bluuebunny/crossref_metadata_2025 huggingface dataset:
512 Megaoesophagus Presenting as Stridor: A Case Report and Review of Literature
Authors: Drever SKM , Thirumal V , Rogers MJC
Published: November 2022

Introduction

Megaoesophagus, dilatation of the oesophagus, is a recognised late complication of achalasia cardia, Chagas disease and, less commonly, dysmotility disorders. Megaoesophagus often presents with dysphagia, regurgitation of food and chest pain. Here, we describe a case of a patient presenting with stridor secondary to chronic dysmotility in the absence of dysphagia.

Case Report

An 85-year-old female presented to the Emergency Department with stridor, and a history of breathlessness and intermittent coughing episodes. Flexible laryngoscopy revealed the larynx to be rotated to the right, corresponding with a palpable swelling of the left neck. A chest X-ray showed a markedly dilated oesophagus. Computed tomography revealed severe oesophageal dilatation causing compression of the tracheobronchial tree and larynx. The patient received nebulised adrenaline and intravenous dexamethasone, resulting in resolution of her stridor. A barium swallow demonstrated marked cricopharyngeal spasm causing significant luminal narrowing but no holdup of barium. The remainder of the oesophagus was chronically dilated to the gastro-oesophageal junction and appeared atonic. The findings were atypical of achalasia, there were no obstructing lesions identified and chronic dysmotility was considered most likely, which was subsequently confirmed by a gastroenterology opinion.

Discussion

Megaoesophagus is rare, most frequently presents with dysphagia and regurgitation of food and is most commonly caused by achalasia. A literature search identified only one previous case of obstructing megaoesophagus secondary to idiopathic dysmotility disorder; however, this case revealed the stridor to be secondary to an impacted food bolus, whereas our case did not demonstrate any obstructing lesions.
518 Efficacy and Safety of Embolo-Sclerotherapy of Low-Flow Vascular Malformations Based on the Experience from a Single Specialist Centre
Authors: Pang C , Arasakumar D , Evans N , Papadopoulou A , Khalifa M , Hamilton G , Brookes J , Lim CS
Published: November 2022

Aim

To evaluate the efficacy and safety of embolo-sclerotherapy (EST) of low-flow vascular malformations (LFVM) in a specialist vascular anomalies centre.

Method

All patients with LFVM who underwent EST from 01 January 2015–31 December 2019 were retrospectively reviewed. All ESTs were performed with foam STS 3%, ethanol, coils and/or other substances e.g., triamcinolone. LFVMs were grouped according to Puig's classification. The outcome measures were treatment effects and complications. Continuous variables were compared using analysis of variance (ANOVA) F test. Other discrete variables were compared using Chi-squared tests. P<0.05 were considered significant.

Results

A total of 207 patients, with a mean age of 32 years (range 1–71 years) were included. The use of EST with foam STS was significantly lower for type I LFVM (61.8%) compared to others (p<0.001). However, significantly higher type I LFVM (26.5%) were treated with surgery than EST (p<0.001). Overall, outcome categories were significantly different across all types of LFVM (p<0.001), with more discharges for Type I (52.9%) LFVMs but more failure to follow-up in patients with Type II (24.5%) LFVM. EST complications was significantly higher with type I (14.7%) LFVMs (p=0.030). The doses of STS in the first procedure were significantly different across all types of LFVM (p<0.001) with most type I LFVM patients receiving ≤2ml.

Conclusions

EST particularly with foam sclerotherapy is clinically effective and safe for patients with LFVM especially in those with Puig's type I and II lesions. This classification may provide an important guide to volume of sclerosant required and the potential success rate.
522 Early Follow-Up Quality of Life and Mental Health of Patients with Congenital Vascular Malformations Cared for in a Multi-Disciplinary Specialist Center
Authors: Pang C , Nisbet R , Gibson M , Evans N , Khalifa M , Papadopoulou A , Tsui J , Hamilton G , Brookes J , Lim CS
Published: November 2022

Aim

To evaluate the early follow-up quality of life (QoL), pain and mental health of patients with congenital vascular malformation (CVM) receiving care by a single multi-disciplinary specialist center

Method

This was a prospective observational study. All patients with CVM who received care (supportive treatment only, open surgery, targeted pharmacological therapy, embolosclerotherapy), and had follow-up, between February 1st 2018 and January 31st 2020 were included. The health-related QoL, pain, and mental health were assessed with validated questionnaires: SF-36, VAS-P and HADS. The CVM were categorized into types – low-flow (LFVM) and high-flow (HFVM), and anatomical locations. Paired t-test was used for all analyses. P<0.05 were considered significant.

Results

110 patients (85 LFVM and 25 HFVM) with a mean age of 36.9 years were included. Significant improvement was found in the bodily pain domain of SF-36 and VAS-P (both P = 0.01) in all patients. However, only patients with HFVM reported significant improvement in the bodily pain domain of SF-36 (P=0.002) and VAS-P (P = 0.02). Patients who received supportive treatment only reported significant improvement in mental health (P=0.004) and social functioning (P=0.03) domains of SF-36. Meanwhile, patients treated with embolo-sclerotherapy reported significant improvement only in VAS-P (P=0.02). Patients who received targeted pharmacological therapy reported no significant early changes.

Conclusions

The effects of care on early follow-up QoL, pain and mental health of patients with CVM were heterogenous. Future research is required to understand the various factors that affect the QoL and mental health of these patients, as well as the holistic approaches to manage them.
793 Examining the True Incidence and Staging of Amelanotic Melanoma in an Irish Population
Authors: Mc Cormack D
Published: November 2022

Introduction

Many patients diagnosed with amelanotic melanoma (AM) have often gone undetected for a long time due to the difficulty in diagnosis of these skin lesion, likely causing underestimation of the prevalence of AM in Ireland. This study aims to determine associated risk factors, incidence, and prevalence of AM in an Irish population.

Aim

Determine the true incidence, staging and prevalence of amelanotic melanoma.

Method

This is a retrospective cohort study of AM patients with melanoma diagnoses made in 2019 in two large Irish hospitals. Data was extracted from hospital patient records and histopathology reports, based on confirmed melanomas. AM was clinically defined as melanomas devoid of pigment on visual inspection before biopsy.

Results

A total of 265 patients with a diagnosis of melanoma were included. The overall prevalence of AM was 17%. Comparison of age between AM and non-AM patients (pigmented melanoma) showed a significantly higher age for AM patients (73 +/- 14 versus 66 +/- 15 years). Breslow Thickness was higher in AM versus non-AM patients (3.4 +/-3.7 versus 1.6 +/-1.8), which is an indicator decreased survival 5-year survival. The estimated incidence of AM was 5.41 per 100,000 of our target population

Conclusions

The incidence of AM has been grossly underestimated in an Irish context and these non-pigmented lesions are far more prevalent than previously thought. It is known that amelanotic melanoma is associated with worse outcomes. These patients are not benefitting from rapid access to pigmented lesion clinics and therefore likely have a worse outcome due to going.
810 The Spiderman Sign - a Novel Method to Identify the Distal End of the Carpal Tunnel
Authors: Mc Cormack D , Sugrue R
Published: November 2022

Aim

Identify the distal end of the carpal tunnel safely and effectively, by passive flexion of their ring and middle finger.

Method

We assessed 20 patients, prior to carpal tunnel decompression surgery and recorded the findings. A number of measurements were taken. The line at which the flexed ring and middle finger lay on the palm was marked, then following surgical exploration measurements were made with the distal end of the carpal tunnel and assessed how accurately this lined up with our pre-operative markings.

Results

Of 20 patients assessed the distal end of the carpal tunnel aligned with the preoperative markings made using the patients’ flexed fingers. 100% of cases the preoperative markings aligned with the distal end of the carpal tunnel found on surgical exploration.

Conclusion

There are various methods described to identify the distal end of the carpal tunnel. We feel our technique is a simple and effective method using the patient's own anatomy to identify this important landmark, which we call the Spiderman sign.
183 Improving Documentation of Antibiotic Prophylaxis and Anticoagulation in Vascular Surgery Operation Notes at a Tertiary Centre: A Quality Improvement Project
Authors: Curlewis K , Weerakkody R , Harris M , Constantinou J
Published: November 2022

Aim

Operation notes have important medico-legal implications and should follow the Good Surgical Practice framework to enable continuity of care.

The aim of this quality improvement project was to determine adherence of vascular surgery operation notes to the Good Surgical Practice framework at a tertiary vascular centre, identify areas of improvement and introduce sustainable change to improve patient care.

Method

Two Plan-Do-Study-Act cycles were enacted. A prospective audit was conducted over September 2021 to identify areas of improvement in documentation. The first intervention that was introduced was electronic patient records (EPR). The second intervention introduced was departmental education via posters, regular educational sessions, and presentations.

Results

The prospective audit of 31 operations over September 2021 identified antibiotic prophylaxis was only recorded in 4/31 (13%) and post-operative anticoagulation in 21/31 (68%). A retrospective audit of 28 operations over October 2021 after the introduction of EPR demonstrated improved documentation of antibiotic prophylaxis (16/28, 57%) but no improvement in post-operative anticoagulation documentation (17/28, 61%). Departmental education improved the documentation of antibiotic prophylaxis (18/30, 60%) and post-operative anticoagulation (22/30, 73%).

Conclusions

We have demonstrated that EPR and departmental education can improve operation note documentation and patient care. Next steps include designing vascular surgery proformas to further improve documentation.
216 Improving Patient Education About Pre-Diabetes in the Community
Authors: Carey C , Natarajan S
Published: November 2022

Aim

Pre-diabetes is a common condition and although its development is linked to lifestyle factors, many patients are unaware of interventions that can improve their condition. One-to-one consultations between patients and GPs focused on reducing carbohydrate consumption are known to be effective at improving pre-diabetes. This QIP aimed to improve patients' understanding of pre-diabetes and reduce carbohydrate intake.

Method

Patients were included if they had 2 HbA1c measurements between 42 – 48mmol/mol and the ability to make dietary changes independently. A questionnaire based on the UK Diabetes and Diet Questionnaire was constructed and used to ask patients about their concern about pre-diabetes, knowledge of foods that contribute to the condition and the frequency at which they consumed various carbohydrates. Advice about reducing carbohydrate intake was given verbally and patients were provided with a diet sheet produced by Unwin et al. Patients were called again after 7 – 14 days to assess dietary changes and the impact of the advice.

Results and Conclusions

31 patients responded to the initial telephone call of which 58.1% were concerned about pre-diabetes and 38.7% mentioned foods high in carbohydrate as a cause of pre-diabetes. 90.3% of patients consumed food high in carbohydrate on 4 or more days per week. 22 patients responded to the follow up telephone call of which 63.6% reported a reduction in carbohydrate intake, 95.5% knew more about pre-diabetes and 90.9% found the dietary advice helpful. These results suggest that pre-diabetic patients should be given verbal and written information about lowering carbohydrate intake at GP consultations.
283 Delayed Discharge-a Pitfall for NHS; Can We Improve?
Authors: Nessa A , Pawloy K , Purewal R , Ganeshamoorthy K , Tayo O , Ghazanfar M
Published: November 2022

Aim

Identify reasons for discharge delays in a tertiary care hospital and find areas of improvement.

Method

Data were collected for seven days, and all inpatients (Elective and Emergency) admissions were included. Patient's demographic data, length of hospital stay, and discharge data were entered on Microsoft Excel and analysed using SPSS.

Results

Out of 102 total patients, 48 (47.1%) were male and 54 (52.9%) females. Mean age was 60.5 years (min 20 max 91). Clinical frailty score (CFS) was not calculated in more than half of the patients (n=55, 57.4%). 47(46.5%) patients had polypharmacy. 61(59.80%) patients did not have a documented Expected date of Discharge (EDD). Median hospital stay was 10 days (1–161 days).

27(26.47%) patients had delayed discharge (mean 4.93 days, median 1 day). Reasons for delay included unavailability of rehab bed (n=5, 4.9%), stoma nurse review (n=6, 5.88%), and awaiting bloods, diabetic control or discharge hub planning (n=3, 2.94%). Delayed discharges do not seem to be affected by polypharmacy (p=0.067), DNACPR (p=0.926), frailty score (p=0.761) or gender (p=0.518). However, Patients aged 65 or above were more likely to have delayed discharge (p=0.037).

Conclusions

Delayed discharge is more likely in over 65years. We recommend early identification of at-risk patients. Possible interventions to avoid discharge delays are EDD, pre-emptive preparation of discharge letters, early morning bloods and training of ward nurses for stoma care.
393 Communication in Catheter Care: A Closed Loop Audit of Catheter Documentation in Emergency Presentations to a Tertiary Urology Centre
Authors: James J , Warwick A
Published: November 2022

Aim

Estimates suggest that 20% of patients admitted to hospital undergo catheterisation, some of whom will end up discharged with catheters. Clear documentation assists in communication between hospital and community teams. The EAUN has identified key areas for documentation including use of care plans. We audited compliance with documentation pre- and post-intervention in a tertiary urology department

Method

Emergency patients presenting to urology were identified over a 3-week period pre-intervention and 3-weeks post-intervention. Clinical notes were audited for documentation of catheterisation. Domains assessed included indication, type/size of catheter, catheter balloon volume, residual volume, urinalysis, and plan. Use of care plans was also audited. Intervention involved development and deployment of a poster as well as discussion with staff.

Results

In total 274 patients were identified. 47 catheters were inserted pre-intervention, with variable compliance in documentation throughout the domains with similar pattern of compliance noted in the post-intervention group (n=42). Compliance was highest in size of catheter and indication for insertion, with urinalysis the most frequently missed domain (14.9% pre-intervention, 9.5% post-intervention). The only area with significant improvement was documentation of balloon volume (p=0.0019). Use of the care plan showed some minor improvement but was generally poor.

Conclusion

Use of visual cues did not result in approvement in documentation. Discussion with the teams suggested awareness of the domains and care plan however, they didn't necessarily think of them at time of documentation. As such a text prompt for the electronic notes is now in development and further audit to assess impact pending.
498 Junior Doctor Checklist for the Management of Neck of Femur Fracture: A Quality Improvement Project
Authors: Leow TW , Chalkley M , Karmarkar A , Pawar R , Sharma V
Published: November 2022

Aim

Patients admitted with Neck of Femur (NOF) fracture are often complex and frail. Junior doctors in our institution are first on call and have minimal orthopaedic experience. Anecdotal experience has shown that patients are often inadequately optimised. For example, fluids not prescribed, and anticoagulants not reversed which could lead to further complications and delay to surgery, affecting patient outcomes. Therefore, we developed a junior doctor checklist to improve the quality of care for patients with NOF fracture.

Method

A plan-do-study-act (PDSA) methodology was utilized in designing this project. Data was collected prospectively from 50 patients presented with NOF fracture pre and post intervention. Clerking proforma, drug chart and electronic systems were reviewed. Outcome measures were prescription of analgesia, fluids, anti-emetics and laxatives, completion of venous thromboembolism (VTE) prophylaxis, abbreviated mental test (AMT), group and save and reversal of anticoagulation, if available. Intervention included production of a checklist outlining the management plan which was distributed to junior doctors.

Results

Areas for improvement identified from pre intervention cycle were prescription of fluids, anti-emetics, laxatives, and anticoagulant reversal, with a compliance of 56%, 44%, 42% and 50%. Other parameters had a compliance of >90% pre and post intervention. Post intervention compliance was 90% for fluids, 66% for anti-emetics, 74% for laxatives and 80% for anticoagulant reversal.

Conclusion

Introduction of a checklist is effective in improving the quality of care for patients with neck of femur fracture. More interventions incorporating the PDSA methodology will be carried out to strive for further quality improvement.
558 An Evaluation of Surgical Input and Management of Head Injury in a New Acute Hospital in South Wales: Does It Need to Be a Headache?
Authors: Owen A , David E , Edwards P
Published: November 2022

Aim

The Grange University Hospital is a new major acute hospital in South Wales. Similarly, to other hospitals without neurosurgery, patients presenting to A&E with head injury (HI) that do not require transfer to a neurosurgery centre are admitted under general surgery. This audit aimed to:

Method

Patients admitted via A&E with the diagnosis code “Head Injury” (N=119) identified between November 28th-April 28th, 2021 (6 months). Paediatric (Aged 0–18) patients (N=25) were excluded as identified admitting team as per protocol is paediatrics. Relevant data extracted using Clinical Workstation.

Results

N =94 patients. Of these, 12 were discussed with neurosurgery and 1 patient transferred to a tertiary centre. 44% were referred to a surgical speciality other than general surgery for assessment. Despite this, of those 41, 61% (25) were admitted under general surgery (Average length of stay 2.5 days). Only 8 admitted patients necessitated plans beyond neuro observations. 28% of patients admitted under general surgery required medical assessment (4 falls assessments, 3 COTE referrals and subsequent takeovers). 0 patients had any general surgical pathology.

Conclusions
629 Improving Gentamicin Prescribing for Intra-Abdominal Sepsis on a General Surgical Firm
Authors: Fardanesh A , Koo HF , Van den Berghe C , Gathercole G , Dilke S , Sengupta N
Published: November 2022

Aim

Gentamicin is recommended by local guidelines for the empirical treatment of intra-abdominal sepsis. However, severe side effects that can occur through prolonged raised through levels requires its use through a specific dosing protocol. Challenges of this means it often “falls off” the drug chart, leading to suboptimal drug-levels. The aim of this quality improvement project was to improve the process of gentamicin prescription.

Method

A two-week retrospective analysis of all patients admitted was performed to obtain baseline data. Information was collected on gentamicin use, if levels were taken at 6–14 hours post-dose, and if subsequently correctly re-prescribed. PDSA 1 involved placing posters in the surgical office, reminding the clerking doctor of the gentamicin protocol. PDSA 2 involved a departmental teaching session to reiterate the above intervention.

Results

At baseline, only 7% (1/15) of patients prescribed gentamicin had a correct post-dose level taken and subsequently received a correct second dose. After PDSA 1, this rose to 67% (2/3). After PDSA 2, this level was similar at 60% (3/5). Furthermore, at baseline 47% (15/32) of patients deemed to have intra-abdominal sepsis received gentamicin. After PDSA 1, this proportion fell to 11% (3/28) and after PDSA 2 this was 38% (5/13).

Conclusions

Education sessions and posters were effective at increasing the proportion of patients that received a safely prescribed second dose of gentamicin, as a result of correctly taken trough levels. However, a reduction in the percentage of patients receiving gentamicin for intra-abdominal sepsis possibly suggests further education on the role of gentamicin is required.
656 Making an Effective Ward Round Model in the Department of Trauma and Orthopaedic Surgery for University Hospitals of Birmingham Trust
Authors: Khaleeq T , Lo N , King J , Turner A , Howland E , Graham T
Published: November 2022

Background

Ward rounds in hospitals are crucial for decision-making in the context of patient treatment processes.

Objectives

Improve the standard of ward rounds with a review of care and planning.

Method

6 key elements were established using the Modern ward rounds report by the Royal College of Physicians and Nursing. This includes daily ward rounds which will be multidisciplinary, documented clearly and handed over to relevant staff; consisting of a board, bedside ward round and debrief; using Prompts in the form of REMIND mnemonic : R = Respect form, E = Electronic Prescribing, M = Mental Capacity, mobility status, I = Investigations, N = Nutrition and Hydration, NBM status, D=DVT assessment and Thromboprophylaxis; with practices being audited.

Results

After running a successful pilot in Respiratory in August 2021 the quality improvement project (QIP) was introduced in Trauma and Orthopaedic surgery.

88 patients were included in the initial audit prior to implementation and 91 in the re-audit. There was a 85% improvement seen in completion of respect and dementia forms with a 90% improvement in electronic prescribing. There was an 75% improvement in documentation of mobility status, investigations performed and NBM status. Fluid prescription, DVT assessment and LMWH prescription also improved by 85%.

Conclusions

A successful Pilot in Respiratory and Trauma and Orthopaedic Surgery shows the feasibility of the QIP in other departments. However, Education should also include Consultant and nurses. We are overcoming this but establishing a virtual module that can be made mandatory for induction of junior doctors, consultants, and nurses.
745 Does a Smartphone Application Improve Medical Students and New ENT Junior Doctors Confidence When Dealing with ENT Clinical Scenarios?
Authors: Akbar S
Published: November 2022

Introduction

Through the use of online applications, doctors can efficiently access an abundance of medical information to ease transition into subspecialities. This is valuable for otolaryngology in which junior doctors may possess little prior experience. The development of a electronic application within otolaryngology may improve doctors’ ability to carry out the junior doctor role.

Method

A cohort of 10 junior doctors and 10 medical students based at Blackpool Victoria Hospital with no prior clinical otolaryngology experience were asked to rate their confidence in approaching 5 common otolaryngology scenarios before and after being granted access to a clinical e-application. The otolaryngology application was locally constructed and included important otolaryngology information and resources for the junior doctor role.

Results

During the course of the project, every single participant showed an increase in their confidence score when dealing with each scenario following access to the application. This was true for both medical students and junior doctors. Junior doctor confidence scores increased for every scenario following access to the otolaryngology application with an overall average increase of 148%. Medical student confidence scores also increased for every scenario following access to the application with an overall average increase in confidence of of 124%.

Discussion

ENT smartphone applications have been shown to be successful in providing relevant information to medical students and junior doctors to develop their confidence in approaching common clinical scenarios. The provision of such a resource for surgical subspecialties promotes a further step towards a paperless NHS as well as a standardised way of approaching patient care.
969 A Quality Improvement Project Centred Around the Introduction of an Exception Reporting Pathway
Authors: Khudr J , Bonsi T
Published: November 2022

Aim

Exception Reporting (ER) is applicable to surgical training so can therefore be used for a variety of reasons. This Quality Improvement Project aims to positively change the attitudes and ease the process of ER.

Method

We conducted a qualitative survey distributed amongst medical and surgical trainees and supervisors from the Royal Liverpool and Aintree Hospitals which focused on assessing their attitudes towards ER. The second measure was a retrospective review in which we compared the number of ER from September-December in 2019 and 2020.

We created a poster showing a clear pathway to ER and the repeated the cycle above including both measures.

Results

We received over a hundred responses to our original survey, with half being trainees and the other being supervisors. It was clear that, huge deficits were discernible in trainee and supervisor understanding of the process and its outcomes.

After introducing the ER pathway, a significant improvement in understanding towards ER was noted with 98.4% (from 84.5%) of trainees and supervisors understanding what ER is and 52.8% (from 42.7%) better understanding outcomes. Despite this, there seems to be a shift in attitude toward ER with a 10.7% increase in exception reporting within a 10-month period.

Conclusions

Our project highlights the importance of exception reporting, and its perception between clinical staff. With the presence of COVID rotas, the introduction of new trainees to the trust, and the higher emphasis on doctor burnout and patient safety in the news, ER measures remain our closest tool to observing such dynamic attitudes and acting on them.
862 Process Mapping of 3D Printing for Complex Limb Problems
Authors: Quang J , Ferguson D
Published: November 2022

Introduction

Difficult limb problems such as complex trauma or re-presentation following orthopaedic revision surgeries can present substantial planning and technical challenges. 3D-printed models built from patient-specific CT scans facilitate creative thinking, problem solving and decision making to find better operative solutions. This quality improvement project aims to map the process of using 3D printers to solve orthopaedic problems.

Method

Stakeholders, including a Consultant Trauma & Orthopaedic surgeon and the Medical Physics team were interviewed to formalise the full structure of their role from start to end, with the support of the Trust's Improvement Team and Innovation Team. A visual representation of the process map was produced using SmartDraw software. Feedback was received from stakeholders and a second cycle of process mapping was completed.

Results

The process map included the chronological steps of the project, the interaction between different roles and the stages of 3D printing. A database template was produced as a shared OneNote, allowing the tracking of each model production. Stakeholders found the map useful for anticipating problems and considering the future process and providing a framework of implementing innovation within the NHS.

Discussion

Unique implants cost the NHS significantly more money than batch-made products. Introduction of 3D models into pre-operative planning allow surgeons to utilise readily available solutions instead of custom, single-use implants, which can be cost saving and prevents unnecessary wastage. The project trialled operations on models, facilitated patient explanations and provided an educational tool. Future aims include roll-out to other specialties and Trusts, encouraging collaboration towards a sustainable internal economy.
626 What Is the Influence of Negative Pressure Wound Therapy (NPWT) on High-Risk Wounds in Pelvic Oncology?
Authors: Al-Aqeel M , Adlan A , Stevenson J
Published: November 2022

Aim

Hindquarter amputation (HQA) has a high incidence of postoperative wound complications. We aim to use the HQA procedure as a model to investigate the potential advantages of negative pressure wound therapy (NPWT) on wound healing complications in high-risk pelvic oncology wounds.

Method

We conducted a retrospective analysis of all patients undergoing hindquarter amputation at a single tertiary centre between January 2009 and November 2020. Patients were divided into groups who had and hadn't undergone neoadjuvant radiotherapy (RT) to the pelvic tumour.

Results

One hundred six patients were included in the study. 43.4% had NPWT. There was no difference in the incidence of reoperation in the patient group without neo-adjuvant RT between NPWT and conventional dressings (odds ratio [OR], 1.01; p=0.983, 95% confidence interval [CI], 0.365–2.8). However, the use of NPWT decreased the incidence of reoperation among the patients who had NPWT who had received radiotherapy [OR], 0.087; p=0.033, 95% CI, 0.009–0.818). The incidence of wound complications has declined with the increasing use of NPWT between 2009–2020.

Conclusions

The application of NPWT reduces the incidence of wound complications in high-risk pelvic oncology wounds. We demonstrated a reduction in the incidence of reoperation due to wound complications in patients who received NPWT following HQA.
636 Impact of the COVID-19 Pandemic on Emergency Admissions with Colorectal Cancer
Authors: Verma A , Payne C
Published: November 2022

Aim

During the first wave of the Coronavirus (COVID-19) pandemic, there was considerable concern that patients with non-COVID pathologies would not seek medical attention, or the healthcare resources to treat these patients would not be available. This may affect the number of patients presenting as an emergency or with more advanced disease. The aim of this study is to establish if admission and outcome patterns changed pre-COVID vs post-COVID.

Method

All patients presenting as an emergency admission with colorectal cancer to our institution were identified from a prospectively collected database. We compared 1 year prior to the national lockdown (April 2019-March 2020) with the subsequent year (April 2020-March 2021). Treatment plans and follow-up were recorded using electronic patient records.

Results

There was no difference between the number of patients attending as an emergency pre-COVID compared with post-COVID (60 vs 67, p=0.474). The proportion of patients undergoing surgery on the index admission fell but did not reach significance (52.5% pre-COVID vs 38.8% post-COVID, p=0.122). No difference observed in the proportion of patients presenting at each cancer stage; I-IV (p=0.881), nor patients proceeding with curative intent (39.0% pre-COVID vs 37.3% post-COVID, p=0.906). The median length of hospital stay was not significantly different (10.0 days pre-COVID vs 9.0 days post-COVID, p=0.128). Finally, no difference in 30-day mortality was observed (25.0% vs 29.9%, p=0.541).

Conclusions

This study appears to show that there was no difference in the number of patients accessing emergency services with acute presentations of colorectal cancer, and that the outcomes have not changed despite COVID.
1060 Surgical Currency - the Link Between Skill Fade and Safe Practice
Authors: St John L , Sandhu A , Baden J
Published: November 2022

Aim

Surgical currency refers to the operating time required per year before a surgeon's skill fade could negatively affect patient outcomes. Increased surgical experience and volume of operating hours directly improves patient outcomes. There is no clear guidance from the NHS or Defence Medical Services on amount of experience needed to maintain current. This paper highlights the importance of surgical currency, investigates if skill fade occurs faster than knowledge, and looks to ensure surgeons are not deployed beyond the point of currency. It explores methods to prevent skill fade and reintegrate surgeons following absence.

Method

A thorough literature search was performed. Currency protocols across Royal Colleges, healthcare systems and other industries were studied, including systems installed to mitigate skill fade during COVID-19.

Results

An average deployment for a military surgeon will be three months, but pre-deployment training can make this six. The AMRC states an absence over three months affects medical knowledge. Skill fade occurs more rapidly than knowledge, but research remains limited for how long a well-practiced skill is retained. The aviation industry clearly stipulates a pilot's currency, and simulator training is provided following absence. US surgical simulator training proved effective in maintaining skills during the pandemic. Health Education England and Royal College of Surgeons Edinburgh provides return programs for trainees but not consultants.

Conclusions

Careful consideration should be given before extending surgical deployments. Surgical simulation could be used while deployed to maintain currency. Return-to-work programs should be available to consultants. Further research should be done on currency and prevention of skill fade.
495 Virtual Reality Simulation Training in Hip Surgery Versus Traditional Surgical Education Method: A Systematic Review of Randomised Controlled Trials
Authors: Tsinaslanidis P , Choudhury A , Smith T , Hing C
Published: November 2022

Aim

The purpose of this study was to perform a systematic review of the effects of orthopaedic virtual reality simulators on surgical skills across randomised controlled trials.

Method

The authors searched PubMed, CINAHL, MEDLINE, AMED, Eric, Embase, Cochrane Central Register of Controlled Trials, TRIP database and grey literature from 1946 to November 2020. Inclusion criteria were all level one studies, specifically randomised controlled trials with orthopaedic training simulators in hip surgery and clear evaluation of skills attained after virtual reality simulation (VR) training. The primary outcome was the reported quantitative assessment of operative skills acquisition. The Jadad scale was used as a tool in order to appraise the methodological quality of the included trials. The data collected were not amenable for meta-analysis as they were too heterogenous and were analysed and presented using a narrative analysis and the Synthesis Without Meta-analysis (SWiM) reporting guideline.

Results

A total of 1095 articles were identified. Four level I studies, all randomised controlled trials, including 86 participants were eligible for the final analysis. There were significant differences in the types of simulators, training structure, validity types, performance scores and outcome measures described in each study. In three out of four studies (75%) the use of VR training simulators led to improved surgical skills acquisition compared to other traditional teaching methods.

Conclusions

Overall, this review showed that the use of VR simulation training is a potential tool that can enhance surgical skills acquisition in hip surgery procedures compared to traditional education methods.
927 An Analysis of the United Kingdom Education Courses for Aesthetic Practice
Authors: Zargaran D , Zargaran A , Caine P , Weyrich T , Mosahebi A
Published: November 2022

Aim

The training of cosmetic and aesthetic practitioners has received national attention since the 2013 Keogh review of the regulations of cosmetic interventions. The 2015 HEE cosmetic guidelines recommended level 7 accreditation in Injectables for Aesthetic Medicine. The Royal College of Surgeons has now established the Cosmetic Surgery Certification Scheme and this analysis looks to identify the cost and availability of courses in the UK.

Method

A review of Google search results using the keywords “Botox”, “Filler”, “Course”, “Certification”, “Level 7”, “Training” and “Foundation” using Boolean operators. The costs of the courses, duration, accreditation, and availability of level 7 certification were extracted from the websites.

Results

A total of 36 courses were identified where a Foundation Course in both Botulinum Toxin and Dermal Fillers were provided. The lowest available cost was £780, a maximum cost of £4,500 and mean cost of £1,557. Mode course duration was 1 day, with a maximum duration of 4 days and mean of 1.4 days. 9 of the 36 providers offered level 7 accreditation.

Conclusions

The provision of education and training has significant implications for patient safety. The completion of foundation courses is often a requirement for insurance companies to provide coverage to practitioners, however, a wide variety of educational quality may account for complications which are experienced by patients. The lack of accreditation beyond CPD points was noted. These findings call for a unified educational approach to ensure, safe training of practitioners
971 Gamification of Education; Can Playable Education Result in Better Learning Outcomes?
Authors: Badenoch T , Benton K , Jacobs E , Curtis A , Law S , Everett S , Ahmed M , Hunter I , Bamford R
Published: November 2022

Aim

Combining traditional simulation (TS) and the emerging field of gamification, to create medical Escape Rooms (ERS) has been used in Nursing to good results but is yet to be widely adopted in medical education. We conducted a pilot study to create ERS for undergraduates to assess their educational value.

Method

Existing Simulation themes of sepsis, post-operative bleeding, trauma, burns and communication in the theatre environment were developed into Escape Rooms by a multidisciplinary team. A cross over study for 4th year students was carried out. Questionnaires were used to evaluate the experience, learning assessed by pre and post quiz and observational tools for teamwork, communication and leadership were utilised.

Results

Qualitative data demonstrated overall good feedback on enjoyment an engagement. Quantitative data collected as pre- and post-exposure learning demonstrated equivocal benefit. Self-assessed teamwork showed equal in all domains and improved in contribution of knowledge and maintaining team focus on the ER group.

Conclusions

Participants find ER enjoyable have similar educational benefits of traditional simulation with the benefits on enhancing non-technical skills amongst a novice group. Escape rooms may be useful as an adjunct to TS particularly at developing non-technical skills.
155 Tibial Malrotation Following Intramedullary Nailing: A Literature Review
Authors: Fernandes A , Sagoo K , Oluku J , Cheema K
Published: November 2022

Aim

The use of intramedullary nail fixation remains the operation of choice for managing unstable and displaced tibia diaphyseal fractures. The literature shows that although commonly performed, there is not a standard approach when performing intramedullary nailing of the tibia; it could be hypothesised that this lack of standardisation may be contributing to the noted complications. This systematic review will look into intramedullary nailing of the tibia in all its parts, from identification of patients through to the surgical procedure techniques and finally the intra- and post-operative complications.

Method

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Search terms included “tibial intramedullary nail” OR “tibial intramedullary rod” OR “tibial IM nail” OR “tibial interlock” AND “malrotation”, and “tibial intramedullary nailing” OR “tibial im nail” OR “tibial interlock” OR “tibial rod” AND “malrotation”.

Results

Eleven studies were considered in the final analysis, with a total number of 425 fractures (n=429, mean ± 95% CI=39 (21.2–56.8)). All included patients were treated with tibial intramedullary nail devices, and 110 showed some degree of malrotation postoperatively (n=110, mean ± 95% CI=10.1 (4.26–15.9)). Expressed as a percentage, a mean of 34.1% of patients had malrotation (mean ± 95% CI: 34.1 (15.8–52)).

Conclusions

This systematic review revealed there are gaps in the literature and in the management process of these patients and suggested that a systematic approach using ‘Get It Right First Time’ (GIRFT), intraoperative assessment, validated assessment tools, and imaging postoperatively should be used to improve outcomes.
268 The Efficacy and Safety of Bariatric Surgery in Patients with End-Stage Renal Disease and Kidney Transplantation: A Systematic Review and Meta-Analysis
Authors: Fernando S , Varma J , Dengu F , Menon V , Malik S , O'Callaghan J
Published: November 2022

Aim

Obesity is associated with adverse outcomes in end-stage renal disease (ESRD) and kidney transplant (KT) recipients. Bariatric surgery (BS) is an effective solution to obesity. The authors aim to summarise the evidence for the efficacy and safety of BS in ESRD or KT.

Method

A literature search was conducted using MEDLINE, EMBASE and Web of Science from inception to date (April 2021). Articles were categorised into patients awaiting waiting list acceptance, awaiting transplantation, undergoing simultaneous BS and kidney transplantation, and undergoing BS following transplantation in the past. Primary outcome was change in BMI with secondary outcomes as adverse events, graft outcomes and KT.

Results

Twenty-eight articles were selected: fourteen on patients awaiting listing (n = 1984), nine on patients listed for KT (n = 196), one on simultaneous BS and KT and ten on patients undergoing BS following KT (n = 198). Mean change in BMI for patients awaiting listing was -10.5 (-4.1 to -17.0, p = 0.001), change in BMI for patients listed for KT was -11.2 (-9.5 to -12.9, p<0.001) and change for patients with prior KT was -11.0 (-7.09 to -14.9, p<0.001). 60.4% of patients undergoing BS were successfully listed for KT. 74.1% of patients listed for KT undergoing BS underwent KT within 17 months (SD = 78.5). Time from KT to BS was 59.2 months (SD = 43.0).

Conclusion

BS is both safe and efficacious on patients with ESRD, those awaiting KT, and those with prior KT and should be considered when obesity is a hurdle to favourable outcomes.
550 A Systematic Review of Aesthetic Outcome Using Dermal Regeneration Templates in Nasal Reconstruction
Authors: Bhatti N , Jamshidi S , Williams G , Wormald J , Wood S , Dunne J
Published: November 2022

Aim

Nasal reconstruction using Dermal Regeneration Templates (DRT) has been proposed due to their ability to reduce contour defects, avoid donor site morbidity, and facilitate reconstruction. This review aims to determine the aesthetic outcomes of DRT's in nasal reconstruction.

Method

A full systematic literature review of DRT use in nasal reconstruction was performed by two authors in December 2021. Cochrane Central Register of Controlled Trials, Ovid EMBASE and Ovid MEDLINE were searched and included papers reporting objective measures of aesthetic outcome. Of the 385 papers identified, 5 were included.

Results

75 patients were included. Defects resulted from excision of skin tumors (74) and vascular malformation (1). 1 study used Hyalomatrix, 1 used Integra or Matriderm and 3 used Integra only. 2 papers using Integra left the defect to heal secondarily without a skin graft and healing time was 6 weeks or less, while 3 studies performed a second stage with a full thickness skin graft at 2 weeks or later. Mean defect size was poorly reported, and several subunits were reconstructed. Using the Vancouver Scar Scale and Visual Analogue Cosmetic Scale, significant improvements compared to pre-operative assessment were observed and good to high patient satisfaction. Complications were infrequent. Subsequent flap reconstruction was performed in 12 patients.

Conclusions

Nasal reconstruction using DRT is reliable however data on aesthetic outcomes are limited. The re-operation rate is reasonably high and data comparing aesthetic outcomes to flaps and skin grafts are lacking. More research reporting objective outcomes is warranted to further evaluate the utility of DRT's.
850 Surgical Versus Non-Surgical Treatment of Unstable Lateral Compression Injuries of the Pelvis with Complete Sacral Fractures (LC1) in Non-Fragility Fracture Patients: A Systematic Review
Authors: Varma J , Foxall-Smith M , Donovan R , Whitehouse M , Rogers C , Acharya M
Published: November 2022

Background

Lateral compression type 1 (LC1) injuries comprise two-thirds of pelvic fractures. Approximately one third of LC1 fractures are unstable and may benefit from surgical fixation to improve stability but it is not clear if this leads to better clinical or cost-effectiveness outcomes.

Method

We performed a systematic review to determine whether surgical or non-surgical treatment yielded better clinical and cost-effectiveness for the treatment of unstable LC1 pelvic injuries with complete sacral fracture, excluding fragility fractures. We searched Medline, Embase and Cochrane databases from inception to June 2021, as well as clinical trials registries.

Results

Five observational studies met the inclusion criteria. 183 patients were treated surgically, and 314 patients treated non-surgically. Patients treated surgically had lower pain levels (Visual Analogue Scale) and fewer days to mobilisation. Quality of life (EQ-5D and SF-36 questionnaires) was better in the surgical group, but not statistically significant. No statistical differences in length of hospital stay or complication rates were found. Formal meta-analysis was not possible due to available study designs and heterogeneity.

Conclusions

This review highlights the low quantity and quality of existing data on patients with unstable LC1 pelvic fractures and the need for a definitive randomised controlled trial to determine whether surgical or non-surgical care should be the preferred treatment in terms of clinical and cost-effective care.