WUTH publication: Bariatric and metabolic surgery in patients with low body mass index: an online survey of 543 bariatric and metabolic surgeons

Citation: BMC surgery. 2023, 23(1), 272
Author: Shahmiri SS; Parmar C; Yang W; Lainas P; Pouwels S; DavarpanahJazi AH; Chiappetta S; Seki Y; Omar I; Vilallonga R; Kassir R; Abbas SI; Bashir A; Singhal R; Kow L; Kermansaravi M; 
Abstract: Background: Metabolic and bariatric surgery (MBS) in patients with low body mass index patients is a topic of debate. This study aimed to address all aspects of controversies in these patients by using a worldwide survey.

Methods: An online 35-item questionnaire survey based on existing controversies surrounding MBS in class 1 obesity was created by 17 bariatric surgeons from 10 different countries. Responses were collected and analysed by authors.

Results: A total of 543 bariatric surgeons from 65 countries participated in this survey. 52.29% of participants agreed with the statement that MBS should be offered to class-1 obese patients without any obesity related comorbidities. Most of the respondents (68.43%) believed that MBS surgery should not be offered to patients under the age of 18 with class I obesity. 81.01% of respondents agreed with the statement that surgical interventions should be considered after failure of non-surgical treatments.

Conclusion: This survey demonstrated worldwide variations in metabolic/bariatric surgery in patients with class 1 obesity. Precise analysis of these results is useful for identifying different aspects for future research and consensus building.

WUTH publication: Treatment priorities and regret in older adults with head and neck cancer: A systematic review

Citation: Clinical otolaryngology. 2023 Sep 05. Online ahead of print.
Author: Fahy E; Cantwell LA; Patterson JM; Cherry MG; Rogers S; Akpan A; Hamilton DW; 
Abstract: Background: The majority of head and neck cancer (HNC) diagnoses are seen in people aged 70 and older; these numbers are set to increase. Greater understanding of treatment needs of older patients with HNC is essential. These older patients often have co-existing health conditions, are prone to frailty and may not prioritise survival when considering treatment options. This systematic review examines the current research with regard to priorities and factors influencing treatment regret in older people with HNC.
Methods: Studies were eligible for inclusion if they (i) reported data from patients with a mean age of 65 years or older who had a confirmed diagnosis of HNC and had been treated using surgery, chemotherapy and/or radiotherapy with either palliative or curative intent, (ii) considered patient's priorities or preferences or examined treatment regret as one of the primary outcomes of the study (iii) were published in English.
Results: Pilot search identified n = 7222 articles; however, following screening, only four papers met the inclusion criteria. Narrative synthesis was indicated to analyse quantitative and qualitative evidence in parallel, as meta-analyses were not possible.
Discussion: There is a paucity in the literature examining older adults with HNC. There is an indication that older adults prioritise maintaining independence when making treatment decisions and treatment regret is seen in those with high levels of depression with level of frailty also a contributing factor. Clinicians should consider patient's social circumstances, premorbid status and priorities in maintaining independence and managing symptoms when making treatment decisions in this cohort..

WUTH publication: Health-related quality of life, functional outcomes, and complications after sentinel lymph node biopsy and elective neck dissection in early oral cancer: A systematic review

Citation: Head & neck. 2023 Aug 29
Author: McDonald C; Kent S; Schache A; Rogers S; Shaw R;
Abstract: Background: Elective neck dissection improves survival in early oral cancer. Sentinel lymph node biopsy may also do this with less morbidity. This systematic review compared health-related quality of life, functional outcomes, and complications after sentinel lymph node biopsy and elective neck dissection in early oral cancer.
Methods: PRISMA guidelines were followed. Thirteen studies met inclusion criteria.
Results: Results favoring sentinel lymph node biopsy were found in complications, scar length and appearance, length of hospital stay, time to drain removal, and objective shoulder measures at timepoints up to 12 months. Where differences in health-related quality of life were found, methodological issues make their clinical significance questionable.
Conclusions: Sentinel lymph node biopsy was associated with fewer complications and statistically better outcomes in a number of physical measures. There is as yet no strong evidence to suggest it is associated with better health-related quality of life outcomes. While a number of health-related quality of life outcome measures show promise, their interpretation is hampered by methodological concerns. Further rigorous research is required to address this.

WUTH publication: ACTivity as medicine In Oncology for Head and Neck (ACTIOHN): Protocol for a feasibility study investigating a patient-centred approach to exercise for people with head and neck cancer

Citation: PLoS One. 2023, 18(8), e0289911
Author: Midgley AW; Levy AR; Rogers SN; Brooker RC; Bryant V; Cherry MG; Lane S; Nugent MM; Price R; Schache AG; Young B; Patterson JM;

Abstract: Background and Aim: Attempts at personalisation of exercise programmes in head and neck cancer (HaNC) have been limited. The main aim of the present study is to investigate the feasibility and acceptability of introducing a remotely delivered, fully personalised, collaborative, and flexible approach to prescribing and delivering exercise programmes into the HaNC usual care pathway.

Methods: This is a single arm, feasibility study. Seventy patients diagnosed with HaNC will be recruited from two regional HaNC centres in the United Kingdom. Patients will undertake an 8-week exercise programme designed and delivered by cancer exercise specialists. The exercise programme will start any time between the time of diagnosis and up to 8 weeks after completing treatment, depending on patient preference. The content of the exercise programme will be primarily based on patient needs, preferences, and goals, but guided by current physical activity guidelines for people with cancer. The primary outcome measure is retention to the study. Secondary quantitative outcomes are uptake to the exercise programme, different measures of exercise adherence, pre- and post-intervention assessments of fatigue (Multidimensional Fatigue Symptom Inventory-Short Form), quality of life (SF-36), physical activity levels (International Physical Activity Questionnaire-Short Form), and various components of physical fitness. The outcomes of the nested qualitative study are acceptability and feasibility of the intervention evaluated via interviews with patients, health care professionals, and the cancer exercise specialists. Intervention and participant fidelity will be determined using checklists and scrutiny of each patient's logbook and the cancer exercise specialists' meeting notes. Analysis of quantitative data will be via standard summary statistics. Qualitative data will be analysed using thematic analysis.

Expected Results: This feasibility study will inform the design and conduct of a future randomised controlled trial. Success will be defined according to a traffic light system for identifying the appropriateness of progression to a randomised controlled trial.

Trial Registration: International Standard Randomised Controlled Trial Number registry (ISRCTN82505455).

Competing Interests: The authors have declared that no competing interests exist.

WUTH publication: Barriers to and facilitators of physical activity in adults living with and beyond cancer, with special emphasis on head and neck cancer: a systematic review of qualitative and mixed methods studies

Citation: Supportive care in cancer. 2023, 31(8), 471
Author: Doughty HC; Hill RA; Riley A; Midgley AW; Patterson JM; Boddy LM; Rogers SN; Maden M; Williams NH; 
Abstract: Purpose: Physical activity can improve health outcomes for cancer patients; however, only 30% of patients are physically active. This review explored barriers to and facilitators of physical activity promotion and participation in patients living with and beyond cancer. Secondary aims were to (1) explore similarities and differences in barriers and facilitators experienced in head and neck cancer versus other cancers, and (2) identify how many studies considered the influence of socioeconomic characteristics on physical activity behaviour.

Methods: CINAHL Plus, MEDLINE, PsycINFO, Scopus and Cochrane (CDSR) were searched for qualitative and mixed methods evidence. Quality assessment was conducted using the Mixed Methods Appraisal Tool and a Critical Appraisal Skills Programme Tool. Thematic synthesis and frequency of reporting were conducted, and results were structured using the Capability-Opportunity-Motivation-Behaviour model and Theoretical Domains Framework.

Results: Thirty qualitative and six mixed methods studies were included. Socioeconomic characteristics were not frequently assessed across the included studies. Barriers included side effects and comorbidities (physical capability; skills) and lack of knowledge (psychological capability; knowledge). Having a dry mouth or throat and choking concerns were reported in head and neck cancer, but not across other cancers. Facilitators included improving education (psychological capability; knowledge) on the benefits and safety of physical activity.

Conclusion: Educating patients and healthcare professionals on the benefits and safety of physical activity may facilitate promotion, uptakeand adherence. Head and neck cancer patients experienced barriers not cited across other cancers, and research exploring physical activity promotion in this patient group is required to improve physical activity engagement.

WUTH publication: Simultaneous Bilateral Patellar Tendon Rupture: A Systematic Review

Citation: Cureus. 2023, 15(7), e41512
Author: Fernandes A; Rufino M; Hamal D; Mousa A; Fossett E; Cheema KS; 
Abstract: The extensor mechanism of the knee can be damaged due to various modes of injury, which, in most cases, will require urgent surgical intervention for repair. Single patellar tendon ruptures are uncommon, but simultaneous bilateral events are even rarer and have been scarcely reviewed in English literature. Research in this area is mainly confined to case series, with some literature reviews but no evidence of more substantial analysis. Therefore, this systematic review was done to analyse the existing literature on bilateral simultaneous patellar tendon ruptures and propose a systematic and standardised approach to diagnosing and managing these injuries. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The search terms included 'bilateral patellar tendon rupture', 'bilateral', 'patellar', 'tendon' and 'rupture'. Three independent reviewers conducted searches in PubMed, OvidSP for Medline, Embase and the Cochrane Library using the same search strategy. The eligibility criteria included studies on bilateral concomitant patellar tendon rupture published in English. Bilateral simultaneous patellar tendon ruptures of traumatic and atraumatic origin in human patients were included. The study types comprised case reports and literature reviews. The key limitation of this study was the low number of patients covered by the eligible literature. Patellar tendon ruptures are a rare and scarcely documented injury, and there is a need for studies with a high level of evidence, especially regarding surgical treatment choice and methods, as well as post-operative management, which could potentially lead to improved outcomes in the management of this injury.

WUTH publication: Shared Decision-making Among Clinicians and Patients With Low-risk Differentiated Thyroid Cancer-Reply

Citation: JAMA otolaryngology-- head & neck surgery. 2023, 149(9), 851-2
Author: Yang W; Rogers SN; Kim D; 

WUTH publication: Urinary tissue inhibitor of metalloproteinase-2 as an early predictor for acute kidney injury in critically ill children

Citation: International journal of health sciences. 2023, 17(4), 22-28
Author: Abouhadid MA; Gawad TAA; Gebaly HHE; Abdallah AA; Refay ASE; Helmy NM; Allam AM;
Abstract: Objectives: Acute kidney injury (AKI) is one of the most devastating complications of critical illness in children. Serum creatinine (Scr) is considered the gold standard for AKI diagnosis yet noted to be late and inaccurate. This raises the need for an early and accurate biochemical parameter for the early detection of AKI. This research aimed to explore the role of urinary tissue inhibitor metalloproteinase 2 (TIMP-2) in the early prediction of AKI, compared to standard biomarkers, in critically ill children admitted to pediatric intensive care unit (PICU). Urine TIMP2 was previously explored in multiple adult studies and showed promising results; however, the study of its role in pediatric population was limited.
Methods: This study was a prospective cohort study including 42 critically ill children who are at increased risk of AKI. Cases were recruited from the PICU in the Children's Hospital of Ain-Shams University, Cairo - Egypt over 10 months' duration. Urine samples were collected to measure urinary TIMP-2 and blood samples were taken to measure the levels of Scr, creatinine clearance, and blood urea nitrogen. Urine output in 24 h was also calculated.
Results: Urinary TIMP-2 showed considerably higher levels in AKI compared to non-AKI patients as early as day 1, whereas increased levels of Scr and decreased urine output were noticed later (day 3 and day 5, respectively). A notable correlation existed between TIMP-2 at day 1 and creatinine at day 3.
Conclusion: The present study revealed that urinary TIMP-2 could have an important role in the early prediction of AKI before the increase in Scr and more deterioration in kidney functions.
Competing Interests: The authors declare that they have no competing interests.

WUTH publication: Diverticular abscess, pelvic and other intra-abdominal abscesses

Citation: Surgery (Oxford). 2023, 41(7), 440-8
Author: Reid, Rebecca; Boyce, Kathryn; Guy, Richard

WUTH publication: Spontaneous colonic perforation and abdominal wall extrusion of an orally ingested fork handle

Citation: Annals of the Royal College of Surgeons of England. 2023, 105(6), 585-8
Author: Tan JR; Buckley K; Guy R;
Abstract: Most ingested foreign bodies pass through the gastrointestinal tract spontaneously, but a small number of cases lead to complications and necessitate surgical intervention. We present a rare case of an ingested fork handle that perforated silently through the colon and fistulated through the abdominal wall. This case highlights the importance of balancing the risks and benefits of surgical intervention and the multidisciplinary approach to complex situations.

WUTH publication: ORthopaedic trauma hospital outcomes - Patient operative delays (ORTHOPOD) Study: The management of day-case orthopaedic trauma in the United Kingdom

Citation: Injury. 2023, 54(6), 1588-94
Author: Stevenson, Iain; Yoong, Andrel; Rankin, Iain; Dixon, James; Lim, Jun Wei; Sattar, Mariam; McDonald, Stephen; Scott, Sharon; Davies, Helen; Jones, Louise; Nolan, Michelle; McGinty, Rebecca; Stevenson, Helene; Bowe, David; Sim, Francis; Vun, James; Strain, Ritchie; Giannoudis, Vasileios; Talbot, Christopher; Gunn, Christopher; Le, Ha Phuong Do; Bradley, Matthew; Lloyd, William; Hanratty, Brian; Lim, Yizhe; Brookes-Fazakerley, Steven; Varasteh, Amir; Francis, Jonathan; Choudhry, Nameer; Malik, Sheraz; Vats, Amit; Evans, Ashish; Garner, Madeleine; King, Stratton; Zbaeda, Mohamed; Diamond, Owen; Baker, Gavin; Napier, Richard; Guy, Stephen; McCauley, Gordon; King, Samuel; Edwards, Gray; Lin, Benjamin; Davoudi, Kaveh; Haines, Samuel; Raghuvanshi, Manav; Buddhdev, Pranai; Karam, Edward; Nimmyel, Enoch; Ekanem, George; Lateef, Razaq; Jayadeep, JS; Crowther, Ian; Mazur, Karolina; Hafiz, Nauman; Khan, Umair; Chettiar, Krissen; Ibrahim, Amr; Gopal, Prasanth; Tse, Shannon; Lakshmipathy, Raj; Towse, Claudia; Al-Musawi, Hashim; Walmsley, Matthew; Aspinall, Will; Metcalfe, James; Moosa, Aliabbas; Crome, George; Abdelmonem, Mohamed; Lakpriya, Sathya; Hawkins, Amanda; Waugh, Dominic; Kennedy, Matthew; Elsagheir, Mohamed; Kieffer, Will; Oyekan, Adekinte; Collis, Justin; Raad, Marjan; Raut, Pramin; Baker, Markus; Gorvett, Alexander; Gleeson, Hannah; Fahmy, John; Walters, Sam; Tinning, Craig; Chaturvedi, Abhishek; Russell, Heather; Alsawada, Osama; Sinnerton, Robert; Crane, Evan; Warwick, Catherine; Dimascio, Lucia; Ha, Taegyeong Tina; King, Thomas; Engelke, Daniel; Chan, Matthew; Gopireddy, Rajesh; Deo, Sunny; Vasarhelyi, Ferenc; Jhaj, Jasmeet; Dogramatzis, Kostas; McCartney, Sarah; Ardolino, Toni; Fraig, Hossam; Hiller-Smith, Ryan; Haughton, Benjamin; Greenwood, Heather; Stephenson, Nicola; Chong, Yuki; Sleat, Graham; Saedi, Farid; Gouda, Joe; Ravi, Sanjeev Musuvathy; Henari, Shwan; Imam, Sam; Howell, Charles; Theobald, Emma; Wright, Jan; Cormack, Jonathan; Borja, Karlou; Wood, Sandy; Khatri, Amulya; Bretherton, Chris; Tunstall, Charlotte; Lowery, Kathryn; Holmes, Benjamin; Nichols, Jennifer; Bashabayev, Beibit; Wildin, Clare; Sofat, Rajesh; Thiagarajan, Aarthi; Abdelghafour, Karim; Nicholl, James; Abdulhameed, Ahmed; Duke, Kathryn; Maling, Lucy; McCann, Matthew; Masud, Saqib; Marshman, James; Moreau, Joshua; Cheema, Kanwalnaini; Rageeb, Peter Morad; Mirza, Yusuf; Kelly, Andrew; Hassan, Abdul; Christie, Alexander; Davies, Angharad; Tang, Cary; Frostick, Rhiannon; Pemmaraju, Gopalakrishna; Handford, Charles; Chauhan, Govind; Dong, Huan; Choudri, Mohammed Junaid; Loveday, David; Bawa, Akshdeep; Baldwick, Cheryl; Roberton, Andrew; Burden, Eleanor; Nagi, Sameer; Johnson-Lynn, Sarah; Guiot, Luke; Kostusiak, Milosz; Appleyard, Thomas; Mundy, Gary; Basha, Amr; Abdeen, Bashar; Robertson-Smith, Bill; Hussainy, Haydar Al; Reed, Mike; Jamalfar, Aral; Flintoft, Emily; McGovern, Julia; Alcock, Liam; Koziara, Michal; Ollivere, Benjamin; Zheng, Amy; Atia, Fady; Goff, Thomas; Slade, Henry; Teoh, Kar; Shah, Nikhil; Al-Obaedi, Ossama; Jamal, Bilal; Bell, Stuart; Macey, Alistair; Brown, Cameron; Simpson, Cameron; Alho, Roberto; Wilson, Victoria; Lewis, Charlotte; Blyth, Daniel; Chapman, Laura; Woods, Lisa; Katmeh, Rateb; Pasapula, Chandra; Youssef, Hesham; Tan, Jerry; Famure, Steven; Grazette, Andrew; Lloyd, Adam; Beaven, Alastair; Jackowski, Anna; Piper, Dani; Lotfi, Naeil; Chakravarthy, Jagannath; Elzawahry, Ahmed; Trew, Christopher; Neo, Chryssa; Elamin-Ahmed, Hussam; Ashwood, Neil; Wembridge, Kevin; Eyre-Brook, Alistair; Greaves, Amy; Watts, Anna; Stedman, Tobias; Ker, Andrew; Wong, Li Siang; Fullarton, Mairi; Phelan, Sean; Choudry, Qaisar; Qureshi, Alham; Moulton, Lawrence; Cadwallader, Craig; Jenvey, Cara; Aqeel, Aqeel; Francis, Daniel; Simpson, Robin; Phillips, Jon; Matthews, Edward; Thomas, Ellen; Williams, Mark; Jones, Robin; White, Tim; Ketchen, Debbie; Bell, Katrina; Swain, Keri; Chitre, Amol; Lum, Joann; Syam, Kevin; Dupley, Leanne; O'Brien, Sarah; Ford, David; Chapman, Taya; Zahra, Wajiha; Guryel, Enis; McLean, Elizabeth; Dhaliwal, Kawaljit; Regan, Nora; Berstock, James; Deano, Krisna; Donovan, Richard; Diamond, Owen; Blythe, Andrew; Salmon, Jennifer; Craig, Julie; Hickland, Patrick; Matthews, Scott; Brown, William; Borland, Steven; Aminat, Akinsemoyin; Stamp, Gregory; Zaheen, Humayoon; Jaibaji, Monketh; Egglestone, Anthony; Sampalli, Sridhar Rao; Goodier, Henry; Gibb, Julia; Islam, Saad; Ranaboldo, Tom; Theivendran, Kanthan; Bond, Georgina; Richards, Joanna; Sanghera, Ranjodh; Robinson, Karen; Fong, Angus; Tsang, Bonita; Dalgleish, James; McGregor-Riley, Jonathan; Barkley, Sarah; Eardley, William; Elhassan, Almutasim; Tyas, Ben; Chandler, Henry; McVie, James; Wei, Nicholas; Negus, Oliver; Baldock, Thomas; Ravi, Kuppuswamy; Qazzaz, Layth; Mohamed, Muawia; Sivayoganthan, Sriharan; Poole, William; Slade, George; Beaumont, Hugo; Beaumont, Oliver; Taha, Rowa; Lever, Caroline; Sood, Abhay; Moss, Maximillian; Khatir, Mohammed; Trompeter, Alex; Jeffers, Aisha; Brookes, Charlotte; Dadabhoy, Maria; Matthews, Edward; Bhattacharya, Rajarshi; Singh, Abhinav; Beer, Alexander; Hodgson, Harry; Rahman, Kashed; Barter, Reece; Mackinnon, Thomas; Frasquet-Garcia, Antonio; Aldarragi, Ameer; Warner, Christian; Pantelides, Christopher; Attwood, Joseph; Al-Uzri, Muntadhir; Qaoud, Qaiys Abu; Green, Stephen; Osborne, Alex; Griffiths, Alexandra; Emmerson, Benjamin; Slater, Duncan; Altahoo, Hasan; Scott, Helen; Rowland, David; O'Donnell, Janine; Edwards, Taff; Hafez, Ahmed; Khan, Basharat; Crane, Emily; Axenciuc, Rostislav; Al-Habsi, Ruqaiya; McAlinden, Gavan; Sterne, Jonathan; Wong, Matthew Lynch; Patil, Sunit; Ridha, Ali; Rasidovic, Damir; Searle, Henry; Choudhry, Jamaal; Farhan-Alanie, Muhamed M; Tanagho, Andy; Sharma, Sidharth; Thomas, Suresh; Smith, Ben; McMullan, Mark; Winstanley, Robert; Mirza, Saqeb; Hamlin, Katharine; Elgayar, Lugman; Larsen, Matthew P; Eissa, Mohamed; Stevens, Samuel; Hopper, Graeme P; Fang Soh, Terrence Chi; Doorgakant, Ashtin; Yogeswaran, Apimaan; Myatt, Darren; Mahon, Joseph; Ward, Nicholas; Reid, Susan; Deierl, Krisztian; Brogan, Declan; Little, Max; Deakin, Sue; Baines, Elliott; Jones, Georgie; Boulton, Helen; Douglas, Trixie; Jeyaseelan, Lucky; Abdale, Abdirizak; Islam, Aminul; Atkinson, Kate V; Mohamedfaris, Khalid; Mmerem, Kingsley; Jamal, Shazil; Wharton, Danielle; Rana, Anurag; McAllister, Ross; Sasi, Sijith; Thomas, Terin; Pillai, Anand; Flaherty, David; Khan, Munir; Akkena, Sudheer; Shandala, Yaseen; Lankester, Benedict; Hainsworth, Louis; Wei, Nicholas; Baldock, Thomas E.; Elamin-Ahmed, Hussam; Walshaw, Thomas; Walker, Reece; Trompeter, Alex; Eardley, William P.G.

WUTH publication: Small Abdominal Aortic Aneurysms Under Surveillance in the Over 80s: A Step Too Far?

Citation: Journal of Vascular Surgery. 2023, 77(6), e70-1
Author: Ninkovic-Hall, George A; Chan, Colin W.M.

WUTH publication: Defective T-cell response to COVID-19 vaccination in acute myeloid leukaemia and myelodysplastic syndromes

Citation: British journal of haematology. 2023 Jun 12. 
Author: Loke J; Upasani V; Gaskell C; Fox S; Fletcher R; Thomas C; Hopkins L; Kumari A; Tang T; Yafai E; Boucher R; Homer V; Toth A; Chan YLT; Randall K; Rider T; O'Nions J; Drew V; Pillai A; Dungarwalla M; Murray D; Khan A; Wandroo F; Moore S; Krishnamurthy P; Huang YJ; Knapper S; Byrne J; Zhao R; Craddock C; Parry H; Moss P; Stanworth SJ; Lowe DM; 
Abstract: Limited data exist on COVID-19 vaccination efficacy in patients with acute myeloid leukemia and myelodysplasia with excess blasts (AML/MDS-EB2). We report results from a prospective study, PACE (Patients with AML and COVID-19 Epidemiology). 93 patients provided samples post-vaccine 2 or 3 (PV2, PV3). Antibodies against SARS-COV-2 spike antigen were detectable in all samples. Neutralization of the omicron variant was poorer than ancestral variants but improved PV3. In contrast, adequate T-cell reactivity to SARS-COV-2 spike protein was seen in only 16/47 (34%) patients PV2 and 23/52 (44%) PV3. Using regression models, disease response (not in CR/Cri), and increasing age predicted poor T cell response.

WUTH publication: Neonatal Drug Formularies-A Global Scope

Citation: Children. 2023, 10(5)
Author: Shaniv D; Bolisetty S; Young TE; Mangum B; Ainsworth S; Elbers L; Schultz P; Cucchi M; de Wildt SN; van der Zanden TM; Caldwell N; Smits A; Allegaert K; 

Abstract: Neonatal drug information (DI) is essential for safe and effective pharmacotherapy in (pre)term neonates. Such information is usually absent from drug labels, making formularies a crucial part of the neonatal clinician's toolbox. Several formularies exist worldwide, but they have never been fully mapped or compared for content, structure and workflow. The objective of this review was to identify neonatal formularies, explore (dis)similarities, and raise awareness of their existence. Neonatal formularies were identified through self-acquaintance, experts and structured search. A questionnaire was sent to all identified formularies to provide details on formulary function. An original extraction tool was employed to collect DI from the formularies on the 10 most commonly used drugs in pre(term) neonates. Eight different neonatal formularies were identified worldwide (Europe, USA, Australia-New Zealand, Middle East). Six responded to the questionnaire and were compared for structure and content. Each formulary has its own workflow, monograph template and style, and update routine. Focus on certain aspects of DI also varies, as well as the type of initiative and funding. Clinicians should be aware of the various formularies available and their differences in characteristics and content to use them properly for the benefit of their patients.

WUTH publication: Efficacy of preoperative axillary ultrasound in excluding nodal disease in early breast cancer

Citation: European Journal of Surgical Oncology. 2023, 49(5), e250
Author: Javed, Nida; Iqbal, Ejaz; Afzal, Sidra; Parvaiz, Muhammad Asad; Rehman, Bushra 

WUTh publication: Identifying challenges in implementing child rights instruments in Nigeria: A nationwide survey of knowledge, perception, and practice of child rights among doctors and nurses

Citation: Annals of African medicine. 2023, 22(2), 189-203
Author: Adeleye QA; Ahmed PA; Babaniyi IB; Oniyangi O; Mukhtar-Yola M; Adelayo AY; Wey YO; Ononiwu UN; Sanni UA; Adeleye BB; Audu LI; 
Abstract: Context: After thirty years of ratifying the child rights convention and nineteen years of the Child Rights Act, implementing child rights instruments remains challenging in Nigeria. Healthcare providers are well positioned to change the current paradigm.

Aim: To examine the knowledge, perception, and practice of child rights and the influence of demographics among Nigerian doctors and nurses.

Materials and Methods: A descriptive, cross-sectional online survey was done using nonprobability sampling. Pretested multiple-choice questionnaire was disseminated across Nigeria's six geopolitical zones. Performance was measured on the frequency and ratio scales. Mean scores were compared with 50% and 75% thresholds.

Results: A total of 821 practitioners were analyzed (doctors, 49.8%; nurses, 50.2%). Female-to-male ratio was 2:1 (doctors, 1.2:1; nurses, 3.6:1). Overall, knowledge score was 45.1%; both groups of health workers had similar scores. Most knowledgeable were holders of fellowship qualification (53.2%, P = 0.000) and pediatric practitioners (50.6%, P = 0.000). Perception score was 58.4% overall, and performances were also similar in both groups; females and southerners performed better (59.2%, P = 0.014 and 59.6%, P = 0.000, respectively). Practice score was 67.0% overall; nurses performed better (68.3% vs. 65.6%, P = 0.005) and postbasic nurses had the best score (70.9%, P = 0.000).

Conclusions: Overall, our respondents' knowledge of child rights was poor. Their performances in perception and practice were good but not sufficient. Even though our findings may not apply to all health workers in Nigeria, we believe teaching child rights at various levels of medical and nursing education will be beneficial. Stakeholder engagements involving medical practitioners are crucial.

Competing Interests: None

WUTH publication: Bell's palsy

Citation: BMJ Publishing Group. 2023
Author: Matthew Q. Miller MD; Liliana Ein MD

WUTH publication: Patient preference for commonly-used, head and neck cancer-specific quality of life questionnaires in the follow-up setting (Determin): A multi-centre randomised controlled trial and mixed methods study

Citation: Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery. 2023 Apr 04.
Author: Mehanna H; Carter B; Hartley A; Abou-Foul AK; Brooks J; Jones J; Fresco L; Moss L; Jones TM; Rogers SN; Morton RP; 
Abstract: Background: Quality of life (QoL) assessment forms an integral part of modern cancer care and research. The aim of this study is to determine patients' preferences and willingness to complete commonly used head-and-neck cancer (HNC) QoL questionnaires (QLQs) in routine follow-up clinics.
Methods: This is a randomised control trial of 583 subjects from 17 centres during follow-up after treatment for oral, oropharyngeal or laryngeal cancer. Subjects completed three structured validated questionnaires: EORTC QLQ-HN35; FACT-HN and UW-QOL, and an unstructured patient-generated list. The order of questionnaire presentation was randomised, and subjects were stratified by disease site and stage. Patients self-rated the questionnaires they found most helpful to communicate their health concerns to their clinicians.
Results: Of the 558 respondents, 82% (457) found QLQs useful to communicate their health concerns to their clinician (OR = 15.76; 95% CI 10.83-22.94). Patients preferred the structured disease-specific instruments (OR 8.79; 95% CI 5.99-12.91), while the open list was the most disliked (OR = 4.25; 95% CI 3.04-5.94). There was no difference in preference by treatment modality. More women preferred the FACT-HN (OR = 3.01, 95% CI 1.05-8.62), and patients under 70 preferred EORTC QLQ-HN35 (OR = 3.14, 95% CI 1.3-7.59). However, only 55% of patients expressed preference to complete questionnaires routinely at the clinic.
Conclusions: Most patients found QLQs helpful during their follow-up and 55% supported routine questionnaires in follow-up clinics. Males and people over 70 years old were the least willing to complete the routine questionnaires and preferred shorter questionnaires (e.g., UW-QOL). Women preferred FACT-HN, and younger patients preferred EORTC QLQ-HN35. Reasons for the reluctance to complete questionnaires require elucidation.

WUTH publication: The Scare 2023 guideline: Updating consensus surgical case report (SCARE) guidelines

Citation: International journal of surgery. 2023 Apr 05
Author: Sohrabi C; Mathew G; Maria N; Kerwan A; Franchi T; Agha RA; 
Abstract: Background: The Surgical CAse REport (SCARE) guidelines were first published in 2016 as a tool for surgeons to document and report their surgical cases in a standardised and comprehensive manner. However, with advances in technology and changes in the healthcare landscape, it is important to revise and update these guidelines to ensure they remain relevant and valuable for surgeons. This paper presents an update to these guidelines.
Materials and Methods: The updated guidelines were produced through a Delphi consensus exercise. Members of the SCARE 2020 guidelines Delphi group, editorial board members, and peer reviewers were invited to participate. Potential contributors were contacted by email. An online survey was completed to indicate their agreement with the proposed changes to the guideline items.
Results: A total of 54 participants were invited to participate and 45 (83.3%) completed the survey. There was a high degree of agreement among reviewers, with 36 items (83.7%) meeting the threshold for inclusion within the updated guidelines.
Conclusion: Through a completed Delphi consensus exercise we present the SCARE 2023 guidelines. This will provide surgeons with a comprehensive and up-to-date tool for documenting and reporting their surgical cases while highlighting the importance of patient-centered care.

WUTH publication: Safety and feasibility of cardiopulmonary exercise testing in head and neck cancer survivors

Citation: Clinical physiology and functional imaging. 2023, 43(3), 170-80
Author: Cunha FA; Key A; Patterson JM; Rogers SN; 
Abstract: Purpose: Assess safety and feasibility of the cardiopulmonary exercise test (CPET) for evaluating head and neck cancer (HaNC) survivors. Also compare their cardiorespiratory fitness to age and sex-matched norms and establish current physical activity levels.
Methods: Fifty HaNC survivors [29 male; mean (SD) age, 62 (8) years], who had completed treatment up to 1 year previously, were recruited. Participants performed a CPET on a cycle ergometer to symptom-limited tolerance. Participants completed a questionnaire to report contributory factors they perceived as influencing test termination. Physical activity levels were determined using a self-reported physical activity questionnaire.
Results: Three participants did not complete the CPET because (1) poor fitting mouthpiece and naso-oral mask due to facial disfiguration from surgery; (2) knee pain elicited by cycling; and (3) early CPET termination due to electrocardiogram artefacts. Participants reached a mean peak oxygen uptake that was 34% lower than predicted and the mean (SD) CPET duration of 7:52 (2:29) min:s was significantly lower than the target test duration of 10 min (p < 0.001). Leg muscle aches and/or breathing discomfort were major contributory factors influencing test termination for 78% of participants, compared to 13% for dry mouth/throat and/or drainage in the mouth/throat. No major adverse events occurred. Participants were categorised as 26% active, 8% moderately active, and 66% insufficiently active.
Conclusion: These preliminary data suggest the CPET appears safe and feasible for most HaNC survivors when strict exclusion criteria are applied; however, low levels of cardiorespiratory fitness should be considered when calculating an appropriate ramp rate.

WUTH publication: Intraoperative and early postoperative complications of reverse shoulder arthroplasty: A current concepts review

Citation: Journal of Orthopaedics. 2022, 35, 120-5
Author: David Hawkes, Steven Brookes-Fazakerley, Simon Robinson, Vijay Bhalaik

WUTH publication: Coronavirus in hip fractures (CHIP) 4 : has vaccination improved mortality outcomes in hip fracture patients?

Citation: Bone Joint Journal. 2022, 104-B(12), 1362-8
Author: Fatima Rashid, Aatif Mahmood, David H. Hawkes, William J. Harrison

WUTH publication: The Effect of the COVID-19 Pandemic on HbA1c Testing: Prioritization of High-Risk Cases and Impact of Social Deprivation

Citation: Diabetes therapy: research, treatment and education of diabetes and related disorders. 2023, 14(4), 691-707
Author: Holland D; Heald AH; Hanna FFW; Wu P; Sim J; Duff CJ; Duce H; Green L; Scargill J; Howe JD; Robinson S; Halsall I; Gaskell N; Davison A; Simms M; Denny A; Langan M; Fryer AA; 
Abstract: 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 and demographic characteristics.

Methods: In a service evaluation, we examined HbA1c testing across ten UK sites (representing 9.9% of England's population) from January 2019 to December 2021. We compared monthly requests from April 2020 to those in the equivalent 2019 months. We examined effects of (i) HbA1c level, (ii) between-practice variability, and (iii) practice demographics.

Results: In April 2020, monthly requests dropped to 7.9-18.1% of 2019 volumes. By July 2020, testing had recovered to 61.7-86.9% of 2019 levels. During April-June 2020, we observed a 5.1-fold variation in the reduction of HbA1c testing between general practices (12.4-63.8% of 2019 levels). There was evidence of limited prioritization of testing for patients with HbA1c > 86 mmol/mol during April-June 2020 (4.6% of total tests vs. 2.6% during 2019). Testing in areas with the highest social disadvantage was lower during the first lockdown (April-June 2020; trend test p < 0.001) and two subsequent periods (July-September and October-December 2020; both p < 0.001). By February 2021, testing in the highest deprivation group had a cumulative fall in testing of 34.9% of 2019 levels versus 24.6% in those in the lowest group.

Conclusion: Our findings highlight that the pandemic response had a major impact on diabetes monitoring and screening. Despite limited test prioritization in the > 86 mmol/mol group, this failed to acknowledge that those in the 59-86 mmol/mol group require consistent monitoring to achieve the best outcomes. Our findings provide additional evidence that those from poorer backgrounds were disproportionately disadvantaged. Healthcare services should redress this health inequality.

WUTH publication: Neonatal IVC thrombosis in a baby born to an aPL positive mother – a case report

Citation: Lupus. 2023, 32(3), 441-43
Author: Ramakrishnan, Smriti; Abbas, Azhar; Jordan, Natasha
Abstract: Neonatal antiphospholipid syndrome (APS) is a rare condition that can occur due to either transplacental transfer of antiphospholipid antibodies (aPL) from the mother, or, more rarely, de novo in the infant.[1] The condition manifests as arterial, venous or mixed thromboses. In the present case, the mother had gestational hypertension, which may have acted as a risk factor for foetal thrombosis.[9] Although maternal hypertension has been found to be independently associated with foetal arterial thrombosis,[10] no such association has been found with venous thrombosis. In the present case, it is possible that gestational hypertension in combination with aPLs resulted in the formation of the IVC thrombosis, but further study is required to determine whether there is a consistent association between maternal hypertension and neonatal venous thrombosis. [Extracted from the article]

WUTH publication: Erratum to ‘Fractured epidural catheter with retained fragment in the epidural space—a case study and proposed management algorithm’ [BJAOpen 4 (2022) 100095]

Citation: BJA Open. 2023 March
Author: Gompels, Ben; Rusby, Tobin; Slater, Neil 

WUTH publication: Removal of breast implants as primary treatment for autoimmune/inflammatory syndrome induced by adjuvants

Citation: Scandinavian journal of rheumatology. 2023, 52(2), 219-20
Author: Ramakrishnan S; Abbas A; Jordan N; 

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

Citation: American heart journal. 2023, 257, 103-10
Author: Harrison SL; Buckley BJR; Zheng Y; Hill A; Hlaing T; Davies R; Guo Y; Lane DA; Lip GYH; 
Abstract: 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 aims of the Liverpool-Huawei Stroke Study are to determine the effectiveness, cost-effectiveness and patient and staff acceptability of using Huawei smart wearables to detect AF following ischemic stroke. The study plans to recruit 1,000 adults aged ≥18 years following ischemic stroke from participating hospitals over 12 months. All participants will be asked to wear a Huawei smart band for 4 weeks postdischarge. If participants do not have access to a compatible smartphone required for the study, they will be provided with a smartphone for the 4-week AF monitoring period.

Results: Participants with suspected AF detected by the smart wearables, without previous known AF, will be referred for further evaluation. To determine the effectiveness of the Huawei smart wearables to detect AF, the positive predictive value will be determined. Patient acceptability of using this technology will also be examined. Additional follow-up assessments will be conducted at 6 and 12 months, and clinical outcomes recorded in relation to prevalent and incident AF post-stroke. The study opened for recruitment on May 30, 2022, and is currently open at 4 participating hospitals; the first 106 participants have been recruited. One further hospital is preparing to open for recruitment.

Conclusions: This prospective study will examine the effectiveness and acceptability of the use of smart wearables in patients following ischemic stroke. This could have important implications for detection of AF and therefore, earlier prophylaxis for recurrent stroke. The study is registered on https://www.isrctn.com/ (Identifier ISRCTN30693819).

WUTH publication: Addressing patients' concerns in speech and language therapy consultations following the diagnosis and treatment of head and neck cancer

Citation: Current opinion in otolaryngology & head and neck surgery. 2023 Mar 03
Author: Zuydam AC; Rogers SN; Roe JWG; 
Abstract: Purpose of Review: Head and neck cancer (HNC) and its treatment impacts profoundly on patients' functional abilities, emotional well being and social interactions. Communication and swallowing are fundamental to everyday life, and the Speech and Language Therapist (SLT) has a critical role for both patients and their carers. In clinical practice, patient-reported outcome measures (PROMs) are a key part of the armamentarium of the SLT. The purpose of the review is to summarize how these measures can be beneficial in the context of time pressured SLT outpatient consultations.

Recent Findings: Unmet needs in HNC are common and impact negatively on quality of life. There is an ever-increasing number of articles in this area, and it can be a challenge to identify, distil and summarize those specific to SLT.

Summary: In this review, we discuss the scope of holistic evaluation, strengths and limitations of PROMs, the Patient Concerns Inventory-Head and Neck, barriers to the use of outcome measures, the carers perspective and surveillance. SLT are uniquely placed members of the multidisciplinary team and provide expert advice and intervention. The inclusion of PROMs in routine consultations provides a model of follow up, which helps address patients and carers complex and unmet needs, ultimately promoting better outcomes.

WUTH publication: Development of the stroke patient concerns inventory: A modified Delphi study

Citation: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2023, 32(6), 107053. 
Author: Chesworth BM; Patel K; Redfern J; Watkins CL; Rogers SN; Hackett ML; Walker MF; Lightbody CE;
Abstract: Objectives: Stroke survivors often have unmet physical, psychological and/or social concerns. Patient Concerns Inventories (PCIs) have been developed for other health conditions to address concerns. Our objective was to develop a PCI for stroke care.

Methods: This was a development study, including Modified Delphi study design, with academic and healthcare professionals with stroke care expertise. In Stage 1, a draft Stroke PCI (Version 1a) was created through identifying patient-reported concerns post-stroke from three previous studies and through expert panel discussions using Nominal Group Technique. In Stage 2, Version 1a was sent to 92 academic and healthcare professionals with stroke care expertise. Participants ranked their top 20 Stroke PCI items in order of importance and provided feedback. Rankings were converted into scores, and, with the feedback, used to amend the Stroke PCI. Two further rounds of feedback followed until consensus was reached between participants. A final draft of the Stroke PCI was created.

Results: In stage 1, 64 potential Stroke PCI items were generated. In Stage 2, 38 participants (41.3%) responded to the request to rank Stroke PCI items. The three highest ranked items were 'Risk of another stroke', 'Walking', 'Recovery'. After three rounds of feedback and amendments, the final draft of the Stroke PCI consisted of 53 items.

Conclusions: A Stroke PCI has been developed using patient-reported concerns in previous studies and input from academic and healthcare professionals. Future work will involve gathering further feedback on the tool and exploring its acceptability and usability in a pilot study.

(Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

WUTH publication: Challenges of Shared Decision-making by Clinicians and Patients With Low-risk Differentiated Thyroid Cancer: A Systematic Review and Meta-Ethnography

Citation: JAMA otolaryngology - head & neck surgery. 2023 Mar 23.
Author: Yang W; Lee YK; Lorgelly P; Rogers SN; Kim D
Abstract: Importance: Several international guidelines have endorsed more conservative treatment of low-risk differentiated thyroid cancer (LRDTC), yet patients are facing more treatment options with similar oncologic outcomes and are expressing feelings of confusion, dissatisfaction, and anxiety. Shared decision-making, which considers the patient's values and preferences along with the most reliable medical evidence, has been proposed to optimize patient satisfaction in the context of the current clinical equipoise.

Objectives: To understand key individual and behavioral factors affecting the patient and clinician decision-making process in treatment decision for LRDTC.

Evidence Review: This systematic review and meta-ethnography involved a comprehensive literature search of MEDLINE, Embase, PubMed, and CINAHL databases for qualitative and mixed-method studies on patient and clinician experiences with the decision-making process for LRDTC treatment. The quality of the studies was assessed using the Mixed Methods Appraisal Tool; meta-ethnography was used for data analysis. Primary and secondary themes of the included studies were extracted, compared, and translated across articles to produce a lines-of-argument synthesis.

Findings: Of 1081 publications identified, 12 articles met the inclusion criteria. The qualitative synthesis produced 4 themes: (1) a bimodal distribution of patient preferences for treatment decisions; (2) clinician anxiety affected equipoise and biased their recommendations; (3) clinicians struggled to identify patient concerns and preferences; and (4) the clinician-patient relationship and psychosocial support were key to shared decision-making but were frequently overlooked.

Conclusions and Relevance: The findings of this systematic review and meta-ethnography emphasize the need for better patient-clinician communication, particularly with respect to eliciting patient concerns and preferences. With an ever-increasing pool of thyroid cancer survivors, future efforts should be directed at establishing and evaluating tools that will aid in shared decision-making for treatment of patients with LRDTC.

Trial Registration: PROSPERO Identifier: CRD42022286395.

WUTH publication: Factors that affect quality of life for older people with head and neck cancer: A systematic review

Citation: European Journal of Oncology Nursing April. 2023
Author: Semple, Cherith J. a; McKenna, Gerry b; Parahoo, Roisin a; Rogers, Simon N. c; Tiblom Ehrsson, Ylva d
Abstract: Purpose Quality of life is a critical aspect in the management of older head and neck cancer patients. It needs to be considered alongside survival benefit, treatment burden, and longer-term outcomes. The purpose was to undertake a systematic review of empirical peer-reviewed studies with a primary focus on factors impacting quality of life for older head and neck cancer patients.

Results Only 10 papers fulfilled the inclusion criteria. Two main themes emerged: 1) Impact of head and neck cancer on quality of life domains and 2) quality of life in treatment decision-making.

Conclusions In an era of progressive personalised care, there is an evident need for more qualitative and quantitative studies focusing on quality of life for older head and neck cancer patients. However, older head and neck cancer patients experience notable differences, especially with poorer physical functioning and greater eating and drinking challenges. Quality of life impacts older patients decision-making, treatment planning and intensifies post-treatment support.

@@@@Highlights •Management of older patients with head and neck cancer (HNC) is a source of much debate.•Older HNC patients have greater eating challenges, with higher enteral feeding requirement.•Older HNC patients seem to cope and adjust well to treatment, reflected in HRQoL scores.•Decision-making and treatment priorities often differ for older patients with HNC.•Necessity for future studies to enhance person-centred care for older patients with HNC

WUTH publication: Neonatal IVC thrombosis in a baby born to an aPL positive mother - a case report

Citation: Lupus. 2023 Jan 23, Online ahead of print
Author: Smriti Ramakrishnan, Azhar Abbas, Natasha Jordan  

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WUTH publication: Prevalence of Potentially Clinically Significant Drug-Drug Interactions With Antiretrovirals Against HIV Over Three Decades: A Systematic Review of the Literature

Citation: Journal of acquired immune deficiency syndromes. 2023, 92(2), 97-105
Author: Daryl Hodge, Eva Maria Hodel, Elen Hughes, Phoebe Hazenberg, Sandra Grañana Castillo, Sara Gibbons, Duolao Wang, Fiona Marra, Catia Marzolini, David Back, Saye Khoo
Abstract: Background: Contemporary first-line antiretrovirals have considerably reduced liability for clinically significant drug-drug interactions (DDI). This systematic review evaluates the prevalence of DDI among people receiving antiretrovirals across 3 decades.
Methods: We searched 3 databases for studies reporting the prevalence of clinically significant DDIs in patients receiving antiretrovirals published between January 1987 and July 2022. Clinically significant DDIs were graded by severity. All data extractions were undertaken by 2 independent reviewers, adjudicated by a third.
Results: Of 21,665 records returned, 13,474 were duplicates. After screening the remaining 13,596 abstracts against inclusion criteria, 122 articles were included for full-text analysis, from which a final list of 34 articles were included for data synthesis. The proportion of patients experiencing a clinically significant DDI did not change over time (P = 0.072). The most frequently reported classes of antiretrovirals involved in DDIs were protease inhibitors and non-nucleoside reverse transcriptase inhibitors; of note, integrase use in the most recent studies was highly variable and ranged between 0% and 89%.
Conclusions: The absolute risk of DDIs has not decreased over the period covered. This is likely related to continued use of older regimens and an ageing cohort of patients. A greater reduction in DDI prevalence can be anticipated with broader uptake of regimens containing unboosted integrase inhibitors or non-nucleoside reverse transcriptase inhibitors.

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WUTH publication: Evaluation of Drain Insertion After Appendicectomy for Complicated Appendicitis: A Systematic Review and Meta-Analysis

Citation: Cureus. 2022, 14(11), e32018
Author: Abduelraheim Abu, Ali Yasen Mohamedahmed, Amin Alamin, Mazin Mohamed, Mohamed Osman, Mohammed Jibreel Mohammed, Hiba Abdalla, Hazim A Eltyeb, Omer Ali, Rifat Mohamad, Safaa Hamid, Shaza Faycal Mirghani, Yousif Hamad, Hussam Khougali Mohamed 
Abstract: This meta-analysis aims to evaluate the comparative outcomes of drain insertion versus no drain after appendicectomy for complicated appendicitis. A systematic search of PubMed, Cochrane Library and Scopus was conducted, and all studies comparing drain versus no drain after appendicectomy for complicated appendicitis were included. Abdominal collection, surgical site infection (SSI), bowel obstruction, faecal fistula, paralytic ileus, length of hospital stay (LOS) and mortality were the evaluated outcome parameters for the meta-analysis. Seventeen studies reporting a total number of 4,255 patients who underwent appendicectomy for complicated appendicitis with (n=1,580) or without (n=2,657) drain were included. There was no significant difference between the two groups regarding abdominal collection (odds ratio (OR)=1.41, P=0.13). No-drain group was superior to the drain group regarding SSI (OR=1.93, P=0.0001), faecal fistula (OR=4.76, P=0.03), intestinal obstruction (OR=2.40, P=0.04) and paralytic ileus (OR=2.07, P=0.01). There was a difference regarding mortality rate between the two groups (3.4% in the drain group vs 0.5% in the no-drain group, risk difference (RD)=0.01, 95% CI (-0.01, 0.04), P=0.36). In conclusion, this meta-analysis has shown that drains have no effect on the development of intra-abdominal collections in complicated appendicitis, but it can significantly increase the risk of postoperative complications such as fistula, surgical site infection (SSI), bowel obstruction, ileus and length of hospital stay.
Keywords: drain insertion; intra-abdominal abscess; intra-abdominal collection; postoperative ileus; ruptured appendicitis.

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WUTH publication: The Validation of Surgical Simulators: A Technical Report on Current Validation Terminology as a Reference for Future Research

Citation: Cureus. 2022, 14(11), e31881
Author: Thomas Hughes, Joseph T Fennelly, Rakesh Patel, Jonathan Baxter 
Abstract: In recent years, surgical trainees have been exposed to a lower volume of operative procedures. In part, this is due to the reduction in working hours and further disruption by the coronavirus disease 2019 pandemic. Much has been done to develop the techniques of surgical skill training outside of the operating theatre. Simulation-based interventions must undergo a process of validation to assess their appropriateness and effectiveness for use in training. The terminology of validation within current literature, however, has not evolved in line with the education community, resulting in varying definitions for the same phrase across domains. This can result in confusion and misinterpretation among researchers and surgeons working within this domain. This technical report describes the "types of validity" definitions used in the traditional framework of surgical simulation literature and the contemporary, unitary framework of validity adopted by educationalist theorists. There is a clear overlap between the traditional "types of validity" and the contemporary, unitary framework. The divergence in the use of those definitions seems, at least partly, influenced by the context of the investigations being conducted. By utilising the contemporary definitions, authors may have struggled to provide the evidence required to justify the use of the multitude of surgical skill simulators developed in the recent past. This report has provided an overview of the current terminology within the validation frameworks and can be used as a reference for future surgical simulation research.
Keywords: simulation education; simulation in medical education; surgical training; terminology; validation.

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