bluuebunny/crossref_metadata_2025 huggingface dataset:
Vacuum-Assisted Suction Drainage as a Successful Treatment Option for Postoperative Symptomatic Lymphoceles
Authors: Franke Mareike , Saager Christian , Kröger Jan-Robert , Borggrefe Jan , Mückner Kersten
Published: October 2021

Purpose Lymphoceles often occur within several weeks or even months after surgery. Mostly asymptomatic and therefore undiagnosed, they may be self-healing without any treatment. A small percentage of postoperative lymphoceles are symptomatic with significant pain, infection, or compression of vital structures, thus requiring intervention. Many different treatment options are described in the literature, like drainage with or without sclerotherapy, embolization of lymph vessels, and surgical approaches with laparoscopy or laparotomy. Inspired by reports stating that postoperative suction drainage can prevent the formation of lymphoceles, we developed a simple protocol for vacuum-assisted drainage of symptomatic lymphoceles, which proved to be successful and which we would therefore like to present.

Materials and Method Between 2008 and 2020, 35 patients with symptomatic postoperative lymphoceles were treated with vacuum-assisted suction drainage (in total 39 lymphoceles). The surgery that caused lymphocele formation had been performed between 8 and 572 days before. All lymphoceles were diagnosed based on biochemical and cytologic findings in aspirated fluid. The clinical and imaging data were collected and retrospectively analyzed.

Results In total, 43 suction drainage catheters were inserted under CT guidance. The technical success rate was 100 %. One patient died of severe preexisting pulmonary embolism, sepsis, and poor conditions (non-procedure-related death). In 94.8 % of symptomatic lymphoceles, healing and total disappearance could be achieved. 4 lymphoceles had a relapse or dislocation of the drainage catheter and needed a second drainage procedure. Two lymphoceles needed further surgery. The complication rate of the procedure was 4.6 % (2/43, minor complications). The median indwelling time of a suction drainage catheter was 8–9 days (range: 1–30 days).

Conclusion The positive effects of negative pressure therapy in local wound therapy have been investigated for a long time. These positive effects also seem to have an impact on suction drainage of symptomatic lymphoceles with a high cure rate.

Key Points: 

Citation Format
14. dggö Jahrestagung 2022 - Moin aus Hamburg!
Authors: Bernhardt Taika , Kifmann Mathias
Published: October 2021

Nach 2018 kommt die Jahrestagung der Deutschen Gesellschaft für Gesundheitsökonomie (dggö) zum zweiten Mal nach Hamburg. Vom 28. bis 29. März 2022 findet die 14. Jahrestagung im Hauptgebäude der Universität Hamburg statt. Mit dem Kongressthema „Ökonomik der Pandemie“ steht die ökonomische Analyse der Folgen der Covid-19-Pandemie im Mittelpunkt der Tagung.
NiNP@rGO Nanocomposites as Heterogeneous Catalysts for Thiocarboxylation Cross-Coupling Reactions
Authors: Bandini Marco , Lombardi Lorenzo , Mazzaro Raffaello , Gazzano Massimo , Kovtun Alessandro , Morandi Vittorio , Bertuzzi Giulio
Published: October 2021

A new type of ligand-free Ni-nanoparticles supported on rGO (size distribution average d = 9 ± 3 nm) was prepared and fully characterized via morphological (Fe-SEM), structural (P-XRD, HR-TEM), and spectroscopic (ICP-EOS, XPS) analysis tools. The metal composite was effectively employed in the unprecedented heterogeneously Ni-assisted cross-coupling reaction of aryl/vinyl iodides and thiocarboxylates. A range of sulfur-containing aryl as well as vinyl derivatives (15 examples) was achieved in high yields (up to 82%), under mild reaction conditions, and with wide functional group tolerance.
Metástase retroperitoneal, hepática e de linfonodo de osteossarcoma tibial proximal: Relato de caso
Authors: Gutierrez Daniela , Sánchez Carlos A. , Linares Francisco B. , Messa Oscar
Published: October 2021

Homem adulto com osteossarcoma na tíbia proximal, tratado com cirurgia de salvamento de membro com endoprótese e quimioterapia. Ele desenvolveu um padrão metastático incomum, comprometendo fígado, ossos e linfonodos inguinais, sem recorrência local na tíbia nem metástases pulmonares. O osteossarcoma (OS) é o segundo tumor ósseo primário mais frequente, depois do mieloma múltiplo em adultos. Os locais frequentes das metástases, em caso de progressão da doença são os pulmões e os ossos. As metástases extrapulmonares são raras. O desenvolvimento de novos esquemas de quimioterapia melhorou a expectativa de vida dos pacientes com osteossarcoma, porém, alterou também os padrões usuais de metástases, resultando em localizações metastáticas incomuns.
Aerosol jet printed 3 omega sensors for thermal conductivity measurement
Authors: Kempf Nicholas , Zhang Yanliang
Published: October 2021

The 3 omega (3ω) method is a trusted technique for measuring thermal conductivity—a fundamental material property of critical importance in a broad range of applications. However, traditional 3ω sensor processing requires some form of physical vapor deposition, such as metal evaporation or sputtering. These 3ω sensor deposition techniques limit the materials and sample sizes applicable to the 3ω method. This work demonstrates an aerosol jet printing method to directly print silver 3ω sensors that yield accurate temperature-dependent measurement up to 300 °C on materials with thermal conductivity ranging from 1 to 150 W/m K. The interrelationship between printed sensor geometry, sensor thermal stability, and applicability to the 3ω method is examined. Thermal conductivity measurement with 3ω sensors conventionally sintered at 300 °C agrees to independent laser flash measurement within 4% from room temperature to 150 °C. An unconventional rapid high-temperature sintering method is shown to produce sensors that agree within 3% of the laser flash measurements from room temperature to 300 °C. The rapid sintering profiles also reduced the sensor–substrate thermal boundary resistance of the printed sensors by as much as 88%. The direct printing of 3ω sensors creates opportunities for measurement of thermal transport properties in applications previously inapplicable to the 3ω method.
Improved photoelectrochemical performance of Nb-substituted LaTi(O,N)3
Authors: Werner V. , Schoiber J. , Redhammer G. J. , Berger T. , Pokrant S.
Published: October 2021

Photoelectrochemical water-splitting is a possible path toward sustainably produced hydrogen, which is a potential solar fuel of the future. Complex tuning of material properties is necessary to further enhance efficiency and, therefore, ensure economic viability of this process. In this study, the influence of Ti-site substitution in the perovskite-related oxynitride LaTi(O,N)3 is investigated. Oxide materials, La2Ti2-2xNb2xO7±δ without and with a substitution of up to 8% of the Ti-sites, are synthesized and, subsequently, transformed into the corresponding phase pure oxynitrides, LaTi1-xNbx(O,N)3±δ. The incorporation of Nb is confirmed via x-ray diffraction and energy dispersive spectroscopy. Changes in morphology, nitrogen content, optical properties, and charge carrier density are investigated using scanning electron microscopy, gas adsorption, thermal gravimetric analysis, and UV-vis and electrochemical impedance spectroscopies. Charge compensation of the positive charge introduced by Nb5+ via additional N3− incorporation is identified as a mechanism that occurs during thermal ammonolysis and results in an increased N content in substituted compounds, probably preventing charge carrier density increase. An improvement of up to 30% of the photocurrent density at 1.23 V vs RHE is achieved for x = 0.01 in comparison to unsubstituted LaTi(O,N)3. The performance increase in this material is related to a reduction in (crystalline) defects at low substitution degrees. These results underline the necessity to tune the synthesis conditions carefully for material design.
Influence of non-adiabatic effects on linear absorption spectra in the condensed phase: Methylene blue
Authors: Dunnett Angus J. , Gowland Duncan , Isborn Christine M. , Chin Alex W. , Zuehlsdorff Tim J.
Published: October 2021

Modeling linear absorption spectra of solvated chromophores is highly challenging as contributions are present both from coupling of the electronic states to nuclear vibrations and from solute–solvent interactions. In systems where excited states intersect in the Condon region, significant non-adiabatic contributions to absorption line shapes can also be observed. Here, we introduce a robust approach to model linear absorption spectra accounting for both environmental and non-adiabatic effects from first principles. This model parameterizes a linear vibronic coupling (LVC) Hamiltonian directly from energy gap fluctuations calculated along molecular dynamics (MD) trajectories of the chromophore in solution, accounting for both anharmonicity in the potential and direct solute–solvent interactions. The resulting system dynamics described by the LVC Hamiltonian are solved exactly using the thermalized time-evolving density operator with orthogonal polynomials algorithm (T-TEDOPA). The approach is applied to the linear absorption spectrum of methylene blue in water. We show that the strong shoulder in the experimental spectrum is caused by vibrationally driven population transfer between the bright S1 and the dark S2 states. The treatment of the solvent environment is one of many factors that strongly influence the population transfer and line shape; accurate modeling can only be achieved through the use of explicit quantum mechanical solvation. The efficiency of T-TEDOPA, combined with LVC Hamiltonian parameterizations from MD, leads to an attractive method for describing a large variety of systems in complex environments from first principles.
Experimental investigation of droplet breakup of oxide-forming liquid metals
Authors: Hopfes T. , Wang Z. , Giglmaier M. , Adams N. A.
Published: October 2021

This work investigates the breakup of liquid metal droplets experimentally using a shock tube. Droplets of Field's metal melt are produced and their flow-induced deformation and rupture are captured by a high-speed camera. Results are compared to previous data on Galinstan droplet breakup using image sequences and deformation data. Regarding differences, we find that Field's metal droplets show slightly larger deformations and breakup into a larger number of smaller fragments, especially at low Weber numbers. We expect this to be an effect of different oxidation rates. However, both oxidizing metals show a very similar behavior with respect to the breakup morphology, transition between modes, and the timing of the deformation across the investigated Weber number range of 10–100. In addition, core features that distinguish the breakup of metals from that of conventional, water-like liquids are confirmed. Based on the similarities, we propose that the findings can be generalized to also represent other oxide-forming metals. Weber number-dependent fits are presented for the initial deformation time, the time of the onset of breakup, and the maximum cross-stream diameter. In addition, we provide an empirical fit for the time-dependent cross-stream deformation and evaluate it against experimental data and models from the literature. The fits can be used directly in numerical studies or help improve current breakup models.
Energy diagram and parameters regarding localized states in InGaN/GaN nanocolumns
Authors: Shimosako N. , Kinjo K. , Inose Y. , Nakaoka T. , Oto T. , Kishino K. , Ema K.
Published: October 2021

The parameters related to the localized states in green-emitting indium gallium nitride (InGaN) have been evaluated by considering the energy diagrams derived by five different methods: (1) the exponential tail of the low-energy side of photoluminescence (PL) spectra, (2) the photon energy dependence of PL decay time, (3) excitation energy dependence of the PL peak energy, (4) the PL excitation spectrum, and (5) the temperature dependence of PL peak energy. The results indicate that the energy diagram of InGaN is divided into four regions: deep localized states, migration region, transition region, and extended states. It is suggested that wider localized states and a narrower transition region are preferable in order to achieve higher PL efficiency. In addition, the dependence of carrier density on PL properties supports the fact of photo-generated carriers forming localized excitons in green-emitting InGaN, although the carriers do not form localized excitons in orange-emitting InGaN and instead exist as localized electrons and holes.
Oil column pinch-off controls the oil fraction of the oil-coated bubble
Authors: Ji Bingqiang , Singh Amrit , Feng Jie
Published: October 2021

We study experimentally the formation of millimeter-sized oil-coated bubbles at a customized co-axial orifice system and the pinch-off dynamics of the oil column attached below the rising gas bubble. After the gas bubble detaches from the inner orifice, it rises under buoyancy and stretches the oil column to cause pinch-off, forming an oil-coated bubble, with the oil fraction set by the pinch-off location. We show that this pinch-off location is dominated by the size ratio of the gas bubble/oil tail to the outer orifice, and a theoretical model is proposed to predict the oil fraction, describing the experimental results well. Our findings provide potential guidelines for the controllable generation of compound multiphase bubbles using co-axial orifices.
Generalization of the Artin-Hasse logarithm for the Milnor

-groups of

-rings
Authors: Tyurin D. N.
Published: October 2021

Let

be a

-adically complete ring equipped with a

-structure. We construct a functorial group homomorphism from the Milnor

-group

to the quotient of the

-adic completion of the module of differential forms

. This homomorphism is a

-adic analogue of the Bloch map defined for the relative Milnor

-groups of nilpotent extensions of rings of nilpotency degree

for which the number

is invertible.

Bibliography: 12 titles.
Waterlogging as an environmental filter to tree recruitment in tropical wet grasslands
Authors: Ribeiro Jonathan Wesley Ferreira , Reis Gonçalo Rafael , Marta Kolb Rosana
Published: October 2021

Wet grasslands from the Brazilian Savanna (Cerrado) are open-canopy vegetation dominated by subshrubs and herbaceous plants. Although they frequently occur between gallery forests and savannas, tree species are rarely observed colonising these grasslands. Here, seed germination and seedling development of Cerrado trees under waterlogging conditions were evaluated in order to elucidate how soil waterlogging constrains tree regeneration in tropical wet grasslands. We used seeds of 11 representative Cerrado tree species that have different requirements for soil moisture (non-flooded v. flooded environments). Short periods (15 days) of waterlogging drastically decreased or inhibited germination and seedling development in four species, whereas long periods (30–45 days) of waterlogging reduced or inhibited germination and seedling development in 6 of the 11 species. As expected, we found fewer waterlogging-resistant seeds associated with those species from non-flooded environments. By contrast, more waterlogging-resistant seeds were associated with species that eventually or typically occur in flooded environments. Our results suggest that soil waterlogging is an important environmental filter constraining tree recruitment in tropical wet grasslands. However, some species can overcome this environmental filter by possessing waterlogging-resistant seeds or avoid it by establishing in less waterlogged locations.
Stiffness of targeted layer-by-layer nanoparticles impacts elimination half-life, tumor accumulation, and tumor penetration
Authors: Kong Stephanie M. , Costa Daniel F. , Jagielska Anna , Van Vliet Krystyn J. , Hammond Paula T.
Published: October 2021

Significance

Layer-by-layer nanoparticles (LbL NPs), comprised of a charged core substrate layered sequentially with oppositely charged polyelectrolytes, are a promising class of drug delivery carriers for cancer therapeutics with demonstrated success in lowering off-target toxicity and enhancing efficacy. However, little is known about how LbL NP stiffness alters trafficking and delivery. Herein, we report that the stiffness of targeted LbL NPs, comprised of a liposome core and tumor-targeting, polymeric outer layers, can be tuned by altering the mechanical properties of its underlying liposomal core. We also show that these changes have a significant impact on in vivo NP trafficking properties; compliant LbL NPs have longer elimination times, higher organ and tumor accumulation, and higher tumor penetration.
1018 Did COVID Compromise the Care of Closed Paediatric Hand Fractures?
Authors: Dbeis R , Yim G , Watts A
Published: October 2021

Aim

To assess the effect of a ‘rapid-access’ musculoskeletal unit, established in March 2020, as part of the Royal Devon & Exeter hospital COVID response, with direct assessment of hand trauma by the Plastic Surgery department staff, on treatment timelines and national guidance compliance for closed paediatric hand fractures.

Method

This was a retrospective review from 1st January to 31st December 2019 and a prospective study from the 1st April to 15th June 2020. The retrospective cases were collated by health informatics. The prospective data was recorded on the department’s database. Exclusion criteria: nail bed injuries with tuft fractures, ligament injuries only, open fractures and patients aged 18 at time of surgery.

Results

In 2019 the majority (73%) of patients (n = 26) were referred within 48hrs but waited a median of 5 days to be seen in clinic by a hand surgeon resulting in significant delays in treatment. After service reconfiguration in 2020, all patients (n = 6) were operated on within 72 hours of the decision to operate - mean time to surgery 1.5 days (range 0-3 days). The mean time from referral to clinic was 1.33 days (range 0-6 days). 4 patients were operated on within 7 days of injury. Of the 2 patients operated on > 7 days, 1 was referred 32 days post injury and 1 failed conservative management.

Conclusions

The introduction of a ‘rapid-access’ musculoskeletal unit with early senior review and a dedicated theatre has created ‘gold-standard’ compliance with national standards for the operative management of closed paediatric fractures.
1050 An Audit of the Management of Acute Epididymo-orchitis
Authors: Sturgess G , Davies A
Published: October 2021

Aim

To evaluate the management of patients referred to our Surgical Assessment Unit presenting with acute epididymo-orchitis. Concordance with local antibiotic guidance, the use of ultrasound scanning, and microbiological testing were all assessed over a one-year period.

Method

All adult patients presenting with acute epididymo-orchitis in 2019 were identified retrospectively using ICD-10 codes and the choice of antibiotic used was compared to our own local guidance. The use of ultrasound scanning was recorded and whether this led to a change in diagnosis or management. Use of microbiological investigations including urine microscopy & culture and sexual health screening were assessed.

Results

After exclusion criteria were applied 64 cases were identified with an average age of 55 (16-88). Concordance with local antibiotic guidance was low with 3/64 patients receiving antibiotics in-line with local guidance. This was predominantly due to the frequent use of Ciprofloxacin (49/64) which is not advised locally, however is in-keeping with guidance from organisations such as EAU/BASHH. Ultrasound was used acutely in 46/64 patients with 28/46 showing evidence of epididymo-orchitis, 15/46 were normal and 1/46 confirmed an abscess which required surgical drainage. All normal scans were still treated with antibiotics based on clinical findings. 25/64 had a urine sample sent for MC&S and uptake of sexual health screening was low.

Conclusions

Urologists should be aware of differences between local prescribing policy and broader guidance from relevant organisations. Epididymo-orchitis remains a clinical diagnosis and ultrasound should be reserved acutely for diagnostic uncertainty, unwell patients, or failure to improve.
1080 An Audit on Compliance with Recommended Duration of Surgical Antimicrobial Prophylaxis in St. Vincent’s University Hospital, Dublin, Ireland
Authors: Ho N X , Clarke L , Collins P M , Fitzgerald S , Sheehan S , Paul T , Treacy G , McNicholas S
Published: October 2021

Aim

Surgical site infection (SSI) is a common healthcare-associated infection, and a frequent cause of post-operative morbidity. SSI comprises any infection of the operative incision, cavity or involved organ, that occurs within the 30-day post-operative period. Antimicrobial prophylaxis is critical in reducing SSIs. Our aim was to assess adherence to the recommended surgical antimicrobial prophylaxis guidelines in St. Vincent’s University Hospital (SVUH), as part of the hospital antimicrobial stewardship programme. Compliance of surgical services was measured against the recommended regimens described in the SVUH Antimicrobial Guidelines.

Method

Data on duration and choice of prophylaxis were prospectively gathered on inpatients undergoing elective surgery during a three-week period between August-September 2020. Patients undergoing transplant procedures, inpatients in the intensive care unit, and patients who moved off-site postoperatively were excluded.

Results

Eighty-one patients were included. Sixty-four (79%) were compliant with prophylaxis duration, while seventeen (21%) were not. Reasons for extended prophylaxis included three (18%) cases where there were intra-operative complications and five (29%) cases of routine prescribing of an additional 24-hour coverage. Nine (53%) did not document the reason for extended cover.

Conclusions

Compliance with recommended duration of prophylaxis improved in comparison to prior audits. Among patients receiving extended prophylaxis, documentation of the indication was poor. Patients with evidence of post-operative infection may be better served with targeted antimicrobial therapy rather than extended prophylaxis. One reason for extended prophylaxis may be due to difficulty accessing guidelines on recommended prophylaxis duration, hence a targeted smartphone application was introduced to improve accessibility.
1100 A Closed Loop Audit Comparing Admission Rates Post Transurethral Resection of Bladder Tumour (TURBT) Before and After Day Case Procedure Was Made the Standard Goal
Authors: Miller S , Hunter-Campbell P
Published: October 2021

Aim

To assess the impact of making day case TURBT the standard goal.

Method

We performed a closed loop audit on the effect of listing all TURBTs as day case from the 1st December 2019. Data was collected retrospectively on all TURBTs from December 2018-March 2019, and from December 2019-March 2020 after implementing the change in protocol. Data collected included patient demographics, procedure and admission details, complications, and readmission rates.

Results

In total, 133 resections were included. Prior to the change in protocol, 36% of TURBTs were performed as day case. Of those admitted, 74% were due to haematuria, and 2% were planned. 8% were readmitted within 28 days and required urology input. There was 12% readmission rate overall. The rate of bladder perforation was 3.8%.

Post intervention, 64% of all TURBTs were performed as day case. 82% of admissions were due to haematuria, and 14% were planned. The rate of bladder perforation remained low at 1.6%, and readmission rate was 3% with no urology input required.

Conclusions

TURBT is the standard endoscopic procedure for the diagnosis, grading and removal of bladder tumours. The use of day case surgery pathways has been emphasised to help reduce lengths of stay and streamline patient care. The British Association of Day Surgery (BADS) recommends that 60% of TURBTs could be performed as a day case procedure. This study shows that this recommendation can be exceeded through a simple and low-cost intervention, whilst maintaining a low complication rate.
1114 Getting it Right First Time: An Audit of Length of Hospital Stay for Mandibular Fractures
Authors: Mitchell F , Parmar J
Published: October 2021

Introduction

GIRFT is a Department of Health programme, created to improve efficiency by providing data that gives departments a national standard to encourage reflection and service-improvement. The 2016 document in Oral and Maxillofacial Surgery, suggests the national average length of stay for isolated mandible fractures was 2 days, 1 day pre-operatively and 1 day post-operatively. This Audit aimed to investigate if all admissions in our trust met this standard, as a short stay reduces costs and improves patient experience.

Method

Data was collected for all isolated mandibular fracture admissions between January – September 2019, with 89 patients identified. Date of admission, surgery and discharge was recorded which allowed calculation of pre-operative, post-operative, and total stay.

Results

78% of patients had surgery within 24 hours of admission. Admissions on a Saturday were most often delayed, with a mean pre-operative stay of 1.60 days and total stay of 2.55 days. Commonly the reason for delay was not recorded, or due to lack of theatre space. 92% of patients were discharged within 24 hours post-operatively. The average length of stay met the 2-day standard, with Monday admissions having the shortest average stay of 1.45 days.

Conclusions

Whilst the majority of patients are treated and discharged within 2 days, improvements and future audit would assist to get closer to the 100% target. Saturday saw the highest number of admissions, which also had the longest average length of stay. A dedicated weekend trauma list would reduce wait times but may be limited by staffing and theatre space.
1132 How Much Are Junior Doctors Aware and Knowledgeable of Colorectal Enhanced Recovery Program? A General District Hospital Audit
Authors: Dorra A , Alhammali T , Arnob A , Murtaza M , Essa N , Fahmy W
Published: October 2021

Aim

Aim of the study is assessment of awareness and knowledge of colorectal Enhanced Recovery Program (ERP) of newly joined junior doctors at a general district hospital. ERP is an essential evidence-based element of surgical colorectal patients’ management during preoperative, operative, and postoperative periods. Junior doctors play an integral part in patients’ management. Local hospital guidelines require 100 % awareness and knowledge of ERP among surgical team members.

Method

A questionnaire of 15 points for assessment of awareness (1 point) and knowledge of Colorectal ERP (14 points) among 8 newly joined junior doctors (Senior House Officers, Foundation year 2 and Foundation year 1) was developed in our surgical department in August 2020.

Results

The responses showed that average score of doctors’ knowledge of ERP was (52.9 %). Two doctors (25%) scored 9 out of 14 (9 /14), two (25 %) scored 8/14, one (12.5 %) scored 7.25 /14, one (12.5 %) scored 7/14, one (12.5%) scored 6/14, one (12.5%) scored 5 /14. Regarding awareness of ERP, 5/8 doctors were aware of ERP (62.5 %).

Conclusions

The study showed presence of a variable average level of awareness and knowledge of ERP among newly joined junior doctors. This was less than local guidelines target (100%). The study recommends education (power point presentation) for improving awareness and knowledge of ERP among newly joined junior doctors. This is to be followed by re-auditing and closing the audit loop.
1135 Improving Surgical Discharge Summaries
Authors: Oyewole B , Liu C , James N , Sandhya A , Ma J , Jethwa P
Published: October 2021

Introduction

Discharge summaries are a means of communication to the patient, the GP and for medical records. An initial audit showed surgical discharge summaries contained misleading information and sometimes omitted relevant information. Changes were implemented to improve the accuracy of surgical discharge summaries.

Method

The initial audit assessed the accuracy of discharge summaries over a two-week period and the re-audit was conducted after implementation of change over a similar time period. Data was extracted from electronic patient records (EPR). Change implementation included educating the surgical team on the need for accurate discharge summaries. The EPR team was notified of the intrinsic error in the PowerChart system which is widely used in various NHS Trust.

Results

Incidence of misdiagnosis or misleading diagnosis in discharge summaries reduced from 42% to zero, lack of relevant investigations decreased from 7% to 1%, No follow up status reduced from 23% to 10% (usually post appendicectomy patients which are not routinely followed up but this needs to be stated in the discharge summary for clarity), at both initial audit and re-audit all patients had relevant surgery or procedures done included in their discharge summaries while the rate at which relevant medications were not stated in the discharge summary decreased from 4% to zero.

Conclusions

Discharge summaries are vital for record keeping and are usually the only written information a patient receives regarding their hospital stay. It is important that errors in EPR systems be flagged up for review.
1138 Complete Cycle Audit of Adults with Incapacity Documentation
Authors: Tang C C
Published: October 2021

Aim

The Adults with Incapacity (Scotland) Act 2000 sets out the framework for regulating intervention in the affairs of adults who have impaired capacity. A certificate of incapacity should be completed for those deem incapable to decide on their medical treatment. We aim to improve the accuracy of adults with incapacity documentation to 90% over 6 months period and

Method

Data was collected over three months, focusing on 3 domains:

The results of first cycle were discussed on the departmental meeting. Education flyers were sent to everyone in the department and put up in the doctors’ room. Data was collected again after 6 months with the same inclusion criteria.

Results

The percentage of patients with a patient with incapacity certificate has dropped to 34% from 50%. Completion of capacity assessment remained 100%. Attempt to contact relevant others has increased from 52% to 92%. Accuracy of documentation has improved to 77% from 44%.

Conclusions

The proportion of patients with a patient with incapacity certificate is in keeping with the prevalence of delirium in surgical wards. Interactive discussion and flyers improve compliances with completion of adult with incapacity certificate. Routine training should be included in departmental teaching to ensure future compliances.
1148 Analgesia Prescribing in Acute Surgical Admissions - Dual-Centre Cross-Sectional Study
Authors: Makhort A , Gavrila A , Hill F
Published: October 2021

Aim

Pain is a common presenting complaint of acute surgical inpatients and has a great impact on their subjective wellbeing and the perception of care they receive if not addressed promptly and efficiently. It is also a common cause of patients’ complaints if not properly addressed. We set out to evaluate if analgesia is prescribed locally in accordance with WHO analgesia ladder and NICE CKS analgesia guidelines for mild-to-moderate pain.

Method

We performed cross-sectional studies of adults aged 16 and over, admitted under general or vascular surgery in two DGHs (2018-2020) with complaints of pain on admission. 30 patients were included in both studies with an average age 53/56 years. We undertook notes review, checked observation charts and drug charts for pain grading and analgesia prescribing following initial clinical assessment.

Results

In the first study, average pain score of 6 was obtained. Only 19/30 patients (63%) had regular analgesia prescribed. Only 2/30 (6%) were started on regular weak opioids, with further 8/30 (26%) on as required/PRN weak opioids. 17/30 (56%) patients had PRN Oramorph prescribed. Only 2/30 (6%) were started on PRN NSAIDs despite only 46% having cautions/contraindications. 5/30 patients with pain scores of 9-10 not had any regular analgesia prescribed. Comparable results were achieved in the second hospital we audited.

Conclusions

This study shows significant under-prescribing of analgesia, especially regular analgesia for surgical patients with moderate-severe pain and skipping of weaker opioids/NSAIDs in favour of Oramorph. There is significant scope for improvement following educational session implementation to junior doctors.
1152 “A Hypoxic Dilemma”- Compliance with Oxygen Prescriptions on The Acute Surgical Take
Authors: Shaladi A , Jesuthasan J , Martin G , Allu J , Shah A
Published: October 2021

Aim

British Thoracic Society Guidelines state that all patients admitted to hospital should have oxygen targets prescribed to promptly start oxygen therapy should clinical deterioration occur. We aimed to assess oxygen prescribing compliance for new surgical patients.

Method

We assessed prescription of oxygen in patients admitted on the surgical take, once weekly for 8 weeks looking at target values, route of administration, frequency and appropriate signing and dating. A re-audit was performed after presenting the initial results at a department meeting.

Results

61 patients were included. Out of 61, 8 patients had COPD. Only 9 patients had adequate oxygen prescriptions with all the criteria completed. After re-audit, 50 surgical take patients’ drug charts were reviewed. 42 out of 50 patients had correctly completed oxygen prescriptions.

Conclusions

Correct oxygen administration in high-risk patients is vital in their management, particularly during clinical deterioration. A discernible improvement in prescriptions was noted in this study.
1205 Clinical Audit Demonstrating an Increase in Referrals to The Ophthalmology AMD Clinic at University Hospital Southampton
Authors: Laali S
Published: October 2021

Aim

To demonstrate if the introduction of OCT imaging by a national optician chain across its 740 stores in UK (followed by other chains) would increase in referrals to the wet AMD clinic. Secondly to assess if the direct increase of referrals would have an impact on the clinic workload.

Method

Retrospective review of all referrals made to the AMD service via optometrists/opticians throughout 2018. Total numbers of referrals that were proven to have nAMD requiring injections Inclusion; direct optician referral or GP referral via an optician. Exclusions: Ophthalmologist, Eye Casualty, other clinics and nAMD not requiring injections.

Results

Opticians were responsible for 62.88% (566) referrals out of 900 to the AMD service The second half of 2018 showed an increase in referrals (130 more) but with improved quality since the diagnostic accuracy of the optometrists increased from 22.94% to 37.64% The improved diagnostic accuracy of the optometrists was found to be statistically significant (Fisher’s exact test: p < 0.0003)

Discussion

Increase in patients requiring injections directly increases clinic by initial screen and follow up injections. Medical retina departments faced an increase in false positive referrals. Potentially due to seeing essentially normal findings in a new way (B scan) that are artefacts or misinterpretation of either the image or the normative values

Conclusions

Upon review and presentation of the audit, NHS will invest in an electronic referral system to aid the clinic. Education and ongoing clinical training are essential to the successful launch of an OCT service in the community.
1280 A Retrospective Audit of The Management of Facial Lacerations in The Emergency Department in A Busy South Wales Tertiary Centre
Authors: Ubhi J , Mihailidis T
Published: October 2021

Aim

To assess the management of facial lacerations in the Emergency department at Morriston Hospital using NICE laceration guidance.

Method

We performed a retrospective audit on the management of facial lacerations that presented to Morriston A&E between 5/7/20 - 23/7/20. Two reviewers independently assessed ED documentation from all patients with a coded diagnosis of facial laceration. The criteria assessed included the examination of neurovascular status, consideration of analgesia, risk assessment for tetanus or infection and antibiotic choice. Following this we have implemented a Facial laceration checklist sticker to serve as a clinical tool to examine, risk stratify and to aid documentation.

Results

In this timeframe we assessed 50 patients in total. Prior to any intervention: 37% had documented Neurovascular examination, 58% had no tetanus risk assessed or prescribed, Analgesia was considered in 43% of cases and antibiotics were prescribed in 20% of cases (10% vs 90% for Flucloxacillin vs Chloramphenicol.) We are currently still collecting post implementation data.

Conclusions

With SHO staff rotations in Plastic Surgery, Maxillofacial Surgery and A&E as frequently as on a 4 monthly basis there can be variation in experience when managing facial lacerations. It is therefore important to have quick, clear and accessible clinical tools to support the recognition of complications in facial lacerations. Chloramphenicol was the most commonly prescribed antibiotic which was not within nice guidelines and only prescribed by Maxillofacial and Plastic surgery. This prompts the next step in reviewing literature in order to delineate the grounds for its usage.
1315 Improving Efficiency of I&D of Abscesses Pathway
Authors: Hassan M
Published: October 2021

Background

It is not always possible for patients with abscesses to undergo I&D under GA on day of attendance the majority of patients wait for a space to become available on CEPOD or asked to return the next day. In 2017 an abscess pathway was introduced in TWH to help streamline these patients. This was audited and found to improve wait times from 8hr23mins to 3hrs 59mins, with 78% of patient having their operation in < 6hrs.

Method

Retrospective analysis of 3 months trial of the abscess pathway. (August - October 2019). Patients were identified by searching the Theatre Man theatre database for patients with codes relating to incision and drainage of abscess under the care of the Department of General Surgery. Data was collected on time referred to surgeons, time seen by surgeons, decision to admit/or ask to return and time sent for theatres. Additional information was collected on severity of symptoms and overnight stay in hospital

Results

Of those managed on the abscess pathway:78% received their surgery within 6 hours of arrival (25/32) - the other 7 patients had their operations later than 6 hours due to long CEPOD lists and multiple urgent operations at the same time. Average wait time from arrival in surgical assessment unit is to theatre is 4 hours 43 minutes. 32 patients were managed on the pathway, 29 had same day discharge. Two patients stayed overnight due to late time of operation (10 pm) and 1 patient was pyrexial post op
1320 Evaluation of Routine Group and Save Testing Prior To Appendicectomy
Authors: Fadel M , Patel I , Brewer J , Behar N
Published: October 2021

Introduction

Group and save (G&S) testing is often performed prior to emergency appendicectomy. However, there are no standard national guidelines regarding the routine use of preoperative G&S. We performed a Trust Audit to review the need for G&S prior to appendicectomy in order to recommend new guidelines.

Method

Retrospective review of all patients that underwent appendicectomy at Chelsea and Westminster Hospital between October 2019 and March 2020. We evaluated the existing literature on blood transfusion rate and the need for G&S prior to appendicectomy.

Results

One hundred and seventy-three patients (female 56%, median age 26 years) underwent appendicectomy (94% laparoscopic, 6% open). One hundred and thirty-four (77%) patients had a valid G&S and none of the patients received a blood transfusion perioperatively. The estimated total cost of G&S sampling for laparoscopic appendicectomy over one year in the Trust is £6825 (excluding all other laparoscopic surgery).

Conclusions

Based on the audit findings and literature review, routine G&S testing is not necessarily required for all patients undergoing laparoscopic appendicectomy. G&S should be requested on a patient case-specific basis (for example, chronic anaemia or haematological conditions) with discussions between the anaesthetist and surgeon. This would reduce delays in emergency lists, have financial implications and there is no evidence to support that the routine use of G&S benefits patient outcomes. These recommended guidelines have been presented at Surgery/Anaesthetics Clinical Governance and have been rolled out in the Trust with the aim to perform a re-audit in 3-6 months.
Examining the Combined Estimated Effects of Hearing Loss and Depressive Symptoms on Risk of Cognitive Decline and Incident Dementia
Authors: Powell Danielle S , Brenowitz Willa D , Yaffe Kristine , Armstrong Nicole M , Reed Nicholas S , Lin Frank R , Gross Alden L , Deal Jennifer A
Published: October 2021

Objectives

Late-life depression is a comorbidity that may co-occur in older adults with hearing loss—each has prevalent and independent modifiable risk factors for dementia.

Methods

Using data from 1,820 Health, Aging and Body Composition study participants (74 ± 2.8 years, 38% Black race), we compared the hearing loss–dementia/cognitive decline relationship between those with normal hearing/mild hearing loss and those with moderate or greater hearing loss. Using linear mixed-effects and Cox proportional hazard models, we investigated if the associations between hearing loss and cognitive decline or dementia (Modified Mini-Mental State [3MS] Examination and Digit Symbol Substitution Test [DSST]) differed by the presence or absence of depressive symptoms. Depressive symptoms were defined as Center for Epidemiologic Study—Depression scale 10 ≥10 at one or more visits from Years 1–5. Algorithmic incident dementia was defined using medication use, hospitalizations, and cognitive test scores. Audiometric hearing loss was measured at Year 5 and categorized as normal/mild versus moderate or greater hearing loss.

Results

Having both hearing loss and depressive symptoms (vs. having neither) was associated with faster rates of decline in 3MS Examination (β = −0.30; 95% confidence interval [CI]: −0.78, −0.19) and DSST (β = −0.35; 95% CI: −0.67, −0.03) over 10 years of follow-up. Having both hearing loss and depressive symptoms (vs. neither) was associated with increased risk (hazard ratio [HR]: 2.91; 95% CI: 1.59, 5.33 vs. HR: 1.54; 95% CI: 1.10, 2.15 hearing loss only and HR: 2.35; 95% CI: 1.56, 3.53 depressive symptoms only) of incident dementia in multivariable-adjusted Cox proportional hazards models.

Discussion

Comorbid conditions among hearing-impaired older adults should be considered and may aid in dementia prevention and management strategies.
PSII-1 Adapting to the new normal: Feedlot cattle circadian rhythm and behavior-based management
Authors: Meneses Xandra Christine A , Park Rachel M , Ridge Emily , Daigle Courtney L
Published: October 2021

Every organism has evolved patterned responses to its temporal and physical surroundings. Rhythmicity is a central regulator of life and a sentinel for animal health and metabolism, thus chronic stress and disease can disrupt behavioral patterns. Feedlot cattle may exhibit irregularities in circadian rhythms due to social, environmental, and nutritional stressors and may benefit from behavior-based management strategies. This study characterized the hourly behavioral patterns of feedlot cattle with and without environmental enrichment, established behavioral expectations for animal managers, and proposed practical interventions. Fifty-four crossbred steers were shipped to Texas A&M AgriLife Feedlot in Bushland, Texas, blocked by weight, and assigned to one of six pens (n = 9 steers/pen), half of which had a cattle brush and half did not. Frequency of headbutting, mounting, bar licking, tongue rolling, allogrooming, and brush usage was decoded from video recordings of cattle from 08:00h to 17:30h on d -2, -1, 0, 1, 2, 4, 8, 16, 32, and 64 relative to brush implementation. The impact of time (hour), treatment, and their interaction on cattle behavior were evaluated using PROC MIXED in SAS. Brush use (P < 0.0001), allogrooming (P < 0.0001), and mounting (P < 0.0001) were performed at lower frequencies during early hours of the day and at higher frequencies in the afternoon. Both tongue rolling (P < 0.0001) and bar licking (P < 0.0349) occurred most often during daylight hours in accordance with a diurnal pattern. Major periods of headbutting (P < 0.0001) were observed in the morning and afternoon. Behavioral expectations were characterized so that stockpeople could observe the prevalence of each behavior during morning, midday, and evening to facilitate the implementation of best management practices. Proposed interventions include medical treatment, modified pen surface or bunk management, altered stocking density, and/or introduction of environmental enrichment.
PSIX-26 Genome-wide search for selection signatures in European wild boar
Authors: Kostyunina Olga V , Traspov Aleksey Aleksandrovich , Ecomonov Alexander Vyacheslavovich , Getmantseva Lyubov , Bakoev Nekruz , Prytkov Yuri , Domsky Igor
Published: October 2021

The search for selection signatures in wild boars was meant to assist in identifying genomic regions associated with adaptation to environmental conditions. The aim of our study was to seek selection signatures in European wild boars of Russia. We studied 66 wild boars from 20 different regions in four different climatic zones. DNA samples were genotyped using Porcine SNP60 BeadChips and GeneSeek SNP-chips (Illumina, San Diego, USA). Quality control procedures were carried out resorting to PLINK v1.9; briefly, individuals with genotype call rates of < 0.8 and SNPs with call rates of < 0.3 or minor allele frequencies less than 0.99 were excluded. Also, we resorted to “–LD” to make prune filtering in Plink. In total 37065 markers from full subset of SNPs were used for subsequent analysis. We removed close relatives with enabling option --rel-cutoff 0.75. After filtering 11271 SNPs remained and total genotyping rate of obtained dataset was 98.4%. We subsequently identified SNPs, which had cross within log-likelihood ratio scores (LLRS) values > 2, in addition to integrated Haplotype Score (iHS) values > 2. After comparing 2 methods we detected 6 common elements in “IHS” and “LLRS” - ASGA0101898 – intergenic variant; H3GA0020102 – intergenic variant; ASGA0093835 - intron variant, RBFOX1 (RNA binding fox-1 homolog 1) is a Protein Coding gene, RNA-binding protein that regulates alternative splicing events by binding to 5’-UGCAUGU-3’ elements, regulates alternative splicing of tissue-specific exons and of differentially spliced exons during erythropoiesis; ASGA0098807 - DSG3 (Desmoglein 3) is a Protein Coding gene, component of intercellular desmosome junctions, involved in the interaction of plaque proteins and intermediate filaments mediating cell-cell adhesion; MARC0064247 – non coding transcript exon variant ENSSSCG00000035431, ASGA0020755 – intron variant, ARHGAP30 Rho GTPase activating protein 30). The result of the research will assist in revealing genetic regions associated with adaptation of the Russian wild boars.

This research was supported by the Russian Scientific Foundation (RSF) within Project No. 19-16-00109.