bluuebunny/crossref_metadata_2025 huggingface dataset:
315 Diversity at the Heart of the Specialty: A National Initiative for Widening Participation in Cardiothoracic Surgery
Authors: Kirkley K , Layton G , Tariq J , Booth K , Bhatti F
Published: August 2024

Aim

Students from widening participation (WP) backgrounds are less likely to apply for and obtain places to study medicine (1). This compromises the long-term diversity of the applicant pool for cardiothoracic surgery (CTS). It is well established that patient care is adversely affected by a lack of diversity within healthcare professionals. As such, this national initiative set out to promote CTS amongst senior school students in the UK, with a focus upon those from WP backgrounds.

Method

Students were invited via the Medical Schools Council to six online lectures and were invited to submit a competitive application to undertake work experience within a CTS unit. Twelve students were selected to participate in a clinical placement and were provided with an online, interactive coaching resource to aid cross-centre standardisation of experience. All attendees were invited to complete electronic questionnaires before and after their experiences.

Results

482 students attended lectures, with 100% providing feedback afterward. Attendees were most frequently female (77%), from ethnic minority groups (80%) and WP backgrounds (42%). Perceived barriers to pursuing this career included inability to gain work experience (71%), financial restrictions (45%) and lack of application mentoring (41%). 100% of students recommend the work experience scheme as helpful. Students reported improved confidence with the hospital environment, the role of a doctor and the specialty. All were more likely to consider a career in surgery following this exposure.

Conclusions

Low-cost interventions utilising pre-existing cardiothoracic surgical networks can successfully engage a large, diverse population of students who feel restricted from accessing our specialty.
346 Transforming ENT Induction: Assessing the Impact of an AI Avatar Delivered Induction Course on Trainee Confidence at John Radcliffe Hospital, Oxford
Authors: Kazemi N , Siddique H , Maweni R
Published: August 2024

In the evolving landscape of surgical education, innovative methods are crucial for enhancing trainee proficiency. This study evaluates the impact of an AI Avatar delivered ENT induction course, which utilises interactive video and image technology, on changes in trainees' confidence in key ENT skills, and as well as the role of AI tutors in this process.

We analysed pre- and post-course feedback from participants enrolled in the entinduction.co.uk SHO induction program from the John Radcliffe Hospital, Oxford, ENT department. The primary focus was on changes in confidence across seven key ENT skills. Paired t-tests assessed the statistical significance of these changes.

There were 24 participants. 8 GP Trainees, 10 FY2s, 2 Core surgical trainees and 4 Clinical Fellows. All areas showed statistically significant improvements in confidence post-course (p < 0.05). The highest increases were observed in identifying normal endoscopic upper aerodigestive tract anatomy (Δ=+3.87), identifying endoscopic pathology (Δ=+3.83), managing ENT emergencies (Δ=+3.67), triaging ENT referrals (Δ=+3.63) and managing upper airway obstruction (Δ=+3.27). Notable increases were also present in identifying ear pathology on otoscopy (Δ=+2.90) and identifying normal ear anatomy on Otoscopy (Δ=+2.88).

Overall course quality was highly rated (mean=8.45/10), with a strong recommendation level from participants. The AI tutors were positively received, with varying impact on learning and retention.

The ENT induction course significantly boosted participants' confidence, affirming the effectiveness of its curriculum and pedagogical approach. The integration of AI tutors was well-received, highlighting their potential in enhancing surgical education. These results advocate for the continued adoption of innovative instructional strategies in surgical training programs.
928 The Process of Learning Anatomical Variations among Surgeons: A Journey of Developing Expertise
Authors: Chand C P , Brand K , Wilmhurst L , Bazira P , Clunie L
Published: August 2024

Aim

This qualitative study aimed to develop a theoretical framework that explained the process of learning anatomical variations among surgeons using the constructivist grounded theory methodology.

Method

Initial purposeful and subsequent theoretical sampling of surgical trainees and consultants was utilised. Semi-structured interviews were conducted with 6 surgical consultants and trainees. Data analysis was informed by the grounded theory methodology.

Results

The resultant theoretical framework proposed a three-step iterative learning process that represents the journey of developing surgical expertise. The first step of the process is encountering a variant which encourages trainees to identify the variant and establish their understanding of normal anatomy. The next step is to deal with the variant as required by evaluating its clinical impact and using surgical skills to manage it accordingly. In the third step, trainees engage in self-directed learning about the variant. As they progress, trainees develop an increasing awareness of anatomical variations relevant to their surgical sub-specialty and begin to learn how to deal with the variant. Playing a crucial role in a trainee’s learning process at each step is the consultant who provides clinical supervision during the encounter, guidance when dealing with the variant, and encourages reflective practice after the encounter.

Conclusions

This study is one of the first to explain the process of learning anatomical variations, providing a unique insight into the current standards of surgical training in the United Kingdom. It calls for a greater emphasis on exploring how the learning and teaching of anatomical variations can be integrated within the surgical training curriculum.
1133 Assessment of Medical Students’ Competence in Wound Closure Techniques
Authors: de Carvalho L , Walker J , Grieve S
Published: August 2024

Aim

The aim of this audit was to assess the level of medical students’ competence in in basic wound closure, which is a skill listed in the GMC’s outcomes for graduates. Secondary aims included assessing self-reported confidence levels, before and after a period of teaching in wound closure techniques, and likelihood of students choosing a surgical career.

Method

A cohort of UK Medical Students attended face to face practical suturing sessions with tutors. Students were assessed against a standardised Objective Structured Assessment of Technical Skills (OSAT) before and after receiving practical suturing sessions and a period of self-directed learning. Students completed pre-session and post-session online questionnaires rating their self-confidence on performing a variety of wound closure techniques. Students were also asked to indicate whether they would be likely to choose a surgical career on the post session questionnaire.

Results

The percentage of students being able to competently perform simple interrupted sutures for wound closure increased significantly from 0 to 100%. Analysis of the student’s questionnaires demonstrated a significant improvement in self-rated confidence across all suturing techniques. 72% of students indicated that they would be more likely to choose a surgical career after the teaching.

Conclusions

Medical students often get minimal suturing teaching during their education despite wound closure being an important skill in many medical specialities and required by the GMC’s standards for medical graduates. Lack of adequate hands-on practice can detrimentally impact student’s competence and confidence, and this can potentially translate post-graduation, and influence their choice of speciality.
675 A Systematic Review of Sustainability Practises in Plastic Surgery
Authors: Iakovou D , Sousi S , Glynou S P , Ahmed Z , Zargaran A , Zargaran D , Mosahebi A
Published: August 2024

Aim

There is an urgent need to tackle climate change, with surgery being a carbon hotspot for emissions in healthcare. This study explores literature detailing current sustainability practices and initiatives in plastic surgery and evaluates methods used facilitating the pursuit of achieving net zero targets.

Method

Following the PRISMA guidelines, systematic search was performed in MEDLINE, EMBASE, and Cochrane Library databases. Studies concerning sustainability practices in plastic surgery were included. The registration number is PROSPERO (CRD42023446104).

Results

The search yielded 1,083 studies of which 13 met the inclusion criteria. The studies were analysed for their data on waste, usage, and carbon footprint. Hand surgery was the leading subspecialty in taking initiatives to tackle waste, such as the use of surgical packs to account for the use of wide-awake local anaesthesia no tourniquet technique (WALANT), while also taking into account surgeons’ preferences. Other initiatives encompassed craniofacial, skin cancer and breast surgery. Hand surgery initiatives also included a survey suggesting that hand surgeons agreed that reductions in carbon footprint while maintaining patient safety is crucial. Successful recycling initiatives were reported with a monthly average of 39.6 tonnes per month. Five studies, representing skin and hand surgery, presented reduction in cost by individualising sustainability practices for specific procedures.

Conclusions

The necessity of tailoring sustainability strategies on the requirements of each surgical procedure was demonstrated. The development of standardised outcome sets was emphasised to evaluate the best practices in sustainability and further research is needed in collaboration with healthcare professionals for a more sustainable clinical future.
74 Efficacy of WHO Surgical Checklist in Reducing Post Operative Complications: A Systematic Review
Authors: Qaiser S , Khan M S
Published: August 2024

Objective

To determine the effect of WHO surgical checklists in reducing post-operative adverse effects.

Method

A single-step search strategy was utilised. The data bases that were included in the search included MEDLINE, CINAHL, EMBASE, Conchrane Data Base, Proquest, Index Copernicus, Google Scholar and Scopus. Moreover, reference lists of identified reports and articles were searched for additional studies. Studies published in English before September 2021 were included. Keywords and titles were used to search through databases. Research included focused on the WHO surgical safety checklist and excluded all other checklists.

Findings

Following review of title and of 17,821 publications, 93 studies were identified as meeting the inclusion criteria and selected for full retrieval and assessment for methodological quality. Of these, 13 were of sufficient quality to be included for review. Among these 10 articles reported that complication rates were impacted and 9 out of these reported an overall decrease in the complication rates. Thirteen studies reported mortality, out of 12 reported a decrease in the mortality rates of the patients.

Conclusions

It is sufficed to say that application of the surgical checklists leads to improved surgical outcomes and a reduction in the post-operative adverse effects such as mortality and complication rates. Further research is required to assess the effect of the checklist on the quality of life of the patients. Research is required to assess applicability while eliminating psychological effects checklists have on the patients.
1230 Mesenchymal Stromal Cells for the Enhancement of Flexor Tendon Repair in Animal Models
Authors: Economou A , Eleftheriou A , Epanomeritakis I E , Khan W
Published: August 2024

Aim

Our goal was to determine the efficacy of MSCs in enhancing the biomechanical properties of surgically repaired flexor tendons in vivo.

Method

A PRISMA systematic review was conducted using five databases (PubMed, MEDLINE, EMBASE, Web of Science, and CINAHL) to identify studies using MSCs for the enhancement of surgical repair of flexor tendon injuries in animal models. Ten studies were included in our systematic review. We extracted the results of biomechanical testing of repaired flexor tendons, including the maximum load, elasticity, stiffness, and range of motion analysis. The histological and macroscopic appearances of repair tissue, as well as any complications observed, were also recorded.

Results

While some authors reported a promising improvement in biomechanical properties following treatment with MSC, this was inconsistent across the studies. This may, in part, be explained by the variety of cell delivery methods used. We suspect that injections of MSCs within a biocompatible solution may perform better than cells embedded in polymer scaffolds, which can provoke an inflammatory reaction that impairs healing. Further variation between studies was noticed with regard to the MSC source, cell concentration, and post-operative immobilisation protocols, all of which may alter the outcome of the repair.

Conclusions

In summary, while current in vivo evidence suggests that MSCs may enhance the surgical repair of flexor tendons, there is insufficient evidence at present to recommend this treatment for use in humans. Future studies are necessary to investigate the role of the individual variables mentioned in order to standardise a potential treatment approach.
750 Simultaneous Islet Cell and Kidney Transplantation: An Initial Single Centre Experience
Authors: Jeyasuresh Y , Doherty D T , Birtles L , Greenwood-Morgan M , Lowe M , Azmi S , Khambalia H , Van Dellen D
Published: August 2024

Aim

Simultaneous Islet and Kidney (SIK) transplantation aims to improve glycemic control and renal function by combining an islet transplant with a renal allograft for patients with Type 1 Diabetes Mellitus (T1DM) and renal failure. This provides diabetic improvement and removal from dialysis burden, with reduced peri-operative risk compared to solid organ simultaneous pancreas and kidney transplantation. We aimed to evaluate the outcomes of the United Kingdom’s initial cohort.

Method

A retrospective analysis of SIK recipients was performed between 03/2017 and 04/2023 at our hospital.

Results

22 SIK were performed (72.7% donors after brain death). The mean recipient age was 56 with 54.5% female. The median diabetes duration was 42 years (IQR 22) with median post-SIK follow-up of 361 days (IQR 783). There was a median 1 infusion per recipient (median IQR 1) with median islet equivalence (IEQ) of 323,500 IEQ (IQR 141,250). HbA1c and exogenous insulin requirements were significantly lower after transplant (HbA1c: 62.7 vs 51.6mmol/mol, p<0.001; IU: 40 vs 23 units/day, p<0.001) while C-peptide significantly increased (15.9 vs 535.8pmol/l, p<0.001). Hypoglycaemic episodes/patient/year reduced (7 pre-transplant, vs 1.5 post-transplant). Median islet graft survival was 4.9 years. lgls functional classification at the end of follow-up was satisfactory (7 Optimal, 1 Good, 10 Marginal and 4 Failure). eGFR significantly increased post-SIK (15.4 vs 49mL/min/1.73m2, p<0.001).

Conclusions

SIK ameliorates renal failure whilst improving glycaemic control with a satisfactory complication profile. Larger and longer cohort analysis is required to fully understand the benefits of SIK for patients with complicated T1DM.
38 Anterior Knee Pain Assessment in Tibial Nailing: A Comparative Retrospective Study of Suprapatellar and Infrapatellar Approaches
Authors: Ilyas M W , Amer A S , Vakil H , Alaraj M , Naqvi S Z , Al-Kharouf K
Published: August 2024

Aim

To assess whether there is a statistically significant difference between incidence of anterior knee pain in supra-patellar vs infra-patellar tibial nailing techniques.

Method

This retrospective study, conducted at a UK trauma centre, data was analysed using ICD-10 and OPCS codes to identify patients with tibial fractures who underwent IM nail fixation. Among 312 patients, 206 met inclusion criteria, excluding those with unavailable records, limited follow-up, and paediatric patients using flexible nails. Two groups, "Suprapatellar Nailing" and "Infrapatellar Nailing," were compared for anterior knee pain incidence via clinical follow-up data. Statistical analysis tested the null hypothesis i.e., "Infrapatellar nailing causes more documented anterior knee pain than suprapatellar nailing."

Results

Out of 206 patients, 140 were males and 66 were females with mean age of 43 years (Range 16-91). 60.2% (n=124) were treated with infrapatellar nailing as compared to suprapatellar nailing 39.8% (n=82). Anterior knee pain was reported in 14.2% (n=17) of infrapatellar cohort as compared to 14.6% (n=12) in the suprapatellar cohort. Chi square statistic with yates’ correction is 0.0124, with a p value of 0.91. The result is not significant (p > 0.05).

Conclusions

The 14.4% mean incidence of anterior knee pain in both groups is relatively low compared to existing literature. Despite the need for a large sample size to establish statistical significance, our study indicates no significant difference in anterior knee pain incidence between infrapatellar and suprapatellar nailing techniques, suggesting equivocal outcomes in skilled hands. We recommend a multicentre study, particularly given the increasing use of suprapatellar nailing, to achieve statistical significance.
59 Adherence to NICE Guidelines for Mobilization After Distal Femoral Fracture Surgery in Elderly Patients: Impact on Surgical Outcomes
Authors: Elegbede A , Sadekar V , Shakya A , Symes T
Published: August 2024

Aim

This study aims to evaluate adherence to NICE guidelines for postoperative mobilization after different distal femoral fracture fixation methods in elderly patients. We also explore the implications of guideline compliance, focusing on the timing and extent of weight-bearing.

Method

Retrospective data collection spanned six months at Hull University Teaching Hospitals, involving patient records and descriptive statistical analysis.

Results

Of the 18 identified patients, 16 were analysed (2 managed non-operatively). The mean age was 82.5 years (4 males, 12 females), with an average surgery delay of 3.4 days. Fracture types included intra-articular (4), extra-articular (4), and periprosthetic (8). Implants included 8 plate osteosynthesis, 6 intramedullary (IM) nails, and 2 dynamic femoral rods (DFRs). Post-surgery weight-bearing status: non-weight bearing (NWB): 7 (5 plates + 2 nails), Partial weight-bearing (PWB): 3 (2 plates + 1 nail), Full weight-bearing (FWB): 6 (2 DFRs + 1 plate + 2 nails). Weight-bearing by implant type: Plate: NWB: 5/8, PWB: 2/8, FWB: 1/8. Nail: NWB: 2/6, PWB: 1/6, FWB: 3/6. DFR: FWB 2/2. Five fatalities occurred: 4 in NWB and 1 in PWB groups; 4 with plate fixation and 1 with IM nail.

Conclusions

Only 37.5% initiated FWB in under a week. Encouraging early weight-bearing may reduce mortality following distal femur fractures in the elderly.
150 Audit in Post-Operative Documentation in Trauma and Orthopaedic
Authors: Abouzied S
Published: August 2024

Introduction

Post operative surgical documentation is a critical component of patient care and ensures seamless communication among health care providers. In this audit we evaluated the quality of orthopaedic operative notes against the RCS-England guidelines aiming to improve adherence to these guidelines.

Method

We prospectively included 50 orthopaedic post-operative patients from July 20th till July 30th 2023. Adult trauma and elective procedures were included regardless of the type of the procedure. We compared the operative notes included in the audit to the RCS good surgical practice guidelines and collected data using a checklist including the parameters in the RCS guidelines. Areas with deficient documentation were highlighted for auditing.

Results

The first Audit cycle identified poor areas in post operative notes as the documentation of ‘emergency/elective procedure’ (25%), ‘weight bearing status following procedure’ (25%), ‘VTE instructions’ (75%), ‘follow up instructions’ (35%), ‘investigations required after procedure’ (25%), ‘instructions regarding post operative wound care’ (50%). We created a mnemonic to aid memorising the necessary post operative instructions. We’re presenting this audit in the orthopaedic department monthly M&M meeting in November and aiming to do a second Audit cycle to compare the quality of post operative documentation following the interventions implemented following the first cycle.

Conclusions

Post operative surgical documentation plays a pivotal role in ensuring effective patient care, enhancing patient safety, shortens their hospital stay and provides a legal protection for healthcare providers.
490 The Management of Distal Radius Fractures Against BOAST Guideline
Authors: Yip C R , Yang J , Zhou R
Published: August 2024

Aim

Distal radius fractures are common injury that can occur following fall onto an outstretched hand or a direct impact to the wrist. The British Orthopaedic Association Audits Standards for Trauma (BOAST) issued guidelines in 2017 specifically addressing the management of distal radius fractures. The guidance states that surgery should be performed within 72 hours for intra-articular fractures and re-displacement fractures following manipulation, and within one week for extra-articular fractures. The aim of this audit is to assess the compliance in all three groups which required operation.

Method

This is a retrospective study conducted at a single centre over six months duration, from September 2022 to February 2023. The study recorded patient demographics, injury types, injury dates, decision dates for surgery and surgery dates. Exclusion criteria encompassed patients under 18 years old, fractures involving both radius and ulna, concomitant elbow fractures and periprosthetic fractures.

Results

During the study period, surgical fixation of the distal radius was performed on a total of 105 patients. 23 were male, and 82 were female, with a mean age of 60 years (ranging from 20-92 years). The overall compliance was 75%. 34 cases were extra-articular, all of which were compliant. For the 67 intra-articular cases, 23 did not adhere to guidance. The remaining 4 cases involved re-displacement fractures following manipulation, all of which were intra-articular; among these, 3 were not compliant.

Conclusions

The overall non-compliance rate is 25%. This rate is notably higher among patients with intra-articular fractures, possibly attributed to instances necessitating the expertise of upper limb specialists.
492 Enhancing Trauma Documentation Accuracy: A Closed-Loop Analysis at a Major Trauma Centre in North Scotland
Authors: Tong E , Tolia M , Lim J W , Roberts S , Baliga S
Published: August 2024

Aim

Aims to evaluate the documentation accuracy of Mechanism of Injury (MOI) and Neurovascular Status (NVS) for trauma patients within a Trauma and Orthopaedic (T&O) ward at a Major Trauma Centre in North of Scotland.

Method

Review of admission and ward notes spanning two weeks included trauma cases with varying mechanisms of injury, excluding elective cases.

Results

Results from two cycles revealed a total of 67 patients. Noteworthy improvements were observed in MOI documentation rates, rising from 85.3% to 87.9% for Foundation Year (FY) doctors and 76.5% to 97% for Registrars. Equally significant improvement in NVS examination documentation were identified, increasing from 23.5% to 42.4% for FY doctors and 20.6% to 42.4% for Registrars. However, the documentation rate of "NVI" remained relatively static at 50% to 49%.

Conclusions

While overall documentation of MOI and NVS improved between foundation doctors and registrars, the study underscores suboptimal "NVI" documentation and the inadequacy of relying solely on acronyms. The proposed plan involves continued formal teaching on NVS examination, incorporating it into the FY teaching package, and a scheduled third cycle in 2024 for ongoing assessment and improvement.
776 Retrospective Audit of CPIP and Hip Surveillance Compliance in a District General Hospital
Authors: Hunter C , Rawlins E , Rapson R , Winfield C
Published: August 2024

Aim

CPIP (Cerebral Palsy Integrated Pathway) is a national pathway used to assess whether children with cerebral palsy show signs of hip migration based on regular pelvic x-rays. This allows Clinicians to determine if early surgical intervention is required. The aim of this audit is to determine if we are adhering to the CPIP at Torbay Hospital.

Method

Data was collected on the children who are under CPIP in the Devon area. Adherence to this pathway was assessed based on whether children were receiving their hip x-rays at the appropriate time based on their Gross Motor Function Classification System Score (GMFCS). Furthermore, we will be distributing a questionnaire to determine patient satisfaction with CPIP.

Results

Based on our analysis 64 children were identified, with 83% having a recent CPIP assessment and 68% of patients receiving their x-rays in an appropriate timeframe. Additionally, it was found that 72% of hip x-rays requested were reported.

Conclusions

It can be concluded that the Trust is adherent to CPIP, however some improvements could be made to increase adherence. To increase adherence, actions such as monthly meetings between the radiography and physiotherapy department will take place. Following these improvements, a repeat analysis will be carried out to determine adherence to CPIP.
994 Enhancing Compliance with BOAST Guidelines: A Closed-Loop Audit on Cervical Clearance in Head Injury Patients
Authors: Kondi S , Soliman A
Published: August 2024

Aim

This audit aimed to evaluate the compliance of cervical spine clearance in head injury patients according to BOAST guidelines following the implementation of a novel intervention, a single request tab, suggested after the previous audits.

Method

BOAST guidelines state that if brain CT is necessary for a head injury, this should include the CT cervical spine. Previous audits (June/Nov 2021 and Aug/Sept 2022) highlighted a persistent lack of adequate cervical spine clearance in head injury patients at Queen Alexandra Hospital. In response, a solution was proposed and implemented on May 5, 2023, introducing a single request tab within the Imaging requesting software (ICE) for CT Brain and CT C-spine. Data collected from July/Aug 2023 assessed the adherence to BOAST guidelines for all admitted head injury patients.

Results

The data encompassed 36 head injury patients, primarily diagnosed with subdural hematoma (55%), followed by skull fractures (14%). The audits in 2021 and 2022 revealed suboptimal compliance (23% and 37% respectively) despite interventions. The new implementation showcased a significant improvement, with a 53% compliance rate. This contrasts with the previous audits, suggesting enhanced adherence to BOAST guidelines.

Conclusions

Ensuring cervical spine clearance in head injury patients aligns with BOAST guidelines, emphasizing patient safety. Our audit demonstrated substantial progress in compliance, signifying improved adherence to guidelines and elevated patient care standards. The implementation of the single request tab streamlined the workflow, enhancing efficiency for clinicians to request scans promptly. We recommend widespread education initiatives for Emergency Department staff and the adoption of the single request tab across all trusts to optimize patient care.
53 The Diagnostic Performance of Uromonitor in the Evaluation of Patients at Risk for Urothelial Carcinoma
Authors: Wombwell A , Lobo N , Nair R , Khan S , Thurairaja R
Published: August 2024

Aim

Uromonitor is a urinary biomarker test that detects hotspot mutations in three genes (TERT, FGFR3 and KRAS) and has been shown to detect non-muscle-invasive bladder cancer with 100% sensitivity. We compared the performance of Uromonitor with urine cytology for the detection urothelial carcinoma in patients presenting with haematuria in our unit.

Method

Between September 2021 and January 2023, voided urine samples were obtained prior to cystoscopy from 56 patients presenting with haematuria. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of Uromonitor for the detection of urothelial carcinoma were calculated and compared to histology.

Results

Uromonitor demonstrated a sensitivity of 40.0%, specificity of 90.3%, a PPV of 76.9% and a NPV of 65.1%. In contrast, urine cytology demonstrated a sensitivity of 40.9%, a specificity of 85.3%, PPV of 64.3% and NPV of 69.0%.

Conclusions

Our ‘real world’ evaluation, Uromonitor showed improved specificity but lower sensitivity for the detection of urothelial carcinoma compared to cytology.
252 Analysis of the High Readmission Rate Following Elective Ureteroscopy – the Need for Improved Patient Information on Stent-Related Symptoms
Authors: Krum T , Frackleton R , Garrod H
Published: August 2024

Aim

To understand the high emergency readmission rate following elective ureteroscopy at Wirral University Teaching Hospital (WUTH) and to develop strategies to reduce readmissions to the national average.

Method

Comparison and retrospective chart review of Model Hospital and equivalent WUTH records and analysis of the nature and duration of readmission.

Results

Between October 2021 and March 2023, 212 elective ureteroscopies were performed at WUTH, 76.9% (n=163) involved insertion or exchange of a ureteric stent. The 30-day readmission rate following ureteroscopy was found to be 13.7% (n=29), which is higher than the median 8.6% Model Hospital national rate. Notably, it was found that 86% (n=25) of readmissions had a ureteric stent inserted or exchanged in their primary procedure. Most patients (75.9%, n=22) were readmitted within a week of their procedure and those that stayed overnight (55.2%, n=16) had a median length of stay of 2.5 days. Of these, 31.3% (n=5) were readmitted due to stent-related symptoms, including loin pain upon voiding, mild haematuria, frequency, and urgency. In contrast, for readmissions not requiring an overnight stay (44.8 %, n=13), stent-related symptoms accounted for 69.2% (n=9) of presentations.

Conclusions

Stent related symptoms are well understood, frequently reported, and do not necessarily require readmission. The high number of emergency presentations at WUTH with stent related symptoms suggests that most patients were unaware of this. ‘Stent passports’ detailing common symptoms, red-flags and when to seek urgent medical advice may be an effective tool to improve patient’s experience and reduce readmissions following ureteroscopy.
368 Single Shot Instillation Intra-Vesical Chemotherapy Administration: A Global Audit of Guideline Compliance – Results From the BURST-RESECT Study
Authors: Simpson K , Gallagher K , Bhatt N , Maclennan S , Hina S , James J , Gartner T , El-Koubani O , Mariappan P , Kasivisvanathan V
Published: August 2024

Aim

Auditing administration of Single instillation intra-vesical chemotherapy (SI-IVC) which has level 1 evidence in reducing cancer recurrence rate after Trans-Urethral Resection (TURBT) for non-muscle invasive bladder cancer (NMIBC).

Method

Using RESECT study (NCT05154084) data, a retrospective observational study was performed. Patients included underwent primary curative TURBT for bladder cancer. Cases were excluded if SI-IVC administration data was missing. The primary outcome was the rate of administration of SI-IVC.

Results

Data from 232 hospitals globally were included. After exclusions, there were 7933 (87.5%) cases analysed (44% low grade, 56% high grade NMIBC).

SI-IVC was administered in 3075 (39%) of cases (Low grade + SI-IVC: 48%, high grade + SI-IVC: 32%).

Considering low grade cases (3390), where SI-IVC is most beneficial, reasons listed for non-administration were “Surgeon did not request it” (68%), “Surgeon requested it, but it was not given” (7%) and “SI-IVC is never given at our hospital” (25%). Of 3566 cases where the surgeon did not request SI-IVC, 1497 (42%) the surgeon thought it was not indicated, 512 (14.4%) were because of potential contra-indications, no reason documented in 1210 (34%). Of these 2707 cases with no documented contraindication, 837 (31%) had low grade disease and likely would have benefitted.

Conclusions

The most common reason for non-administration of guideline recommended SI-IVC was that the surgeon did not request it, in almost one third of these cases the patient is likely to have benefitted. The RESECT study will test whether providing feedback and education to surgeons about their guideline compliance can improve compliance and outcomes.
984 Evaluation of Calcium and Urate Level Testing on Patients for the Acute Stone List Surgery
Authors: Tayo O , Karanjia R
Published: August 2024

Aim

Is to assess compliance with the newly implemented protocol for requesting calcium and urate levels at the initial patient presentation in an Accident & Emergency / Urgent Treatment Centre setting, who were managed either conservatively or with ureteric stent insertion, prior to undergoing laser fragmentation of renal stones in preparation for the acute stone list.

Background

Ensuring comprehensive pre-operative assessments, including calcium and urate level checks, is vital in the management of patients with renal colic symptoms or infective obstructed urinary systems. Following the initiation of the acute stone list, a standard protocol was introduced in the urology department to standardize this process.

Method

This single-cycle audit reviewed the records of 51 patients listed on the acute stone list from the commencement of the initiative. The focus was on determining whether these patients had their calcium and urate levels checked at the time of their surgery.

Results

Calcium Testing: Of the 51 patients, 27 (52.94%) had undergone calcium testing at presentation, while 24 (47.06%) had not. Urate Testing: 23 patients (45.10%) had their urate levels tested, compared to 28 patients (54.90%) who did not receive this test. The target is 100% compliance in all patients on the acute stone list, should have had these test by time of procedure

Conclusions

This audit underscores the importance of strict adherence to pre-operative testing protocols for patients on the acute stone list. Improved compliance, especially in urate level testing, is essential for optimizing patient outcomes and the overall success of surgical interventions.
1063 Establishment of Pneumoperitoneum for Renal Surgery Using the Kii Fios First Entry System: Early Experience and Case Series
Authors: Collins P , O’Gorman L , Hairdaran I , Hennessey D
Published: August 2024

Introduction

The ideal technique for establishing pneumoperitoneum for renal laparoscopic surgery is unknown. Veress and Hasson methods have been commonly employed, but the use of a direct vision entry port is less widely described. The aim of this study was to assess the success, safety, and efficiency of this technique in our first fifty cases.

Method

The Kii Fios First Entry system was used in all cases. The camera is placed in the trocar and this was advanced under vision, with simultaneous insufflation. Patient BMI, time to pneumoperitoneum, complications, and subsequent hernia rates were recorded.

Results

Fifty patients were included with mean body mass index 30.5kg/m2. All patients were placed in the lateral position for surgery. The entry port was placed between umbilicus and costal margin. A 10mm port was used for the first 10 cases, with a 5mm port and smaller calibre camera used for the remaining 40. Twenty-two (44%) patients underwent pyeloplasty, 19 (38%) underwent nephrectomy, and 9 (18%) other surgeries. Mean time to establishment of pneumoperitonem was 31 seconds, with the shortest recorded time being 12 seconds. No patient suffered a visceral or vascular injury. The 10mm port sites were closed formally, but 5mm sites were not. No patient has developed a port-site hernia. The First Entry port costs €39 per item.

Conclusions

The Kii Fios First Entry system represents a safe, easy, and inexpensive alternative for establishing pneumoperitoneum in laparoscopic renal surgery, with very short entry times in this series.
318 Unmasking Unusual Penile Complications in External Iliac Artery Stenting
Authors: Iossifidis E , Bennett P
Published: August 2024

Introduction

Distal embolisation following percutaneous transluminal angioplasty (PTA) is a recognised complication, occurring in 7.9%-23.7% of procedures. Whilst ischaemic complications have been reported following internal iliac artery embolisation, most commonly causing buttock claudication and erectile dysfunction, distal embolisation into the internal pudendal artery has been scarcely reported.

Case Report

A 65-year-old diabetic smoker attended for elective bilateral external iliac artery (EIA) stenting for chronic limb threatening ischaemia via retrograde left femoral approach. Pre-procedural CT demonstrated lining thrombus at the aortic bifurcation and the left common iliac artery (CIA). Following discharge, they attended the emergency department with a painful necrotic lesion on the left posterior side of the scrotum, which was excised by the urology team with sections showing necrotic and acutely inflamed tissue. A painful, necrotic lesion had also developed on the left side of the glans penis which was treated conservatively.

Discussion

The posterior scrotum and penis are supplied by the internal pudendal artery, a terminal branch of the anterior division of the internal iliac artery (IIA). This patient embolised from their left CIA and aortic bifurcation lining thrombus into the left internal pudendal artery resulting in ischaemic ulceration of the penis and scrotum. The scrotal tissue has healed completely, whereas the penile wound is still healing 6 months later.

Conclusions

Internal pudendal artery embolus following iliac PTA is a rare, but important, complication which can lead to significant distress for patients. Education and councelling of these risks to patients could lead to earlier recognition, treatment, and better desired outcomes.
507 Assessing the Standard of Referral Letter Documentation and Outcomes of Claudicants in the Vascular Outpatient Clinic
Authors: Iossifidis E , Shehata M , Bennett P
Published: August 2024

Aim

Referrals to the vascular outpatient clinic are made by GPs and Allied Health Professionals (AHPs), who may not have prior vascular training. We assessed standards of referral letters with associated clinic outcomes.

Method

Referral letters for new patients attending clinic 01/01/2023-31/08/2023 were reviewed for intermittent claudication (IC) diagnosis along with referral urgency and referring clinician grade. Documentation of IC distance, pulses, cardiovascular risk factors (CVSRF), antiplatelet and statin prescriptions were assessed as minimum standard.

Results

141 (GP:111,AHP:30) new IC patients were reviewed in clinic: 72.3% male, mean age 71.2(SD:10.5) years. 100 were referred as routine, 33 urgent and 8 not specified. 86(61%) referral letters recorded claudication distance (47(54.7%) <100m, 39(45.3%) >100m). GPs and AHPs had no differences in documentation for ≥1 CVSRF (71(64%) vs 19(63.3%), p=0.949), antiplatelet prescription (43(38.7%) vs 10(33.3%), p=0.588) and statin prescription (60(54.1%) vs 16(63.3%), p=0.944). 100(70.9%) referrals had documented pulses, with no difference between GPs and AHPs (81(73.6%) vs 19(63.3%), p=0.302). No differences in referral urgency were found related to pulse assessment in community. Patients with IC distance <100m were more likely to be referred for further investigations than >100m (21(45.6%) vs 7(17.9%), p=0.008).

Conclusions

Walking distance <100m on referrals was the only factor associated with further clinic investigations. Therefore, we are developing an IC management flowchart for the integrated care board with distance >100m to be managed in the community with best medical therapy/exercise, and <100m to be referred for clinic assessment.
563 Graft Failure After Revascularization of CLTI Patients: Graft Surveillance
Authors: Miah M , Avabde D , Ghahramani I , Hemanth R , Abbas R , Maha Q , Beech A , Salem M
Published: August 2024

Background

Failure of infrainguinal bypass grafts remains, despite expert surgeons and meticulous surgical technique, a matter of concern for both patient and surgeon. Anastomotic intimal hyperplasia is commonly greater at the downstream or at the outflow anastomosis. All infrainguinal bypasses should go under routine surveillance to pick the grafts at risk for the prevention of graft failure.

Aim

The aim was to find out if we are following the standard guidelines in the management of CLTI patients, including postoperative follow up. Also, to monitor whether the patients were having postoperative Duplex surveillance scan to pick any graft at risk.

Method

All patients were included who underwent infra-inguinal bypass procedure for CLTI during last 8months (from mid-January to Mid-September 2023) in our Vascular unit. Retrospective data were collected.

Results

Total 38 patients had lower limb bypass procedure over last 8 months (from 15th January till 14th September 2023). However, two Fem- Fem crossover, one Ilio-popliteal and one Pedal bypass were excluded. Thus, total 36 patients were included for the study (n=34). The vast majority (n=27, 79.4%) had Femoro Popliteal Bypass (AK/BK) and the rest (n=7, 20.5%) had Distal bypass (Fem-distal or Pop-distal bypass). 18% patients had amputation and 15% patients died. 61% of the remaining patients were on surveillance. Those, who were not on surveillance, 44% of them had graft occlusion.

Conclusions

Surveillance can predict graft at risk and the graft occlusion can be prevented by appropriate intervention. Every vascular unit should have their own post procedural follow up strategies.
722 A Rapid Review on Paediatric Arteriovenous Malformation Intervention Modalities, Associated Symptomatic Outcomes, and Complication Rates
Authors: Lee R , Wang J
Published: August 2024

Aim

Symptomatic congenital extracranial paediatric arteriovenous malformations (AVM) carry disproportionate risks of massive haemorrhage or heart failure. Treatment of these rare AVMs is complex due to patient presentation heterogeneity. We aim to elucidate interventional approaches resulting in optimal patient outcomes through analysis of previous case literature.

Method

Using PRISMA guidelines, Medline and PubMed were searched systematically. Inclusion criteria was limited to full-text, English language case reports focusing on paediatric patients (≤18 years) with surgically and/or endovascularly treated symptomatic, extracranial, congenital AVMs within connective tissue. Data regarding case characteristics, Schobinger classification, treatment modalities, symptom resolution, complications, and presence of interventions past the initial treatment plan, were extracted.

Results

38 studies were included out of 959 records. 66 patients were identified. Patients were treated either with endovascular embolisation (n=38), open (n=10), or combined approaches (n=18). 65% (43/66) of all patients reported resolution of symptoms with no complications. This rate was 83% (15/18) in the patient group which underwent interventions through a combined approach. 80% (12/15) of the patient group requiring additional intervention past the initial treatment plan, experienced worse symptom relief and complications. This rate was 4.2% (2/47) in the patient group not requiring additional intervention past the initial treatment plan. 4 patients had incomplete follow-up.

Conclusions

Combining open surgical and endovascular modalities in management of AVMs appear most effective in achieving symptom resolution with lower complication rates. If lesions are not effectively occluded after the initial intervention plan, surgeons should proceed cautiously to avoid iatrogenic harm, weighing the risk-benefit ratio of performing additional interventions.
Resuscitation of Asphyxiated Newborn Infants With Room Air or Oxygen
Authors: Davis Peter G. , Baker Elizabeth
Published: August 2024

The Resair 2 trial challenged the long-standing practice of resuscitating newborn infants with 100% oxygen. This quasi-randomized trial enrolled 703 infants with birth weight >999 g and compared 100% with 21% oxygen (room air). Resuscitation with 21% oxygen did not reduce the rate of the primary composite outcome of mortality or moderate/severe encephalopathy (23.7% versus 21.2%; odds ratio 0.94, 95% confidence interval 0.63 to 1.40), or its components. However, important secondary outcomes were improved with resuscitation with 21% oxygen, including time to breathing and 5-minute Apgar score. Resair 2 paved the way for further studies, leading to 21% oxygen becoming standard therapy for term infants requiring resuscitation.
Association of Umbilical Cord Milking vs Delayed Umbilical Cord Clamping With Death or Severe Intraventricular Hemorrhage Among Preterm Infants
Authors: Kim Seh Hyun , Kim Han-Suk
Published: August 2024

Umbilical cord milking (UCM) may serve as an alternative to delayed umbilical cord clamping (DCC) in preterm infants. This study was planned as a non-inferiority randomized trial to compare the rates of death or severe intraventricular hemorrhage (IVH) in preterm infants receiving UCM versus those receiving DCC. The trial was terminated early for safety, precluding a non-inferiority analysis. A post hoc analysis of 474 infants <32 weeks’ gestation showed no difference in the preplanned composite primary outcome (12% versus 8%; 95% confidence interval [CI] –0.02 to 0.09, p = 0.16), but the UCM group had a higher incidence of severe IVH than the DCC group (8% versus 3%; 95% CI 0.01 to 0.09, p = 0.02), which prompted early stopping.
Valganciclovir for Symptomatic Congenital Cytomegalovirus Disease
Authors: Ma Li
Published: August 2024

A 6-week course of ganciclovir improves audiologic outcomes at 6 months for infants with symptomatic congenital cytomegalovirus (CMV) disease, but effects wane over time. This international trial investigated prolonged valganciclovir therapy (6 months). Ninety-six infants with symptomatic congenital CMV were randomized to receive valganciclovir for either 6 months or 6 weeks. Despite no improvement in the primary end point of change in “best-ear” hearing at 6 months (p = 0.41), secondary endpoints at 2 years demonstrated benefit (maintained “total-ear” hearing (p = 0.04) and better neurodevelopmental scores in language (p = 0.004) and receptive-communication scale (p = 0.003). There was no significant difference in the occurrence of adverse events between the two groups.
Supplemental Therapeutic Oxygen for Prethreshold Retinopathy of Prematurity
Authors: Mitra Souvik
Published: August 2024

Retinopathy of prematurity (ROP) is a neovascular retinal disorder of preterm infants. Its progression may be exacerbated by hypoxic stimuli leading to release of angiogenic growth factors. STOP-ROP, a multicenter randomized controlled trial of 649 preterm infants with prethreshold ROP, investigated if supplemental oxygen therapy to achieve an oxygen saturation target of 96%–99%, compared with a target of 89%–94%, reduced progression to threshold ROP. There were no statistically significant differences in the primary ophthalmic outcomes or secondary pulmonary outcomes between the 2 groups. However, harms of hospitalization and need for supplemental oxygen were significantly higher in the supplemental oxygen arm at 3 months’ corrected age.
Long-term Effects of Indomethacin Prophylaxis in Extremely Low Birth Weight Infants
Authors: McGuire William , Fowlie Peter W.
Published: August 2024

The TIPP investigators assessed whether prophylactic indomethacin, used to reduce the incidence of PDA and severe IVH, reduced the risk of death or adverse neurodevelopmental outcomes in extremely low birth weight infants. This multicenter trial assigned 1202 infants, soon after birth, to receive indomethacin (0.1 mg/kg) or placebo intravenously once daily for 3 days. The primary outcome was a composite of death, cerebral palsy, cognitive delay, deafness, or blindness at 18 months’ post-term. This composite outcome was found to be similar in the intervention and placebo cohorts (47% versus 46%, respectively; odds ratio [OR] 1.1, 95% CI 0.8 to 1.4). Severe periventricular hemorrhage, but not other intracranial abnormalities seen on cerebral ultrasound, was lower in the indomethacin group (9% versus 13%; OR 0.6, 95% CI 0.4 to 0.9, p = 0.02).