23-hour stay following total parathyroidectomy in renal patients (2021)

Type of publication:Conference abstract

Author(s):*Neophytou C.; *Chang J.; *Howard E.; *Houghton A.

Citation:British Journal of Surgery; Oct 2021; vol. 108, Supplement 7

Abstract:Aim: Total parathyroidectomy in end-stage renal failure (ESRF), is an effective way to improve or stabilise calcium and parathormone levels and thus improve renal osteodystrophy. Previous BAEST guidelines were not in favour of true day-case neck surgery due to the risk of airway compromise from bleeding. Additionally, ESRF patients are at risk of profound hypocalcaemia after total parathyroidectomy. Patients undergoing total parathyroidectomy are prescribed Alfacalcidol 4mcg daily for 5 days prior to surgery. Following surgery under GA on a morning list, the potassium and calcium levels are checked in the afternoon. Calcium levels are then monitored daily for 3 days and subsequently when required. Oral Alfacalcidol is continued at the same dose until the nephrologists advise otherwise. Method(s): All ESRF patients undergoing total parathyroidectomy for secondary hyperparathyroidism were identified between 01/01/2005 and 31/12/2019 from a prospectively maintained electronic database. Demographics, biochemistry, length of stay (LoS) and outcomes were analysed. Result(s): There were 43 (30 male) total parathyroidectomies. The median age was 53 (range 14 – 78), and median LoS 1 day (range 0 -13). 26 patients (60%) were discharged within 23 hours (26% were day-case). Prolonged stay was due to calcium replacement (n=8) or dialysis (n=4) requirements. Pre- and post-operative calcium values over 2.49mmol/L were significantly related to 23-hour stay (p=0.010482 and p=0.000263 respectively). No 30-day re-admissions were observed Conclusion(s): Careful patient selection and adherence to a perioperative management protocol in total parathyroidectomy may enable early discharge within 23 hours. Preoperative calcium levels help predict this outcome.

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Fascial defect closure in laparoscopic incisional/ventral hernia: A systematic review and meta-analysis of published randomized, controlled trials (2021)

Type of publication:Conference abstract

Author(s):Rehman S.; *Akhtar M.S.; Khan M.; Sains P.; Sajid M.S.

Citation:British Journal of Surgery; Oct 2021; vol. 108, Supplement 7

Abstract:Aims: Closure of fascial defect (CFD) during laparoscopic incisional/ ventral hernia repair (LIVHR) remains a controversial issue which requires further investigations to reach a solid conclusion. The objective of this study is to present a systematic review comparing the outcomes of randomized controlled trials evaluating the defect closure versus no-defect closure in patients undergoing LIVHR. Method(s): A systematic review of randomized, controlled trials reporting the fascial defect closure in patients undergoing LIVHR until January 2021 published in Embase, Medline, PubMed, PubMed Central and Cochrane databases was performed using the principles of metaanalysis. Result(s): A total of four RCTs involving 443 patients were included. In the random effects model analysis, using the statistical software Review Manager, defect closure during LIVHR showed no difference in hernia recurrence (risk ratio (RR), 0.89; 95% CI, 0.31, 2.57; z=0.21; P=0.84). In addition, the post-operative complications (RR, 0.69; 95% CI, 0.41, 1.16; z=1.41; P=0.16), duration of operation (Standardized mean difference (SMD), -0.04; 95% CI, -0.52, 0.43; z=0.18; P=0.86) and hospital stay (SMD, 0.27; 95% CI, -0.02, 0.56; z=1.80; P=0.07) were also statistically similar in both groups. CFD was associated with an increased post-operative pain score (SMD, 1.82; 95% CI, 0.61, 3.03; z=2.95; P=0.003). Conclusion(s): Fascial defect closure in patients undergoing LIVHR does not demonstrate any superiority over no-defect closure in terms of recurrence, post-operative morbidity, post-operative pain duration of operation and length of hospital stay.

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The post graduate virtual learning environment: An effective platform for the delivery of a surgical teaching programme in the West Midlands (2021)

Type of publication:Conference abstract

Author(s):El-Sayed C.; *Ahmed U.; *Farquharson A.

Citation:British Journal of Surgery; Oct 2021; vol. 108, Supplement 7

Abstract:Aim: The Postgraduate Virtual Learning Environment (PGVLE) is a digital platform developed by HEEWM in response to the COVID-19 pandemic to deliver a virtual teaching programme to surgical trainees. The programme is delivered through the BigBlueButton; an integrated virtual classroom. All teaching sessions are recorded and archived to allow trainees to review content at their convenience. We performed a contemporaneous study to review the effectiveness and quality of the platform in delivering teaching and suggest its future role in the surgical curriculum. Method(s): Anonymised feedback was gathered of trainee's perspective of the platform experience, the quality of teaching and the archived content. All trainees were General Surgery higher trainees (HST) (ST3- ST8). The data from sequential teaching days was analysed. Result(s): Of 90 HST, on average 40 attended each monthly training day (consistent with pre-COVID attendance). 122 trainee responses were completed. 68% of respondents were between ST3-ST5. 91% rated the administration and delivery of the teaching sessions as excellent or very good. 16% of trainees watched the archived sessions after the teaching day of which 46% felt it met their educational expectations. Conclusion(s): The PGVLE is an effective platform for the delivery of a virtual surgical teaching programme. It met with high levels of trainee satisfaction in the context of the pandemic. The archived content provides advantages to consolidation of learning. It is thought that the PGVLE platform will become a key feature of the surgical training programme in a hybrid learning model, related to relevant curricula, in the future.

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30-day morbidity and mortality of sleeve gastrectomy, Roux-en-Y gastric bypass and one anastomosis gastric bypass: a propensity score-matched analysis of the GENEVA data (2021)

Type of publication:Journal article

Author(s):Singhal R.; Wiggins T.; Cardoso V.R.; Gkoutos G.V.; Super J.; Ludwig C.; Mahawar K.; Pedziwiatr M.; Major P.; Zarzycki P.; Pantelis A.; Lapatsanis D.P.; Stravodimos G.; Matthys C.; Focquet M.; Vleeschouwers W.; Spaventa A.G.; Zerrweck C.; Vitiello A.; Berardi G.; Musella M.; Sanchez-Meza A.; Cantu F.J.; Mora F.; Cantu M.A.; Katakwar A.; Reddy D.N.; Elmaleh H.; Hassan M.; Elghandour A.; Elbanna M.; Osman A.; Khan A.; layani L.; Kiran N.; Velikorechin A.; Solovyeva M.; Melali H.; Shahabi S.; Agrawal A.; Shrivastava A.; Sharma A.; Narwaria B.; Narwaria M.; Raziel A.; Sakran N.; Susmallian S.; Karagoz L.; Akbaba M.; Piskin S.Z.; Balta A.Z.; Senol Z.; Manno E.; Iovino M.G.; Qassem M.; Arana-Garza S.; Povoas H.P.; Vilas-Boas M.L.; Naumann D.; Li A.; Ammori B.J.; Balamoun H.; Salman M.; Nasta A.M.; Goel R.; Sanchez-Aguilar H.; Herrera M.F.; Abou-mrad A.; Cloix L.; Mazzini G.S.; Kristem L.; Lazaro A.; Campos J.; Bernardo J.; Gonzalez J.; Trindade C.; Viveiros O.; Ribeiro R.; Goitein D.; Hazzan D.; Segev L.; Beck T.; Reyes H.; Monterrubio J.; Garcia P.; Benois M.; Kassir R.; Contine A.; Elshafei M.; Aktas S.; Weiner S.; Heidsieck T.; Level L.; Pinango S.; Ortega P.M.; Moncada R.; Valenti V.; Vlahovic I.; Boras Z.; Liagre A.; Martini F.; Juglard G.; Motwani M.; Saggu S.S.; Momani H.A.; Lopez L.A.A.; Cortez M.A.C.; Zavala R.A.; D'Haese RN C.; Kempeneers I.; Himpens J.; Lazzati A.; Paolino L.; Bathaei S.; Bedirli A.; Yavuz A.; Buyukkasap C.; Ozaydin S.; Kwiatkowski A.; Bartosiak K.; Waledziak M.; Santonicola A.; Angrisani L.; Iovino P.; Palma R.; Iossa A.; Boru C.E.; De Angelis F.; Silecchia G.; Hussain A.; Balchandra S.; Coltell I.B.; Perez J.L.; Bohra A.; Awan A.K.; Madhok B.; Leeder P.C.; Awad S.; Al-Khyatt W.; Shoma A.; Elghadban H.; Ghareeb S.; Mathews B.; Kurian M.; Larentzakis A.; Vrakopoulou G.Z.; Albanopoulos K.; Bozdag A.; Lale A.; Kirkil C.; Dincer M.; Bashir A.; Haddad A.; Hijleh L.A.; Zilberstein B.; de Marchi D.D.; Souza W.P.; Broden C.M.; Gislason H.; Shah K.; Ambrosi A.; Pavone G.; Tartaglia N.; Kona S.L.K.; Kalyan K.; Perez C.E.G.; Botero M.A.F.; Covic A.; Timofte D.; Maxim M.; Faraj D.; Tseng L.; Liem R.; Oren G.; Dilektasli E.; Yalcin I.; AlMukhtar H.; Hadad M.A.; Mohan R.; Arora N.; Bedi D.; Rives-Lange C.; Chevallier J.-M.; Poghosyan T.; Sebbag H.; Zinai L.; Khaldi S.; Mauchien C.; Mazza D.; Dinescu G.; Rea B.; Perez-Galaz F.; Zavala L.; Besa A.; Curell A.; Balibrea J.M.; Vaz C.; Galindo L.; Silva N.; Caballero J.L.E.; Sebastian S.O.; Marchesini J.C.D.; da Fonseca Pereira R.A.; Sobottka W.H.; Fiolo F.E.; Turchi M.; Coelho A.C.J.; Zacaron A.L.; Barbosa A.; Quinino R.; Menaldi G.; Paleari N.; Martinez-Duartez P.; de Esparza G.M.A.R.; Esteban V.S.; Torres A.; Garcia-Galocha J.L.; Josa M.; Pacheco-Garcia J.M.; Mayo-Ossorio M.A.; Chowbey P.; Soni V.; de Vasconcelos Cunha H.A.; Castilho M.V.; Ferreira R.M.A.; Barreiro T.A.; Charalabopoulos A.; Sdralis E.; Davakis S.; Bomans B.; Dapri G.; Van Belle K.; Takieddine M.; Vaneukem P.; Karaca E.S.A.; Karaca F.C.; Sumer A.; Peksen C.; Savas O.A.; Chousleb E.; Elmokayed F.; Fakhereldin I.; Aboshanab H.M.; Swelium T.; Gudal A.; Gamloo L.; Ugale A.; Ugale S.; Boeker C.; Reetz C.; Hakami I.A.; Mall J.; Alexandrou A.; Baili E.; Bodnar Z.; Maleckas A.; Gudaityte R.; Guldogan C.E.; Gundogdu E.; Ozmen M.M.; Thakkar D.; Dukkipati N.; Shah P.S.; Shah S.S.; Adil M.T.; Jambulingam P.; Mamidanna R.; Whitelaw D.; Jain V.; Veetil D.K.; Wadhawan R.; Torres M.; Tinoco T.; Leclercq W.; Romeijn M.; van de Pas K.; Alkhazraji A.K.; Taha S.A.; Ustun M.; Yigit T.; Inam A.; Burhanulhaq M.; Pazouki A.; Eghbali F.; Kermansaravi M.; Jazi A.H.D.; Mahmoudieh M.; Mogharehabed N.; Tsiotos G.; Stamou K.; Rodriguez F.J.B.; Navarro M.A.R.; Torres O.M.; Martinez S.L.; Tamez E.R.M.; Cornejo G.A.M.; Flores J.E.G.; Mohammed D.A.; Elfawal M.H.; Shabbir A.; Guowei K.; So J.B.; Kaplan E.T.; Kaplan M.; Kaplan T.; Pham D.T.; Rana G.; Kappus M.; Gadani R.; Kahitan M.; Pokharel K.; Osborne A.; Pournaras D.; Hewes J.; Napolitano E.; Chiappetta S.; Bottino V.; Dorado E.; Schoettler A.; Gaertner D.; Fedtke K.; Aguilar-Espinosa F.; Aceves-Lozano S.; Balani A.; Nagliati C.; Pennisi D.; Rizzi A.; Frattini F.; Foschi D.; Benuzzi L.; Parikh C.; Shah H.; Pinotti E.; Montuori M.; Borrelli V.; Dargent J.; Copaescu C.A.; Hutopila I.; Smeu B.; Witteman B.; Hazebroek E.; Deden L.; Heusschen L.; Okkema S.; Aufenacker T.; den Hengst W.; Vening W.; van der Burgh Y.; Ghazal A.; Ibrahim H.; Niazi M.; Alkhaffaf B.; Altarawni M.; Cesana G.C.; Anselmino M.; Uccelli M.; Olmi S.; Stier C.; Akmanlar T.; Sonnenberg T.; Schieferbein U.; Marcolini A.; Awruch D.; Vicentin M.; de Souza Bastos E.L.; Gregorio S.A.; Ahuja A.; Mittal T.; Bolckmans R.; Baratte C.; Wisnewsky J.A.; Genser L.; Chong L.; Taylor L.; Ward S.; Hi M.W.; Heneghan H.; Fearon N.; Geoghegan J.; Ng K.C.; Plamper A.; Rheinwalt K.; Kaseja K.; Kotowski M.; Samarkandy T.A.; Leyva-Alvizo A.; Corzo-Culebro L.; Wang C.; Yang W.; Dong Z.; *Riera M.; *Jain R.; Hamed H.; Said M.; Zarzar K.; Garcia M.; Turkcapar A.G.; Sen O.; Baldini E.; Conti L.; Wietzycoski C.; Lopes E.; Pintar T.; Salobir J.; Aydin C.; Atici S.D.; Ergin A.; Ciyiltepe H.; Bozkurt M.A.; Kizilkaya M.C.; Onalan N.B.D.; Zuber M.N.B.A.; Wong W.J.; Garcia A.; Vidal L.; Beisani M.; Pasquier J.; Vilallonga R.; Sharma S.; Parmar C.; Lee L.; Sufi P.; Sinan H.; Saydam M.

Citation:International Journal of Obesity; 2021 [epub ahead of print]

Abstract:Background: There is a paucity of data comparing 30-day morbidity and mortality of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB). This study aimed to compare the 30-day safety of SG, RYGB, and OAGB in propensity score-matched cohorts. Material(s) and Method(s): This analysis utilised data collected from the GENEVA study which was a multicentre observational cohort study of bariatric and metabolic surgery (BMS) in 185 centres across 42 countries between 01/05/2022 and 31/10/2020 during the Coronavirus Disease-2019 (COVID-19) pandemic. 30-day complications were categorised according to the Clavien-Dindo classification. Patients receiving SG, RYGB, or OAGB were propensity-matched according to baseline characteristics and 30-day complications were compared between groups. Result(s): In total, 6770 patients (SG 3983; OAGB 702; RYGB 2085) were included in this analysis. Prior to matching, RYGB was associated with highest 30-day complication rate (SG 5.8%; OAGB 7.5%; RYGB 8.0% (p = 0.006)). On multivariate regression modelling, Insulin-dependent type 2 diabetes mellitus and hypercholesterolaemia were associated with increased 30-day complications. Being a non-smoker was associated with reduced complication rates. When compared to SG as a reference category, RYGB, but not OAGB, was associated with an increased rate of 30-day complications. A total of 702 pairs of SG and OAGB were propensity score-matched. The complication rate in the SG group was 7.3% (n = 51) as compared to 7.5% (n = 53) in the OAGB group (p = 0.68). Similarly, 2085 pairs of SG and RYGB were propensity score-matched. The complication rate in the SG group was 6.1% (n = 127) as compared to 7.9% (n = 166) in the RYGB group (p = 0.09). And, 702 pairs of OAGB and RYGB were matched. The complication rate in both groups was the same at 7.5 % (n = 53; p = 0.07). Conclusion(s): This global study found no significant difference in the 30-day morbidity and mortality of SG, RYGB, and OAGB in propensity score-matched cohorts.

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Paediatric anaphylaxis 'EduCAKEtion' in 10-minutes: A multicentre initiative (2021)

Type of publication:Conference abstract

Author(s):Dhesi A.; Mathias F.; Willets J.; Makwana N.; Halton F.; *Sohal I.; *Clarkson A.; *Brown K.

Citation:Clinical and Experimental Allergy; Dec 2021; vol. 51 (no. 12); p. 1664

Abstract:Objectives: Anaphylaxis is often over or undertreated with intramuscular adrenaline. Previous research in the Midlands has found that 32% of health professionals/medical students would administer intravenous adrenaline inappropriately. Our aim is to promote training in the recognition and management of anaphylaxis using an innovative technique. Method(s): We designed a 10-minute anaphylaxis education program composed of classifying symptom discs into type of reaction, management scenarios and adrenaline autoinjector (AAI) training. Small group sessions were designed to ensure social distancing in the COVID era, but also to allow hands-on training. Pre and post education scores were monitored. Following the session there was cake and debrief with participants to give the opportunity to answer any questions and provide feedback. Result(s): 131 health professionals were trained across three trusts (Sandwell and West Birmingham Hospitals NHS Trust, University Hospitals of North Midlands NHS Trust and Shrewsbury and Telford Hospitals NHS Trust) over a period of four months. 49% (64/131) were qualified nurses, 24% (32/131) doctors, 17% (22/131) healthcare assistants and 10% (13/131) other professionals. Experience of nurses ranged from 10% (7/71) being students to 14% (10/71) having worked over 30 years. 56% (18/32) doctors were ST3 level or below. Mean pre-education and scenario score was 18 and post score was 23 indicating a 28% improvement. Mean AAI training pre score was 4, post score was 8, indicating 100% improvement. The total mean pre score was 21 and post score 30, indicating a 43% improvement (p value <0.01). The maximum overall score possible was 32. Conclusion(s): This is a novel education method developed to be short, interactive and suitable for a wide variety of professionals. Feedback has included "concise and stimulating", "fun way of learning". It is being adapted to be delivered virtually for easier access but will also be reassessed to ensure retention of information.

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An evaluation of the current assessment methods used within a district general NHS trust spasticity service (2021)

Type of publication:Journal article

Author(s):*Fitzgerald, A. ; Pandyan, P.A.

Citation:Physiotherapy, December 2021. Vol 113, Supplement 1, p. E21-E22

Abstract:The management of spasticity in specialist clinic has not been evaluated objectively. One of the barriers to conducting an audit is the lack of a robust patient-centred assessment framework. The aim of this study was to audit the existing patient notes and from this develop a patient-centred assessment framework that provides objective data that can be used to audit the service.

Cerebrospinal fluid leak following a COVID-19 nasopharyngeal swab (2021)

Type of publication:Journal article

Author(s):*Hill, Thomas ; *Sivapatham, Stefan; *Metcalfe, Christopher; *Tzortzis, Sevina

Citation:British Journal of Hospital Medicine (17508460); Nov 2022; vol. 82 (no. 11); p. 398-400

Abstract:The article describes the case of an adult who developed cerebrospinal fluid leak after taking a COVID-19 nasopharyngeal swab.

The release of adhesions improves outcome following minimally invasive repair of Achilles tendon rupture (2022)

Type of publication:Journal article

Author(s):*Carmont, Michael R; Knutsson, Sara Brandt; Brorsson, Annelie; Karlsson, Jón; Nilsson-Helander, Katarina

Citation:Knee Surgery, Sports Traumatology, Arthroscopy : official journal of the ESSKA; Mar 2022; vol. 30 (no. 3); p. 1109-1117

Abstract:PURPOSE Operative repair of Achilles tendon rupture may lead to complications, which influence outcome adversely. The aim of this study was to determine the incidence, impact and response to treatment of post-operative adhesions. METHODS From February 2009 to 2021, 248 patients operated on with percutaneous or minimally invasive surgical repair have been prospectively evaluated using the Achilles tendon Total Rupture Score (ATRS) and Heel-Rise Height Index (HRHI), following acute Achilles tendon rupture. RESULTS Fourteen (5.6%) patients were identified as having adhesions. Four patients reported superficial adhesions and ten patients reported a deeper tightness of the tendon. At a mean (SD) of 10.5 (2.3) months following repair, the overall ATRS was at a median (IQR) 65 (44.5-78) points and (HRHI) was mean (SD) 81.5 (13.5)%. Of those deemed to have deep adhesions the antero-posterior diameter of the tendon was at mean (SD) 15.6 (4.6) mm. Open release of superficial adhesions resulted in improved ATRS in all patients. Endoscopic debridement anterior to the Achilles tendon led to alleviation of symptoms of tightness and discomfort from deep adhesions and improved outcome in terms of the ATRS score. At a mean (SD) of 15.9 (3.3)-month follow-up from initial rupture and repair, the patients reported at median (IQR) ATRS scores of 85 (64.8-92.8) points, Tegner level 5 (3-9) and mean (SD) HRHI 86.2 (9.5)%. Patients significantly improved both ATRS and HRHI following release at median (IQR) of 16.5 (- 1.8-29.3) points (p = 0.041) and mean (SD) 5.6 (8.3)% (p = 0.043). CONCLUSIONS The incidence of patient-reported adhesions following minimally invasive repair of Achilles tendon rupture was estimated to be 5.6%. The occurrence of superficial adhesions was associated with a lower outcome scores as well as symptoms of anterior tendon tightness and stiffness were associated with a lower score in most patients. Surgical release of adhesions led to a significant improvement in outcome.