bluuebunny/crossref_metadata_2025 huggingface dataset:
170 Are Templates the Future? a Comparison of Compliance with GIRFT Guidelines on Post-Operative Documentation for Hip Arthroplasty
Authors: Hunt A. , Kapoor S. , Adegeye S. , Patel P.
Published: February 2022

Aim

Departmental audit cycle on post-operative documentation following hip arthroplasty in comparison with national ‘Get It Right First Time’ recommendations 2019. This project set out to review compliance with the new national GIRFT medical records standards and promote patient safety through improved documentation following the introduction of a post-operative template.

Method

50 hip arthroplasty post-operative notes from 2019 performed at ESHT were evaluated against all of the 24 criteria from Get It Right First-Time guidelines 2019. A post-operative template was introduced and a further 50 post-operative notes from 2020 were evaluated.

Results

Following the introduction of the template, compliance against the 24 criteria improved by an average of 38%. The greatest improvement observed related to commenting on bone quality with a 71% increase in compliance following the introduction of the template. Certain criteria such as the named surgeon, implant stickers, wound closure, haemoglobin check, and weight-bearing status remained at 100% across both groups. Only one criterion, assistant grade, saw a decrease across the two groups with an 18% reduction in compliance.

Conclusions

When utilised, the introduction of a post-operative template significantly increased compliance with respect to the GIRFT guidelines 2019. This is important given the ever-increasing litigation the NHS is subjected to and indeed is mentioned in the original GIRFT report. A significant limitation of this audit cycle was when surgeons opted to write the post-operative note free hand. A further period of education is suggested in order to increase the uptake of this and other post-operative templates.
174 An Audit on First Time Shoulder Dislocations: Are We Following BESS Guidelines?
Authors: Tariq F. , Remtulla M.A. , Jordan R.
Published: February 2022

Aim

Traumatic shoulder dislocations are the most common joint dislocation in the UK. They are often associated with concurrent injury to the joint and its stabilisers which can occasionally get missed. This can severely affect functional recovery and lead to chronic instability. Our aim was to assess adherence to the BESS guidelines for first time shoulder dislocations in a large acute general hospital.

Method

We conducted a retrospective review of all patients who attended the emergency department at Birmingham Heartlands Hospital between January and December 2019. A total of 20 patients were selected after verifying data received from the health informatics team. Patient notes, investigations and clinic letters were reviewed.

Results

The average age of our cohort was 50 with a male to female ratio of 13:7. The cohort was divided into three groups depending on their age i.e.,16–25, 25–40 and >40. Although 85% were seen in a fracture clinic only 25% were seen by a consultant. It was noted that among all three groups only 40% of appropriate imaging was requested. In addition, only 50% were correctly referred to a shoulder surgeon or shoulder clinic to assess shoulder function, however most patients were seen by a physiotherapist.

Conclusions

We found a large number of concomitant injuries in those investigated for a first-time dislocation. We have therefore designed a pathway to ensure that all patients with a first-time shoulder dislocation are followed up in fracture clinic and appropriate investigations ordered in a timely manner.
175 Comparative Evaluation of Efficacy of Ultrasound-Guided Erector Spinae Plane Block Versus Oblique Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia of Adult Patients Undergoing Laparoscopic Cholecystectomy: A Retrospective Study
Authors: Harvitkar R.U. , Harishkumar P. , Gattupalli G.B.
Published: February 2022

Background

Laparoscopic cholecystectomy (LC) is a frequently applied minimally invasive surgery. Intraoperative access is provided with small keyhole entries on the abdominal wall. However, LC causes moderate to severe postoperative pain. To counteract this LC surgeries are always accompanied using nerve blocks.

Method

A retrospective study evaluating the outcome of two different post-operative analgesia techniques in patients undergoing LC surgeries. Eighty-two patients with the American Society of anaesthesiology grade I-II (ASA) who underwent LC records were analysed. Erector spinae plane block was performed in the erector spinae plane block (ESPB) group and oblique subcostal transversus abdominis block was performed in the oblique subcostal transversus abdominis plane block (OS-TAPB) group. Postoperative static and dynamic pain score as per the visual analogue scale (VAS), the intraoperative requirement of fentanyl, postoperative use of diclofenac, time to ambulation after surgery, and presence of any pain after surgery were noted. Separate t-test and Mann–Whitney U-test were used for quantitative data, while Chi-square test was used for comparing qualitative data.

Results

Static and dynamic VAS scores were significantly lower in the ESPBgroup (P< 0.05). Intraoperative fentanyl requirement (165 ±30.72–ESPB,180.95±29.12–TAPB,P = 0.020) and number of patients requiring diclofenac(28/42–ESPB,37/42–TAPB,P = 0.019)were lower, while number of patients ambulating by 4 hours(20/42–ESPB,9/42–TAPB,P = 0.012)were higher in ESPB group. Patients suffering from pain at 1 week (22/42– ESPB and 34/42–TAPB, P = 0.005) and 1 month (9/42–ESPB and 13/42–TAPB,P = 0.207) were lower in the ESPBgroup.

Conclusions

Ultrasound-guided ESP block reduced postoperative pain score, analgesics consumption more effectively than OS-TAPB after laparoscopic cholecystectomy surgery.
179 Using QIP to Create a Structured Teaching Programme to Improve Confidence in Basic Surgical Topics in Foundation Year 1 Doctors
Authors: Harris M. , Alfred J. , Tempany J.
Published: February 2022

Aim

We aim to create a new, structured teaching programme to help fill in knowledge gaps in newly qualified doctors, who have rotated into General Surgery.

Method

We ran the programme over three four-month periods.

Prior to each rotation, we used a survey to assess multiple aspects: prior experience of surgical teaching, overall feeling of preparedness and confidence. We also asked for a self-evaluation on the doctor's confidence for specific basic surgical topics, on a 5-point scale. We asked for suggestion topics that doctors found difficult or lacked confidence in. We used this information to create a curriculum for the programme.

We then reassessed these variables at the end of the cycle, using the information to plan and implement the next cycle.

Results

During the first cycle, we made no significant difference in any area. Experiencing significant barriers to attendance, organisation, and interaction with the survey. We used this first cycle to identify these barriers and address them for the second cycle.

These changes led to a significant improvement in attendance, feedback from sessions and interaction with the questionnaires. We saw a 3-fold increase in attendance to sessions on average.

After the second cycle, there was an overall improvement of confidence in all basic surgical topics. There was an increase in the number of doctors considering a career in surgery.

Conclusions

This teaching programme has led to an improvement in junior doctors’ confidence in basic surgical topics. Repeated PDSA cycles are allowing continuous improvement and change to maximise exposure to surgical teaching and training.
194 The Effect of the Disruption Caused by the COVID-19 Pandemic on the Rates of Post-Tonsillectomy Complications After the Recovery of Services
Authors: Amin M. , Abdeen B. , Hassaan A.
Published: February 2022

Aim

In June 2020, and after the first wave of the COVID outbreak has settled, we resumed operating in our trust for elective surgery in three different hospitals. However, it was thought that the number of post-tonsillectomy complications had increased. We performed an audit to evaluate the rate of post-tonsillectomy complications in our trust and investigate possible causes.

Method

We measured the rates of patients who developed complications post-operatively during the period from June to November 2020 and compared it to the rates in the pre-COVID year and the national rate. Moreover, we scrutinized retrospectively the operative notes of each patient presenting with a post-tonsillectomy complication and identified risk factors.

Results

In the study period, we performed 129 tonsillectomies. Of these patients, 14 presented with complications; 11of which had bleeding, while 3 had post-operative pain. Two patients needed to return to the theatre to control the bleeding. During the same period in 2019, 28 patients had complications out of a total of 199 patients. The rate of complications in 2020 was 10% which compared favourably with the previous year (14%). The highest number of patients (9/14) was in a hospital which posed a new environment to our surgeons. Dissection by Bipolar diathermy was the most contribute factor for bleeding in most patients (11/14).

Conclusions

The disruption caused by the pandemic situation did not influence overall rates of complications. However, the hospital which presented a new operating environment had the highest rate.
195 Surgical Education Runs A-MOOC!
Authors: Mellor C. , Musbahi A. , Rangarajan S. , Eagles E. , Immanuel A.
Published: February 2022

Aim

This study aims to review the available surgical Massive Open Online Course (MOOCs), to assess their scope, users, function and to use a quality assurance score to assess whether they are of sufficient quality. Understanding gaps will aid development of future surgical MOOCs.

Introduction

MOOCs have been changing the fabric of medical education over the last ten years1. They are perceived to be disruptive in their dismantling of the traditional methods of content delivery. Their offer of remote but flexible access and visually appealing content has been an integral part of their success.

Method

We scrutinised publicly accessible websites offering MOOCs using the search terms “surgery” and “surgical”. Thirty-eight of the 234 MOOCs found were deemed relevant and analysed further. Each MOOC was ranked into categories (not achieved, partially achieved, largely achieved, fully achieved) for standards set out by a validated OpenUp education tool.

Results

Only 34.2% of MOOCs were suitable for patients or relatives. The average cost of accessing a course (and certificate if available) is £50.39. Only 5.26% courses met the minimum recommended 25-hour study time. Only 5.26% MOOCs provided different learning pathways with different activities with a range of difficulties. An astounding 34.2% of MOOCs did not achieve providing reliable and fair assessments and providing regular feedback to students.

Conclusions

Not many high-quality surgical MOOCs exist. There is scope to produce more MOOCs aimed at patients and medical students, to reduce the cost of accessing the course and to improve how the courses are designed and assessed.
203 Clinical Significance of Haemorrhagic Cholecystitis: Retrospective Case Series
Authors: Khan Hotak M. , Gananadha S.
Published: February 2022

Aim

Hemorrhagic cholecystitis (HC) is a rare entity of acute cholecystitis. HC is hard to detect clinically as its symptoms are easily confused with acute calculus or acalculus cholecystitis. Although it is rare the purpose of this study is that early recognition may prevent possible life-threatening complications.

Method

A retrospective review of HC patients diagnosed by histopathology from 2010 to 2021 at the Australian Capital Territory health hospitals. A search of the histopathology database, patients’ medical records, laboratory results and imaging were conducted.

Results

Thirty-five patients (1%) were diagnosed on the histopathology report from approximately 3500 patients with cholecystectomies. Thirty-one Patients (88.6%) were presented to emergency, four patients (11.4%) had elective surgery. Twenty-one patients (60%) were female, fifteen patients (40%) were male. The median age was 51 years. All patients had laparoscopic cholecystectomy, four patients (11.4%) were converted to open, and five patients (14.2%) required ERCP. Two patients (5.7%) were on anti-coagulation. Twenty-three (65.7%) had ultrasound, twelve patients (34.2 %) had CT just one was reported as HC. Three patients (8.5%) had MRCP. Intraoperative findings were 8 patients with mucocele (22.8%), 6 patients had gangrenous gall bladder (17.1%),4 patients had empyema of gall bladder (11.4%) and 2 patients had perforated gall bladder (5.7%).

Conclusions

Our results revealed that all patients with HC were treated with surgical removal of gall bladder and had no post-operative complications. This shows diagnosing HC not effecting the overall clinical outcome for patients.
206 Longevity of Deep Brain Stimulation Batteries at a Tertiary Neurosurgical Centre
Authors: Saad M. , Morris R. , Rudwick C.
Published: February 2022

Introduction

Deep brain stimulation (DBS) is a surgery used in the treatment of movement disorders. It involves surgical placement of electrodes in the brain that are connected to a battery-powered stimulator to regulate brain activity. DBS has been used successfully in the management of Parkinson's disease (PD). It has improved patients' movement and quality of life. However, one inconvenience is the limited battery life and the need for battery change to prevent deterioration in function. In this audit, we measured the longevity of DBS batteries in PD at a tertiary neurosurgical centre.

Method

A retrospective audit on the longevity of DBS batteries in 86 Patients with PD. We collected data on; date and position of device implant, type of battery used (rechargeable vs non-rechargeable), and the two most recent battery changes. We excluded battery changes that were due to infection.

Results

86 patients had DBS batteries. 21 patients had rechargeable batteries (Abbot Brio, Medtronic Activa RC and Boston Gevia), and 65 had non-rechargeable batteries (Abbot Infinity, Abbot Libra XP, Medtronic Activa PC). 53 patients have undergone a battery change, 49 of those were non-rechargeable batteries. Average battery life of non-rechargeable batteries was 3.06 ± .55 years in Infinity (n = 16), 4.0 ± 1.7 years in Libra XP(n = 22), and 4.6± .9 years in Activa PC (n = 11).

Conclusions

All three types of non-rechargeable batteries are lasting less than five years. Activa PC batteries had the lengthiest battery life of 4.6± .9 years, while infinity had the shortest battery life of 3.06± .55 years.
213 Utility of Botox Injection in Early Laparostomy Closure for Abdominal Compartment Syndrome in Acute Severe Pancreatitis – a Case Report
Authors: Ain Q. , Chouari T. , Awonaya K. , Thomas R.
Published: February 2022

Acute pancreatitis can cause significant visceral oedema due to fluid resuscitation, paralytic ileus and ascites with raised intra-abdominal pressure(IAP) and abdominal compartment syndrome (ACS >20mmHg). Failure of conservative management is an indication for decompressive laparostomy. Early fascial closure is the priority following laparostomy to reduce morbidity, mortality, and the risk of enteric fistulation. Chemical component separation with Botulinum toxin injection is proven to be of benefit prior to elective complex ventral hernia repairs and has been reported in laparostomy closure. We report our use of Botox to assist with vacuum and mesh-assisted early closure of laparostomy in a patient with acute severe pancreatitis.

A 29-year-old male was admitted with severe alcohol induced pancreatitis. He developed acute respiratory distress and was intubated and ventilated. On day 14 of admission, he developed raised IAP of >40mmHg with multiorgan dysfunction and underwent laparostomy and application of Abthera© vacuum assisted negative pressure dressing. 3 days later, the dressing was replaced and a prolene mesh was sutured to the fascial margins to allow approximation of the wound to prevent retraction of the rectus sheath. He underwent further dressing change with trimming of mesh on day 6 and received 300U of Botulinum toxin injection into the abdominal musculature bilaterally. On day 7 following botox injection, the mesh was excised, and the midline wound was closed without tension. He remained stable with normal IAP and no wound related complications. Chemical component separation with Botulinum toxin may be a valuable adjunct in early closure of laparostomy.
216 Open Versus Minimally Invasive Surgery (MIS) Transforaminal Lumbar Interbody Fusion (TLIF): A Single-Centre Experience
Authors: Eldoadoa M. , Aldarragi A. , Rao P. , Sian P. , Kapoor V. , Mazarakis N.K.
Published: February 2022

Introduction

Transforaminal Lumbar Interbody Fusion (TLIF) is a technique used for the management of various pathologies such as degenerative disc disease, recurrent disc herniations and spondylolisthesis, to mention the most common indications. There is an ongoing debate regarding the use of open versus minimally invasive techniques for TLIF. Each has its own advantages and disadvantages. In the present study, we aim to present our experience regarding the use of open vs MIS TLIF at Stepping Hill Hospital in Manchester.

Method

A retrospective observational cohort study involving 60 patients was conducted at Stepping Hill Hospital in the UK. Patients who had TLIF surgery between 2019 and 2020 were included. Patients were consecutively allocated to either the open TLIF or the MIS TLIF group. Data were collected from hospital records including pre- and post-operative follow up notes. We also assessed pain score using the visual analogue scale.

Results

26 patients underwent MIS TLIF whereas 34 patients underwent an open procedure. The MIS group showed better outcomes compared to the open group in terms of post-operative complications, improvement of symptoms and the average hospital stay: 7.6% vs 8.8%, 73.7% vs 58.8% and 1.82 vs 2.76 days, however, the open group had a lower rate of metalwork failure 8.8% vs 11.5% in the MIS.

Conclusions

Our study showed that MIS TLIF at our unit seems to result in better outcomes related to symptoms alleviation, post-operative complications and less hospital stay despite having a slightly higher rate of metalwork failure.
226 Management of Closed Fractures of the Hand; Single Centre Audit
Authors: Saleki M. , Abdelaty M. , Kandil M. , Ashfaq F.
Published: February 2022

Aim

To compare current practice at the local Plastic Surgery Department to national Standard

British Society for Surgery of the Hand BSSH guidelines recommend for closed hand fractures.

Method

Retrospective data collection

All procedures done within one month June 2021, compare it to previous audit done in Feb 2021 and close the audit loop

Electronic data records

Results

June 2021 (90.5 %) meet the standard of time to presentation compared to 76% in Feb 2021

June 2021 62% meeting the standard for time to surgery compared to 46% in Feb 2021

Main reasons for delay unavailable dedicated Plastic Surgery theatre lists, busy emergency theatre lists.

Conclusions

Documentation of delays in presentation/Management has improved.

More theatre capacity is required to avoid cancelation and delayed management.
229 A Systematic Review Protocol Examining the Role of Immobilisation in Hand Infections
Authors: Banhidy N. , Ramjeeawon A. , Nolan G. , Jain A.
Published: February 2022

Aim

Hand infections are common and varied, leading to long-term complications when managed poorly. Splinting of the hand in a position of safe immobilisation (POSI) is frequently used to avoid complications including pain and stiffness, however it is not a universally accepted technique because the effects of splinting in hand infections remain unestablished.

This systematic review will compare outcomes in adult hand infections between those treated using hand immobilisation and those not immobilised. The primary aim is to compare patient reported outcomes, for example pain, and the secondary aim is to compare functional active range of motion, complications, and resource use.

Method

A systematic review protocol has been developed. The search strategy was developed following background reading, expert opinion, and review by an academic librarian, and will be used to search MEDLINE, Embase, CINAHL, Web of Science and the Cochrane Central Register of Controlled Trials, to identify publications on management of hand infections including use of hand immobilisation. Title, and full-text screening will be carried out by two independent investigators to identify studies for inclusion. Editorials, letters, and literature reviews will be excluded.

Results

This systematic review has been successfully registered on the PROSPERO International prospective register of systematic reviews (CRD42021232880)

Conclusions

This systematic review will summarise the available evidence to establish the effect of hand immobilisation in hand infections, including whether hand immobilisation leads to improved outcomes in hand infections, which could guide health care professionals in their practice and influence future clinical guidelines.
241 Is There a Role for Empirical Treatment of Orthopaedic Patients with Suspected, but Not Confirmed, VTE in the Post-Operative Period?
Authors: Menon D. , Abcha O. , Kallel S. , Pandit H.
Published: February 2022

Introduction

Major surgery, including major orthopaedic surgery, is a key risk factor for developing venous thromboembolism (VTE). This poses a challenge in the post-operative phase when considering initiation of therapeutic-dose anticoagulation for suspected VTE due to the risk of major bleeding.

Method

A search strategy was developed with inclusion criteria involving all studies relating to the treatment of suspected VTE in the post-operative orthopaedic patient. Journal articles predating 3rd June 2021 were searched for in Medline, Embase and PubMed. Titles and s were reviewed based on clinical relevance.

Results

56 articles were generated using this search strategy. 22 results were excluded as conference papers and/or case reports. Title and review of the remaining 34 studies did not identify any relevant articles reporting outcomes.

Conclusions

No evidence is available to guide recommendations for the empirical treatment of suspected VTE in the post-operative orthopaedic patient prior to a confirmed VTE diagnosis. This is therefore a risk-benefit clinical decision to be undertaken based on individual patient factors. Current American College of Chest Physicians guidelines advise initiation of anticoagulation for suspected acute VTE in cases with a high clinical suspicion, or intermediate clinical suspicion with expected delay in diagnostic imaging for at least 4 hours. However, this does not apply to patients following recent surgery who are at increased risk of bleeding post-operatively. Empirical systemic treatment dose anticoagulation for VTE in the post-operative period should therefore only be initiated when timely image-based diagnosis cannot be achieved.
284 Pneumomediastinum in the COVID-19 Era: To Drain or Not to Drain
Authors: Loufopoulos I. , Geropoulos G. , Kapriniotis K. , Kakos C. , Bhakhri K. , Panagiotopoulos N.
Published: February 2022

Introduction

Although quite uncommon in the pre-COVID-19 era, pneumomediastinum has been increasingly reported in COVID-19 cases complicating the management and prognosis of these patients. The aim of this study is to present the current experience on COVID-19 associated pneumomediastinum and to propose a management algorithm based on the existing literature.

Method

A search strategy focused on electronic databases (Medline, Embase, Google Scholar) was performed. Main search keywords were pneumomediastinum and COVID-19-related keywords. Eligible studies were included without strict limitations on type of study, type of publication, language, or date.

Results

Several reports of pneumomediastinum management in the context of COVID-19 infection have been reported. An initial diagnostic approach with computed tomography scan is recommended for all patients with increased oxygen requirements and suspicious chest X ray. In stable, non-intubated patients, pneumomediastinum can be initially monitored, whereas in the event of progressing air accumulation and cardiorespiratory compromise, a subxiphoid drain alone may preserve the cardiopulmonary reserve. In cases with coexisting pneumothorax and pneumomediastinum, a pleural drain should be prioritised and a subxiphoid drain should be reserved for cases not responding to initial treatment. In surgical emphysema cases, conservative management, especially in non-intubated patients, is suggested, while coexisting pneumothorax as described above. For refractory surgical emphysema cases, subcutaneous drain or subxiphoid drain- in presence of pneumomediastinum- might be required.

Conclusions

In air space complications such as pneumomediastinum, surgical emphysema and pneumothorax, a proposed treatment algorithm can be applied aiming to improve the outcomes of these complicated COVID-19 patients.
292 Patient Centred Care in the Outpatient Department
Authors: Moore E. , Dholoo F. , Dinneen A. , Solan M.
Published: February 2022

Aim

The NHS long term care plan recognises the need for a personalised approach to healthcare. Patient initiated follow up (PIFU) is one way in which the NHS can support patients with becoming more autonomous in decisions about their own health.

Method

Our trust implements PIFU in 2 ways. Firstly, patients considering an elective operation were provided with a clinic letter detailing the treatment options and a PIFU card. They were discharged and asked to return the card if they wished to proceed to surgery, at which point they were added to the waiting list. Secondly, patients discharged from clinic were provided with a card which they returned if they needed to be seen again for the same complaint.

Results

95 patients were recruited for the operative pathway. 38 (40%) requested surgical treatment within 6 months. 149 patients were recruited for the clinic pathway, of which 17% returned for the same condition within 6 months.

Conclusions

This study has shown that 60% of patients choose, after meaningful dialogue and time to reflect, to avoid surgical treatment. In all cases the surgeon would have “added to the waiting list” had a joint decision been made at the end of the consultation. Furthermore, 83% of patients who would ordinarily have had a routine follow-up appointment did not return to clinic.

This PIFU system empowers patients to make decisions about treatment. Offering direct access to the operative waiting lists and clinics has multiple benefits: fewer primary care and hospital appointments; reduced waiting times and reduced costs.
301 Blood Grouping and Save in Day Case Laparoscopic Surgery – Potential for Resource Savings?
Authors: Ramasamy S. , Kumar S. , Al-Habsi R. , GS D. , Keeler B. , Khanna A.
Published: February 2022

Introduction

Currently, patients listed for Laparoscopic cholecystectomy and Laparoscopic Appendicectomy undergo routine Blood Grouping and Saving (G&S) pre-operatively. Blood transfusion administration in this context is a rare occurrence. Processing of G&S samples takes approximately 45 minutes and costs £31 per sample. This excludes the phlebotomy and junior doctor resources for sample collection, which incurs additional costs.

We retrospectively assessed the blood transfusion requirements in those patients who underwent either a laparoscopic appendicectomy or cholecystectomy in the last 18 months at a busy District General Hospital (Milton Keynes Hospital) to determine if there were any potential costs and resource savings that could have been made.

Method

Retrospective case notes analysis of patients who had laparoscopic cholecystectomy and laparoscopic appendicectomy from January 2019 to June 2020 focusing on timing of G&S, preoperative and postoperative haemoglobin, the timing of blood transfusion and the number of units transfused.

Results

Of a total of 613 patients, 323 patients had laparoscopic cholecystectomy. 256 (78.8%) of these had 1 G&S sample and 96 (29.7%) had 2 samples.

290 patients had laparoscopic appendicectomy. 190 (65.5%) of these laparoscopic appendicectomy patients had 1 G&S sample and 89 (30.6%) had two G&S samples.

None of the 613 patients was transfused. The total cost of G&S was £22,196.

Conclusions

Our study illustrates that in this group there was no requirement for blood transfusion. Routine group and save samples result in a significant waste of resources and finances. Targeted groups and save samples should be reserved for high-risk groups only.
304 To Raise Awareness About the NHS Cervical Screening Programme and to Reduce the Number of Did-Not-Attend (DNAs) Cervical Screening Appointments Among Women Aged 25–35 Years Through a Collaborative Reward System with Local Businesses
Authors: Singh S.
Published: February 2022

Introduction

Cervical screening is offered free under NHS Cervical Screening Programme since 1988. However, compliance is dwindling in the last decade, especially among women aged 25–35 years who had the least awareness. NHS Digital suggests overall coverage be 72 percent with 1.2 million Did-Not-Attend appointments.

Method

This project proposes financial and non-financial incentives can propel people to adopt healthier lifestyles. Project advocates CSR with local businesses, especially MSEs such as local gyms, local pharmacies, boutiques, salons, restaurants, and takeaways usually frequented by women aged 25–35 years. The project proposes, firstly, participating businesses will display ‘we support cervical screening program’ on their on-site and online portals. Secondly, they will provide exclusive offers (cash rewards, hampers, vouchers, priority services, free home deliveries, and personalised picture cards signed by staff) to women attending their cervical screening appointments. Thirdly, in their adverts, they would promote the cervical screening programme in a respectable manner to prevent the embarrassment of cervical swab and body-shaming. Fourthly, the businesses will ensure flexible staff working hours to attend the cervical screening to eradicate work-related practical barriers.

Conclusions

Cervical screening program is the best prevention against cervical cancer and can potentially reduce mortality by cervical cancer by up to 70 percent. If NHSCSP coverage reaches 84%, £10million can be saved per annum. Apart from early detection of cervical cancer and reducing Did-Not-Attend appointments by offering exclusive rewards for attending Cervical Screening to the participants.
320 Augmented Reality in Vascular and Endovascular Surgery: A Scoping Review
Authors: Eves J. , Sudarsanam A. , Shalhoub Joseph. , Amiras D.
Published: February 2022

Introduction

Technological advances have transformed vascular intervention over recent decades. Augmented reality (AR) is a subject of growing interest within surgery, with potential to improve the clinicians’ understanding of 3D anatomy and their processing of real-time information. The aim of this review was to summarise the fundamental concepts of these technologies and to systematically assess the literature currently applying AR to vascular surgery.

Method

A systematic literature review of ‘Medline,’ ‘Scopus’ and ‘Embase’ was performed according to PRISMA guidelines. Studies were selected by a blinded process between two investigators and assessed with data quality tools.

Results

AR technologies have had a number of applications across vascular and endovascular surgery. The majority of studies use 3D imaging (e.g.) CT angiogram derived images of vascular anatomy to augment the clinicians anatomical understanding during procedures. A wide range of AR technologies have been employed with ‘heads up’ fusion imaging and AR head-mounted displays the most commonly clinically applied. AR applications have included guiding open, robotic, and endovascular surgery while minimising dissection, improving procedural times, and reducing radiation and contrast exposure. Additionally, AR has been successfully applied to surgical training, with scope to improve technical and team communication skills.

Conclusions

AR has shown promising developments in the field of vascular and endovascular surgery, with potential benefits to surgeons and patients alike. While more technological advances are required to overcome current limitations, it is likely that AR will be a regular feature of vascular surgery clinical practice and training in the future.
332 Paediatric Ultrasound Scan: Are We Providing a Quality Service?
Authors: Barghash M. , Nassif S. , Anwar S. , Obayi E. , Alnsour A. , Mansour M.
Published: February 2022

Aim

Ultrasound scan is the preferred imaging modality in children as it carries no risk of radiation exposure. In this audit, the number of inpatient paediatric ultrasound referrals was assessed over a period of one year. The waiting time was also reviewed in addition to the impact of the results on the management plan.

Method

This was a retrospective audit which included patients who were below 16 and had inpatient ultrasound scan. Case notes were included from January 2020 to December 2020 in a busy district hospital in the UK. The time taken to perform the ultrasound scans and the impact on the management plan were only analysed for the scans requested for abdominal pain.

Results

A total of 914 paediatric ultrasounds scans were requested in 2020. A total number of 28 scans were requested for abdominal pain. The waiting time ranged from 3 to 135 hours with a mean of 23 hours. No scans were positive for appendicitis. Only 2 scans were positive for gynaecological pathologies, i.e., ovarian cysts. All the 28 patients were discharged without undergoing any procedure. Out of the 28 patients, 15 patients had a length of hospital stay of more than 24 hours before discharge.

Conclusions

A mean delay of 23 hours could potentially delay the management of paediatric patients with acute abdominal pathology. None of the patients in this audit underwent any procedure following performed scans. This may indicate that such scans did not alter the management of the studied patients in this audit.
335 Early Initiation of Biochemical Venous Thromboembolism Prophylaxis Following Traumatic Spleen Injury Is Safe and Effectively Reduce VTE Events.
Authors: Rizkallah G. , Lee S.L. , Mahmoud A. , Handa I. , Long J. , Massella V. , Modi S. , Fun Ngan F.S. , Rahman A. , Elberm H.
Published: February 2022

Aim

This study examines the safety and timing initiating VTE prophylaxis post traumatic splenic injuries (TSI).

Method

Patients with TSI were identified from prospectively maintained Trauma Audit and Research Network (TARN) database from 2015–2020 in a single tertiary trauma centre. Clinical and radio-logical information were collected retrospectively. TSI were graded using American Association for the Surgery of Trauma (AAST) splenic injury scale. Chemical venous thromboprophylaxis initiation were categorised as not given, <48h and >48h following the injury.

Results

In total 102 patient were included out of 136 patients identified with TSI. 34 patients were excluded for lack of electronic data, palliative decision, or fatal condition on arrival. 12 patients out of 102 required operative management (OM) and 90 patients NOM. VTE prophylaxis was not given for 31 (30.4%). Medical reasons for this include severe brain injury and early discharge before 48 hours. VTE prophylaxis was initiated for 37 (36.3%) patients within 48 hours, and for 34 patients (33.3%) after 48 hours of admission. Seven patients developed thromboembolic events, majority of which (6/7) received VTE prophylaxis after 48 hours. Importantly, none of the patients who received VTE prophylaxis had rebleeding.

Conclusions

This study showed that early initiation of chemical VTE prophylaxis (<48h) is safe, resulted in lower incidence of DVTs/PEs without increasing the risk of bleeding. Results from this study supports recommendation from other studies 1 to initiate chemical VTE prophylaxis after TSI as early as 24h post injury with no other contra-indications.
342 Percutaneous Cholecystostomy: Single Hospital Review of Indications and Outcome
Authors: Saleh D. , Rawashdeh A. , Parmar J.
Published: February 2022

Aim

Percutaneous cholecystostomy is used for the treatment of various gallbladder conditions and biliary emergencies, such as cholecystitis or cholangitis. Patients undergoing this procedure are usually elderly and surgically high risk. The objective of this audit is to investigate risks versus the benefits of percutaneous cholecystostomy at University Hospital Birmingham and hence propose a work plan for cholecystostomy drain placements and reduce drain-related complications.

Method

We retrospectively identified patients who underwent percutaneous Cholecystostomy between January 2018 and December 2019. Clinical and demographic data were collected, including age, co-morbidities, ASA grade, indications, pre-procedure blood tests, complications, and re-admissions.

Results

25 patients were identified and included median age was 76.3 years, 16 out of 25 patients had deranged Liver function tests. All patients were deemed unfit for surgery at the time of decision. Median Hospital stays after the procedure was 7 days. The number of patients required readmission with a blocked drain is 16. Total number of readmissions for blocked drain is 33. Number of patients required readmission after drain removal with cholecystitis/cholangitis is 14. Total number of readmissions for cholecystitis/cholangitis after drain removal is 21.

Conclusions

The main reason for readmissions was for blocked cholecystostomy drains. A protocol where patients are educated about flushing their cholecystostomy drains prior to discharge is vital to reduce complications with a blocked drain. Also, careful selection of patients for cholecystostomy is important due to the high morbidity associated with this procedure.
345 Development of Breast Disease Teaching in the Low and Lower-Middle Income Countries
Authors: Nojoum M. , Macaskill E.J. , Al Khairalla M. , Al-Barrak S.M.
Published: February 2022

Aim

Breast cancer is the most common cancer worldwide, with incidence and mortality rates significantly worse in the developing world. There is a need to improve general health professional’s knowledge of breast disease. The recent COVID-19 pandemic has led to an increase in use of online resources, and remote teaching has had a significant role in medical education particularly post-pandemic. This project aims to assess available breast disease related online resources for use in the context of medical undergraduate education in low and lower-middle income countries.

Method

A search for online resources was conducted using generic search engine and specialist databases. In the planning phase, predefined search terms were selected, and exclusion and inclusion criteria were identified. In the search execution phase resources were searched for, and the main target and resources type were recorded. In the screening and information management phase resources identified were assessed for comprehensiveness using the Royal College of Surgeons Breast learning outcomes.

Results

A total of 33 e-resources were identified that met predefined criteria. This included text-based websites (n = 19), tutorials (n = 8), and video resources (n = 6). The majority of resources were aimed at patients (n = 12). None of the resources identified met all 11 outcomes outlined by the Royal College of Surgeons, however most resources met 10 of the learning objectives (n = 7).

Conclusions

There was a good selection of available educational resources in the area of breast disease, however further exploration of the suitability and usefulness of e-resources in the setting of low and lower-middle income countries is required.
350 New Service of Intravenous Antibiotics Administration at Home- a Single Centre Experience
Authors: Bista A. , Singh H. , Unnithan A. , Das G. , Kesawarini D. , Bristoll S. , Lewis N. , Alnoori N.
Published: February 2022

Introduction

Outpatient Parenteral Antibiotics Therapy (OPAT) provides a safe and effective alternative to prevent a long-term hospital stay. If used efficiently, it is beneficial and cost-effective.

Method

199 patients from January 2017 since the services started to March 2021 were included in this retrospective observational study. Demographics, clinical management and OPAT outcome data were studied and compared with local guidelines. Patients receiving services for oral medications or ambulant to reach AECU were excluded.

Results

205 patients received the service with a total of 248 patient episodes. 6 patients were excluded because of inadequate data availability. 199 cases were analysed with a mean age of 72±13.9 years (age ≥60 years: 79.8%; M:F 3:2). 24.6% cases were osteomyelitis followed by 12% prosthetic infections. The average duration of antibiotics received was 38.4 days (3–187 days). We assumed 3 days as a benchmark for duration deviated from the planned duration and found 45% of patients got more antibiotics than they were planned: with an average of 20 days excess. 65.8% of patients had microbiological investigations done before antibiotics. Flucloxacillin was the first-choice antibiotic. When compared to the trust guidelines, 29% of patients were managed in line with the recommended duration, proper investigations, and choice of antibiotics. 14.5% of patients developed side effects.

Conclusions

With this being a new service, there are a lot of opportunities to improve monitoring, patient experience and safe clinical practice. We have already started the improvement by changing our record-keeping for clinical governance and are working on the clinical pathway.
352 Improving Consent for Elective Inguinal Hernia Repair
Authors: Lorimer J.
Published: February 2022

Introduction

Litigation costs the NHS billions each year. To avoid litigation against known risks of elective surgery it is important that proper consent it obtained. The initial aim was to establish the percentage of patients consented fully for inguinal hernia repair at Warrington and Halton teaching hospitals, a moderately sized district general hospital. The Trust uses the information produced by EDIO as their standard of informed consent. One of the main outcomes was the rate of consent for risk of chronic pain as this is the 3rd most commonly litigated complication and an identified risk of inguinal hernia repair.

Method

A retrospective audit looking at consent forms for adult men who underwent elective open inguinal hernia repair, over a 6-month period in 2019, was undertaken. After the first audit the results were discussed at the local audit meeting and teaching was given for what should be included on a consent form for inguinal hernia repair. A second cycle of the audit was run in 2021, after the COVID pandemic, to assess if consenting had improved.

Results

66 vs 22 cases met the inclusion criteria for the first and second 6-month periods respectively. An improvement in consent for chronic pain was observed with 91% of patients in the second cycle being consented for chronic pain vs 79% in the first cycle. In the second cycle 32% of patients were also consented for the risk of “COVID”.

Conclusions

Teaching proper consent works effectively to improve consenting.
359 Standardised Management Guidelines of Sudden Sensorineural Hearing Loss for Departmental Use
Authors: Kujeke H. , Reddy-Kolanu G.
Published: February 2022

Introduction

Sudden sensorineural hearing loss (SSNHL) remains a condition of unknown aetiology with low incidence of 20 cases per 100,000 per year. This has led to a lack of consensus on overall management as there are no NICE guidelines. Trends in management are aimed at attempting to find an identifiable cause and to treat accordingly.

Method

A double loop audit performed at East Surrey Hospital looked at the management of Sudden sensorineural hearing loss. The first loop looked at retrospective data over 7 years identifying how patients with this diagnosis were managed by assessing the following 6 parameters: Pure tone audiometry test performed, Oral steroids, tympanic injection, autoimmune blood screen, MRI booked, and outpatient follow up appointment given. The inconsistent management of those patients led to the design of an algorithm for standardised management ensuring all 6 parameters were covered. This was implemented over a three-year period and a retrospective audit was performed.

Results

Between 2010–2017, 7 patients were diagnosed on audiometry as having SSNHL. Only 1 patient was managed comprehensively with all 6 parameters covered. The department algorithm was implemented in 2018 suggesting all patients are to be managed according to the algorithm within the first 72hrs of diagnosis. From 2018–2020,14 patients had the diagnosis and managed as per algorithm. There was 92% compliance.

Conclusions

Although there are no current NICE guidelines, there is great benefit to the patients diagnosed with sudden sensorineural hearing loss in having standardised departmental guidelines. This ensures that pertinent investigations and medications are administered in a timely manner.
374 Are Operative Notes Adhering to the Standards of Good Practice?
Authors: Lipski C. , Bleibeh S. , Hanif U. , Sinha M. , Waites M.
Published: February 2022

Aim

Thorough documentation is imperative for postoperative care, quality improvement, research, and medico-legal enquiries. For these reasons this closed loop audit aimed to assess whether the local Trauma and Orthopaedic departments’ operative notes were adhering to the guidance outlined by The Royal College of Surgeons, in order to to follow good practice.

Method

This was a random data collection, single centre study performed which analysed 50 operative notes from a variety of Trauma and Orthopaedic surgical procedures (not including neck of femur fractures and elective surgeries). The next cycle of the audit was completed after departmental re-education and a new operative note pro forma was created and put in place.

Results

The first audit cycle demonstrated that 8 categories in the operative note were below 96 % compliance with the guidance, of these being: time, name of operating surgeon/anaesthetist, operative procedure, incision, operative diagnosis, DVT prophylaxis, signature. Furthermore, an interesting finding showed no complications were identified in any operative note, similarly no extra procedures were documented. The second audit cycle showed that there was 100% compliance gained across all categories. Additionally, the new pro forma had an option to specify if there was/or not any complications, which had 100 % compliance in the second cycle and identified one complication.

Conclusions

Overall this audit was able to standardise the operative notes and improve quality and structure in order to follow good practice, by implementing a new pro forma and re-educating the department. This ensures that the best standard of care is being delivered.