bluuebunny/crossref_metadata_2025 huggingface dataset:
218 Compliance With the British Society for Surgery of the Hand (BSSH) Guidelines on the Management of Open Hand Fractures Audit
Authors: John H. , Nagrath N.
Published: February 2022

Aim

British Society of Surgery of the Hand (BSSH) have defined standards for managing open hand fractures. We intended to ascertain our and referring peripheral units’ adherence with BSSH’s standards of care in managing open hand fractures and determine the associated morbidity.

Method

We performed a 6-month prospective audit reviewing clinical records of patients referred to our department with open hand fractures, to determine whether: antibiotic prophylaxis had been started, and discontinued at definitive closure; wound washout and closure had been performed within 24 hours of injury; patients had continued rehabilitation with hand therapists.

Results

25 patients sustained open hand fractures in this period. All patients, except 1 who declined, received antibiotic prophylaxis. 19 (76%) had a wound washout and closure within 24 hours of injury.

Antibiotic prophylaxis was discontinued at time of definitive closure in theatre in 3 (12%) patients. The remaining 21 patients continued antibiotic prophylaxis beyond 72 hours. 3 (12%) patients developed a wound infection, 2 (6%) of these requiring debridement and irrigation in theatre. Both patients had proximal interphalangeal joint fracture dislocations who underwent a wound debridement within 24 hours of injury, 1 of which was secondary to an animal bite. 22 (88%) patients attended their hand therapy appointment.

Conclusions

The incidence of deep infection requiring subsequent operative debridement remains low in open hand fractures, despite the substandard adherence to BSSH’s recommendations.

Educating colleagues will improve the adherence to guidance. The BSSH hand injury triage app fulfils this purpose. We intend to raise awareness and encourage its use.
224 Measurement of the Hippocampal Volume Among a Sample of Healthy Sudanese Adults
Authors: Mohammed O.A.A. , Ibrahim A.A.H. , Salman M.S.T. , Elhassan A.B.E. , Ali M.A.M. , Bashir S.A.T. , Mustafa Ahmed W.M. , Mohamed N.E.M.
Published: February 2022

Aim

The hippocampus is involved in many functions; most importantly the short-term memory and memory consolidation. Hippocampal volume is an important determinant for cognition, memory function and as an indicator for the development of many diseases such as Alzheimer’s, depression, and schizophrenia. This study aimed to measure the cortical structures of the hippocampus in young adult Sudanese to examine the effect of sex, age, body mass index (BMI) and education on the cortical structures.

Method

A cross-sectional descriptive community-based study was done. It included 60 individuals within the age range of 20–40, for which, MRI imaging was done using 1.5 Tesla Philips scanners, Version: 3.2.1. T1-weighted images obtained using three-dimensional acquisition by Magnetization Prepared Rapid Acquisition (MP-RAGE). Images were analysed using the BrainSuite software, and the data was analysed using SPSS version 26.

Results

The mean volume for the right and left hippocampus was 3.22±0.92 cm3 and 3.35±0.79 cm3, respectively. The right hippocampal white matter volume and left hippocampal cortical volume were larger in males than females. There was no significant asymmetry between the right and left sides. There was no statistically significant association between the hippocampal volume and age, educational status, or the BMI.

Conclusions

Measurements of the right and left hippocampal volume among Sudanese adults goes in line with other international studies. The cortical volume of the hippocampus is not affected by age, BMI, and education level, but can be affected by gender. Further studies with larger samples are required in order to support these data.
225 First Contact: A Series of Zoom-Based, Virtual on Call Shifts
Authors: Choi B. , Fu H. , Ogunmwonyi I. , Gargan K.
Published: February 2022

Aim

COVID-19 has resulted in reduced exposure to on-call shifts where medical students could increase confidence and proficiency in task prioritisation and decision making. Existing ‘simulated on-calls’ provide a substitute in a controlled environment, however in person teaching has also been limited by COVID-19. Our virtual on-call sessions use ZOOM to replicate the higher-level learning experiences normally conferred by live simulation.

Method

We designed a series of virtual ‘on-calls’ for medical students. Participants were ‘on-call’, receiving ‘bleeps’ which were ‘answered’ by calling a facilitator via ZOOM. The facilitator would roleplay a scenario and the ‘Electronic Patient Record’ (EPR) on Google Forms contained patient notes and observations. Students needed to collect information from the facilitator and document a management plan into the EPR. Participants received ‘bleeps’ of varying complexity, urgency and relevance and were expected to prioritise and triage tasks accordingly. Evaluation was via a pre/post session quiz with separate feedback forms.

Results

23 students from 18 universities participated. Students reported increased confidence in managing on-call scenarios, and average scores improved in the post session quiz. Positive feedback was paid to the variety of scenarios, the EPR system and the feeling of realism elicited from the need to triage and prioritise jobs.

Conclusions

Our framework uses readily accessible technology to provide interactive learning experience. Feedback suggested students engaged in higher order learning and thinking, achieving our stated aims. We aim to incorporate technologies such as automation software which will allow for a scalable, free, and accessible virtual on call.
227 Measurement of the Cortical Structures of the Insula Among Young Adult Sudanese Using Automatic Segmentation
Authors: Salman M.S.T. , Mohammed O.A.A. , Ibrahim A.A.H. , Elhassan l.B.E. , Ali M.A.M. , Bashir S. A.T. , Ahmed W.M.M. , Mohamed N.E.M.
Published: February 2022

Aim

The insula is important in gustatory (taste) and visceral sensations, pain, emotion, and tactile senes. This study aimed to measure the cortical structure of the insula in young adults and the effect of gender, age, Body mass index (BMI) and education on it. This will provide base line data about cortical volume and thickness of the insula in normal subjects.

Method

A cross-sectional descriptive was done in 60 individuals, their age was ranged from 20–40 years. MRI imaging using 1.5 Tesla Philips scanners was done, version: 3.2.1. T1-weighted images was obtained using three-dimensional acquisition by Magnetization Prepared Rapid Acquisition (MP-RAGE). Images was analysed using the BrainSuite software, and the data was analysed using SPSS version 26.

Results

The mean cortical volume of the right and left insula were 8.60±1.31 and 8.01±1.26 cm3, respectively. There was significant asymmetry between the right and left sides. Additionally, there was a statistically significant difference between the cortical structures of the insula and the gender; also, there was statistically significant correlation between the insular cortical volume and the education. However, there was no statistically significant correlation between the cortical volume and age or body mass index.

Conclusions

Measurements of the right and left insula cortical structures among Sudanese adults were similar to the previous studies with males having larger volume than females. The right insula cortical volume was significantly larger than the left. I. There was a significant correlation between the cortical volume and education. Further studies with larger samples are needed to support these data.
228 Single Centre Compliance to National Guidelines for Management of Flexor Tendon Injuries, Clinical Audit
Authors: Saleki M. , Abdelaty M. , Kandil M. , Ashfaq F.
Published: February 2022

Aim

To evaluate compliance to British Society for Surgery of the Hand (BSSH) guidelines for timing of review and surgical management of Flexor tendon injuries.

Method

Retrospective data collection over a period of (February 2021) for the first cycle, and (June 2021) for the second cycle through EPR and Galaxy soft wares.

Results

Time from injury to review by Plastic Surgery team: 100% of patients were reviewed within the national timeframe in both cycles. Time from injury to definitive surgical procedure: 86% compliance to national timeframe on both cycles.

Conclusions

Flexor tendon injuries require further prioritization for operative management.

Increase theatre capacity to accommodate the need.
233 A Closed-Loop Audit Assessing the Compliance of General Surgery Department in Completing Treatment Escalation Plan (TEP)
Authors: Lee L. , Parmar C. , Allen C.
Published: February 2022

Aim

In the event of clinical deterioration, a treatment escalation plan describes individualized interventions that would be appropriate for a patient. Likewise, it allows clear communication amongst staff members and the patient about the limits of treatment. This audit aimed to evaluate the compliance of the General Surgery department during the pandemic.

Method

A closed-loop audit was conducted by looking at notes of General Surgery patients retrospectively and identifying those who’s had their treatment escalation plan form filled out during their admission. Data were collated, analysed, and presented in our local audit meeting. Thereafter, we disseminated the results to the department and modified our admission clerking proforma to ensure this is done. Afterwards, a re-audit was done to assess the improvement of compliance.

Results

A total of 24 patients were included. Before the modification of the clerking proforma, only 21% of TEP were completed. After the added changes, 36% of admitted patients had their form completed.

Conclusions

Our department was generally doing poorly with regards to ensuring our patients had TEP forms completed. Even though we generally have young, fit and well patients, according to our trust guidelines, all patients are meant to have their forms filled out. This ensures clear communication among staff and proper allocation of resources if there will be any shortages in the services that could be provided. By shining light on this topic, our department had been more compliant and proactive with ensuring that patients, especially the elderly, had a TEP form filled out.
234 Outcomes of Periprosthetic Femoral Fractures Between 2011–2021: An Observational Study
Authors: Singh H. , Bista A. , Baggott J. , Unnithan A. , Sobti A. , Farook M. , Jacob J. , Khaleel A. , Elliot D.
Published: February 2022

Background

Periprosthetic femoral fractures (PPFF) present a significant burden on the health services due to an increase in the ageing population and the number of hip and knee arthroplasties performed. This study observed how this burden changed between 2011 and 2021 and the outcomes for these patients undergoing an operation.

Method

Ten-year retrospective observational study assessing the variance depending on the fracture/operation, ASA scores, time to operation, length of stay and mortality.

Results

From January 2011 to March 2021, we identified 209 operations for femur periprosthetic fractures. The mean age was 83 with a female preponderance of 76%. There was a significant change in the ASA scores of the patients, with the proportion of ASA 3 or more increasing from 43% (2011–2016) to 73% (2017–2021), and ASA 4 or greater increasing from 10% to 17% respectively. There were 68 periprosthetic hip arthroplasty fracture fixations, 81 periprosthetic hip arthroplasty fracture revisions, 45 periprosthetic total knee replacements, and 15 inter-prosthetic fractures. One year mortality rates were 24.6%, 6.7%, 16.3% and 13.3% respectively. The average times to operation were 2.5 days, 4.5 days, 2.1 days, and 1.7 days respectively. The average lengths of stay were 20.8 days, 19.8 days, 12.1 days, and 13.1 days respectively.

Conclusions

PPFF carry a significant mortality risk and ASA scores have increased. Mortality rates were better in the periprosthetic hip arthroplasty patients who had revisions rather than fixations (representing different cohort). one year mortality figures were comparable to similar studies in Ireland and USA.
235 Understanding Stage of Innovation of Invasive Procedures and Devices
Authors: Scroggie D. , Elliott D. , Cousins S. , Avery K. , Blazeby J. , Blencowe N.
Published: February 2022

Aim

New and modified surgical procedures and devices are often introduced into clinical practice without adequate evidence of their safety and efficacy. To promote systematic evaluation of surgical innovations, the IDEAL and IDEAL-D frameworks outline recommendations for study design and governance for procedures and devices according to their stage of innovation. However, determining stage of innovation can be difficult, hindering use of such frameworks. There is a need for a detailed understanding of what stage of innovation means, and how it can be determined. The aim of this study is to understand the concept of stage of innovation as reported in the literature.

Method

A systematic review is being conducted. Searches of Ovid Medline and Embase databases have been performed. Articles were screened by title and, then by full text. s and foreign language articles were excluded. Data will be extracted verbatim regarding approaches to evaluating surgical innovations and determining stage of innovation. A thematic analysis will be conducted, and findings summarised in a narrative report.

Results

The search returned 2,946 articles, of which 46 were included. Preliminary findings have identified two approaches for evaluating procedures, and one for devices. Following thematic analysis, the narrative report will explore approaches to evaluating surgical innovations and determining stage of innovation, including barriers to implementation and proposed solutions.

Conclusions

A report of progress will be presented at the Surgical Innovation Summit. An improved understanding of stage of innovation will facilitate better evaluation of surgical innovations.
236 E-Prescribing and Smart Antimicrobial Stewardship in Upper Limb Infections
Authors: Rela M. , Peberdy D. , Heard K. , Fok R.
Published: February 2022

Aim

Upper limb infections secondary to traumatic wounds, animal bites and other causes are a common reason for admission to the plastic surgery service for intravenous antibiotics. This audit investigated the compliance of treatment of upper limb infections with trust guidance. The guidance stipulated an antibiotic treatment duration of five to seven days total and microbiology advice suggested that in cases requiring multiple washouts, this should start from the date of the last surgical washout where pus was present.

Method

There was retrospective sampling for four months using inpatient lists to include patients admitted for intravenous antibiotics for upper limb infections. Notes were requested by the secretaries and data was collected using patient notes, discharge summaries and electronic drug charts.

Results

The analysis included twenty-seven suitable patients. All patients had the correct antibiotics prescribed according to guidance, however only 22% of patients had five to seven days total of antibiotics either from the start of therapy or from the date of last infected washout in those who underwent surgical treatment. 14/27 patients had more than seven days total antibiotics. 13/27 patients were discharged with an additional seven days of oral antibiotics regardless of the total duration.

Conclusions

These infections are significantly over-treated with antibiotics, which has serious potential consequences for antimicrobial resistance. The findings of the audit prompted new trust guidelines to be produced and prescribing guidance was sent to the junior doctors to calculate the total antibiotic duration when preparing discharge summaries. There is a plan for re-audit in a few months’ time.
238 The Use of MRCP in the Assessment of Choledocholithiasis in Patients Presenting with Symptomatic Gallstone Disease
Authors: Hobbs J. , Marks B. , Young J.
Published: February 2022

Aim

Magnetic Resonance Cholangiopancreatography (MRCP) is the investigation of choice for choledocholithiasis; however, use is varied and guidelines vague. The National Institute for Health and Care (NICE) recommend MRCP when common bile duct (CBD) dilatation ≥ 8mm or liver function tests (LFTs) are abnormal but do not quantify this further. The Sunflower Study classifies patients as “high-risk” for choledocholithiasis if alanine aminotransferase (ALT) ≥ 80 IU/L, alkaline phosphatase (ALP) ≥ 200 IU/L or CBD ≥ 8mm. We aimed to assess compliance with NICE criteria and determine what biochemical abnormalities are most associated with choledocholithiasis.

Method

A retrospective analysis of inpatient MRCPs performed at QEH between March and May 2021 was performed (n = 72). Pre-MRCP bloods and imaging were used to assess concordance with NICE guidelines. We compared LFTs between patients with and without choledocholithiasis, looking for significant differences.

Results

84.7% of MRCPs were performed in accordance with NICE guidance, of which 31.1% demonstrated choledocholithiasis. No cases of choledocholithiasis were identified if NICE criteria were not fulfilled. A significant difference between the mean values of gamma glutamyltransferase (GGT) and ALP was noted between patients with and without choledocholithiasis.

Conclusions

We identified that the majority of MRCPs were performed in accordance with guidance. Significantly, no cases of choledocholithiasis were identified if these criteria were not met. Although our sample size was small, we found the most specific biochemical markers were ALP and GGT and propose that further research with larger cohorts may help develop a risk stratification tool to aid decision making.
242 The Importance of Frailty Assessment as a Mortality Indicator and Surgical Decision-Making Tool
Authors: Cheng Y.S. , Brown K. , Harley S. , Allen C. , Nasr H. , Rudzki D. , Claridge M. , Adam D. , Juszczak M.T.
Published: February 2022

Background

Frailty is a multidimensional syndrome, which can lead to poorer health outcome. Frailty score is a proven reliable indicator of post-operative morbidity and mortality; however, its application in clinical practice is limited.

Aim

The study aimed to assess the association between frailty marker and one- year mortality rate and explore its impact in clinical decision making in patients with abdominal aortic aneurysms.

Method

Consecutive patients with abdominal, thoracic, and thoracoabdominal aortic aneurysms presented at dedicated aortic clinic between July 2019 and April 2020 were included. Markers for frailty and sarcopenia using Rockwood Clinical Frailty Scale, SARC-F questionnaire, morphometric analysis for sarcopenia, one-year mortality and fitness were recorded. Multi-disciplinary team (MDT) was blinded to frailty and sarcopenia data; surgical decisions made by MDT were recorded separately.

Results

We assessed 83 patients (median age 75 [72,82], 85% male; median aneurysm diameter 6cm [5.8,7.0]. Sixteen patients were deemed frail, five patients had sarcopenia and thirty-one patients had myopenia. Seventeen patients were deemed not fit for surgery; 41% of these were frail compared with 14% out of those who were deemed fit. The odds ratio of being frail and unfit for surgery was 4.33 (95% CI 1.27–14.82, p = 0.010). Frailty was significantly associated with one-year mortality irrespective of fitness for surgery, sarcopenia and myopenia (OR 10.28, 95%CI 1.82–57.93, p = 0.009). SARC-F and myopenia was not associated with one-year mortality at (OR 1.66, 95%CI 0.03–19.25, p = 0.523) and (OR 0.59, 95%CI 0.09–2.85, p = 0.514), respectively.

Conclusions

Frailty score was associated with both one-year mortality and fitness for surgery decision made by MDT.
243 How to Reduce Breaches of Trauma & Orthopaedics Patients in the Emergency Department: A District General Hospital Experience
Authors: Burnett-Jones L. , Eltagy H. , Elerian S. , Elashry S.
Published: February 2022

Aim

The handbook to the NHS constitution for England pledges a maximum four-hour wait in the Emergency Department (ED) from arrival to admission, transfer, or discharge. We present a closed-loop audit of ED waiting times for patients admitted under Trauma and Orthopaedics (T&O), before and after implementation of a change in practice, with the aim of reducing the number of patients that breached the four-hour target.

Method

An initial single-centre audit of patients that were admitted under T&O through ED was undertaken (25/11/2019 – 02/12/2019). All stakeholders were educated on audit findings through departmental meetings. Protocols were updated and new guidelines were synthesised and implemented in collaboration between the ED and T&O departments. Waiting times were re-audited (21/06/2021 – 28/06/2021). Data was collected retrospectively from clinical e-documentation.

Results

57 patients were included in the initial audit and 51 patients in the loop closure. The total number of breaches improved from 86% to 65% (p < 0.05). The first audit highlighted that the biggest cause of breaches was ‘waiting for an ED review’ (56%) followed by ‘waiting for over thirty minutes for a bed’ (28%). Following our intervention, breaches due to ‘waiting for an ED review’ reduced (28%) and the biggest cause of breaches changed to ‘waiting for over thirty minutes for a bed’ (45%).

Conclusions

Our closed-loop audit identified that improved formalised protocols for ED referrals to specialities and clinical guidelines agreed upon by both parties (ED and T&O) reduces the number of breaches in ED.
245 Changing Demographics of Head Injury During the COVID-19 Pandemic
Authors: Chia C.W.L. , Merola J. , Taylor P. , Hayhurst C.
Published: February 2022

Introduction

Studies have shown that men are more likely to sustain head injuries (HI) due to a higher likelihood of participation in high-risk behaviours. However, the COVID-19 lockdown caused substantial alterations to the daily routines of the Welsh population. We aimed to describe the demographical changes of HI patients caused by this large-scale restriction of public social activity.

Method

A retrospective review of our neurosurgical referral database was performed between 1/1/19 to 31/12/20 to extract patient demographics and referral outcomes (admission/advice only) of adult head injury patients. Referrals during lockdown in Wales (26/3/20 – 1/6/20 and 31/10/20 and 2/12/20) were compared with non-lockdown periods in 2019 and 2020.

Results

There was no significant difference in HI referral volume in 2019 (n = 1228) vs 2020 (n = 1179) (OR: 0.71; 95% CI: 0.53 – 0.96, p = 0.02). Women were less likely to be admitted in 2019 (OR: 0.60, 95%CI: 0.39 – 0.91, p = 0.02) and 2020 (OR: 0.52, 95%CI: 0.31–0.88, p = 0.01). We observed evidence of interaction by age and sex in lockdown vs non-lockdown (p = 0.02). Most strikingly, there was higher odds of admission in women aged 40–70 years during lockdown (OR: 10.4, 95%CI: 1.13 – 95.8, p = 0.04).

Conclusions

We observed significant demographical shifts in HI during lockdown periods, with striking increases in admission rates of men under 40 years and women aged 40–70. The cause of these substantial changes need clarification and have important public health implications. Given likely reduced road traffic accidents during lockdown, other factors such as alcohol or assault need considering.
246 A Case Report on Bilateral Spontaneous Carotico-Cavernous Fistula with Literature Review
Authors: Porag R. , Kulkarni G.
Published: February 2022

Background

CCF is an abnormal vascular communication that allows blood to either directly or indirectly flow from the carotid arteries to the cavernous sinus. We present a rare case of spontaneous bilateral direct CCF. Coil embolization is a very effective treatment for CCF.

Case report

86-year-old lady presented in ED with two weeks history of progressive painful, swollen right eye & drooping of eyelid with double vison in left eye. Patient also had a history of intermittent headache and had pulsatile tinnitus in right ear. There was no history of head or eye trauma. On examination, the lady had proptosis, chemosis and restricted movement in right eye, 3rd nerve palsy in left eye. Corrected vision +0.3 in right eye, +0.1 in left eye. Pupils were bilaterally sluggish, there was no relative afferent pupillary defect.

CTA showed bilateral direct CCF along with dilated superior ophthalmic veins on both sides (L>R). No other associated or underlying pathologies were seen.

She was started on oral Acetazolamide, Travoprost and Brimonidine topically. Patient was urgently referred to neurosurgery department and Coil embolization of her CCF was done successfully the following day.

Eye casualty review was done day after her coil embolization. IOP pressure was decreased to normal limits -12 RE and 8 LE. Although her VA was slightly down compared to her preoperative visit, her other symptoms were improving.

Six months later her vision has returned to normal.

Conclusions

Bilateral spontaneous CCF is a rare entity.

Early diagnosis and treatment lead to successful outcomes.

Neuro-radiological intervention is an effective treatment in acute setting.
247 Axillary Hidradenitis Suppurativa: A One-Stage Reconstruction Approach Using Acellular Dermal Substitute
Authors: Dhannoon A. , Hurley C.M. , Carr S. , Hussey A.
Published: February 2022

Hidradenitis suppurativa (HS) is a chronic recurrent debilitating condition. It is characterized by abscesses, and can be complicated by rupture, scarring sinuses. The management of HS is multidisciplinary, involving general lifestyle modification, medical treatment, and surgery. A wide range of surgical interventions have been described for HS disease control and management. However, surgical management strategies are highly variable. We present a case of a 33-year-old female with extensive HS in both axillae resulting in extreme pain, restriction of shoulders movement with severe impact on quality of life. After failure of non-operative management, she underwent a wide excision of all pathological axillary disease. One week later, she had a single-stage reconstruction with Matriderm®. and a meshed split thickness skin graft. Acellular dermal skin substitutes may be an alternative to conventional means of hidradenitis suppurativa reconstruction, producing subtle, pliable, and durable skin.
248 Urethral Self-Insertion of a USB Cable as Sexual Experimentation: A Case Report
Authors: Loufopoulos I. , Kapriniotis K. , Kennedy C. , Huq S. , Reid T. , Sridhar A.
Published: February 2022

Introduction

The insertion of a foreign body in the urethra is an uncommon urological emergency. A wide variety of inserted objects have been described, presenting either asymptomatically or with lower abdominal discomfort and lower urinary tract symptoms. Sexual experimentation and gratification as well as mental disorders are considered the main underlying causes. The aim of this report is to present the case of a USB wire self-insertion and its challenging urological management.

Case Presentation

A 15-year-old male patient presented to his local Accident and Emergency department with gross haematuria following self-insertion of the knotted cable of a USB wire into his urethra in the context of sexual experimentation. Endoscopic approach via rigid cystoscopy and optical urethrotomy was not effective. A suprapubic catheter was inserted, and the patient was urgently transferred to our hospital for tertiary management.

Following radiological assessment to confirm the position of the wire, a longitudinal peno-scrotal incision over the palpable foreign body was made. Urethrotomy revealed the knotted cable in the proximal aspect of the penile urethra, which was cut and removed. Urethra was subsequently closed over a urethral catheter. Postoperative recovery was uneventful, and patient was discharged home with oral antibiotics. Urethral catheter was removed following normal fluoroscopic assessment of the urethra two weeks later.

Conclusions

The management of a foreign urethral body can be challenging and usually requires tertiary expertise to achieve optimal outcomes. Poor initial management could potentially lead to devastating long-term complications such as urethral strictures and fistulas.
256 Implementing and Reinforcing Positive Change to Regional Hand Trauma Service with Introduction of the Golden Patient Initiative
Authors: Jayasuriya N. , Milto K. , Liew M.Y. , Douglas H. , Hughes D. , Rust P.
Published: February 2022

Introduction

Significant theatre delays were identified in hand trauma lists at our regional adult hand surgery unity. We aimed to improve theatre delays by implementing a golden patient initiative.

Method

Literature review identified the golden patient initiative, which ensures first patient on the list is identified, communicated to multidisciplinary team, and is optimized for theatre.

Multi-stage intervention according to change management models (ADKAR and McKinsey 7s) was used. This included (1) a new protocol, (2) educational intervention, 3) poster and (4) a variety of information dissemination methods. To ensure multidisciplinary staff engagement and reinforce positive change, we used multiple verbal, visual and written prompts: trauma co-ordinator-led daily reminders, senior involvement, new column in handover list, verbal reminders at departmental meetings, posters in key areas and widely-accessible reference booklet.

Prospective analysis of theatre utilisation pre- and post-intervention to measure impact of intervention.

Results

Analysis of emergency general list (EG) and local anaesthetic list (LA) start times identified an average 40 and 20-minute-long delays respectively. Following introduction of golden patient there was a reduction in delays by 9 minutes in LA and 5 minutes in EG. The latest start time improvement by 8 minutes in LA and 50 minutes in EG. There was also a reduction in operation delays by 2.8% in LA and 14.3% in EG. The estimated annual cost saved in EG is approximately £45,200.

Conclusions

We believe that implementing sustainable change is a complex and challenging process. Implementing the golden patient initiative resulted in a positive impact on hand trauma services.
258 The Impact of Types of Clerking Document on the Compliance of Initial HAT Risk Assessment on Admission in Trauma and Orthopaedic Patients
Authors: Toe K.K.Z. , Tarar Y.M. , Moussa W. , Shah N.
Published: February 2022

Aim

Assessment of risk of venous thromboembolism (VTE) is crucial as VTE is a significant problem in surgical patients. Trauma and orthopaedic (T&O) patients have additional risks given lower limbs and/or pelvic surgery with restricted mobility periods/ weightbearing status. Risks should be assessed as soon as possible after admission. At this point, clerking is a first point of patients’ information gathering. This study aims to examine the compliance of VTE risk assessment on admission against guideline and its relation to the types of clerking proforma.

Method

A QI project was undertaken using PDSA cycle analysing documents of clerking and VTE risk assessment in 44 T&O patients. Education sessions and routine reminder emails were conducted aimed at oncall doctors receiving admissions. A further 44 patients’ records were audited after 3 months. Primary outcome: VTE risk assessment completion on admission, secondary outcome: impact of types of admission pro-forma upon risk completion rate.

Results

Initial VTE risk assessment compliance was improved after interventions: from 77.27% to 88.63% generally and from 69% to 100% full compliance particularly in neck of femur cases. Use of structured pro-forma can increase the compliance rate of 91.3% (pre-intervention) to 100% (post-intervention) compared to other 2 freehand documents: 91% Vs 85.71% and 30% Vs 63.64%.

Conclusions

VTE risk assessment is improved through education sessions, and it is evident the use of structured clerking document can help to optimize the compliance rate although further sustained input is needed to achieve the targeted compliance rate.
259 Effect of Telegram Videos on Anatomy Education Among 2nd Year Medical Students, University of Khartoum, 2021
Authors: Ibrahim A. , Elhassan A.B.E. , Salman M. , Mohammed O. , Bashir S. , Mohamed N. , Ali M. , Awad K. , Abdelkarem A.
Published: February 2022

Aim

COVID-19 had major effect on the health and medical education. In order to oblige with the social distancing and quarantine, universities shifted to online learning. This study aimed to assess the effect of online education on anatomy DR (dissection room) teaching by the use of telegram software.

Method

This was a cross-sectional, prospective interventional study, which was carried out among 2nd year medical students in University of Khartoum. Students undertook initial tests on the heart and anterior abdominal wall modules. Telegram videos, prepared by the author, on the anatomy of the heart and the anterior abdominal wall were distributed to students. Students took a second test after watching the videos. A total number of 41 students attended heart sessions and 40 students attended the anterior abdominal wall sessions were included.

Results

The pre-test mean score for the heart and abdomen modules were 4.56 ± 2.335 and 6.15 ± 2.94, respectively. The post-tests means were 9.98 ± 2.877 and 8.95 ± 3.14, respectively. 90% and 75% of the students were satisfied with these videos, respectively.

Conclusions

This study revealed that Telegram videos as a method of online teaching had a positive effect on the students' performance, which was evidenced by the significant improvement in student's scores after watching the videos. Additionally, most of the students were satisfied with the videos and give positive feedback.
260 Comparison of Patient Satisfaction and Outcomes of Day Case Mastectomy Versus Inpatient Model, Using a Validated Questionnaire
Authors: Ramasamy S. , Fazel M. , Patel G.
Published: February 2022

Introduction

Many women undergoing simple mastectomy have an overnight hospital stay. Offering a day case procedure for simple mastectomy has the potential to improve outcomes in terms of patient safety, feasibility, and reduction in associated costs. We aimed to study the proportion of day case mastectomies over a 2-year period and assessed relative readmission and complication rates alongside patient reported outcome measures (PROMs). Following this, we wanted to analyse whether a day case procedure should be routinely offered.

Method

A retrospective audit was conducted on all patients undergoing a simple mastectomy. Data were collected from patient and pathology records. PROMs were obtained via telephone conversation using the validated BREAST-Q survey. Patient demographics, reason for mastectomy and readmission for complications were all assessed.

Results

Out of the 202 patients analysed, over 75% had an overnight stay. The most common complications for both groups of patients were readmission due to infection and haematoma evacuation, with similar rates across the two (p = 0.26, p = 0.69). Data from PROMs also suggested that patients had similar outcome and satisfaction levels (p = 0.27).

Conclusions

The result from this study shows that it is safe as well as acceptable to patients to offer simple mastectomies as a day case procedure. This has become more important since COVID-19 reduced inpatient theatre capacity, and it is anticipated that these outcomes will allow a routine day case mastectomy pathway to be established even when normal operations recommence as encouraged by the association of day case surgery.
262 Full Cycle Audit on Definitive Management of Biliary Pancreatitis
Authors: Islam R. , Hashmi Z.Z. , Aljarad F. , Madanur M.A. , Imtiaz N. , Warren R.
Published: February 2022

Aim

To reaudit the practice of definitive management of gall stones pancreatitis in our trust for the period of 1st May-31st October and compare the result with previous one (1st June 2019–31st Dec 2019).

Method

It was a retrospective collection of data of patients admitted to our trust with biliary pancreatitis. Electronic notes, PACS for US report, Electronic discharge summary and Operative notes analysed.

Results

We identified 4 patients admitted with biliary pancreatitis during the re-audit period. US report was checked for confirmation of diagnosis of gall stones. The EDN was checked for date for Laparoscopic cholecystectomy. Unfortunately, none of them had their procedure time in 2 weeks’ time of their diagnosis. The reason behind this was because of COVID-19 pandemic, we were backlogging with our elective list. All the patients eventually underwent their procedure, but not in 2 weeks’ time as per the guidelines. All suitable patients had their cholecystectomy in a timely manner during first audit. None had it in timely manner during second audit.

Conclusions

Early Laparoscopic cholecystectomy for simple gallstone pancreatitis prevents life threatening Pancreatitis and readmissions.

The UK guidelines on management of pancreatitis issued by British society guidelines (BSG) states that all mild gall stones pancreatitis should have definitive management of lithiasis on the same admission or within 2 weeks (Recommendation B). In our practice, all our suitable patients during first audit had timely Laparoscopic cholecystectomy, however, no one had it in timely manner on the next audit for COVID-19 pandemic.
263 Tuberculosis of the Bile Duct: A Rare Cause of Obstructive Jaundice
Authors: Islam R. , Sarder M.M. , Rabbi H. , Arefin M.S.
Published: February 2022

Tuberculosis (TB) is a very rare cause of biliary stricture that is difficult to diagnose and usually requires surgical intervention in order to rule out underlying malignant etiology. A 28-years old woman with obstructive jaundice, who was originally thought to have cholangio-carcinoma. Diagnosis of tuberculosis was made on PCR testing of bile. Patient was started on antitubercular treatment, and she responded well. This case presented a rare case of common bile duct stricture due to biliary tuberculosis. This is an important condition to diagnose because early recognition with prompt treatment results in complete resolution. Even though biliary tuberculosis is a rare cause of obstructive jaundice, in endemic areas, it should be considered as a differential diagnosis and investigated, as it can be potentially curable.
265 Assessing Management of Rib Fractures in the ICU Patient
Authors: Kenny L.
Published: February 2022

Aim

Assess if the General Intensive Care Unit (ICU) are appropriately following trust guidelines on rib fracture management.

Method

Data gathered from patients admitted to the General Intensive Care Unit between March and May 2021 with any diagnosis code involving rib fracture (n = 19). Exclusions: patients not admitted to general ICU, or who died before being extubated.

Of the remaining patients (n  = 14) data gathered on:

Results

All patients were prescribed regular simple analgesia. Most patients were prescribed strong analgesia (n = 10) and lidocaine patches (n = 13). All patients had regular pain assessments. 9 patients were referred for a block/epidural, out of 12 who met criteria for referral. 10 patients were referred for rib fixation, and 4 patients had rib fixation, out of 11 who met criteria for referral. 6 patients developed a LRTI post rib fracture.

Conclusions

The basic management of rib fractures in General ICU is appropriate; 100% of patients had analgesia prescribed and had regular assessments of pain. However, some patients who met criteria for consideration of a block (n = 3) or fixation (n = 1) did not have documentation that they were referred. Rib fractures often do not occur in isolation, and it may be that other injuries served as distractors.
267 Improving the Surgical Teaching Opportunities: A QI Project to Deliver a Course at a Local Hospital Level During COVID-19 Pandemic
Authors: Rezk K. , Alamassi A.
Published: February 2022

Aim

During the COVID-19 pandemic, the training opportunities were markedly disrupted particularly, the surgical teaching which usually requires face to face teaching to help the acquisition of procedural skills. We implemented a QI project in a district hospital to improve the training opportunities for medical students & foundation doctors. The project was a face-to-face free course for teaching generic procedural and clinical skills in surgery.

Method

The course was a mixture of two well-known surgical courses in the UK, Basic Surgical Skills and the CCrISP courses. It included clinical and procedural skills sessions on models which simulated the basic wound closure techniques and types of knots, as well as skin lesion excision training. The course was delivered to medical students, foundation year one & two doctors and core surgical trainees. The improvement achieved by the course was measured by a questionnaire assessing the level of confidence between the candidates before and after each session. The questionnaire’s answers were categorised into (not confident, neutral, confident & very confident).

The course was delivered on two occasions.

Results

The qualitative analysis of the results on two different occasions showed a considerable improvement in the level of confidence between the candidates. They were able to demonstrate engagement throughout the course especially with the procedural skills sessions.

Conclusions

Formulating a course at a local hospital level was an efficient alternative for maximising the training opportunities reduced during the pandemic. It was an impressive opportunity for newly graduated doctors and medical students having any surgical placement.
268 Improve Clerking of Vascular Patients at Royal Devon and Exeter (RDE) Hospital Presenting with Acute Limb Ischaemia (ALI) Using Standardized Electronic Proforma
Authors: Chillarge G. , Abouelella Y. , Burton H.
Published: February 2022

Aim

Improve clerking of vascular patients at Royal Devon and Exeter (RDE) hospital presenting with acute limb ischaemia (ALI) using standardized electronic proforma.

Method

Results

A total of 65 patients presented to vascular surgery during the 3-month period. Of these 20 patients presented with ‘acute limb ischaemia’. Documentation of rest pain (75%), pulses (Dorsalis paedis in 90%) and exam finding of cold feet (95%) was adequate. However, poor documentation of vascular risk factors such as previous stroke (20%) and atrial fibrillation (15%) was identified. ECG was performed on admission in only 35% patients. Examination like ABPI (10%) and Buerger's test (15%) were also inadequately documented.

Conclusions

This audit shows inadequate clerking of vascular patients presenting with ALI. The second cycle will include further data collection post-implementation of the electronic proforma to analyse improvements in documentation of the above-mentioned factors at initial clerking.
270 Mid-Oesophageal Traction Diverticulum in a Patient with Systemic Lupus Erythematosus
Authors: Chillarge G. , O'Neill R. , Safranek P.
Published: February 2022

Oesophageal diverticulae are rare out-pouchings of oesophageal wall with a prevalence of 2/100,000 population/year. Known associations of traction diverticula are causes of mediastinal inflammation including tuberculosis, histoplasmosis, anthracosis, sarcoidosis and rarely systemic lupus erythematosus. Two-thirds of oesophageal diverticula are asymptomatic, and they are a rare cause of dysphagia. Most asymptomatic oesophageal diverticula are managed conservatively with surveillance imaging or endoscopy. Symptomatic patients with diverticula >4cm are usually treated surgically due to the increased risk of aspiration pneumonia and malignancy.

In this report, a case of a large mid-oesophageal traction diverticulum in a 66-year-old female with systemic lupus erythematosus has been presented. She was initially managed conservatively with active surveillance for 6 years. When her symptoms progressed, she had repeat endoscopy and computed tomography scan which showed an increase in size of the diverticulum to 6cm in diameter.

Her dysphagia had progressively deteriorated, and she was only managing a liquid diet. She therefore proceeded to resection of the diverticulum by right thoracotomy and stapled diverticulectomy. She made an excellent post-operative recovery and at last review, 5 months after the operation, she was back at work, had put on weight, and was tolerating a normal diet.

Several surgical/endoscopic treatment options exist for management of oesophageal diverticula, and these must be tailored to every individual case. In this case report, we have compared minimally invasive (laparoscopic/thoracoscopic/robotic assisted) and open (transabdominal/transthoracic) techniques. Patients often have a good symptomatic outcome following surgery. Multi-Disciplinary Team (MDT) involvement with dietetic support is important for optimal recovery of these patients.
272 Factors Influencing Medical Student Future Career Choice – Why Not Surgery?
Authors: Madden S. , Clements J.M. , Martin N. , Kirk S.J.
Published: February 2022

Introduction

Decisions made by medical students on future career choice have demonstrated consistency with resulting postgraduate career path. The aim of this qualitative study was to identify factors influencing career choice amongst medical students in Northern Ireland.

Method

An anonymous voluntary non-monetised survey consisting of binominal, Likert and free text responses was distributed to all medical students registered at Queen’s University Belfast (QUB). Data was collected over 6 weeks in April-May 2021. Primary outcomes were factors influencing future career choice and the secondary outcomes were the impact of finance and mentorship on ultimate career choice. Local ethical approval was obtained.

Results

202 responses were received (Response rate 15%). 67% (n = 135) were female. One third of respondents remained undecided about their future career choice. Respondents were least likely to choose a career in Surgery (33%). Factors positively influencing career choice were academic interest and flexibility in working hours. Negative predictors of career choice were lack of interest in the area, perceived workload, and duration of training schemes. 71% (n = 144) of respondents reported that a subspecialty mentor would positively influence their career choice and two-thirds of respondents reported that financial factors would not influence their career decision.

Conclusions

Surgery was the least the popular specialty. Mentorship, integrating flexibility in training and enhancing academic interest may create greater traction for prospective trainees to surgery.