithotripsy (SWL). Introduction Historically, surgical outcomes are measured by surgeon-specific outcomes such as ‘stone-free rates’. More recently, there is increasing emphasis on PROMs to ascertain a patient’s perspective..

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Separating the components of an abdominal wall fellowship

Abstract Complex abdominal wall reconstruction is an emerging subspecialty yet, despite the abundance of abdominal wall hernias requiring treatment and the increasing complexity of this type of surgery, there are few opportunities for surgeons to gain subspecialist training in this field. In this paper we discuss the need for focused..

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Impact of COVID-19 policies on perceptions of loneliness in people aged 75 years and over in the cognitive function and aging study (CFAS II)

Background The COVID-19 pandemic and associated social distancing measures have profoundly impacted society and social contact patterns, with older people disproportionately affected. Concerns have been raised about a resulting pandemic of loneliness in older people, although the current evidence is mixed. This study provides a unique perspective on the prevalence..

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CXR-Net: A Multitask Deep Learning Network for Explainable and Accurate Diagnosis of COVID-19 Pneumonia from Chest X-ray Images

Abstract Accurate and rapid detection of COVID-19 pneumonia is crucial for optimal patient treatment. Chest X-Ray (CXR) is the first-line imaging technique for COVID-19 pneumonia diagnosis as it is fast, cheap and easily accessible. Currently, many deep learning (DL) models have been proposed to detect COVID-19 pneumonia from CXR images...

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COVID-19 related myopericarditis and cardiac tamponade: a diagnostic conundrum

Abstract We report the case of a 45-year-old man presenting with worsening shortness of breath and chest tightness on a background of type 2 diabetes mellitus, hypertension and stable angina. He felt generally unwell and had a productive cough two weeks prior to presentation. Initial examination found quiet heart sounds and..

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Patient satisfaction with telephone consultations in cardiology outpatients during the COVID-19 pandemic

Abstract The COVID-19 pandemic required a radical change in healthcare delivery methods, including the remote delivery of many outpatient services. We aimed to understand patient satisfaction with telephone consultations. Patients who had undergone a cardiology telephone consultation between 24 February and 19 July 2021 were asked to complete a survey. The survey assessed..

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Emergency Urology procedures during the COVID-19 pandemic in the UK: A 3-month prospective study

Objective COVID-19 resulted in Regional tiered restrictions being introduced across the UK with subsequent implications for planned and emergency surgical care. Specific to Merseyside, Tier 4, Tier 2 and Tier 5 restrictions were introduced in late 2020 and early 2021. The purpose of this study was to examine the nature and workload of emergency urological..

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A Comparative Study of Symptoms, Nasal Eosinophilia and Pulmonary Function Tests Before and After Short Term Treatment with Corticosteroid Nasal spray in Patients with Allergic Rhinitis

Abstract Allergic rhinitis has been on the rise because of urbanization and major population shift in addition to changes in the particulate matter in the atmosphere. Intranasal corticosteroid sprays are recommended as first-line prescription treatment in all cases of allergic rhinitis. The propensity of co-existing non-apparent lower airway hyper-responsiveness is..

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A comparison of age-banded and weight-based oral paracetamol dosing in hospitalized children

Introduction The British National Formulary for Children contains two dosing strategies for oral paracetamol; age-banded dosing for pain and pyrexia or weight-based dosing for post-operative pain. Only weight-based is used in our hospital. The aim of this study was to compare these dosing strategies using weights from a pediatric inpatient..

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Safety and effectiveness of ustekinumab in elderly Crohn’s disease patients

Objective Anti-tumour necrosis factor (TNF) agents are associated with increased infection risk among elderly IBD patients, but little is known about non anti-TNF biologics in this cohort. We examined the safety and effectiveness of ustekinumab in elderly Crohn’s patients. Methods This retrospective multi-centre cohort study included Crohn’s patients ≥60..

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Perceptions of arthritis glove wear of patients with rheumatoid arthritis and persistent hand pain

Introduction Arthritis gloves are prescribed in rheumatoid arthritis (RA) to reduce hand pain, stiffness, and improve hand function. As part of a randomised controlled trial, this study investigated participants' perceptions of wearing arthritis gloves. Method Participants with RA and persistent hand pain (n = 206) were randomly assigned and prescribed either loose-fitting..

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Psychometric and biomedical outcomes of glycated haemoglobin target-setting in adults with type 1 and type 2 diabetes

Background The disease burden of diabetes can have wide-ranging implications on patients’ psychological well-being and health-related quality of life. Glycated haemoglobin targets are commonly used to guide patient management in diabetes to reduce the future risk of developing diabetes complications, but little is known of the psychological impact of glycated..

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Letter to the Editor re: Evaluation of the Clinical Effects of Abobotolinum Toxin A (Dysport) Injection

  Gadelrab, M; Chamsin, A; Khadr, R; Omar, AM; Floyd Jr, MS. (2022). Letter to the Editor re: Evaluation of the Clinical Effects of Abobotolinum Toxin A (Dysport) Injection in the Treatment of Neurogenic Lower Urinary Tract Dysfunction. Urology Journal. epub 25 October(.), p.7345. [Online]. Available at: https://journals.sbmu.ac.ir/urolj/..

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Morton Neuroma

Continuing Education Activity Morton neuroma is a compressive neuropathy of the interdigital nerve in the forefoot due to compression and constant irritation at the plantar aspect of the transverse intermetatarsal ligament. It is not a true neuroma as the condition is degenerative rather than neoplastic. It is also referred to..

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An intertriginous hyperpigmented macular eruption

Abstract A 23-year-old woman presented with a hyperpigmented intertriginous eruption unresponsive to topical steroids and to topical and systemic antifungals. Histopathological assessment demonstrated patchy inflammatory infiltrate at the demoepidermal junction with pigment incontinence.   Harnett, C; Meah, N; Low, SE; Eustace, K. (2022). An intertriginous hyperpigmented macular eruption. Clinical and Experimental Dermatology. 47(12),..

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P-135 First experience with a new closed incision negative pressure wound therapy, Prevena ^TM

Aim Surgical site infection (SSI) contributes a significant proportion of post operative morbidity in patients undergoing abdominal wall reconstruction (AWR). PrevenaTM closed incision negative pressure wound therapy (ciNPT) has been demonstrated to reduce SSI rates in the elective and emergency laparotomy setting. However, there is no evidence for PrevenaTM use..

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Augmented Reality–Assisted Design of Local Flaps: A New Practical and Educational Tool in the Field of Plastic Surgery

Abstract: Augmented reality (AR) is a new and promising technology that has been incorporated into several aspects of our everyday life, including surgery. Examples of its application throughout various fields of surgery, although most of them are in experimental stage, have already been demonstrated and published. In this article, we..

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OC-022 Maintaining an elective abdominal wall reconstruction service during the COVID 19 pandemic

Aim Elective surgery services suffered significantly due to the COVID-19 pandemic. The aim of this study was to analyse the impact and outcomes of abdominal wall reconstruction (AWR) performed during the COVID-19 pandemic, assessing safety and sustainability. Material & Methods A retrospective review of all patients undergoing AWR in a single..

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P0490 Opioid exposure in IBD and associated factors: a UK prospective multicentre audit of 1362 patients

Introduction Opioid exposure in inflammatory bowel disease (IBD) is associated with premature mortality, yet exposure in IBD increasing. International guidelines have been introduced to rationalise opioid use. While opioids may improve acute pain, long term exposure is rarely beneficial and is associated with side effects.We conducted a multicentre audit..

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Hormone therapy for uterine and endometrial development in women with premature ovarian insufficiency

Background Premature ovarian insufficiency (POI) is a clinical syndrome resulting from loss of ovarian function before the age of 40. It is a state of hypergonadotropic hypogonadism, characterised by amenorrhoea or oligomenorrhoea, with low ovarian sex hormones (oestrogen deficiency) and elevated pituitary gonadotrophins. POI with primary amenorrhoea may occur as a..

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Hormone therapy for uterine and endometrial development in women with premature ovarian insufficiency

Background Premature ovarian insufficiency (POI) is a clinical syndrome resulting from loss of ovarian function before the age of 40. It is a state of hypergonadotropic hypogonadism, characterised by amenorrhoea or oligomenorrhoea, with low ovarian sex hormones (oestrogen deficiency) and elevated pituitary gonadotrophins. POI with primary amenorrhoea may occur as a..

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Antibiotic Review Kit for Hospitals (ARK-Hospital): a stepped wedge cluster randomised controlled trial

Background Strategies to reduce antibiotic overuse in hospitals depend on prescribers taking decisions to stop unnecessary antibiotic use. There is scarce evidence for how to support these decisions. We evaluated a multifaceted behaviour change intervention (ie, the antibiotic review kit) designed to reduce antibiotic use among adult acute general medical..

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Augmented Reality–Assisted Design of Local Flaps: A New Practical and Educational Tool in the Field of Plastic Surgery

Abstract Augmented reality (AR) is a new and promising technology that has been incorporated into several aspects of our everyday life, including surgery. Examples of its application throughout various fields of surgery, although most of them are in experimental stage, have already been demonstrated and published. In this article, we..

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Stroke-heart syndrome: sex-specific incidence, risk factors, and major adverse cardiovascular events in 486,515 patients

Background Newly diagnosed cardiovascular complications post-stroke, termed stroke-heart syndrome, are common and associate with worsened prognosis. Purpose To investigate the sex-specific incidence and 5-year major adverse cardiovascular events following stroke-heart syndrome, stratified by pre-existing risk factors (sex, age, obesity, hypertension, type 2 diabetes mellitus, and high LDL cholesterol). Methods A retrospective..

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Hallux Varus

Continuing Education Activity Hallux varus is a clinical condition characterized by medial deviation of the great toe at the metatarsophalangeal (MTP) joint. This condition has multiple etiologies and patients may present with various symptoms and with varying severity of hallux varus. Adult acquired hallux varus deformity is commonly iatrogenic, occurring..

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Electrochemotherapy for the treatment of cutaneous squamous cell carcinoma: The INSPECT experience (2008-2020)

Introduction Cutaneous squamous cell carcinoma (cSCC) is a frequent skin cancer with a high risk of recurrence characterized by tumor infiltration and, in advanced cases, a poor prognosis. ECT (electrochemotherapy) is an alternative treatment option for locally advanced or recurrent cSCC that is unsuitable for surgical resection. In this study,..

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Signposts to the Promised Land in Alopecia Areata

Abstract Alopecia areata (AA) is an autoimmune disease of the hair and nails. Although genotype alters the risk, the etiology remains unclear. AA typically presents as one or more hairless patches; however, full loss of scalp hair occurs in about 15% of patients (Cranwell et al., 2019; Ikeda, 1965). The relative ease in..

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Signposts to the Promised Land in Alopecia Areata

Clinical Implications Costs associated with emerging therapies will require disease severity to be redefined. The Severity of Alopecia Tool score was not predictive of life quality. Patient-reported outcomes provide a more accurate depiction of diminished life quality.   Wall, D; Rees, H; Bokhari, L; Meah, N; York, K; Sinclair, R. (2023). Signposts..

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Can a prostate biopsy be safely deferred on PI-RADS 1,2 or 3 lesions seen on pre-biopsy mp-MRI?

Introduction Multi-parametric magnetic resonance imaging (mp-MRI) is currently used to triage patients with suspected prostate cancer, before deciding on prostate biopsies. In our study, we evaluated normal and equivocal pre-biopsy mp-MRIs to see whether it is safe to avoid biopsy with such findings. Methods A retrospective study was conducted at..

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Differential attainment and recruitment to Intensive Care Medicine Training in the UK, 2018–2020

Background Differences exist among doctors in examination performance, clinical and academic career progression, and prevalence of performance assessment by professional regulatory bodies. Some of these differences have been reported in relation to individual characteristics. The purpose of this study is to establish whether any specific individual characteristics are associated with..

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A Randomized Trial of Enteral Glutamine for Treatment of Burn Injuries

Background Glutamine is thought to have beneficial effects on the metabolic and stress response to severe injury. Clinical trials involving patients with burns and other critically ill patients have shown conflicting results regarding the benefits and risks of glutamine supplementation. Methods In a double-blind, randomized, placebo-controlled trial, we assigned patients..

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Current practice and surgical outcomes of neoadjuvant chemotherapy for early breast cancer: UK NeST study.

Abstract: oadjuvant chemotherapy (NACT) is increasingly being used to treat early breast cancer, and offers several advantages, including reducing the extent of breast and axillary surgery, and providing an in vivo assessment of tumour sensitivity to treatment1–4. Clinical trials have identified tumour subgroups with high rates of pCR. A pCR..

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P014 Video assisted anal fistula treatment (VAAFT): A 5 year review

Aim VAAFT is claimed to be the only technique that allows the surgeon to see inside the anal fistula tract and locate the internal opening using an endoscope light. It is designed to only affect the fistula tract and there preserve sphincter function and faecal continence. Our aim was to..

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P066 Incisional hernia rate following laparoscopic anterior resection. Does extraction site matter?

Aim Incisional hernia are an established complication following abdominal surgery. There is limited data available on the relationship between formation of an incisional hernia and choice of extraction site for patients undergoing a laparoscopic anterior resection. This study aimed to determine the prevalence of incisional hernia following this operation and..

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Implications for sequencing of biologic therapy and choice of second anti-TNF in patients with inflammatory bowel disease: Results from the IMmunogenicity to Second Anti-TNF therapy (IMSAT) therapeutic drug monitoring study

Background Anti-drug antibodies are associated with treatment failure to anti-TNF agents in patients with inflammatory bowel disease (IBD). Aim To assess whether immunogenicity to a patient's first anti-TNF agent would be associated with immunogenicity to their second, irrespective of drug sequence Methods We conducted a UK-wide, multicentre, retrospective cohort study..

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287 Retrospective Review of a Single Surgeon 5-Year Experience of Paediatric Breast Reconstruction

Aim This case series reviews the presentation, clinical and surgical management of paediatric breast cases undertaken by a single surgeon. The series demonstrates the powerful role of lipomodelling when used with breast reshaping techniques to achieve good outcomes and avoid the need to commit young patients to breast implants. Method..

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622 Tranexamic Acid Use in Meningioma Surgery – a Systematic Review and Meta-Analysis

Aim Meningioma surgery is associated with increased intraoperative bleeding and transfusion requirement. Tranexamic Acid (TXA) has been used in medical and surgical practice to reduce haemorrhage. This review aimed to evaluate the effect of TXA use on bleeding and transfusion requirement, and functional outcomes in meningioma surgery. Method A systematic..

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945 Usefulness of Skull X-Ray in diagnosis and management of craniosynostosis and suspected NAI in children less than 4 years, results of three years retrospective observational study

Aims Evidence for the indications of skull X rays (SXR) in children is limited. There is substantial evidence to suggest that children are more susceptible to the effects of ionizing radiation than adult. The risks from exposure to ionizing radiation are dependent on the age at which exposure occurs, and..

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67 The occurrence of contaminated blood culture in paediatric unit in DGH, simple intervention to prevent cost and unnecessary treatment

Aims Micro-organisms are present on the skin surface of patients, staff and the immediate patient environment which can result in contamination of blood cultures. Contamination can lead to inappropriate treatment, prolonged hospital stay, increased cost (estimated: £5000/contaminated culture), family and patient inconvenience and it affect mandatory surveillance data and protocols...

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853 Disseminating new clinical guidance during a pandemic

Aims Establishing an innovative method of disseminating a new bronchiolitis guideline in a tertiary paediatric hospital. The ripple effect of the Covid-19 pandemic and subsequent lockdown periods on the paediatric population has been far reaching.1 With isolation drawing to a close, we saw a resurgence of patients presenting to hospital..

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905 Comparison of prednisolone vs dexamethasone in acute asthma and viral induced wheeze

Aims Early oral corticosteroid therapy is recommended in the treatment of acute asthma exacerbations in children. BTS/SIGN guidelines recommend that children with severe symptoms of viral induced wheeze (VIW) should still receive oral steroids, and that it is advisable in moderately severe cases without a previous diagnosis of asthma...

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784 Review of bronchopulmonary dysplasia services in the North West of England

Aims Bronchopulmonary dysplasia (BPD) or neonatal chronic lung disease is the commonest adverse outcome in very premature neonates. BPD incidence is increasing unlike other prematurity associated conditions and despite advances in aetiological understanding. BPD incurs substantial healthcare costs which extend beyond initial hospitalisation, such as home oxygen therapy, recurrent admissions..

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1224 Audit of neonatal hypoglycaemia in Whiston Hospital and study of incidental hypoglycaemia during sepsis screen

Aims Babies at risk of hypoglycaemia should be identified at birth and placed on a care pathway that includes early commencement of feeds, regular glucose monitoring and clinical assessment. Our hospital has a hypoglycaemia policy for managing these babies and this project aims to examine current local practice through auditing..

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1074 Surgical care closer to home: is it up to the mark?

Aims Paediatric surgery is challenging and training in this area is subspecialised including anaesthesia and post operative care. The Royal College of Surgeons Standards of Surgical care for Children, 2013 supports the ‘provision of care closer to home’ in patients with access to appropriate level of care. Typically this is district..

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677 GP with Extended Remit (GPwER) in Paediatrics-Ensuring children and young people are seen in the right place, at the right time, by the right person

Aims The GPwER for paediatrics manages a defined cohort of paediatric conditions in a community setting, ensuring patients are seen at the right time, in the right place by the right clinician. By bringing the skills of a generalist to a specialist area, care is delivered to children & young people..

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A survey of UK critical care pharmacists research involvement and associated barriers

Introduction Pharmacist led research provides evidence of impact of safe, effective and economic advanced pharmaceutical care in critical care medicine. Examples include impact of extracorporeal therapies on drug handling1; sedation delirium management2; medication safety3 and broader pharmacist interventions.4 The New Zealand Hospital Pharmacist Association (NZPHA), Society of Pharmacists of Australia (..

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TU8.10 Should patients with a predicted NELA mortality of 5–10% be managed on ICU? An audit of the management of high-risk laparotomies as per NELA Guidelines

Aims The National Emergency Laparotomy Audit (NELA) has been pivotal in improving the care of patients undergoing emergency laparotomy. One key recommendation is ‘high-risk’ patients are managed on ICU post-operatively. We aimed to identify if there was a difference in outcomes between ‘high-risk patients’ (predicated NELA mortality >5%) managed on ICU..

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Invited Discussion on: “Comparison of Classic Mastopexy Method Versus Double-pedicled Auto-augmentation Mastopexy with with Conic-Shaped Modified Inferior Butterfly Flap".

  Taghizadeh, R. (2022). Invited Discussion on: “Comparison of Classic Mastopexy Method Versus Double-pedicled Auto-augmentation Mastopexy with with Conic-Shaped Modified Inferior Butterfly Flap". Aesthetic Plastic Surgery. epub 4 August(.), p... [Online]. Available at: https://doi.org/10.1007/s00266-022-03016-0 [Accessed 16 August 2022]

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Review of Burn Resuscitation: is Plasmalyte® A Comparable Alternative to Ringer’s Lactate?

Abstract Ringer’s lactate has been the most widely used fluid for burn resuscitation for decades. Plasmalyte®, a newer balanced crystalloid, is gaining popularity for use in the critically ill, including patients with burns. This popularity is partly due to the fact that Plasmalyte® theoretically offers a favourable metabolic profile,..

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Medical Student Perspectives on Undergraduate Oncology Education in the UK

Aims The British Oncology Network for Undergraduate Societies (BONUS) surveyed students who attended an oncology revision day to determine their views on the current quantity, quality and type of curriculum-based oncology teaching they have experienced. Materials and methods Students attending two BONUS revision days received a questionnaire assessing their experience..

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National audit of non-melanoma skin cancer excisions performed by plastic surgery in the UK

Introduction Keratinocyte or non-melanoma skin cancer (NMSC) is the most common malignancy worldwide, encompassing basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC). The mainstay of treatment for NMSC is excision. The likelihood of recurrence is directly related to achieving tumour-free margins. Just 1 per cent of BCCs recur where..

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The frequency and clinical significance of centromere enumeration probe 17 alterations in human epidermal growth factor receptor 2 immunohistochemistry-equivocal invasive breast cancer

Background and Aims Keratinocyte or non-melanoma skin cancer (NMSC) is the most common malignancy worldwide, encompassing basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC). The mainstay of treatment for NMSC is excision. The likelihood of recurrence is directly related to achieving tumour-free margins. Just 1 per cent of BCCs..

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Clinical Outcomes and Risk Stratification of Early-Stage Melanoma Micrometastases From an International Multicenter Study

Purpose Indications for offering adjuvant systemic therapy for patients with early-stage melanomas with low disease burden sentinel node (SN) micrometastases, namely, American Joint Committee on Cancer (AJCC; eighth edition) stage IIIA disease, are presently controversial. The current study sought to identify high-risk SN-positive AJCC stage IIIA patients who are more..

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Retrospective Review of Arthroplasty Radiographs: How to Define an Adequate Radiograph

Introduction Adequacy of postoperative hip and knee radiographs has a direct impact on its interpretation. We undertook a quality improvement project by creating local standards to meet the arthroplasty team expectations for a satisfactory radiograph. The purposes of the study are 1. Assessment of the adequacy of radiographs according to defined..

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Editorial commentary: COVID-19 and COVID-19 vaccination: Observations on thrombosis and thrombocytopenia

  Elsheikh, S; Lip, GYH. (2022). Editorial commentary: COVID-19 and COVID-19 vaccination: Observations on thrombosis and thrombocytopenia. Trends in Cardiovascular Medicine. 32 (5), 257-258

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BONUS: the National Oncology Network for Students and Junior Doctors

The British Oncology Network for Undergraduate Societies (BONUS) is a national oncology network for medical students and junior doctors. The network aims to promote careers and education in clinical, medical, surgical and interventional oncology, a subspeciality of interventional radiology, and is, therefore, a ‘pan-oncology society’ [[1]]. Both a recent Royal College..

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BONUS: the National Oncology Network for Students and Junior Doctors

The British Oncology Network for Undergraduate Societies (BONUS) is a national oncology network for medical students and junior doctors. The network aims to promote careers and education in clinical, medical, surgical and interventional oncology, a subspeciality of interventional radiology, and is, therefore, a ‘pan-oncology society’ [[1]]. Both a recent Royal College..

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Whole-genome sequencing reveals host factors underlying critical COVID-19

Abstract Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2,3,4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of..

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Desmoplastic trichoepithelioma: an uncommon adnexal tumour with a predilection for cosmetically sensitive sites

Introduction Desmoplastic trichoepithelioma is an uncommon adnexal tumour (Rahman et al, 2020) predominantly affecting young women in cosmetically sensitive sites (Mamelak et al, 2010). Detection is often incidental and histological diagnosis can be impeded by biopsies that are insufficiently deep (Mamelak et al, 2010). Clinically and histologically it can mimic morphoeic basal cell..

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Physical therapy for facial nerve paralysis (Bell's palsy): An updated and extended systematic review of the evidence for facial exercise therapy

Objective To conduct a systematic review of the effectiveness of facial exercise therapy for facial palsy patients, updating an earlier broader Cochrane review; and to provide evidence to inform the development of telerehabilitation for these patients. Data Sources MEDLINE, EMBASE, CINAHL, Cochrane Library, PEDro and AMED for relevant studies published..

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H17: Botulinum toxin: from lethal adversary to dermatological sensation – how the power of poison was harnessed

Abstract Botulinum toxin, produced by the bacterium Clostridium botulinum, is a remarkably versatile agent. Its dermatological applications include the treatment of both hyperhidrosis and rhytides, and its myriad of medical functions are numerous and far reaching. Yet, capable of inducing paralysis and subsequent death, its origins belie the reputation it..

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BI27: Two cases of capecitabine-induced subacute cutaneous lupus erythematosus

Abstract Capecitabine-induced subacute cutaneous lupus erythematosus is a documented but seemingly underappreciated phenomenon. We report our experience of two cases reviewed in a specialist immunochemotherapy dermatology clinic. A 73-year-old woman with a background of stage 4 oesophageal cancer presented with a rapidly progressive pruritic eruption. She had received one cycle of..

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E 389 - Survey of Bronchopulmonary Dysplasia (BPD) Services in Twenty Hospitals in the North West Region of England

Abstract The purpose of this report is to analyze the functioning of BPD services, in accordance with evidence-based medicine, in a range of North West hospitals and then suggesting changes to the service if needed. To enable this, the authors have designed a standardized questionnaire to interview the hospitals which..

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E 389 - Survey of Bronchopulmonary Dysplasia (BPD) Services in Twenty Hospitals in the North West Region of England

Abstract The purpose of this audit is to assess the efficacy of single dose oral dexamethasone in preventing acute readmissions in comparison with a three-day course of oral prednisolone. A new local guideline was introduced in 2019, that recommends the use of single dose oral dexamethasone for management of asthma in..

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P23 Comparative safety and effectiveness of ustekinumab and vedolizumab in elderly crohn’s disease patients

Background Anti-TNF agents are effective in treating elderly Crohn’s disease (CD) patients but its use is limited by increased risk of infections and treatment discontinuation. Evidence for safety and efficacy of non-anti-TNF biologics in the elderly is limited. We aimed to compare the safety and effectiveness of ustekinumab and..

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O16 Gastrostomy placement in MND: the impact of weight loss and respiratory compromise

Introduction Motor neurone disease (MND) is a neurodegenerative condition causing progressive deterioration of muscle weakness that affects breathing, movement and swallowing. The Progas study1 is the largest study in recent years focussing on nutrition in MND, demonstrating that 30 day mortality post PEG (percutaneous endoscopic gastrostomy) insertion was 10.7 times higher in..

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O15 Benefits of gastrostomy tract dilatation following gastrostomy tube displacement

Introduction It is estimated that 2% of gastrostomies will become displaced in the first 10 months of placement and 37% within five years.1 Replacement of a displaced gastrostomy tube should only be attempted 4 weeks after initial placement, as prior to this, the tract may not be fully formed and the risk of misplacement..

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Prevention and management of post-deep inferior epigastric perforator flap abdominal bulge

Background Abdominal bulge in the absence of a hernia is a known complication following free abdominal flap breast reconstruction and can be associated with significant aesthetic and functional morbidity. This study aims to review the impact of permanent subrectus mesh placement on the incidence of post-DIEP bulge. Methods All patients..

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992 Results of a pilot HIV/Frailty Clinic - can comprehensive geriatric assessment benefit frail people living with HIV?

Introduction Frailty has been recognised among people living with human immunodeficiency virus (HIV) and will become more prevalent in coming years given treatment success (Pathai et al J Gerontol A Biol Sci Med Sci 2014;69:833–842). Assessment of frailty and its common syndromes through comprehensive geriatric assessment (CGA) is routinely delivered by..

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P1141: Ibrutinib and rituximab as first line therapy for mantle cell lymphoma: a multicentre, real-world UK study

Background Ibrutinib (IBR) is an oral covalent Bruton tyrosine kinase inhibitor (BTKi), licensed for treatment of relapsed or refractory mantle cell lymphoma (MCL). Under NHS interim Covid-19 agreements in England, IBR with or without rituximab (R) was approved for the frontline treatment for MCL patients (pts) as a safer alternative..

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Commentary on: Utilization of Free Soft Tissue Grafts in Otoplasty: A Simple Yet Effective Way to Avoid Suture Extrusion

Extract The authors have summarized their experience from over 200 cases relating to soft-tissue interposition between postauricular skin and suture knots in suture-based otoplasty.1 Suture extrusion is one of the most common complications in procedures that utilize concho-mastoid or concho-scaphal sutures. Therefore, any intervention that reduces this complication should be seriously..

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P10-9 Correlation of Hounsfield units and stone volume with LASER time in stone surgery

Introduction Time taken for stone disease surgeries are variable and can be unpredictable. Appropriate planning of cases and theatre lists improves efficiency, saves costs, and prevents cancellations. This study aims to determine if Hounsfield units (HU) and stone volume (SV) has a correlation with various factors, in particular LASER time...

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Developing priorities for quality improvement in acute medicine using a modified Delphi method

Introduction The SAM Quality Improvement Committee (SAM-QI), set up in 2016, has worked over the last year to determine the priority Acute Medicine QI topics. They have also discussed and put forward proposals to improve QI training for Acute Medicine professionals. Methods A modified Delphi process was completed over four rounds..

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The scope for radiology to contribute to the NHS net zero target: findings from a survey of radiology staff in the UK

Aim To assess attitudes towards the climate emergency among radiology staff and to identify current practices that may contribute towards the National Health Service (NHS) net zero target. Materials and methods An online survey of radiology staff was conducted assessing current attitudes to the climate emergency. Further questions focused on..

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P04 Adverse events following immunization (AEFI) with COVID-19 vaccines: case series and literature review

Abstract There currently exists no formal consensus on advice given to patients who have experienced an adverse event following immunization (AEFI) (WHO definition) following COVID-19 vaccination. The incidence of vaccine-related cutaneous events is only likely to increase with the UK launching subsequent vaccine doses as part of the mass vaccination..

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Assessing the required glenoid peg penetration in native scapula when bone graft is used during primary and revision shoulder arthroplasty

Aims Achieving purchase in native glenoid bone is essential for the stability of the glenoid baseplate when bone graft is used to address bone loss in both primary and revision shoulder arthroplasty procedures. The aim of this study is to assess the required depth of the baseplate peg in native..

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Treatment of Attention Deficit Hyperactivity Disorder (ADHD) in Pregnant Women: A Systematic Review of Cohort Studies

Abstract: Aims. The aim of this systematic review is to identify and appraise pharmacological options available for management of ADHD in pregnant women and adverse effects of ADHD medications on pregnancy and foetus (malformations or long-term effects). Methods. Systematic review of prospective or retrospective cohort studies, available on this topic..

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Corticosteroids for the treatment of Kawasaki disease in children

Background Kawasaki disease (KD), or mucocutaneous syndrome, is the leading cause of childhood‐acquired heart disease in high‐income countries. There is much controversy on how best to treat children with KD and in particular who may benefit from additional treatment beyond the standard intravenous immunoglobulin (IVIG) and aspirin, such..

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Metastatic melanoma to the heart causing ventricular tachycardia: looking beyond the troponin

  Abstract: A man in his mid-50s presented with palpitations, chest pain and syncope. After initial workup for a non-ST elevation myocardial infarction, a CT scan revealed metastatic melanoma. The malignancy was infiltrating his right ventricle, resulting in recurrent ventricular tachycardia. Although initially hard to manage, his arrhythmias were eventually..

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Digital screening for postnatal depression: mixed methods proof-of-concept study

Background: Depression during the postnatal year is prevalent in mothers (17%) and fathers (9%), and suicide is the leading cause of maternal death in this period. Lifelong costs and consequences of untreated postnatal depression (PND) are high due to impacts on infants as well as parents. We aimed to improve access to..

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Medical Student Perspectives on Undergraduate Oncology Education in the UK

Influence of MRI use on surgical outcomes in lobular breast cancer Aims The British Oncology Network for Undergraduate Societies (BONUS) surveyed students who attended an oncology revision day to determine their views on the current quantity, quality and type of curriculum-based oncology teaching they have experienced. Materials and methods Students..

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Restoration of smile: The role of the masseteric to facial nerve transfer in facial reanimation

Objectives The masseteric nerve has become a popular donor nerve for transfer in facial reanimation surgery. Results are comparable to, if not better than other nerve transfer techniques. This article describes the use of a masseteric to facial nerve transfer for facial reanimation in a group of patients with facial..

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Variability in Test Interval Is Linked to Glycated Haemoglobin (HbA1c) Trajectory over Time

Aims: We previously showed that the glycated haemoglobin (HbA1c) testing frequency links to diabetes control. Here, we examine the effect of variability in test interval, adjusted for the frequency, on change in HbA1c (ΔHbA1c). Materials & Methods: HbA1c results were collected on 83,872 people with HbA1c results..

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Evaluation of the Indications for Sentinel Node Biopsy in Early-Stage Melanoma with the Advent of Adjuvant Systemic Therapy

Background Patients presenting with early-stage melanoma (AJCC pT1b-pT2a) reportedly have a relatively low risk of a positive SNB (~5–10%). Those patients are usually found to have low-volume metastatic disease after SNB, typically reclassified to AJCC stage IIIA, with an excellent prognosis of ~90% 5-year survival. Currently, adjuvant systemic therapy is..

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Epidemiology of Neonatal Acute Respiratory Distress Syndrome: Prospective, Multicenter, International Cohort Study

Objectives Age-specific definitions for acute respiratory distress syndrome (ARDS) are available, including a specific definition for neonates (the “Montreux definition”). The epidemiology of neonatal ARDS is unknown. The objective of this study was to describe the epidemiology, clinical course, treatment, and outcomes of neonatal ARDS. Design Prospective, international, observational, cohort..

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Nephrogenic metaplasia in a female person with spinal cord injury

  Introduction Chronic irritation caused by urinary catheter may predispose to metaplastic changes in the bladder and very rarely, nephrogenic metaplasia. Case presentation A 53-year-old lady with T-2 paraplegia and urethral catheter drainage for 27 years presented with haematuria. MRI of pelvis, performed seven years ago, showed a 10 cm intramural fibroid within..

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Developing a burn-specific peri-operative checklist: Version zero, a starting point

Winning poster presentation in the Care category at the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Introduction: The World Health Organization (WHO) surgical safety checklist is a widely applied tool in surgical practice aimed at identifying potential faults..

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Photodynamic antimicrobial chemotherapy coupled with the use of the photosensitizers methylene blue and temoporfin as a potential novel treatment for Staphylococcus aureus in burn infections

Winning poster presentation in the Research category at the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Aim This study aimed to assess the antimicrobial efficacy of methylene blue (MB) - and temoporfin-mediated PACT against both Gram+ve and..

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Aesthetic tattoos as a treatment adjunct for scars from burns & trauma: A literature review and treatment approach

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Introduction Aesthetic tattoos are extremely common in the UK and around the world. Medical tattoos have been employed in a variety of subspecialties across burns and plastic..

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Burn fluid resuscitation using plasmalyte®: Is it a safe replacement for ringers lactate and what is the potential cost saving?

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Introduction Fluid resuscitation remains the basis of early burn management. Both the type and volume of fluids can impact the outcome of burn patients. Appropriate fluid resuscitation..

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A service evaluation of the Cosmetic camouflage service at a UK regional plastic surgery department

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Introduction The negative impact of scars and cutaneous dermatoses including vitiligo and rosacea are well known. Cosmetic camouflage is one potentially helpful intervention and involves the application..

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Further perspectives on burns from E-cigarette battery explosions: a public health concern

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Introduction Electronic cigarettes (e-cigarettes) are a fairly recent invention which substitutes conventional cigarettes. The use of e-cigarettes is on the rise as these devices are often marketed..

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Overcoming challenges around wounds and wound dressings in burn patients requiring nerve conduction studies

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Conclusions Through collaborative efforts a new protocol and a SOP are being developed which address the logistics around performing the tests in patient who have unhealed burns..

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A patient’s perspective of extravasation injury treated at a burns centre

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Aim We sought to understand better the patient experience and journey in the aftermath of an extravasation injuries and how care pathways for these patients might be..

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The role of burns professionals in public health awareness and strategies to prevent burns

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Introduction A number of plants and other naturally occurring substances have been shown to cause skin irritation or cutaneous chemical burns. In many of these cases the..

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Hypothermia in severe burns presenting at a regional burns centre

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Conclusions Our study demonstrates a link between hypothermia and mortality but not whether this link is causative. Our study also demonstrates a link between TBSA and hypothermia...

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An audit of ward-level pain management at a regional burn centre: Is the National standard adequate?

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Aims To audit pain management practice at ward level against set national standards. To gauge the adequacy of that standard. To assess the true effectiveness of pain..

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The Peroneus Brevis muscle flap for distal third tibia reconstruction in burns and trauma – a non-microsurgical and expeditious technique offering rapid wound healing of a complex wound.

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Introduction Reconstructive options for defects of the distal third of the tibia are often limited, challenging and cited as requiring free tissue transfer. Local options can be..

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Is the use of a powered dermatome an aerosol-generating procedure (AGP)? Implications for personal protection against COVID-19 virus.

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Introduction Many healthcare workers have contracted SARS-CoV-2 during the pandemic, many cases of which have resulted in severe illness and death. No studies have assessed the potential..

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Ulnar nerve compression at the elbow secondary to burn related heterotopic ossification – a case report and literature review of management options

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Introduction Heterotopic ossification (HO) is a poorly understood pathological process which can complicate the management of burns. It is thought to be mediated by tissue hypoxia amongst..

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Preliminary experience of HDR Brachytherapy for treatment of keloid scars

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Introduction Keloids are challenging with significant recurrence External beam radiotherapy has been effective in recurrent keloids but with significant exposure. Brachytherapy allows for surgical excision of keloids..

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Use of DERMABOND® PRINEO® Skin Closure System to optimise results of excision and direct closure in acute burns

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Introduction Primary excision and direct closure of deep/full thickness burn is historically contraindicated due to purported risk of complications. Self -adhering mesh (Prineo™ and glue (Dermabond™..

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Tangential excision and skin grafting for sever chronic ulcerative allergic reaction to tattoo pigment. A case report and review of literature in the context of a European ban on coloured pigment tattoos

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Introduction Tattooing is used in both recreationally and for scar management including burn patients to disguise burn scar knowledge about the clinical spectrum, pathogenesis and treatment of..

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Giant Hogweed: The role of burns professionals in public health awareness and strategies to prevent burns

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Introduction A number of plants and other naturally occurring substances have been shown to cause skin irritation or cutaneous chemical burns. In many of these cases the..

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Influence of MRI use on surgical outcomes in lobular breast cancer

Introduction Lobular carcinomas account for around 10% of invasive breast cancers. Accuracy of pre-operative evaluation can be troublesome. NICE guidelines recommend MRI "to assess the tumour size if breast-conserving surgery is being considered for invasive lobular cancer". However, each additional investigation introduces cost and potentially prolongs the treatment pathway, which is..

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Feasibility of breast lesion localisation using Sirius Pintuition

Introduction Impalpable breast cancers can be localised using different techniques. Recently, magnetic seed localisation systems have been developed and shown to offer benefits over traditional wire guided techniques. This study aims to assess the feasibility of a new seed localisation device, Sirius Pintuition, at St Helen's and Knowsley NHS Trust.  ..

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Reverse abdominoplasty advancement flap: An effective and low morbidity reconstruction option for the radical mastectomy patient

Introduction Radical mastectomy (RM) is indicated for patients with locally uncontrolled breast carcinoma or angiosarcoma of the breast, for either local control or with curative intent. Flap coverage is routinely offered using pedicled or free flap reconstruction, committing the patient to a long post-operative recovery and risks significant donor site..

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Formalised mentorship within oncoplastic breast surgery training - Is it indicated? A systematic review

Introduction Oncoplastic breast surgery places unique psychosocial and multi-disciplinary demands upon its trainees. As such, a healthy balance of personal and professional spheres are necessary to cultivate resiliency, emotional intelligence and self-awareness. Whilst the UK is a global leader in oncoplastic breast surgery training, no current trainee self-development scheme exists..

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Preparing to survive: Improving outcomes for young women with breast cancer

Introduction Young women with breast cancer (YWBC) have unique needs compared to their older-age counterparts, due to life-stage at diagnosis; often yet to start a family, responsible for young children, and/or in the midst of career progression. Interventions to address this are limited. We aimed to understand the unmet..

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P115 Optimising obstetric care in high BMI patients: should we offer elective caesarean sections based on BMI?

Introduction Obesity in the obstetric population is increasing. Obese patients pose obstetric and anaesthetic challenges, contributing to maternal and fetal morbidity and mortality [1]. Our maternity department is increasingly busy, with 4000 deliveries/year. More women with high BMIs are booking, and increasingly require involvement of the anaesthetic team, especially out-of-hours, when..

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Implementation of a telemedicine service to provide skin cancer care in a tertiary plastic surgery unit during COVID-19 – a comprehensive review

Background In response to the COVID-19 pandemic, our tertiary skin cancer service had to adapt rapidly to reduce hospital footfall. Consequently, all clinic appointments for skin cancer patients were converted to telephone consultations. This study aims to provide a comprehensive review of this new service. Methods This study consisted of..

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The utility of the lateral orbital orbicularis propeller flap in periocular reconstruction

Aims: The lateral orbital orbicularis propeller flap (LOOP) is a propeller flap raised on a non-axial orbicularis oculi pedicle. Once mastered, it is speedy to raise, extremely reliable, and capable of transposing thin, supple, and relatively hairless skin and subcutis from the temple region to the periocular region. We aim..

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The individualisation of glycaemic targets in response to patient characteristics in type 2 diabetes: a scoping review

Background Evidence and guidelines increasingly support an individualised approach to care for people with type 2 diabetes and individualisation of glycaemic targets in response to patient factors. Methods We undertook a scoping review of the literature for evidence of factors impacting upon glycated haemoglobin target individualisation in adults with type 2 diabetes...