bluuebunny/crossref_metadata_2025 huggingface dataset:
1318 Cross-Sectional Study of Recurrent Disc Herniation Risk Factors and Predictors of Outcomes After Primary Lumbar Discectomy: A STROBE Compliance
Authors: Dokponou Y C H , Obame F L O , Mouhssani M , El Akroud S , Siba Z , Saad M E , Sahri I E , Chandide Tlemcani Z , Imbunhe N , Yero D , Abderrahmane H , Laaguili J , El Kacemi I , Mohcine S , Belhachmi A , El Asri A C , Mostarchid B , Gazzaz M
Published: August 2023

Aim

The purpose of this study is to determine if lifting weight, smoking status, occupational work, and diabetes were predictors for recurrent lumbar disk herniation (rLDH) leading to reoperation and if the outcome can be influenced by the reoperated level and side.

Method

From June 2010 to July 2019, the 2196 consecutive patients who underwent first-time single-level lumbar discectomy at our institution were revised. Data on first and second lumbar spine surgery were brought into the analysis. Multivariate Logistic Regression Analysis was performed to determine whether lifting weight, smoking status, occupational work, and diabetes were predictors for recurrent lumbar disk herniation. Multivariable Cox-regression analysis was performed for repeated lumbar disc herniation excision at the L4L5 and L5S1 levels independently.

Results

From the 101(4.59%) patients that presented with recurrent lumbar disc herniation (rLDH), 75 cases (3.41%) met the inclusion criteria. There were 54 cases of ipsilateral recurrent herniation and 21 contralateral. The group of diabetes patients who smoke was at high risk (Odds 2.77) of rapid recurrence of lumbar disc prolapse. Only the group of patients reoperated on the opposite side at the L4L5 level showed very less recurrence risk (Odd ratio 1.01) for lumbar disc prolapses compared to those reoperated on the same side who are 6.73 times at risk of recurrence.

Conclusions

Coexisting diabetes and smoking status increase the risk of rLDH and the patient’s outcome is favorable with pain-free after reoperation without the need for physiotherapy when the recurrence is on the same level and opposite side.
799 Positive Resected Lymph Nodes, Five-Year Recurrence/survival and Overall Survival After Pancreatoduodenectomy for Ampullary Adenocarcinoma
Authors: Mariathasan M , Grayson N , Ribaud J , Nair A ,   Raw Study Collaborators, Srinivasan P
Published: August 2023

Aim

Pancreatoduodenectomy (PD) is recommended in patients with resectable ampullary adenocarcinoma (AA). This study aimed to quantify the correlation between histologically involved lymph nodes and survival using a large multicentre cohort.

Method

Data were extracted from the Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study of outcomes following pancreatoduodenectomy for pancreatic head malignancy (29 centres in 8 countries, n = 1484). Patients with histologically confirmed AA were identified and grouped by their number of positive resected nodes. Five-year survival rates and median estimated survival were compared using Fisher’s exact test, Kaplan-Meier method and the log-rank test.

Results

In total, 394 patients (26.5%) had AA. 212 (55.1%) patients had <2 involved nodes and 173 (44.9%) had ≥2 involved nodes (data unavailable for nine patients). The former had reduced five-year recurrence (29.2% vs 64.2%, p<0.0001) and increased five-year survival (69.8% vs 33.5%, p<0.00001). The number of patients with zero, one and two or more positive nodes was 37 (20.8%), 27 (15.2%) and 114 (64.0%), respectively (patients with missing data were excluded). Median survival was 787 (95% confidence interval: 526-1048), 515 (423-607) and 567 (501-632) days, respectively (p = 0.01).

Conclusions

In our multicentre study, a histological finding of <2 positive lymph nodes was associated with reduced five-year recurrence and increased five-year survival in patients who underwent PD for AA. Patients with positive lymph nodes had reduced median survival when compared to those without positive nodes. However, patients with only one positive node did not survive longer than those with two or more positive nodes.
825 Imaging in Suspected Gallstone Patients: Are We Optimising Resources?
Authors: Lawson R
Published: August 2023

Aim

Suspected biliary pathology necessitates imaging to assess for gallstones. Ultrasound is gold-standard but often limited by bowel gas/body habitus. MRCP has become popular due to superior ability to detect CBD stones. CT is often used with concerns of a wider differential diagnosis. This study aimed to explore the diagnostic journey of suspected gallstone patients, and whether increased imaging furthered patients’ management.

Method

This study used retrospective data collection of 2 months' referrals, October 1st-November 30th 2022 (inclusive), to the QEQM General Surgery team with suspected gallstones. This yielded 76 patients, for which PACS was reviewed to collate imaging performed.

Results

28 patients received 1 scan type (37%) and 41 received 2 types (54%). 7 patients received all 3 of CT, US and MRCP (9%); 100% of these gained new information ranging from ductal stones/dilated CBD, to choledochal cysts.

63%with 2+ scan types obtained new information. An additional 15% of patients with 2+ scan types had the absence of CBD stones confirmed on MRCP, where US couldn't comment.

16 patients (33%) had an US/CT that could not confidently comment on CBD dilation.

Conclusions

Most patients had two or more scans, often CT/US followed by US/MRCP respectively, which typically expanded the clinical picture. Multi-modal imaging certainly proves useful, eradicating the individual limitations of each type as shown in this study. MRCP as first-line would prevent multiple scans for one patient but is much more limited in availability. US therefore continues to have significant value in detecting pathology in practice.
1191 Novel Biomarkers for the Diagnosis of Chronic Pancreatitis: An Exploratory Case-Control Study
Authors: Goldsworthy M , Purssell H , Al-Omari D , Barciela C , Brown J , Athwal V , Geraghty J
Published: August 2023

Aim

Chronic pancreatitis is a complex inflammatory syndrome with manifestations including abdominal pain, malnutrition, and diabetes. Early recognition is necessary for optimal management; however this remains clinically challenging and there are no established biomarkers for diagnosis. This exploratory study aims to determine the expression of a set of fibrosis-related serum biomarkers in patients with chronic pancreatitis relative to controls.

Method

Participants were recruited from specialist outpatient clinics at a single centre. Ethical approval was granted via the institutional biobank. Cases were defined as adult patients with a radiological and/or histological diagnosis of chronic pancreatitis. Controls were adult patients with no history of pancreatic disease. Blood samples were collected from each participant and the serum concentrations of candidate biomarkers measured in duplicate by enzyme-linked immunosorbent assays.

Results

In cases (n = 17; median age 53 years) compared to controls (n = 4; median age 54 years), the mean serum concentration of osteoactivin was 39.32 ng/ml vs. 18.70 ng/ml (2.1 fold); fibronectin was 512.33 μg/ml vs. 328.83 μg/ml (1.6 fold), osteopontin was 8.19 ng/ml vs. 7.47 ng/ml (1.1 fold), vimentin was 637.94 ng/ml vs. 562.14 ng/ml (1.1 fold), TIMP1 was 0.25 μg/ml vs. 0.23 μg/ml (1.0 fold) and osteonectin was 3.8 μg/ml vs. 4.71 μg/ml (0.8 fold).

Conclusions

This pilot study demonstrated differential expression of several fibrosis-related serum biomarkers in patients with chronic pancreatitis compared to controls. An expanded study will aim to establish the utility of these biomarkers for the early diagnosis of this condition.
53 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
Authors: Nelson A , Taghizadeh R
Published: August 2023

Background

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 reducing breast cancer mortality risk. Reconstruction options can be classified into immediate vs delayed reconstruction and autologous vs alloplastic reconstruction. Complete reconstruction may take considerable time depending on waiting lists and may include additional aesthetic corrections such as lipomodelling and nipple reconstruction.

Method

Retrospective analysis of referrals (all ages) to a single surgeon at Whiston Hospital for breast reconstruction following RRM between 1/04/2015-1/04/2020.

Results

There were a total of 467 referrals. Of these, 76 (16%) were referred for breast reconstruction following RRM, 51 (67%) of these patients had confirmed genetic mutations and 24 (32%) had no genetic mutation. 48 (94%) patients were BRCA gene carriers of which 32 (63%) were BRCA2 carriers, 14 (27%) were BRCA1 carriers and 2 patients with unknown BRCA variants. There were 2 (4%) patients with CHEK2 mutations and 1 (2%) patient with Cowden’s syndrome.

Conclusions

There is currently no standardised guidance on the timing of RRM and reconstruction in high-risk patients. The risk of breast cancer in high-risk patients increases with age, and there is need for a risk stratification tool for RRM and reconstruction waiting lists, to identify patients with the highest risk of breast cancer development considering their personal and family history.
65 Conservative Management of Wound Dehiscence Following Inguinal Lymph Node Dissection Using Topical Metronidazole Gel Compared to Simple Wound Packing - a Cohort Study
Authors: Ridwanul Hassan M , Henry N
Published: August 2023

Aim

The aim of this study is to determine the effect of simple packing against topical metronidazole in the management of wound dehiscence following inguinal lymph node dissection.

Method

This is a retrospective cohort study of all adult patients who underwent groin dissection between 2014 and 2020 at the Queen Elizabeth Hospital Birmingham. Patients who had flaps or grafts for wound closure, and those with incomplete follow up records were excluded. Patients who developed wound dehiscence were treated with either topical metronidazole or simple packing and were followed up regularly by specialist wound care nurses. Data was collected from electronic medical records from the date of procedure to the latest follow up and analysed in SPSS. The two groups were compared for the time taken for the wound to heal in days as the primary outcome.

Results

From the 157 patients that had groin dissection, 76 (48.4%) developed wound dehiscence. Eight of them were still unhealed at the time of data collection. Among the 68 healed patients, 32 (47%) had been treated with metronidazole-soaked packing, and 44 (53%) had received packing without metronidazole. The two groups were comparable in terms of age, sex, indication for groin dissection and wound size. The mean time to healing for patients treated with topical metronidazole was 63.7±40 days, compared to 45 ±24.7 days in the non-metronidazole group. The difference is significant with a p value of 0.02.

Conclusions

Simple packing of dehisced wounds following groin dissection leads to significantly shorter healing times compared to topical metronidazole.
126 When Does a Pressure Dressing Become a Tourniquet: A Prospective Single Centre Study Assessing Variation and Factors Affecting Pressures Exerted by Pressure Bandages
Authors: Brzeszczynski F , McGhee J , Rust P
Published: August 2023

Introduction

Pressure bandages are frequently used for emergency haemostasis in arterial forearm injuries. This study assesses the range of pressures exerted by pressure bandages and the relevant variables, thus evaluating the safety of use.

Method

We measured pressures under a standard Oleas modular pressure bandage using Flexiforce Prototyping Kit when applied by various members of the hand trauma unit with differing levels of experience.

Results

15 measurements of pressure were recorded. The mean applied pressure was 209mmHg (range: 50 – 485mmHg) with 40% measurements exceeding pressure of 250mmHg. Multivariate regression analysis showed the colour of the hand is statistically significantly related to exerted pressures (p<0.005), but not related to clinical experience (p = 0.101), perceived force of application (p = 0.203) or gender (p = 0.289). Pink hands had a mean pressure equal to 79mmHg compared with purple hands; 336mmHg.

Conclusions

Pressure bandages have large variation in the pressure created, often exceeding safe pressure ranges. Our results suggest if the hand is purple, pressures under the dressing are similar to that of a pneumatic tourniquet. If pressure dressings are required in an emergency setting, these should be removed after 2 hours to prevent the risk of compression injury.
547 Evaluating the Excision and Diagnosis Rates of Non-Melanoma Skin Cancers in a Plastic Surgery Department
Authors: Richardson P S , Khashaba H
Published: August 2023

Aim

Skin cancer is the most common cancer in the UK. 95% of complete excision is considered the national average and achieving this is important for our patients and our practice.

The aims of our study were to evaluate our complete excision rates, sensitivity, and specificity in diagnosing and excising Non-Melanoma Skin Cancers (NMSC) as a department.

Method

We conducted a retrospective audit of adult patients undergoing excision of NMSC in our department in July 2022. Data was collected on age, gender, clinical and pathological diagnosis, surgeon grade, complications, site and subtype of lesion excised.

Results

Of the 100 cases identified, 43% of lesions excised were BCC and 22% were SCC. 72% of procedures were carried out by registrars. 98% of excisions were complete with 2 incomplete excisions and 13 excisions with narrow margins. 86% of specimens with narrow margins or incomplete excision were excised from craniofacial areas. Clinical diagnosis sensitivity for BCC was 79% and 86% for SCC, whereas specificity was 79% for BCC and 58% for SCC. The overall clinical diagnosis sensitivity for NMSC was 81% and negative predictive value was 88%.

Conclusions

Our complete excision rate and sensitivity is above the national average, however our ability to distinguish benign from cancerous lesions has room for improvement. This may reflect surgeon grade and concerns over prolonged waiting times delaying treatment. We therefore recommend regular skin cancer teaching and encourage all grades to use loupes, dermatoscopes and adequate lighting in clinic and theatre to ensure adequate margins and adherence to national guidelines.
549 Foot Syndactyly: Operative Management, Postoperative Webspace Splinting, and a Retrospective Review of Cases Across 15 Years at a Tertiary Plastics Centre
Authors: Skan O , Fleet M , Nikkhah D
Published: August 2023

Aim

Syndactyly of the foot is a common congenital abnormality, with an estimated prevalence of 1 in 2,000. While thought to be more common than hand syndactyly, there is considerably less discussion of foot syndactyly in the literature. We describe our operative approach to foot syndactyly and a postoperative technique for splinting with silicone moulds to reduce webcreep complication. We sought to further characterise the nature of, and postoperative outcomes for, foot syndactyly cases managed at our centre.

Method

We performed a retrospective analysis of cases of paediatric foot syndactyly managed at our centre over the last 15 years.

Results

47 patients (52 primary foot syndactyly repair operations), involving 75 webspaces were identified (80.0% simple syndactyly, 1.3% complex, 18.7% not specified). 54.7% webspaces were incomplete syndactyly (21.3% complete, 24.0% not specified). The second webspace was the most commonly involved (57.3%). Median age of first operation was 47.5 months.

Of patients with documented follow-up, 24.1% of webspaces developed a complication. Complications included webcreep (13.8%), keloid (5.2%) and hypertrophic (5.2%) scarring, graft loss (3.4%), infection (3.4%), overgranulation (1.7%), clinodactyly (1.7%), and suture granuloma (1.7%). The most common documented repair technique involved ‘V-shaped’/’triangular’ interdigitating local flaps. There was no difference in webcreep rates between FTSG and STSG repairs.

Conclusions

Webcreep remains the most common complication of foot syndactyly, and one parents must be suitably informed about. This work adds to a relatively small body of work internationally and describes a simple method to help reduce post-operative contracture.
680 A Systematic Review of Outcomes Measures Evaluating Treatment Efficacy in Vulval Lichen Sclerosus
Authors: Goble M , Jasionowska S , Langridge B , Iakovou D , Kamel F , McKenzie M , Almadori A , Butler P
Published: August 2023

Aim

Vulval lichen sclerosus (VLS) is an inflammatory skin disease characterised by pain, itching, burning, apareunia, loss of vulval architecture and scarring. Despite its detrimental effect on patients’ quality of life, the evidence on currently available treatments remains scarce. Significant heterogeneity in outcome reporting precludes evaluation and meaningful comparison of different treatment options. This study aims to systematically review the different outcome measures used to evaluate efficacy of all VLS treatments.

Method

This review followed PRISMA guidelines using a registered protocol (PROSPERO: CRD42022356738). Multiple databases were searched, along with grey literature on Clinicaltrials.gov, European Union Clinical Trials, and International Standard Randomised Controlled Trial registries. All randomised controlled studies (RCTs) assessing the outcomes of patients undergoing any treatment for VLS were eligible for inclusion.

Results

A total of 775 patients were assessed across 21 RCTs. The identified assessment tools reported outcomes in the following domains: patient-reported symptoms assessed with one validated scale in 12 studies and seven non-validated scales in nine studies; sexual function with validated FSFI and FSDS in two studies and two non-validated scales in two studies; quality of life with three validated scales in three studies; clinician-reported objective outcomes with two validated scales in three studies and six non-validated scales in fourteen studies. Histological changes were assessed in 10 studies and tissue biomechanics in one.

Conclusions

There is high heterogeneity in assessing treatment outcomes for LS. To appropriately evaluate and compare the effectiveness of VLS treatments it is crucial to adopt a core set of outcome measures in future studies.
881 Content Evaluation of First Aid Information of Burn Centre Websites Worldwide
Authors: Deliyannis E , Stanley G , Pitt E , Squires O , O'Brien A M , Aquilina C , Tandle S , Lau C , Tarafdart A , Daly P , Al-Khalil M , Kim E , Lun A , Leong S , Gierzstein S , Wood F , Pleat J
Published: August 2023

While the internet is an invaluable resource for both patients and healthcare providers in the management of burns, websites are often unregulated and highly variable in the quality of their content. Burns centres are in the unique position of possessing presumed reputability amongst the public. It is therefore imperative that their websites provide information that is consistent in its content, through a format that is accessible and coherent.

In this study, we aimed to evaluate first aid websites of burns centres in the UK, Ireland, USA, Canada, Australia and New Zealand. This study highlights the importance of the leadership role that these centres should possess online. A multicentre, observational, cross-sectional study was performed over a period of two years (October 2020 to July 2022). Each centre’s website was evaluated using a 10-point scoring system to assess burns first aid content accuracy. The content was evaluated using a scoring system by Burgress et al, that is based on the basic burns first aid principles of “stop, remove, cool and cover”.

188 burn centres across the stated countries were included. The country with the highest average score was Australia & New Zealand (5), followed by the USA (2.89), Canada (1.78) and the UK & Ireland (2.89). The consistency of content and quality of these resources remains an area for potential improvement and should be considered in the future design of such websites. The most common step missed in burn first aid was to keep victims warm to prevent hypothermia.
117 Achilles Tendon Rupture Clinic, a Successful and Reproducible Model
Authors: Eniola G , El-Gendy M , Soliman E , Shah N , Hassan A , Leong E , Rudge B
Published: August 2023

Background

In the view of busy Emergency departments and general fracture clinics, a delay in the assessment, diagnosis and treatment of Achilles tendon injuries can lead to poor outcomes. A dedicated Achilles tendon rupture clinic can provide efficient care and avoid such complications.

Aim

To assess the efficiency of the dedicated Achilles tendon rupture clinic (model) in avoiding delay in the assessment and management of Achilles tendon injuries.

Method

Analysis of retrospectively collected data of the patients who have been reviewed in the Achilles clinic. All patients had Ultrasound scan (USS) by trained Orthopaedic surgeons to assess the size of the gap. Non operative treatment followed an approved functional rehabilitation protocol in the department. Data for analysis included : demographic data, Time interval between injury and assessment in the Achilles clinic ,size of the gap (USS) and ATRS (The Achilles tendon Total Rupture Score ).

Results

45 patients have been reviewed in the Achilles tendon rupture clinic over nine months, the mean age was 52.05 the mean time interval between referral and assessment in the Achilles clinic was 6.1 days (SD 3.59 ), The mean size of the tear was 10.65 mm (SD 5.95). The mean ATSR score at three months follow up was 70.29 ( SD 15.3).

Conclusions

The model of dedicated Achilles tendon rupture clinic including on-site USS can help deliver a safe and more efficient arm of the trauma service to patients and avoid delay in management that might affect the patients functional outcome and require complex surgical procedures.
142 Comparison of Patients’ Satisfaction Outcome of Primary Closure and Traditional Volcano Dressing Following Ileostomy Reversal
Authors: Rezacova M
Published: August 2023

Introduction

Reversal of ileostomy is usually last step following major surgery. For patient this is quite significant procedure, and the outcome is vital. Not only they achieve continuity of GI tract again, but they can live without stoma. Providing them with skin closure that results in minimal scaring can improve patient satisfaction with cosmetic outcome of surgery.

Method

I have designed patient outcome and satisfaction questionnaire over 2 hospital sites. One hospital performs in majority of cases traditional volcano dressing, while the other attempts primary closure.

Results

50 patients were included in total. One group (25 patients) underwent closure with traditional volcano approach while the other (25 patients) had primary closure of skin. The patients with the volcano dressing needed further visits to health care providers for dressing change and this had huge impact on their recovery. From the patients who had primary closure, 2 patients had minor wound infection with partial wound breakdown. The rest of a group healed with no complications. Patients in the primary closure group were satisfied with cosmetic result after the surgery while only 32% of patients from the volcano group have been satisfied with the cosmetic result. However, this was not related to the overall satisfaction from surgical outcome.

Conclusions

Primary closure is a very plausible option and when performed correctly, has minimal complications. It results in longer but more cosmetically acceptable scar than volcano dressing. Overall patients' satisfaction is mainly guided by the functional result of surgery but the cosmesis should be considered when planning ileostomy reversal.
332 Improving Preparedness of Junior Doctors in Surgery Through Development and Implementation of an Induction Booklet
Authors: Smith C , Richardson D , Watt J , Haji A
Published: August 2023

Aim

Disruption to undergraduate clinical training during the COVID-19 pandemic caused a perceived lack of preparedness amongst newly qualified junior doctors. We aimed to improve junior doctor preparedness in surgery, through development and implementation of an induction booklet.

Method

An electronic survey distributed in December 2021 assessed junior doctors’ perceived preparedness for their surgical job and identified inadequacies in the existing induction programme. Through feedback and suggestions, we designed a 30-page induction booklet containing information for each surgical sub-specialty, on-call commitments, the rota, practical tips, and important contact numbers. The booklet was distributed to the subsequent two junior doctor cohorts, six weeks prior to them joining, in April and August 2022. They completed an electronic survey within their first week to assess the impact of the induction booklet.

Results

Survey response rate was 60% (n = 29) from the pre-intervention cohort and 55% (n = 28) from the post-intervention cohort. Prior to intervention, most junior doctors felt unprepared for their day-to-day surgical job (79%) or their first on-call shift (69%). Following the implementation of the booklet, only 11% of respondents felt unprepared for their day-to-day surgical job, more than a seven-fold improvement (p<0.0001). The proportion of respondents who felt unprepared for their first on-call shift significantly decreased to 32% (p = 0.0081). 93% of respondents reported that the induction booklet was useful in preparing them for their surgical job.

Conclusions

Development and implementation of a departmental induction booklet is a useful tool to improve preparedness amongst junior doctors in surgery.
338 Wide-Awake Hand Surgery in Trauma: Optimising Patient Experience and Strategies to Advance Patient Care
Authors: Shah S , Amin K , Elzaagh A , de Berker H , Bedford J
Published: August 2023

Background

Our regional hand trauma unit in Greater Manchester underwent significant service reorganisation from predominantly GA to WALANT early in the COVID-19 pandemic. We implemented a variety of strategies to optimise patient care and maintain adherence to national standards. Here, we present a review of these strategies.

Method

Five domains throughout the patient pathway were explored, with chi-square and student t-testing used to assess significance.

Results

‘Time-to-treatment’ compliance with national standards were maintained following reorganisation, with an improvement in compliance for extensor tendon repairs. A pre-operative information leaflet resulted in significant improvements in patient knowledge and anxiety levels. A knowledge-gap in post-operative analgesia administration amongst patients was identified and addressed through a standardised protocol and supplemental written guide to optimally manage peak post-operative pain. Additionally, the shift of our services to our ambulatory unit has resulted in a significant in reduction in our theoretical carbon footprint through reduced patient travel and gaseous anaesthesia use.

Conclusions

Despite dramatic service reorganisation to a primarily WALANT service, we have demonstrated a multi-faceted approach to optimise the patient journey, whilst upholding compliance with national standards and reducing our overall ecological footprint.
349 How a Service Evaluation Carried Out by Junior Doctors Helped the Post Pandemic Management of Lumps and Bumps
Authors: Delaney C , Driver K , Salfity L , Tawfik L , Tomasi I
Published: August 2023

Aim

The GI surgery department deals with many clinical conditions including lumps and bumps that affect the torso, posterior neck, groin, buttock, perianal and perineal areas. Over the pandemic it was noted that there were many referrals for ‘lumps and bumps’ at a time where theatre capacity and staffing was limited. To create a referral pathway to assess patients for suitability for referral and treatment in the secondary care setting/ to determine which lesions were suitable for treatment in the community.

Method

A review of 374 cases of lumps and bumps referred between 2019 and 2021. Various patient factors were taken in to account, as well as the size and type of lesion to determine whether it could be managed in the community under local anaesthetic.

Results

Of the total cases, 45% were deemed to be suitable for treatment in community. Of all lesion types, epidermoid cysts were most suitable for GP treatment. Patients were travelling long distances to reach the hospital and we were treating patients outside our catchment area. We also found that the average waiting time from referral until treatment for lesions managed in community was nearly 9 times shorter than when managed in the hospital setting.

Conclusions

A new referral pathway was created for all of South East London to reduce the number of lumps and bumps referred. This ultimately allowed for increased theatre capacity for more complex cases, ensured faster treatment and reduced travel distances for patients.
377 A Quality Improvement Project to Improve the Documentation of Post-Operative Complications on Discharge Documentation of Patients Undergoing Elective Colorectal Surgery at a Tertiary Centre
Authors: Baker D
Published: August 2023

Aim

To improve the documentation of post-operative complications on discharge letters following elective colorectal surgery.

Method

Notes were retrieved for patients undergoing elective colorectal surgery and who were discharged in the month of August 2021. Notes were retrospectively analysed and complications occurring in the post-operative course were documented and cross-checked with discharge documentation. Summary statistics were used to summarise and compare inpatient complications vs discharge documentation of complications. A proforma was created to aid juniors in summarising inpatient complications and to be utilised as a reference for completing discharge documentation. A one-month period of using the proforma was trialled and data was re-collected to assess for improvement in discharge documentation.

Results

A total of 17 patients were discharged in August 2021 and suffered a total of 72 complications. Complications ranged from minor electrolyte disturbances to requiring operative intervention for anastomotic leak. Of the 72 complications only 28/72 (38.9%) were included (range 0-100%). The proforma for documentation was trialled for one-month and included a total of 18 patients suffering from 46 complications. Of these 46 complications a total of 31 (67.4%, range 50-100%) were documented on discharge letters. No major complications were missed when utilising the proforma.

Conclusions

Utilisation of a proforma to aid in documentation of complications on discharge has markedly improved the accuracy of discharge documentation. Further work is required to assess barriers to completion and to further improve the accuracy of discharge documentation.
405 Improving Confidence in Managing Acute Urology: A Quality Improvement Project
Authors: Bradley C , Iqbal R , Shivakumar N , Ibrahim I
Published: August 2023

Introduction

A lack of confidence in the management of acute urology presentations amongst junior trainees was identified. Out of hours cover is provided by middle-grade doctors (FY2 to ST2), from general surgery and orthopaedics.  Ward cover is provided by FY1s. There are no dedicated urology juniors, therefore exposure to urology presentations/teaching is limited. A teaching course was designed to address this and improve confidence in managing common acute urological presentations.

Method

The ‘Emergency Urology Course’ was delivered at a district general hospital over four weeks, comprising of four sessions (stones, penoscrotal, catheters/retention, oncology/miscellaneous topics). Teaching sessions were undertaken by trainees with experience of urology at registrar level. The course was advertised via email, posters and word of mouth. Teaching topics were based on common presentations. All sessions were well attended by juniors with no prior urology experience. 20 completed the pre and post course evaluations.

Results

Course evaluations showed an increase in reported confidence amongst junior doctors across all topics/sessions. The juniors rated their confidence out of 10 with regards to management of emergencies. The average score prior to the course was 4.6/10. Following course devliery, the average confidence had increased to 7.9/10.

Conclusions

Overall, we demonstrated an increase in junior doctors' confidence in the management of emergency urology presentations, following delivery of a focused course. This will aim to support the juniors and reduce registrar involvement, especially out of hours. Future plans include converting the course into an online format to be more flexible, and reach a wider audience.
469 Improving the Quality of Trauma Meeting Documentation
Authors: Yip C R , Nadar N , Warrington D , Kassir A , Peach C
Published: August 2023

Aim

Trauma meeting allows discussion of new referrals, formulate treatment plan and coordinate the trauma threatre list. Modern electronic patient record platform has facilitated the feasibility of real-time documentation. The purpose of this audit is to evaluate the current practice of trauma meeting documentation, subsequently implementing a proforma which provides structured and effective documentation using an electronic smart-phrase function, aiming to improve the overall quality and consistency of trauma meeting documentation.

Method

Three retrospective Plan, Do, Study, Act (PDSA) studies of ten days duration each, were performed for all patients discussed in three occasions: pre-implementation, post-implementation, and one-month post-implementation of the smart-phrase. Appropriate adjustments were made based on data analysed and multi-disciplinary feedback. Eight standards were measured which include documentation of consultant on-call, consultants present, imaging discussed, concerns from the multi-disciplinary team, diagnosis, laterality, clear plan and weight-bearing status.

Results

A total of 296 cases were discussed in three study periods, 90 cases in PDSA 1, 98 cases in PDSA 2 and 108 in PDSA 3. Only 64% of the cases discussed in PDSA 1 had documentation. Following introduction of the smart-phrase, 94% and 88% of cases discussed were documented in PDSA 2 and 3 respectively. An overall improvement was noted in all eight standards measured following implementation of the smart phrase in PDSA 2 and 3. Lack of time to complete documentation was highlighted.

Conclusions

The smart phrase has provided a structured and effective mean of documentation. However, orthopaedic consultants need to allocate more time to ensure completion of documentation for each cases discussed.
471 Accuracy of Preoperative MRI for Rectal Cancer: A Retrospective Study at a District General Hospital
Authors: Wani I , Husain N , Thomas P , Alam A , Narayanasamy S
Published: August 2023

Aim

To investigate the accuracy of preoperative MRI for rectal cancer in the form of sensitivity, specificity, positive predictive value and negative predictive value.

Method

The retrospective study included a cohort of 47 patients of rectal cancer from April 2017 to March 2022 who were treated with upfront surgery. With histopathology taken as standard the accuracy of preoperative MRI was calculated.

Results

The records of 47 rectal cancer patients were analysed who were offered primary surgery. The sensitivity and specificity of MRI for T1-T4 were 60%, 19%, 94% and 100% and 97%, 84%, 48% and 100% respectively. The sensitivity and specificity of N0- N2 staging were 46%, 57% and 50% and 61%, 53% and 95% respectively. The positive predictive value and negative predictive value of MRI for T and N staging were 69%, 85%, 44% and 77% respectively.

Conclusions

In our study, the results were not at par with other national and international studies. MRI is a useful tool for planning management of rectal cancer patients. The accurate preoperative staging is very important for planning the management of these patients.
475 Forgotten Antegrade Ureteric Stent: What Can We Do?
Authors: Desouky E , Koura M , Gill S , Omar M
Published: August 2023

Introduction

In the UK, forgotten ureteric stents are considered a ‘never event’ and hence can be a source of significant litigation. Forgotten ureteric stent was the most frequent postoperativerelated claim over 14 years in 2011.

Aim

To assess the possible risk factors for missing an antegrade (AG) stent in a patient.

Method

Retrospective data collection from Interventional radiology (IR) department: 1. Date of AG stent insertion 2. Date of request for the next step (definitive treatment either removal or exchange) To assess: • Time lag = Number of days between AG stent insertion and requesting the definitive procedure • Any other possible risk factors for ‘forgotten stent’ Audit

Results

Audit (01 Jan – 15 Dec 2019): • Total number of cases (N) = 45. • Time lag: Range 1 up to 73 days (Mean: 13.1 days).

Action plan

1-requests for AG stent insertion must come only via urology team 2-on AG stent request, provisional draft is already drafted 3-AG stent request generates auto,atci request for the next uro-radiology meeting as a safety net 4-in IR, documentin patient notes and flag to uro-radiology meeting 5-discharge summary to include stent management time frame.

Re-audit

Results (01 Jan – 30 Jun 2020): • Total number of cases (N) = 30. • Time lag: Range – 1 up to 11 days (Mean 3.5 days).

Conclusions

Safe practice of AG stent insertion requires coordination between urology and radiology departments to action a plan for stent removal /exchange can safety net such patients and avoid the hazard of a ‘forgotten stent’.
554 One Stop Flexible Cystoscopy; Impact of COVID-19
Authors: Corrigan A E , Jauhari S , Frater J , Ahmed I
Published: August 2023

Introduction

Due to the COVID-19, there has been a decrease in patient access to flexible cystoscopy within urology and an increase in telemedicine to assist with patient contact and care. It is pertinent to consider the impact of the pandemic on the patient experience, satisfaction, and awareness of services alongside clinical delays.

Aim

The aim was to assess degree of patient satisfaction across East Kent University Hospital Trust and illicit the prevalence of patient education across the cohort. The secondary aim was to report distribution of referral time as well as timings of CT/USS scans across the cohort.

Method

A retrospective analysis of hospital appointments from March-October 2020 and telephone surveying of the patient population was conducted. A 14-question survey was created to consider patient-reported outcomes and experiences.

Results

539 flexible cystoscopy appointments took place from March-October 2020. From these, 44.4% of CT/USS scans were done after the flexible cystoscopy, rather than before (16.40%). 76% of referral times took under 14 days. Patient satisfaction remained high, 60% and 27% reported feeling very satisfied and satisfied, respectively, with the service. However, 47.1% of the cohort did not completely understand the plan after discharge.

Conclusions

While patient experience appears to have remained positive despite the COVID-19 pandemic, there has been a significant impact on secondary investigation timings and patient education. There is a need to consider the clinical implications of delayed imaging and consider methods to improve patient care and information after discharge. QIPs are underway to address issues raised.
566 Improving Neurovascular Status Assessment and Documentation in the Emergency Department: A Closed-Loop Audit
Authors: Harper J , Freeman O , Esland J
Published: August 2023

Aim

To improve neurovascular status assessment and documentation in the Emergency Department.

Method

Clinical notes were reviewed for 55 consecutive patients presenting with extremity fractures during February and March 2022. Neurovascular (NV) assessment and documentation was reviewed at presentation and after any intervention to the limb. Semi-structured interviews were conducted with Emergency Department staff, to identify barriers to NV assessment and documentation. Changes were implemented and the audit cycle repeated in October 2022 for 56 consecutive patients.

Results

The main barriers to NV assessment and documentation were forgetfulness, lack of awareness of requirement to document NVS pre- and post-intervention, poor quality induction given to clinicians of the importance of documenting NVS and lack of awareness of track commands. Three changes were therefore implemented: a video on NV assessment for new starters; a teaching session for current staff; a ‘shortcut’ for typing the NV assessment in the electronic patient record.

Improvements were made in all domains; documentation of NVS for ankle fractures pre-manipulation increased from 73% to 96%, and from 31% to 46% for post-manipulation between loop 1 and 2. Documentation of NVS for wrist fractures pre-manipulation increased from 93% to 96%, and from 14% to 36% for documentation post-manipulation. Improvement was most noticeable in the documentation of individually named nerves, increasing by 16.4% (p<0.05).

Conclusions

Semi-structured interviews were helpful in illuminating areas for improvement. Importantly, these were sustained for over 6 months. A third cycle is in progress, where further incremental gains are sought.
661 Evaluating the Efficacy of Post-Operative VTE Prophylaxis in Fragility Hip Fractures: DOAC vs LMWH
Authors: Karthikeyan N , Efiannayi A , Karim D , Sutharson M , Al-Saffar B
Published: August 2023

Aim

Direct oral anticoagulants (DOACs) are licensed for use as venous thromboembolism (VTE) prophylaxis in elective hip surgery however low molecular weight heparin (LMWH) is the mainstay for VTE prophylaxis in hip surgery following fragility fractures. Due to social distancing regulations during the COVID pandemic in 2021, it became increasingly difficult for community nurses to administer LMWH injections post-operatively whilst DOACs offered a less invasive alternative. This study aims to evaluate efficacy of DOACs in comparison to LMWH as VTE prophylaxis following hip surgery in fragility fractures.

Method

Retrospective, population-based cohort study of patients discharged on VTE prophylaxis with LMWH and DOAC in 2019 and 2021 respectively following fragility hip fracture. Data was obtained through National Hip Fracture Database and electronic medical records. Data collected included patient demographics, comorbidities, current medications, time to surgery, level of independence pre- and post-discharge and length of stay. Main outcomes assessed were incidence of VTE within 6 months.

Results

A total of 200 randomly selected patients were included. Following discharge, incidence of VTE was 1% in the LMWH group (n = 100) and 1% in the DOAC group (n = 100). All patients received LMWH and TED anti-embolism stockings as an inpatient. Average length of time on DOAC following discharge was 3.5 weeks.

Conclusions

The study shows non-inferiority of DOACs in VTE prophylaxis post-operatively when compared to LMWH. It supports a case for their use in post-operative management of fragility hip fractures. Further data surrounding compliance to DOAC following discharge will allow accurate evaluation of its efficacy.
739 A Service Evaluation of Post-Operative Risks for Surgical Dental Procedures Following Paediatric Out-Patient General Anaesthetic
Authors: Loo Y , Budhdeo R , Newton L , Kabban M , Harrison M
Published: August 2023

Aim

To evaluate post-operative outcomes for paediatric patients who have undergone surgical procedures under general anaesthetic in the out-patient day surgery unit.

Method

A retrospective evaluation of all children under 16 years old who attended for Day Surgery procedures between 1/10/22 and 31/12/22 at Guy’s Hospital, London was completed.

Patient notes were assessed to identify surgical procedures, the risks the patient had been consented for pre-operatively and the incidence of post-operative risks.

Results

In the 2-month period, 303 patients were seen in Day Surgery. 209 completed a course of comprehensive dental care, 94 required exodontias only and 21 had a surgical extraction included in their treatment under general anaesthetic.

1 patient experienced a risk that had been planned for: an oro-antral communication following removal of an infra-occluded maxillary molar.

1 patient required an apically repositioned flap after unfavourable positioning of the orthodontic bracket during exposure and bonding of an unerupted tooth.

2 patients were offered a telephone review post-operatively and no patients required a face-to-face review.

Conclusions

All patients requiring dental surgical procedures should be consented for appropriate risks including damage to adjacent structures and possible altered sensation if nerve tissue is close to the expected surgical site. The possibility of oro-antral communication should also be addressed pre-operatively. Where exposure and bonding of orthodontic brackets are planned, the risk of a change in the gingival contour and health should be outlined. By comprehensively discussing possible post-operative complications, patient expectations and care can be optimised, and consent can be fully informed.
759 Electronic Discharge Summary Audit
Authors: Asif A , Elmaradny A
Published: August 2023

Aim

Electronic discharge summaries (EDS) in General Surgery were found to be lacking adequate clinical information. The Professional Records Standards Body (PRSB) released guidance, endorsed by NICE, with the information required in an electronic discharge summary. The aim of the study was to monitor and record how many EDS’s have been completed with all the relevant/required sections completed.

Method

A retrospective analysis of EDS of 50 patients admitted under general surgery at Worcestershire Royal Hospital was conducted. Yes, No or N/A were marked against 13 categories based on PRSB guidelines. 4 cycles were carried out between 2020 to 2022.

After cycle 1, a poster was introduced outlining the criteria for electronic discharge summaries (Figure 1). A printed version of the poster was placed in the doctor’s office. After cycle 2, feedback was collected from junior doctors who suggested a teaching session on how to write electronic discharge summaries. A teaching session was delivered to junior doctors prior to cycle 3 and 4.

Results

The overall level of compliance for each cycle was as follows-Cycle 1- 8% complianceCycle 2- 22% complianceCycle 3- 34% complianceCycle 4- 69% compliance

Conclusions

The poster and teaching session proved effective at improving compliance.It was found there was poor compliance in completing the comorbidities section in the EDS. Acknowledging feedback from the junior doctors helped provide useful teaching sessions so we will continue regular teaching sessions. Continue annual audit of EDS' to increase compliance.