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.