bluuebunny/crossref_metadata_2025 huggingface dataset:
Lysis of human erythrocytes due to Piezo1-dependent cytosolic calcium overload as a mechanism of circulatory removal
Authors: Kuck Lennart , McNamee Antony P. , Bordukova Maria , Sadafi Ario , Marr Carsten , Peart Jason N. , Simmonds Michael J.
Published: August 2024

Hematopoietic stem cells surrender organelles during differentiation, leaving mature red blood cells (RBC) devoid of transcriptional machinery and mitochondria. The resultant absence of cellular repair capacity limits RBC circulatory longevity, and old cells are removed from circulation. The specific age-dependent alterations required for this apparently targeted removal of RBC, however, remain elusive. Here, we assessed the function of Piezo1, a stretch-activated transmembrane cation channel, within subpopulations of RBC isolated based on physical properties associated with aging. We subsequently investigated the potential role of Piezo1 in RBC removal, using pharmacological and mechanobiological approaches. Dense (old) RBC were separated from whole blood using differential density centrifugation. Tolerance of RBC to mechanical forces within the physiological range was assessed on single-cell and cell population levels. Expression and function of Piezo1 were investigated in separated RBC populations by monitoring accumulation of cytosolic Ca
2+
and changes in cell morphology in response to pharmacological Piezo1 stimulation and in response to physical forces. Despite decreased Piezo1 activity with increasing cell age, tolerance to prolonged Piezo1 stimulation declined sharply in older RBC, precipitating lysis. Cell lysis was immediately preceded by an acute reversal of density. We propose a Piezo1-dependent mechanism by which RBC may be removed from circulation: Upon adherence of these RBC to other tissues, they are uniquely exposed to prolonged mechanical forces. The resultant sustained activation of Piezo1 leads to a net influx of Ca
2+
, overpowering the Ca
2+
-removal capacity of specifically old RBC, which leads to reversal of ion gradients, dysregulated cell hydration, and ultimately osmotic lysis.
Exploring immersion competencies in secondary education
Authors: Ní Dhuinnín Sarah , Ó Ceallaigh TJ , Ní Aogáin Sylvaine
Published: August 2024

This study delves into immersion competencies within secondary education, specifically focusing on transformative
professional development in Home Economics pedagogical integration. Specifically, this paper investigates how six teacher
participants, in the Gaeltacht education context in Ireland, acquired the necessary competencies for meaningful
language integration, as outlined by the IPACK framework. In addition, the role of a bespoke professional development programme in
fostering such competencies was examined. Through qualitative action research design, data collection tools such as classroom
observations, stimulated recall interviews, questionnaires, and reflective diaries were employed. Findings demonstrated evident
evolvement of participants’ pedagogical approach of Form-Focused Instruction and contributed to understanding the intricacies of
immersion competencies at secondary level, highlighting their interdependence as a prerequisite for effective pedagogical
integration. Implications suggest the need for targeted professional development initiatives to empower teachers with the
competencies necessary for effective integration of content and language pedagogies.
Classical Biological Control of the Pink Mealybug in Trinidad and Tobago
Authors: Khan Ayub
Published: August 2024

The pink mealybug,
Maconellicoccus hirsutus
, was accidentally introduced in the Caribbean in 1994 before which it was a pest in the Far East. This mealybug has a wide host range and is normally managed in its native habitat by a combination of biological, cultural and chemical control. It was an ideal candidate for implementation of a classical biological control programme in Trinidad and the Caribbean partly because it was an exotic pest. Four natural enemies were chosen to effect suppression of the pink mealybug populations, two coccinellids,
Cryptolaemus montrouzieri
and
Scymnus coccivora
and two hymenopteran endoparasitoids,
Anagyrus kamali
and
Gyranusoidea indica
. In Trinidad and Tobago, an extensive public awareness campaign, reduction in pesticide applications and release of these natural enemies contributed to the success of the classical biological control programme. All three natural enemies worked harmoniously to reduce pink mealybug populations throughout the Caribbean.

Information

© The Author 2024
Comparative Test Analysis of Exhaust Noise of OEM, HPLPM and Free Flow Under Three Test Conditions
Authors: Roziqin Ahmad , Kriswanto  , Septiyanto Angga , Munako Iman , Hangga Arimaz , Wiratama Bayu , Prasetyo Mahendra , Fathkhurokhman Najib
Published: August 2024

This research aims to measure OEM, HPLPM and Free flow mufflers under several noise level testing. In this study, the factory-installed exhaust was replaced with a free-flow type and HPLPM exhaust. The research employed a quantitative method with an experimental approach. Testing was carried out under three different vehicle conditions that correspond to their usage: normal condition, exhaust condition, and acceleration condition. Each type of exhaust was tested three times for each testing condition. Subsequently, the collected data were analyzed and compared against the established quality standard in Indonesia, which stipulates that the noise level must not exceed 90 db. Based on the average noise levels produced by the free-flow exhaust type, it was found that under normal vehicle conditions, the average noise level was 28.08% higher compared to the OEM exhaust type. Under exhaust conditions, the free-flow exhaust type resulted in an average noise level 23.13% higher than the OEM type. During acceleration, the free-flow exhaust type generated an average noise level 14.54% higher than the OEM type. Employing the HPLPM exhaust type under normal vehicle conditions yielded an average noise level 25.9% higher than the OEM type. Under exhaust conditions, the HPLPM exhaust type led to an average noise level 21.2% higher than the OEM type. Finally, during acceleration, the OEM exhaust type produced an average noise level 0.03% higher than the HPLPM type. Based on this data, HPLPM can reduce noise levels better than free flow muffler. At the higher RPM HPLPM can produce almost the same noise as the OEM type.
Energy Sources for Soft Bone Milkfish Cooking Toward Time and Cost Efficacy
Authors: Sunyoto  , Saputro D D , Prasetyo P E , Ratnawati J , Muhammad I H
Published: August 2024

This study assesses the time and cost efficiency of LPG (Liquefied Petroleum Gas) and electricity for cooking soft bone milkfish (Bandeng Presto). An experimental approach was employed, where the weight of the milkfish served as the controlled variable, systematically varying across different cooking sessions. This manipulation of the milkfish’s weight allowed us to investigate the comparative efficacy of LPG and electricity as energy sources for cooking. The experiment involved collecting numerical data on cooking time and cost, which were critical in addressing our research questions. Our findings revealed that LPG exhibited remarkable time efficiency, consistently resulting in shorter cooking durations and quicker boiling points than electricity. On cost-effectiveness, electricity emerged as the preferred choice for soft bone milkfish cooking, offering reduced expenses in terms of energy consumption, particularly when utilising commercial electricity. These results shed light on the practical implications of choosing between LPG and electricity for cooking soft bone milkfish and provide valuable insights for consumers and culinary establishments seeking to optimise their cooking methods.
Comparison of Cast-in place Pullout Anchor Pullout Capacity to Post- Installed Concrete Drill Model and Drill Bit Extractor Concrete (DBEC) Model
Authors: Apriyatno Henry , Sutarto Agung , Budi Listiyono , Kusbiantoro Arief , Harihanggoro Chirstopher Bimo , Silviana Nadifa , Ma’arif Syamsul
Published: August 2024

Cast-in-place is the anchor’s installation method where the anchors are installed together with the casting of the concrete, while post-installed is the method of installing the anchors after the concrete has hardened, namely by drilling holes in the concrete with a concrete drill and then injecting the holes with chemical epoxy paste then immersing the anchors to the holes. In general, concrete drilled holes will produce a plain concrete surface, while drill bit extractor concrete (DBEC) will produce screw-textured concrete holes which are expected to increase the pullout capacity of the post-installed anchor.

The pullout capacity test of cast-in-place, post-installed, and post-installed (DBEC) anchor studs 12x160 mm anchors planted with various depths (hef) of 70 mm, 80 mm, 90 mm, and 100 mm injected with chemical epoxy paste in the borehole concrete and drill bit extractor concrete (DBEC). The pullout capacity of the post-installed with drilled holes concrete (concrete drill model) and pullout capacity drill bit extractor concrete (DBEC) will be compared with the pullout capacities of cast-in-place and post-installed concrete with drilled holes.

The result of the study showed that the pullout capacity of cast-in-place increased by 64.05% compared to theory, the pullout capacity of the post-installed concrete drill model increased by 68.23% compared to theory, and the pullout capacity of post-installed DBEC increased by 71.51% compared to theory while the pullout capacity of post-installed concrete drill model increased by 11.64% compared to the pullout capacity of cast-in-place and pullout capacity of post-installed DBEC increased by 20.75% compared to pullout capacity of cast-in-place while the pullout capacity of post-installed DBEC increased by 10.3% compared to the pullout capacity of the post-installed concrete drill model. The results of the t-test pullout capacity increased significantly for all variations of anchor hef depth and anchor installation methods.
Enhancing DVB-T2 Coverage using Antenna Pattern Optimization
Authors: Sulistyawan Vera Noviana , Andrasto Tatyantoro , Fathoni Khoirudin , Hasanah Uswatun , Widhira Sepfianda Eka , Abas Faizal Ghozali , Fauza Zaky Mulki
Published: August 2024

In Indonesia, the government has adopted digital TV broadcasting standards using the DVB-T2 (Digital Video Broadcasting-Second Generation Terrestrial) system. The development of television technology today is highly dependent on advances in antennas. Antennas are an important part of the significant development of wireless technology. This research focuses on developing an optimal antenna pattern design to overcome existing problems. By optimizing the antenna’s radiation pattern, beamforming can increase coverage area, improve signal reception, and reduce interference from other areas. In this research, the utilization and simulation are conducted with the purpose of utilizing software as a tool to aid in the design of an antenna pattern beamforming. The aim is to create a design that aligns with the characteristics of the topography and geographical conditions specific to the Jateng 1 region. This research employs software assistance for precise analysis and simulation, aiming to create efficient radiation patterns. Through the implementation of the appropriate antenna pattern beamforming design, it is anticipated that the broadcasting quality of DVB-T2 in the Jateng 1 region could experience a significant enhancement. This research aims to produce an antenna pattern design that possesses strong and efficient signal strength and distribution, thus fulfilling the information needs of the community in the Jateng 1 region.
Arduino-Based Automatic Weighing Machine Design
Authors: Asri Sarwi , Hidayat Hanif , Husodo Dono , Pratiwi Isna , Pradnya Irene Nindita , Hasanah Uswatun , Al-Qudhus Abdul Rachman
Published: August 2024

The advancement of automation technology is currently in a critical stage. Automatic weights are now a necessity for commerce and agriculture in order to improve small, medium, and large-scale business owner’ production. Automatic electrical technology plays a significant part in the development of weighing machines from conventional systems to intelligent power systems, which in this case refers to the process of weighting. The use of an automatic weighing machine can improve efficiency and productivity because an automated weigher can operate automatically without the need for human assistance. Precise and valid weighing results can reveal improved product quality. It can help reduce weighing errors and improve production efficiency. The Arduino Mega 2560 microcontroller and load sensor play an important role in the entire operation process of the automation system in the design of this automatic weighing machine. The research phase includes the process of design, assembly, and testing of the device. The mass measurement system is based on the principle of the work of the load sensor with a maximum capacity of 20 kg. The experiment’s findings demonstrate that this instrument can accurately measure masses. The entire weighing process for 1 kg rice, from initial storage to entering packing, takes approximately 12 seconds. Utilizing an effective automatic weighing system will assist reduce energy usage. This automatic weigher’s power design is low power, electricity consumption for weighing 2000 kg of rice is 0.23345 kWh.
Development of a Preoperative Psychological Screening Tool: Piloting the Cosmetic Readiness Questionnaire (Pilot-CRQ)
Authors: Pikoos Toni D , Buchanan Ben , Hegarty David , Rossell Susan L
Published: August 2024

Background

Patients with psychological risk factors such as body dysmorphic disorder (BDD) and unmanaged mental health concerns are considered at higher risk for dissatisfaction with aesthetic procedures. Identifying these risks before a procedure may decrease the chance of adverse outcomes for patients and practitioners.

Objectives

In this study we aimed to develop a comprehensive psychological screening tool to assess patient's psychological suitability for surgical and nonsurgical aesthetic procedures.

Methods

Items for the Pilot Cosmetic Readiness Questionnaire (CRQ) were developed by psychologists (n = 3) and then reviewed by plastic surgeons (n = 2) and nonsurgical cosmetic doctors (n = 3). Patient interviews (n = 15) and piloting of the questionnaire (n = 69) provided data regarding the scale's initial psychometric properties.

Results

Results supported the reliability and validity of the Pilot-CRQ's subscales of Body Dysmorphia, Psychological Distress, Self-Criticism, Perfectionism, and Lack of Openness. Lack of Openness was a validity scale that examined the degree that respondents might be underreporting symptoms. The CRQ predicted individuals with a BDD diagnosis, as rated by a blinded expert clinical psychologist, with high sensitivity and specificity.

Conclusions

These results provide support for the Pilot-CRQ identifying people with BDD and psychological factors related to aesthetic treatment outcomes and provide a strong basis for employing the CRQ in clinical contexts and in future research.

Level of Evidence: 2 (Diagnostic)
148 A Retrospective Assessment of the Management of Bladder Outlet Obstruction in a District General Hospital
Authors: Olaniyi O , Ullah H , Muoka O
Published: August 2024

Aim

To evaluate the management & care outcome of all male patients undergoing bladder outlet obstruction(BOO) intervention by benchmarking against national figures as well as established NICE & EAU guidelines.

Method

A descriptive & retrospective analysis of all patients with BOO, using anonymised unit-level data from patient/operative notes, pre/post-operative clinic letters & investigation portal over 12 months(July 2020 - June 2021).

Results

Of the 77(out of 125) cases that satisfied the inclusion criteria, retention with an in-dwelling catheter was the most prevalent indication for surgery at 45.45%. Overall, perioperative complications such as unsuccessful trial without catheter(TWOC), transfusion, postoperative infection and return to the theatre was 5.19%, with a median length of stay of one day. Comparatively, the failed TWOC rate was 9.09%(< national average of 13.90%) while the post-operative infection rate was 3.89% which was slightly above the national figures. Nonetheless, the unscheduled re-admission rate was 6.49%, fulfilling the 9.60% GIRFT objective. Furthermore, 82.17% of catheterised patients and those performing self-catheterisation before surgery were catheter-free at follow-up. However, 14.20% of preoperatively uncatheterized patients had one at follow-up.

Conclusions

The larger sample size of our re-audit showed the service was comparatively similar to the national norm with minimal unplanned 30-day readmissions, perioperative complications & a large proportion of successful TWOC at follow-up as our initial data suggested. However, while most patients were catheter-free at follow-up, we were slightly below the national average. In addition, it highlighted the need to assess the reason(s) why preoperatively catheter-free patients had one at follow-up.
214 Review of Chaperone Documentation in Surgical Clerkings
Authors: Merrison H , Okocha M , Alexander R , Lim J
Published: August 2024

Introduction

A recent tribunal resulted in a doctor being suspended after a dispute regarding an examination. This prompted a review of chaperones in the surgical department for both the safety of the patient and practitioners. According to NICE guidelines chaperones are needed for all intimate examinations and should be considered for all examinations.

Aim

Identify what percentage of surgical clerking’s state:A chaperone was present. (Standard 80%)A chaperone was present during intimate examinations (Per rectum, breast or testicular). (Standard 100%)A chaperone was present during a paediatric consultation. (Standard 100%)

Method

This audit examined the notes of patients seen by the surgical on-call team between 14/12/2022 and 17/12/2022. Information regarding type of examination, age and documentation of a chaperone were collected.

Results

During the study period 81 patients were seen in SAU. Of these 22 received a review by only a junior and 12 received a review by only a registrar. 47 received two reviews. Therefore, this audit examined a total of 128 clerkings. Overall, 4.7% of all examinations had a chaperone documented with no examinations of children documenting a chaperone. 30.8% of intimate examinations had a chaperone documented.

Conclusions

Few chaperones were documented in surgical clerking falling below the standards; however, this may not correlate with chaperone presence. Whilst chaperones may be present, without documentation the practitioner has no protection, should their practice be questioned. Education is necessary to improve chaperone documentation, most urgently paediatric and intimate examinations. A reaudit will be necessary to assess any improvement in documentation.
309 Antibiotic Usage in Abdominal Surgery Patients in Colorectal, Hepatobiliary and Upper Gastrointestinal Surgery
Authors: Akula Y , Oo A , Ratnaraja N , Menon V
Published: August 2024

Aim

Guideline-adherent antimicrobial usage is associated with a 35% relative risk reduction in mortality and superior post-surgical outcomes. This audit assessed: 1/adherence to local antimicrobial surgical prophylaxis guidelines 2/documentation of antimicrobial indication 3/duration 4/ review outcomes. This was re-audited following teaching sessions to surgical departments.

Method

Data was obtained from drug charts and medical notes of post-surgical inpatients. Data collection periods were: 9/10/23- 20/10/23 (initial audit, 64 patient) and 13/11/23- 17/11/23 (re-audit, 40 patients). Patients were identified from theatre lists for colorectal, hepatobiliary and upper GI surgery. Exclusion criteria included: 1/ age <16 years 2/ long term steroid use or immunocompromised 3/ known colonisation/infection with multidrug resistant organisms. Data was electronically encrypted. Presentation of findings to local surgical and microbiology audit/quality improvement programmes (QIPS) 25/10-7/11/23. Comparison of re-audit findings with the initial audit.

Results

Following the teaching sessions and presentation: Adherence to local antimicrobial prophylaxis improved from 68.8% to 77.5%. Adequate documentation of antimicrobial duration improved from 78.9% to 85.7%. Adequate documentation of antimicrobial review outcome was 20% on initial audit and 22.5% on re-audit. Adequate documentation of indication for antimicrobial regimen increased from 37% to 60%.

Conclusions

Compliance with antimicrobial prophylaxis guidelines, documentation of antimicrobial duration and indication improved. However, documentation of antimicrobial review outcome remained poor. Further collaboration with surgical teams, alongside revision of guidelines for modern surgical practice, is required to improve compliance rate. A further audit is planned to assess for sustained improvement in these outcomes.
325 Cutting Through Assumptions: Assessing Patient Understanding on General Surgical Discharge
Authors: Marsh K , O’Neil A M , Rollo B , Proctor M
Published: August 2024

Aim

Hospital admission can be a stressful and confusing time for patients. There is concern that upon discharge, they may not always be fully aware of their diagnosis, current treatment and proposed follow up, which can in turn negatively affect overall patient experience. This audit aims to quantify patient understanding upon discharge from a busy District General Surgical unit.

Method

Emergency and elective colorectal and UGI general surgical patients (n=98) attending the Victoria Hospital Kirkcaldy (NHS Fife) between November 2022 and April 2023 were included. A handout inspired by, and with permission from, E.N. Thomas et al (1), was created with five key questions assessing patient understanding of elements of their admission including current diagnosis and changes to medicines. These were scored from 1-5 (5 being strongly agree).

Results

Overall the results were positive with most patients scoring highly in all areas. Diagnosis was the highest scoring factor with a mean score of 4.68/5, whilst there was least patient certainty regarding follow up plans scoring 4.37/5. Knowledge surrounding medication changes during admission scored 4.62/5, knowing what problems can occur and who to contact if they do occur, scored 4.58/5 and 4.51/5 respectively.

Conclusions

The findings highlight that patient understanding surpasses levels previously reported, demonstrating that even fast paced surgical ward rounds can provide patients with the correct information. As has been previously suggested, this is a simple cost-effective assessment process that can be used to ensure adequate patient understanding.
336 Elective Operative Note Compliance in General Surgery
Authors: Ang K L , Chen S , Hosten K , Khanna A
Published: August 2024

Aim

Good Surgical Practice document by the Royal College of Surgeons (RCS) England emphasizes the importance of “clear operative notes for every procedure”. Importance of clear documentation is well-established. Accurate and comprehensive documentation facilitates effective handover and aids in medicolegal issues. We assess the current documentation standards for all elective cases in General Surgery between June 2023 – August 2023. We aim to identify and improve compliance of documentation in general surgery operation notes in a district general hospital.

Method

Mandatory operative note domains were taken from Good Surgical Practice (2014) by the RCSEng. Acceptable compliance domains >=90% and poor compliance domains <=50%. We performed a retrospective review of all elective operations performed between June 2023 – August 2023 in the General surgery department.

Results

107 typed operation notes were identified. The department was compliant in the domains of date (94.39%), Operative surgeon (93.46%), procedure (97.20%), operative diagnosis (98.13%), operative finding (91.59%), details of operation (100%), closure technique (96.26%), post-op instructions (99.07%) and signature (100%). We saw poor compliance the domains of elective/emergency procedure (0%), complications/problems (36.45%), additional procedures (0.93%), anticipated blood loss (0.93%), antibiotic prophylaxis (28.04%) VTE prophylaxis (11.21%).

Conclusions

Operation notes are an essential document for post-operative care and effective handover. Appropriate use of the operation note proforma could improve patient care and compliance with RCS guideline.
401 Cardiovascular Risk Factor Optimisation Amongst Inpatients with Peripheral Artery Disease – a Single-Centre Audit
Authors: Kawka M , Camelio M , Farrell–Dillon K , Howie S , Abdelhamid M , Moxey P , Azhar B , Roy I , Budge J
Published: August 2024

Aim

Patients with symptomatic peripheral artery disease (PAD) are highly co-morbid and thus may benefit from cardiovascular disease risk factors optimisation at the time of admission. This audit aimed at reviewing adherence to NICE guidelines for secondary prevention of cardiovascular disease amongst hospital in patients with critical limb-threatening ischaemia (CLTI) or intermittent claudication (IC).

Method

A retrospective review of all CLTI or IC inpatient admissions to a tertiary referral vascular surgery centre, over 9 months, was performed. We assessed adherence to five NICE recommendations for cardiovascular risk factor optimisation: 1) smoking cessation 2) lipid modification 3) antiplatelet therapy 4) blood pressure control 5) diabetes risk assessment, with target adherence of 100%.

Results

97 admissions for PAD were recorded (CLTI n=87, 89.7%; IC n=10, 10.3%). The average age was 70.8±11.7 years, and 68.4% were male. Smoking cessation service was provided to 40.5% of eligible patients, lipid modification to 18.8%, blood pressure control to 29.5%, diabetes risk assessment to 21.1%, and antiplatelet therapy to 38.9%. Admissions longer than 10 days had a significantly higher rate of adherence (>10 days 35.5% vs ≤10 days 19.8%, p=0.017).

Conclusions

There are gaps in risk factor optimisation amongst PAD inpatients, with risk factors either not documented, or addressed appropriately. Shorter, elective hospital admissions were associated with worse risk factor optimisation. A dedicated review of risk factors should be offered to all PAD inpatients early during their admission. To achieve the best long-term adherence, multidisciplinary engagement of geriatrics, smoking cessation, diabetes, and primary care is essential.
402 An Insight into the Use of Tourniquet During Orthopaedic Surgery at a District General Hospital
Authors: Khan M A , Rddah M , Gaukroger A , Ashby L , Logan J
Published: August 2024

Introduction

Tourniquet is a device used by orthopaedic surgeons to produce a bloodless field for limb operations. Historically applied to the most proximal part of the limb.  The British Orthopaedic Association (BOA) created guidelines for the use of intraoperative tourniquet in October 2021.

Method

A retrospective study of the elective and emergency operation notes utilising tourniquet was performed over one month. The results were presented at the departmental educational meeting. A new operation note template was employed. A further month period was retrospectively reviewed.

Results

Over one month, 72 operations were carried out where a tourniquet was used, of them 45.8% (n=33) were on the upper limb (UL) compared to 54.2% (n=39) on the lower limb (LL). The inflation pressure was incorrectly used in 72.7% (n=24) of UL operations and 43.5% (n=17) of LL operations. The type and size of tourniquet was not recorded in 68.05% (n=49) and 41.7% respectively.

A further one-month period was appraised post changed applied.

Tourniquet was used in 34 operations with 54.2%(n=15) on the UL and 55.8% (n=19) on the LL. The inflation pressure was incorrectly applied in 30% of UL operations in comparison to 72.7% previously. The LL tourniquet pressure was incorrect in 22% of operations compared to 43.5% beforehand. The type and size of tourniquet used was recorded in 71% and 60% respectively. The skin condition prior to tourniquet was recorded in 40% of operations.

Conclusions

The implementation of an electronic operation note has improved our hospital’s compliance with national standards on safe tourniquet use.
413 Standardised Informed Consent for Right Hemicolectomies
Authors: Mann L , Peacock M
Published: August 2024

Aim

Consent is vital to enable patients to make informed decisions in regard to their treatment. Our audit reviewed the risks patients undergoing a right hemicolectomy consented for, with the aim of introducing a standardised consent form sticker.

Method

A retrospective analysis of all patients undergoing a right hemicolectomy was undertaken over a 1-year period at a district general hospital. Clinical notes were reviewed to compare consent forms regarding the indication for operation, risks and complications consented for, along with actual outcomes. Patients were excluded if additional operations were performed or if a consent form 1 was not used.

Results

25 patients were included with an average age of 71 years. The forms were completed by a Consultant in 40% of cases, the remaining being completed by a registrar. 2 consent forms were illegible. Risks consented for were inconsistent between patients. Interestingly, 40% of patients suffered from a post-operative complication, not all of which were consented for.

Conclusions

This project demonstrates variation within our consent process. We have proposed a pre-printed right hemicolectomy consent form sticker listing complications as agreed by the consultant body for our speciality. This has been presented at our departmental governance meeting and alterations have been made in response to feedback. We will complete the audit cycle and plan to extend this initiative to all colorectal procedures at our hospitals. An exciting innovation may involve digital consent forms via text or email whenever appropriate.
417 Improving Peri-Operative Management of the Acute Diabetic Vascular Patient
Authors: Moosa S , Hallett C , McBride R , Rahi M
Published: August 2024

Aim

Vascular patients are a high acuity cohort of patients with a high prevalence of diabetes. It’s well established that poor diabetic control is implicated in higher incidence of wound infections/systemic infection and poor healing amongst other sequalae. Many trusts have established guidelines for the peri-operative care of diabetics undergoing surgery and we sought to investigate our departmental compliance.

Method

Over a prospective 30-day period (18/9/23-19/10/23) patients admitted under the acute vascular take or pre-operative for expedited procedures were included. Patient notes and drug charts were reviewed looking for compliance with peri-operative diabetic guidance as well as blood glucose(BM) control.

Results

All 28 patients were type 2 diabetics, fourteen of which were on insulin regimes. Adherence to guidance was 50%, identified issues included background insulin stopped (N:5,18%), SGLT inhibitor not stopped (N:9,32%), Sliding scale not prescribed where indicated (N:3,11%). BM levels were on average higher in those for whom trust guidance was not followed 11.2mmol/L vs 8.6mmol/L with increased BM lability in the 24hr post-operative particularly in those whose background insulin should’ve been continued or sliding scale been prescribed (10.3mmol/L average difference between lowest and highest reading).

Conclusions

Our results highlight improvements required in adherence to trust guidance especially given the implications of poor BM control as established in the literature. We aim to build upon these findings having sent out a questionnaire to investigate the root causes as well as working on building a decision-based app to enable juniors to make timely correct decisions regarding diabetic peri-operative care.
469 Operation Notes Audit: Excellent Bridge in Continuity of Care
Authors: Binti Jamalludin A N , Mann H , Kot M , Ng A , Alkarooshi S
Published: August 2024

Background

Operation notes are vital as part of patient care in-line with Good Medical Practice to provide excellent continuity of care and for medicolegal purposes. This also to raise awareness on existing guidelines and accuracy of operation note documentation.

Aim

To assess compliance of op-notes documentation against Royal College of Surgeons (England) Good Surgical Practice Guidelines “1.3 Record your work clearly, accurately and legibly” in ENT Department Imperial College NHS.

Method

This is a retrospective 2-cycles audit (n=27) analysing October 2023 theatre list for first cycle and November 2023 theatre list for second cycle. Inclusion and exclusion criteria applied to ensure uniformity of data collected based on type of operations. Data documentation analysed against domains in RCS guidelines.

Results

Results are compared for both cycles, for which the results of first cycle were presented in a regional meeting. Almost all domains achieved 100% compliance of documentation except deep vein thrombosis (DVT) prophylaxis (10%), blood loss (5%), antibiotic prophylaxis (85%) and anaesthetists name (50%). Part of the discussion is that blood loss should be documented even in minor cases with minor bleeding risk. DVT prophylaxis might be overlooked in some cases (e.g., hemithyroidectomy which require only overnight inpatient).

Conclusions

Surgical teams are responsible in documenting clear plans and instructions peri-operatively to provide optimum level of patient care, reduce perioperative complications, improve patient satisfaction and ensuring patient safety.
544 The VIP QIP - Reducing the Rate of Inpatient Phlebitis
Authors: O’Donnell C , Fardanesh A , Bakare O , Spiteri A , Dewan L , Rohatgi A
Published: August 2024

Introduction

The VIP (visual infusion phlebitis) score was introduced to monitor cannulation for early signs of phlebitis. This is an avoidable morbidity of hospital inpatients risking cellulitis and potentially increasing length of stay. Nevertheless, a tool is only as effective as the hand that wields it. This quality improvement project aimed to improve VIP score documentation and reduce the rate of inpatient phlebitis.

Method

Baseline measurements of VIP documentation, subjective VIP score, cannulation dates and non-flushing cannulas were recorded over the 3 surgical wards at a district general hospital. This was followed by 2 Plan-Do-Study-Act (PDSA) cycles. In PDSA 1, baseline measurements were displayed in an eye-catching poster and dispensed evenly amongst the wards. For PDSA 2 face-to-face teaching sessions were delivered to clinical teams highlighting both the importance of the VIP score and its documentation.

Results

At baseline, 26% cannulas had appropriate VIP score documentation and 6.5% cannulas had VIP score >2 indicating early phlebitis signs. With implementation of PDSA 1, this rose to 43.8% documentation and reduction to 2.3% early phlebitis. After PDSA 2 education sessions, VIP documentation reached 91.5% and early phlebitis rate was 2.1%.

Conclusions

This QIP has successfully reduced early phlebitis rate in this patient population to 2.1%, which is now in-keeping with CDC guidance of <5%. In addition, there was a 65.5% improvement in documentation of VIP score demonstrating increased application of the tool in clinical practice. These results are replicable and necessary to improve patient care in both surgical and medical wards.
551 Ultrasound Scans Versus Computerised Tomography Scans in the Diagnosis of Acute Appendicitis: What Is the Preference?
Authors: Terrieux-Taylor A , Dholoo F , Kurian S , Johnson O
Published: August 2024

Aim

Acute appendicitis (AA) is one of the most common surgical presentations. Timely diagnosis reduces complications but is challenged by presentational variability. Computerised Tomography scans (CT) are the preferred diagnostic investigation, offering higher sensitivity and specificity than Ultrasound scans (US). We reviewed AA investigation practice at St Peter’s Hospital (SPH), analysing the utility of CT and US.

Method

Data for 189 SPH AA patients (16/05/2022-13/01/2023) were collated by age, sex (females: F, males: M), pregnancy testing, urine dip, Clinicians’ judgement, imaging performed, and results. Age parameters were: <18, 18-40, 41-64, 65+.

Results

84 F (<18: 11, 18-40: 37, 41-64: 25, 65+: 11) and 105 M (<18: 26, 18-40: 37, 41-64: 31, 65+: 11) were included. 55 F and 52 M had urine dip. Pregnancy testing was performed in 82.0% of applicable F. Judgement was most accurate in 18-40 (M: 94.9%; F: 97.3%). Commonest imaging was US in <18 (F: 5/9 confirming AA; M: 10/13 confirming AA). US-only accuracy was highest for 18-40 (F) and also commonest (24 performed: 16 confirming AA). For 18-40 (M), CT-only were commonest (15 performed, all confirming AA); 11 US performed (6 confirming AA). All F 65+ (11) had CT (all confirming AA); 2 US performed (all inconclusive). All 65+ M (11) had CT (10 confirming AA); 1 US performed (confirming AA). M <65 were more likely (than F) to have no imaging.

Conclusions

The data indicate a disparity between imaging rates and modality based on sex, age, and accuracy. We will highlight this to SPH for consideration.
606 Faster Diagnosis Standards in 2 Week Wait Haematuria Clinic
Authors: Kulkarni A , Pa Pa Lin Y , Warren K
Published: August 2024

Introduction

The Faster Diagnosis Standard (FDS) has been introduced to ensure that patients have cancer diagnosed or ruled out within a maximum of 28 days from referral, for at least 75% of patients. This audit focuses on assessing and improving the time taken for diagnosis or exclusion of suspected bladder or upper tract cancer in the 2-Week Wait (2WW) Haematuria Clinic.

Method

This quality improvement project involved a retrospective analysis of data collected from the 2WW Haematuria Clinic at our centre from February 2023 to May 2023. We analysed waiting times at key stages of the pathway to evaluate adherence to the FDS and identify areas for improvement. Data was collected in two cycles: before and after implementing the change of introducing a Cancer Clinical Nurse Specialist (CNS) led CT Urogram (CTU) results clinic.

Results

Analysis of the data from 50 patients revealed that the median time taken for diagnosis or exclusion of cancer was 54 days (range: 25 – 113 days) from the time of GP referral. Following the introduction of the CTU results clinic, data collected from another 50 patients showed that the waiting time significantly improved to a median of 27 days (range: 13 – 76 days).

Conclusions

This audit demonstrates significant improvement in the adherence to the FDS in the 2WW Haematuria Clinic, which has resulted in timely diagnosis or reassurance of absence in cases of suspected urothelial cancer.
612 A Quality Improvement Project of Management of Acute Pancreatitis in a District General Hospital; How Well Are We Doing Against NICE Guidelines?
Authors: Scott L , Park J K , Revill V
Published: August 2024

Aim

Pancreatitis is a common condition with significant complications, and mortality in 5% of cases. We aimed to identify compliance to the National Institute for Health and Care Excellence (NICE) guidelines of pancreatitis management in our District General Hospital (DGH) to improve patient safety and outcomes.

Method

A retrospective analysis of first-time presentations of acute pancreatitis over a 12-month period, assessing the five domains addressed in NICE-NG104: identifying cause, antibiotic stewardship, nutrition, severity and complications, and lifestyle advice. Our data was compared to that of the PANC study, a UK-national cohort study.

Results

A total of 33 cases fit criteria –17 male and 16 female. Cause was identified in 55%, of which 86% were within 48 hours. 51% were prescribed antibiotics on admission, of which 23% had an indication recorded. 91% of patients were nil-by-mouth, only 20% of those cases had a reason recorded. Only 6% had severity documented. Four patients were discussed with a tertiary centre. Lifestyle advice was offered to 33% of patients on discharge.

In comparison with the PANC Study, there were domains with significant differences. For example, the study reported that 56.4% of cases were offered oral nutrition vs 9% in our DGH, and antibiotics were prescribed in 34% vs 51% locally.

Conclusions

The audit highlighted need for improvement in NICE guideline compliance of acute pancreatitis management in our DGH. This is being tackled by cycles of quality improvement, including introduction of a ‘Pancreatitis Management Bundle’ and local clinical guidelines, increased staff awareness and patient education.
656 Is Routine Group and Save Required for Laparoscopic Cholecystectomy? An Audit of a High Volume NHS Centre
Authors: Akharaekpanya T , Nair A , Ward K , Nevins E J
Published: August 2024

Aim

Bleeding is a recognised complication of laparoscopic cholecystectomy (LC). Yet very few patients require blood transfusion in the perioperative phase. However, it is routine practice for patients undergoing LC to have a group and save (G&S) prior to surgery. This audit aims to assess number of LC patients at Northumbria Healthcare NHS Foundation Trust who required transfusions, and the number who had “valid” group and save (G&S) samples obtained within 72 hours pre-operatively.

Method

Records of patients who had either elective or emergency LC at Northumbria Healthcare NHS Trust between 1st January 2021 to 31st December 2022 were reviewed retrospectively using theatre and transfusion records.

Results

A total of 836 patients were included (557 female and 279 male, age ranges 19 to 90 years old). Out of 571 elective LC, none required transfusion. 383 had a “valid” G&S, despite 360 having at least one historical sample. Of 265 emergency LC, 245 patients had a “valid” G&S, despite 207 having at least one historical sample. No patients needed intra-operative transfusion. 2 emergency LC patients required non-urgent post-operative transfusion where G&S sampling could have been taken once transfusion decision was made. One patient had cirrhosis and anaemia secondary to liver metastases, and the other developed a post-operative liver haematoma.

Conclusions

This audit suggested that no patients required intra-operative transfusion, and very few patients required peri-operative transfusion for LC. Eradication of routine G&S sampling is likely to provide financial and environmental benefits without increasing the risk profile of this procedure.
760 Intravenous Maintenance Fluid Prescribing in Nil-by-Mouth Patients in General Surgery: A Closed-Loop Audit
Authors: Ismail R
Published: August 2024

Aim

Inappropriate intravenous fluid prescribing in peri-operative nil-by-mouth patients increases the risk of electrolyte, metabolic imbalances, and starvation ketosis.(1) NICE guidelines offer recommendations for intravenous maintenance fluid prescribing in nil by mouth' patients. (2) This audit assessed the prescribing of maintenance intravenous fluids in nil-by-mouth patients in our General Surgery department.

Method

We retrospectively audited our practice over two randomized 14-day periods pre and post-intervention to check compliance with guidelines. Inclusion criteria included non-diabetic patients, no pre-existing electrolyte imbalances and nil-by-mouth for ≥24hrs. Interventions: We delivered teaching sessions to FY1/2 on General surgery highlighting NICE guidelines on correct IV fluids prescribing. Posters summarizing this were displayed around the surgical wards.

Results

Cycle 1 showed significant lack in the prescribing of potassium and glucose in our department. Cycle 2 revealed that 82% of patients met their daily water requirements, while 94% and 96% met their sodium and chloride requirements, respectively. This translates to 40%, 10% and 11% increase in adherence to recommended water, sodium, and chloride intake, respectively. Although a small percentage of patients met their glucose (24%) and potassium (16%) requirements, the department witnessed a 55% and 54% increase in prescribing of glucose-containing and supplemental potassium-containing bags, respectively.

Conclusions

This audit identified an area of miseducation in our department and created a positive impact in the correct prescribing of maintenance fluids, particularly in the prescribing of potassium and glucose in nil-by-mouth patients.
767 A Retrospective Analysis of Unplanned Admissions in Inguinal Hernia Repairs, Laparoscopic Cholecystectomies and Para-Umbilical Hernia Repairs (Day Surgery) Against the GIRFT Guidelines
Authors: Ponnuswamy K , Burke J , Dalip A , Bugren S , Natarajan M , Khan A
Published: August 2024

Aim

Getting It Right First Time (GIRFT) is a national initiative to homogenise and improve the treatment pathways amongst various NHS trusts. Unplanned admission after day case surgery results in unexpected cost and burden to the NHS. In this study, we investigated the causes for unplanned admission of patients undergoing laparoscopic cholecystectomy, paraumbilical and inguinal repair.

Method

A retrospective analysis of day cases over a period of one-year (January 2022 – January 2023) was undertaken. All patients’ pathways were compared against the GIRFT pathway.

Result

A total of following cases were included: 51/232 (22%) laparoscopic cholecystectomy, 7/48 (14.5%) paraumbilical hernia, and 18/152 (12%) inguinal hernia cases had unplanned admissions. The main causes for unplanned admissions for laparoscopic cholecystectomy were high-risk patients booked as day case (5 cases), complex intra-operative procedures (11 cases), and post-op complications/social reasons (4 cases); for paraumbilical hernia, the causes included social concerns, obstructive sleep apnea, extended post-op recovery; for inguinal hernia the main causes were urinary retention (5 cases) and high-risk patients booked as day case (11 cases).

Conclusions

For majority of cases, the GIRFT pathway was followed. Most of the unplanned admissions had predictable and preventable causes.
802 Assessing the Below Knee Amputation Service in a London Major Trauma Centre: An Audit
Authors: Chan K , Singh P , Iliadis A , Pafitanis G
Published: August 2024

Aim

For certain complex orthoplastic patients, a below knee amputation (BKA) is the best form of reconstruction. An audit was carried out to assess whether orthoplastic patients undergoing BKAs at a major trauma centre in London were being managed according to best practice guidance set out by NICE and the Vascular Society.

Method

A retrospective review was carried out to analyse all BKAs that were performed on orthoplastic patients at the Royal London Hospital between 2020-2022. Patients were found by manually searching through the plastic surgery departmental inpatient database, and their electronic medical notes were reviewed for information specifically related to the recommendations set out by NICE guidelines for complex fractures and the Vascular Society’s guidance for major amputations.

Results

19 cases were identified. The average age of patients was 45.8 years. 11 amputations were emergencies, 8 were planned. The average time to surgery once a decision was made to amputate was 1.75 days. Compliance was 100% with having an MDT discussion pre-operatively, recording the decision to amputate in the patient’s notes, and making a formal referral to the amputee rehabilitation team for prosthetics. Areas of lower compliance included giving written counselling to families, naming a discharge co-ordinator pre-operatively, and review by the pain team within 24 hours post operation.

Conclusions

This audit has identified specific areas for improvement and will help to develop a written pathway for lower limb amputations in the trust, ensuring that patients undergoing BKAs receive the best care possible.