bluuebunny/crossref_metadata_2025 huggingface dataset:
162 A Closed Loop Audit Assessing and Improving the Quality of Electronic Discharge Documents in a Neurosurgical Ward for Patient Safety and Continuity of Care
Authors: Ali T. , Ho J. , Solth A.
Published: February 2022

Aim

To assess the quality of neurosurgical electronic discharge documents (EDDs) as per the Scottish Intercollegiate Guidelines Network's (SIGN) discharge document guidelines, and to implement interventions to ensure patient safety and continuity of care.

Method

We performed a closed loop audit on the quality of EDDs at the neurosurgical unit at Ninewells Hospital. We collected six sets of two-weeks’ worth of EDDs from the Tayside EDD system coinciding with foundation trainee changeover times for a representative sample of pre- and intra-COVID-19 EDDs. We analysed our findings and developed interventions in collaboration with the MDT. These included a copy-paste template, educational poster, and presentation, and more. We implemented the interventions and reassessed EDDs after three months.

Results

A total of 207 EDDs were included. Pre-interventions, 88% of the EDDs were inadequate in quality when compared to SIGN’s guidelines. This had 33% reduction post-interventions. The percentage of EDDs adequate in quality doubled post-interventions, from 22% to 43%. The most commonly mistaken or missed criterion pre- and post-intervention was the neurological status on admission and discharge. Others were mistaking presenting complaint for diagnosis and vice versa, and not mentioning follow-up or new medications.

Conclusions

Accurate records of care, including discharge documents, are central to the principles of good medical practice outlined by the GMC. This study showed that EDD quality is compromised due to time pressures, lack of information and constant changeover due to COVID-19. We alleviated this by creating accessible interventions that assure safe patient care despite the challenges of changeover and COVID-19.
169 Can Volume Replacement with Local Perforator Flaps Reduce the Trauma to Patients Caused by Mastectomies and Cost of Reconstructions in Breast Cancer Treatment?
Authors: Karagiannidis G. , Mallidis E.
Published: February 2022

Aim

National reported mastectomy rate varies from 25% - 45%. Improved screening and raised breast awareness raise the demand for breast cancer treatment. 25% - 45% of breast cancer treatment will be mastectomies, some of them followed by reconstruction. Mastectomy +/-reconstruction is a traumatic procedure which affects quality of life of patients plus extra cost for NHS for reconstruction. We would like to investigate if the technique of local perforator flaps can reduce the volume of mastectomies.

Method

Retrospective review of yearly breast cancer treatment operations from 2016 to 2020 in Ipswich Hospital.

Results

1367 surgical operations performed for breast cancer.In 2016,52/273(19%) patients had mastectomy and 8/273(2.9%) underwent a perforator flap operation. In 2017, 85/292 (29,1%) had mastectomy and 13/292 (4,4%) had local perforator flap surgery. In 2018, the number of mastectomies was 74/299 (24.7%), while 4/299 (1.3%) patients underwent local perforator flap surgery. In 2019, the amount of perforator flaps increased to 24/305(7.8%) while the mastectomies remained in equivalent percentages [72/305 (23.6%)]. Finally, in 2020, despite the presence of COVID19 and the decrease in surgical management of cancer, 16/198(8.5%) had local perforator flaps surgery and only 34/198 (18%) had mastectomy.0/57 (0,00%) of the local perforator flaps failed.

Conclusions

Local perforator flaps have resulted in 11.1% reduction in mastectomy rate (also reducing reconstructions). The exchange of mastectomy and reconstruction with breast conserving surgery and local perforator flap reduces the operating time and cost of cancer treatment without compromising oncological outcome or patient satisfaction.
177 Broad Ligament Hernia: Two Contrasting Ways to a Common Goal – Two Case Reports
Authors: Harvitkar R.U. , Rohtagi Y. , Joshi A.
Published: February 2022

Introduction

Broad ligament hernia (BLH) is a rare but potentially life-threatening condition. One of the two cases described here is the only reported case of BLH in recent literature, where marsupialization was done. These two case reports comprise the only reported side-by-side pictorial comparison of the two laparoscopic surgical therapeutic options for BLH.

Presentation of cases

Both patients presented with classical symptoms and signs of acute intestinal obstruction. Imaging confirmed obstructed left BLH in case 2 and indicated a complete small bowel obstruction in case 1. Both cases were successfully managed laparoscopically. Both patients had an uneventful immediate postoperative recovery and have not had recurrence over a mean follow-up period of 34.5 months.

Discussion

BLH is rare among all types of internal herniae. It accounts for only 4% of internal herniae and is a difficult condition to diagnose. The advent of computed tomography has increased the chances of accurate preoperative diagnosis.

Conclusion

BLH can be successfully managed by minimally invasive surgery, even in the acute setting. When tightly entrapped bowel is unyielding; it is better not to risk injury to it by aggressive attempts at its reduction. It is safer to attempt widening of the defect into which it is entrapped, whenever feasible.
183 A Systematic Review of Sample Size Calculations in High-Profile Surgical Trials That Use Patient-Reported Outcome Measures.
Authors: Jacklin C. , Rodrigues J. , Collins J. , Cook J. , Harrison C.
Published: February 2022

Background

Patient reported outcome measures (PROMs) are increasingly recognised as a measure of treatment efficacy in randomised controlled trials (RCTs). It can be difficult to determine meaningful target differences in PROM scores for sample size calculations and this can risk over-recruitment and/or erroneous trial conclusions. The Difference ELicitation in TriAls (DELTA2) statement sets recommendations for sample size calculations in RCTs including target difference determination. We aimed to evaluate sample size calculations from high-profile surgical RCTs that used PROMs as their primary outcome, against DELTA2 standards, with a focus on target differences.

Method

Pubmed was systematically searched for surgical RCTs published in the five highest ranking journals, by Thomson Reuters impact factor, for medicine and surgery. Studies were included if surgery was the intervention and/or comparator arm, and a PROM was the primary outcome. Surgery was defined as using instrumentation to change macro-anatomy with the aim of improving health. Data were extracted with a piloted data collection sheet that included the DELTA2 reporting recommendations.

Results

Most target differences used in sample size calculations were determined with suboptimal techniques and target difference justification was overall poor. In this sample, £28 million of UK public research spending supported trials with poor target difference justification.

Conclusions

In this sample of trials, sample size calculations were generally not reported to DELTA2 standards. There was frequent use of sub-optimal methods to determine the target difference. This risks over-recruitment and/or erroneous trial conclusions. Clinicians should be aware of these potential pitfalls when interpreting published trials.
184 Group and Save Studies Prior to Appendicectomy
Authors: Da Costa K. , Islam R. , Peh J. , Gelber E.
Published: February 2022

Aim

Group and save studies prior to appendicectomy

Method

219 appendicectomy cases from Jan 2018 until Dec 2020. This was to look for whether patients had a blood transfusion post appendicectomy. Whether this was cost effective?

Results

19/219 did not have G and S studies performed. None of the patients required a blood transfusion post operatively. Price per bottle £20

Conclusions

Based on the above results we referred to the study performed by the RCS

Royal College of Surgeons did a study on ‘blood group and antibody screening prior to emergency laparoscopy’. Study included 562 cases. Concluded that routine G&S studies are not required and ‘majority of patients had a low risk of major intraoperative haemorrhage’ and thus G&S was not warranted O –ve blood can be used in cases of acute haemorrhage from major vessel injury Time taken to receive O neg blood = minutes.
192 An Early Innovation Report of an Epidermal Ventriculoperitoneal (VP) Shunt Pressure Sensor
Authors: Ho J.W. , Savvidis P. , Ismail M. A , Zonza S. , Kamath A. , Needham A. , Carmona Sánchez R.d.C. , Liao H. , Teo Mario.
Published: February 2022

Introduction

Ventriculoperitoneal shunt insertion, a common procedure for hydrocephalus, has a revision rate of approximately 20–30% within the first year, and continues to increase with each consecutive year. In Leeds, the average work-up cost for suspected shunt malfunctions was £765/patient. Additionally, patients with malfunctioning shunts present with vague symptoms potentially contributing to delayed presentation, especially important in Low-Middle Income Countries (LMICs) where neurosurgical expertise is less accessible. To reduce investigative costs and delayed presentations, we sought to design an epidermal shunt reservoir sensor to detect shunt malfunction by measuring the reservoir pressure.

Method

Literature searches were conducted to identify a proof of concept and suitable materials to engineer a concept device based on a Failure Modes and Effects Analysis (FMEA) table with design specifications to assess relative clinical risks. Using the IDEAL-D Framework, we designed our low-fidelity prototype using Solidworks® software.

Results

Literature revealed several devices aimed to detect shunt malfunctions. For our concept device, our focus was an accurate sensor and reliable connectivity. Our prototype uses gold nanowires to achieve high sensitivity to pressure change, as small as 15mPa. Near-field communication (NFC) for connectivity has less power requirement and has rapid connectivity compared to Bluetooth. Estimated cost of the device is £500.

Conclusions

Our device, in Stage 0 of the IDEAL-D Framework, identified potential sensors and connectivity methods. We could utilise magnets to adhere to the reservoir with overlying hair. However, magnetic fields and atmospheric pressure could cause interference. Power source options still require exploring before benchtop testing for accuracy, interference, and feasibility.
198 Caveat Chirurgicus- Opioid Use Following Surgery
Authors: Vijayagopal K.A. , Majeed T. , Wilson J. , Magee C.
Published: February 2022

Introduction

Over the last 20-years there has been increasing opioid related deaths, in the context of a worldwide epidemic of misuse including addiction and overdose. Startlingly, opioid commencement is usually iatrogenic. Most published data is from the USA with little evidence from UK surgical practice.

Method

Retrospective analysis of surgical unit opioid prescriptions. Data included opioids prescribed on discharge, 1, 3- and 6-months post-discharge usage and milligrams-of-morphine equivalence(mgEq) used to compare regimes.

Results

One hundred cases reviewed. 35% of patients were opioid naïve on admission and of these 20%, 5.71% and 8.57% remained on opioids at 1, 3- and 6-months post discharge respectively.

Females more likely to remain on long-term opioids at 6 months at lower doses (42% v 30%).

Only 6% of discharge summaries recommended GP follow-up and assessment of opioid requirements. Furthermore, none were prescribed a tapering dosage regime on-discharge.

Patients receiving Acute Pain Team reviews, more likely to remain on long-term opioids, at lower doses (30.67mgEq, 29.25mgEq and 32.63mgEq at 1-, 3- and 6-months post-discharge) compared to those without (69.16mgEq, 74.25mgEq and 65.13mgEq).

Only 11% of patients with pre-existing opioid prescriptions were reviewed by the acute pain team.

Worryingly, there was no documented assessment of opioid misuse risk in patients.

Conclusions

Standardised assessments i.e., opioid Risk Assessment Tools and mgEq need to be documented and monitored in primary and tertiary care. Acute pain team services should be offered to more patients. Our study hopes to raise awareness of the need for effective opioid stewardship in surgical patients.
219 The Opportunities and Challenges of Robotic Surgery: A Surgeon and Robotic Company Perspective
Authors: Ramesh N. , Talajia K. , Anwar M. , Arshad S. , Xu S. , Brar G. , ter Wal A.
Published: February 2022

Introduction

As an increasing number of specialties have begun to adopt robotic surgery (RS), its prevalence within the NHS is continually rising. This study aims to establish stakeholders’ opinions on the opportunities and challenges of the widespread adoption of RS.

Method

Participants were recruited through social media platforms such as LinkedIn or via university affiliations and current RS research. Semi-structured interviews of eight surgeons and five company representatives were conducted online. Transcripts were analysed to formulate themes surrounding the opportunities and challenges of RS.

Results

This study identified six common themes amongst shareholders: Perspective, Ethics, Impact of Robotics, Training, Adoption and Finances. The success rates and quality of results offered by RS make it a recognised future surgical staple amongst interviewees. However, the technology remains a contentious subject amongst surgeons, with many doubting whether the benefits outweigh the costs associated with implementation. Such reservations are further exacerbated by the absence of a formal training pathway. National guidelines are necessary to embed RS within the NHS infrastructure, allowing greater standardisation for patients and surgeons. The importance of patient education to address misconceptions was emphasised. Despite current high costs, robotic technology is forecasted to become cheaper with greater use and increased market competition. Interviewees stressed that responsibility for errors lies with the surgeon, but with the manufacturer for instrument malfunctions.

Conclusions

This study highlights stakeholders’ views on the opportunities and challenges of RS. The identified themes should form the basis of the proposed recommendations to facilitate a more widespread adoption of RS.
231 Diagnostic Outcomes in Suspected Appendicitis Before and During the COVID-19 Pandemic
Authors: Vera V. , Ashcroft J. , Bennett J. , Davies R.J.
Published: February 2022

Introduction

Routine operative treatment of appendicitis was temporarily interrupted during the COVID-19 pandemic. Non-operative management in suspected appendicitis makes a definitive diagnosis difficult. This study investigated diagnostic outcomes of suspected appendicitis patients before and during COVID-19.

Method

A retrospective review of patients aged 16–45 undergoing treatment for suspected appendicitis pre-COVID-19 (1st January 2019–1st January 2020) and during the COVID-19 pandemic (1st March 2020 to 31st June 2020) was performed. Patients were followed up for one year (31st June 2021) to explore diagnostic outcomes.

Results

At one year follow up, 206 patients were identified in the pre-COVID-19 cohort with 100% (n = 206) undergoing an appendicectomy. On histopathological examination 77.2% (n = 159) had appendicitis; 10.7% (n = 22) another pathology; 2.9% (n = 6) neuroendocrine tumour. There were 62 patients in the COVID-19 cohort in which 79% (n = 49) underwent appendicectomy (56% (n = 35) immediate appendicectomy; 23% (n = 13) interval appendicectomy). On histopathological examination 61% (n = 38) had appendicitis; 13% (n = 8) another pathology; 5% (n = 3) neuroendocrine tumour.

Of the remaining 13/62 patients, one had undergone a CT scan and colonoscopy for gastrointestinal symptoms demonstrating signs of chronic caecal inflammation treated conservatively. One underwent a CT scan alone for gastrointestinal symptoms finding no pathology. The remaining 11/62 patients had no further reported symptoms or diagnostics.

Conclusions

This study demonstrates that the risk of appendiceal malignancy and chronic inflammation is important in non-operative management of suspected appendicitis and establishing consistent follow up pathways is essential.
232 “SuturesApp”: A Digital Application to Improve Cancer Patients” Understanding of Surgical Procedures
Authors: Essangri H. , Bensbih S. , Majbar M.A. , Benkabbou A. , Souadka A.
Published: February 2022

Aim

Patient participation in decision making is of utmost importance, particularly in oncological surgery where body image altering procedures may be required. “SuturesApp” is a digital application developed by oncological surgeons in a low-middle income setting and where users can replicate any resection and/or reconstruction technique on the screen. The study is an interpretation of surgical residents’ opinion of the use of a digital application in comparison to traditional modalities (pen and paper) used to explain surgical procedures to patients.

Method

This is a qualitative study using semi-structured interviews conducted with surgical trainees following the use of “SuturesApp” for a 1-week period from July 13th to July 20th, 2020, in order to depict possible outcomes of “SuturesApp” use in comparison to pen and paper in explaining surgical procedures and body image changes in oncological surgery. Participants number was determined according to data saturation when no more new themes emerged from the individual interviews.

Results

Fifteen surgical residents were interviewed after using “SuturesApp'' for a 1-week period in preoperative consultations. Successful patient-surgeon communication faces the challenges of workload and illiteracy, which surgical residents try to overcome with verbal communication and drawing. The use of SuturesApp can provide a frame for the progressive explanation and visualization of procedures, despite the need for improvements.

Conclusions

The use of SuturesApp alongside verbal communication and drawing can benefit patient understanding and adherence to treatment, as well as future surgeons’ communication skills. A next step would be to further develop “SuturesApp” and engage patients in the process.
237 Antibiotic Prophylaxis of Precision Point Prostate Biopsy Under LA: Changed Practice in a District General Hospital
Authors: Islam F. , Saiyara N. , Fazili Z. , Shahid J.
Published: February 2022

Aim

More than 4 million prostate biopsies are performed worldwide each year (1). Out of three different techniques (Template, transperineal, TRUS), Transperineal precision point biopsy under local anaesthesia is the latest and reported to have fewer infectious complications (2). UTI, Urosepsis, septicaemia are some well-known infectious complications following prostate biopsies. Therefore, the Canadian Urological Association recommended the use of broad-based Gram-negative antibiotic prophylaxis 30 to 60 minutes before the procedure and continued for 2 to 3 days in their guideline (3). Our aim was to compare the outcome of two different antibiotic prophylaxis regimens.

Method

In our study to assess the outcome of single-dose prophylaxis compared to regular dose, we collected retrospective data of 119 patients who had undergone precision point biopsy in our hospital.

Results

Among 119 patients, 52 (43.69%) were given 3 days of oral antibiotic followed by preprocedural dose and 67 (56.31%) were given just a single dose before the procedure. None of these patients from both groups were readmitted with any infectious complication post-procedure. 1 patient from the second group (single dose) was admitted with urinary retention but no increased inflammatory markers were found.

Conclusions

TRUS biopsy breeches the rectal mucosa and carries higher chances of post-biopsy infection so requires antibiotic prophylaxis. Single-dose antibiotic prophylaxis is recommended option for transperineal biopsies as the infection rate is lower. Our study shows the same outcome for single-dose and 3-day regimens for transperineal precision point prostate biopsy. Moreover, the use of single dose will significantly reduce medicine costs and antibiotic resistance to improve patient compliance.
239 Surgical Techniques Relating to First Carpometacarpal Joint Osteoarthritis - a Hand Therapy Perspective
Authors: Menon D. , Stavropoulos S.
Published: February 2022

Introduction

First carpometacarpal joint (CMCJ) osteoarthritis contributes a significant burden of disease. Patients with unremitting disease, despite conservative measures, may be considered for surgical intervention. Evidence has not identified superior outcomes relating to any one particular surgical technique. This study aims to identify whether a predisposition and preference towards an intervention exists in UK practice from the hand physiotherapist perspective.

Method

An online questionnaire was distributed to UK-based hand therapists by electronic mail. Seven commonly utilised techniques in the management of first CMCJ osteoarthritis were listed as treatment options. Questions included demographic information, procedural experience, and ranking of these treatment options based on perceived post-operative functional outcomes.

Results

32 responses were recorded. All listed techniques were performed in UK practice. Trapeziectomy alone was the most widely used option, with 94% (n = 31) of respondents stating this intervention was performed in their centre of practice. Trapeziectomy with ligament reconstruction and interposition (LRTI) was associated with the highest rating relating to post-operative functional outcome as perceived by hand therapists. Partial arthroscopic trapezium resection with spacer was not favoured, with the lowest rating reported.

Conclusions

This study has identified that trapeziectomy alone remains a widely used operative technique in first CMCJ osteoarthritis in UK practice with good post-operative outcomes relative to other options as perceived by hand therapists. The most favourable intervention was trapeziectomy with LRTI. However, no significant relationship was identified between the pre-defined interventional options and rating, which may suggest no superiority in any one particular technique.
244 The Lessons Learned from Managing Malignant Melanoma During COVID-19 Pandemic in a Plastic Surgery Unit in Ireland
Authors: Dhannoon A. , Hurley C.M. , Regan P.J.
Published: February 2022

Aim

The COVID-19 pandemic continues to present unprecedented challenges for healthcare systems. This has resulted in the pragmatic shift in practice of plastic surgery units worldwide. Many units reported a significant fall in urgent melanoma referrals, leading to patients presenting with advanced disease. Our objective was to evaluate our unit's experience with both non-invasive and invasive melanoma during the COVID-19 pandemic and compare it to the UK, mainland Europe and North America.

Method

A Retrospective chart review was performed on all patients diagnosed with invasive and non-invasive cutaneous melanoma between March to December of 2019 (control) compared to 2020 (COVID-19 pandemic) in a single plastic surgery unit in Ireland.

Results

A total of 589 patients were included in the study. Of these, 314 (53%) with invasive melanoma, compared to 275 (47%) with non-invasive disease. Overall, more patients were diagnosed with both invasive and non-invasive melanoma in 2020 than 2019 (p<0.05). However, significantly longer waiting times in 2020 (64 days) compared to 2019 (28 days) (p<0.05) with the majority of referral being from GP in 2019 (83%) compared to 61% in 2020. Positive sentinel lymph node was higher in 2019 at 56% (n = 28) compared to 24% (n = 22) in 2020. There was no statistically significant difference in the tutor characteristics or metastasis status.

Conclusions

Our study highlights that with prompt efficient restructuring of services, including governmental agreement to utilise private sector to continue urgent elective surgery, virtual triaging and follow-up and most importantly virtual complex skin multidisciplinary team meeting, we could reserve successful management of skin cancer even in the most devastating times.
253 Innovative Teaching Early in Medical Career to Expose Medical Students to Surgery
Authors: Hennessy M. , Johnson J. , Spence T. , Justusson D. , Paladugu M. , Shetty V.
Published: February 2022

Aim

At Lancashire Teaching Hospitals medical students begin their clinical career in Year 3 and are posted in General Surgery for 4 weeks, a relatively short period to experience the wide variety of surgical specialities and operative techniques. A surgical skills course - Lancashire Teaching Hospitals Surgical Skills for Medical Students (LTHSSMS) was designed and piloted. The aim was to assess the student experience of the LTHSSMS course conducted for Year 3 students at Lancashire Teaching Hospitals in 2019.

Method

This all-day course was optional, taught in groups of 15 students per course with a minimum of 2 experienced tutors. The LTHSSMS course included practical skills such as scrubbing, gloving, surgical knotting, suturing, excision of skin lesions and local anaesthetic techniques. It also included lectures on suture materials, abdominal incisions, laparoscopic and robotic surgery. There were interactive discussions to include non-technical skills, theatre in brief and WHO checklist.

Results

95% (n- 86) of students posted in surgery attended the course. 86.3% (n-75) felt the course was very relevant for their training. 90.7% (n-78) stated they enjoyed the course and 98.8% (n-85) stated they would recommend the course to fellow third-year students. 97.7% (n-84) stated the tutors delivered the course in an enthusiastic and positive manner. 79.1% (n-68) rated the audio video as excellent.

Conclusions

This course has provided a high impact surgical experience for the medical students at the beginning of their clinical careers. Similar opportunities if made available to students in all medical schools could improve and renew the interest in a surgical career.
255 An Audit on the Knowledge of Junior Doctors About DKA at a Local Hospital, Khartoum, Sudan
Authors: Elhassan A.B.E. , Ibrahim A. , Salman M.S.T. , Ali Al. , Mohammed O.A.A. , Bashir S.A.T. , Mohamed N.E.M. , Ali M. , Abdalla N.
Published: February 2022

Aim

DKA is the most common cause of death in pediatric patients with insulin-dependent diabetes mellitus (IDDM). Junior doctors have a significant role in the management of those patients. We conducted this audit to assess and improve the knowledge of house officers about the characteristic features and management of DKA.

Method

The audit was conducted in Alshuhada hospital, Khartoum. It consisted of two cycles (2019–2021). A 14 items questionnaire based on Sudan Diabetes Mellitus guidelines 2011 was used for the assessment. All house officers in the department of pediatrics were involved in this study. Teaching sessions were used as an intervention in the first cycle, while poster presentations and teaching sessions were used in the second cycle.

Results

Nine house officers participated in the first cycle, while seven house officers were involved during the second cycle. The correct choice of initial fluid correction was selected by 55.5%, 88.8%, and 100% of the house officers before the first cycle, after the first cycle, and after the second cycle, respectively. The figures for the initial management of cerebral edema also rose from 33.3% to 66.7% after the first cycle and reached 100% after the second cycle. The percentage of house officers who identified Investigations needed in suspected cases of DKA improved with each cycle, from 66% to 77% in the first cycle and increased to 100% after the second cycle.

Conclusions

Teaching sessions and posters helped to improve the knowledge of the House officers about the diagnosis and management of DKA.
295 Ear Conditions in Adult Patients with Learning Disabilities and Autism: A New Approach to Outpatient Management
Authors: Hundle A. , Atkins S. , McAnenny S. , Lindley K. , Whittaker H. , Dalton C.L.
Published: February 2022

Introduction

Patients with learning disability and autism (PwLDA) are a priority group for care quality and outcomes improvement in the NHS Long Term Plan. The aim of this project was to establish a new standard of care for PwLDA in our otology department.

Method

We first conducted a retrospective analysis of PwLDA who accessed routine adult otology clinics (RCs) between August-October 2020. We assessed achievement in four broad outcome domains: i) documentation of patient-specific special needs; ii) examination of ears; iii) assessment of hearing; iv) completion of hospital passport. We then formed a multidisciplinary team (MDT), which introduced specialised MDT-clinics (SCs) for PwLDA with otology conditions. These SCs were continuously improved by incorporating reasonable adjustments. We subsequently performed a retrospective analysis of PwLDA reviewed in the initial four months of SCs. This enabled a comparison between the type of clinic, RCs or SCs, and the achievement of specific outcomes. This interaction was statistically analysed using Chi-squared test.

Results

A mean of 7.7 and 5.0 PwLDA per month were booked into RCs and SCs respectively. Type of clinic had a significant effect on achievement of outcomes in domains i. and iv. (χ2 (1)>10.3; p<0.005) favouring attendance at SCs. There was no significant interaction for these variables in domains ii. and iii.

Conclusions

This is the first dedicated otology MDT service for PwLDA in the UK. Overall, these results demonstrate an improvement following implementation of the SCs. This innovative work establishes a new MDT-clinic outpatient model for PwLDA who suffer with ear- and hearing-related conditions.
323 Carcinoma of Prostate Masquerading as Retroperitoneal Lymphoma
Authors: Kale S. , Rashid T.
Published: February 2022

Prostate cancer is the fifth most common malignancy worldwide and the second most common in men. It usually metastasizes to the bony skeleton, followed by lung, liver, pleura, and adrenals. We report a 71-year-old male patient who initially presented only with retroperitoneal lymphadenopathy and constitutional symptoms, misleading the diagnosis of retroperitoneal lymphoma. Who later on was discovered to have carcinoma prostate.
325 Improving the Documentation in the Consent Form for Patients Lacking Capacity: A Completed Audit Cycle
Authors: Al-Kharouf K. , George A. , Elbayyar O.
Published: February 2022

Aim

According to GMC guidance, we are bound to discuss with close members of the patients to consider their views and reach the consensus of clinical management when patients lack capacity to make decisions. Our audit aimed to compare the practice of our institution against this guidance and instigate changes as necessary.

Method

We collected data of 30 randomly selected patients with dementia, undergoing emergency orthopaedic operations, from February to April 2021 in the first cycle. The data were collected from medical notes prospectively. The findings were presented in the local meeting. The implementations involved raising awareness of the GMC guidance among the members of the Trauma & Orthopaedics team by organizing a teaching session, creating posters, and sending an email from the clinical lead to the staff members to highlight the audit result. It was followed by the second audit cycle, which included 40 patients from June to August 2021.

Results

The first cycle revealed that there was only 36% compliance to the GMC guidance in our department, since only 9 out of the 30 cases had documentation about the discussion with the appropriate family member. The compliance rate of the second cycle (40 patients) saw a huge improvement up to 83%.

Conclusions

Significant improvement in documentation of the socially and medicolegally important discussion with the close contact of the patient was achieved. This was done by identifying the area which needed improvement and instigating changes in our department. Further audit loops will be conducted in due course to sustain this achievement.
329 Virtual Orthopaedic Trauma Meetings, Is This the Future?
Authors: Toma O. , Karagiannidis G.
Published: February 2022

Aim

The Covid -19 pandemic has drastically altered how we conduct handover meetings. To adapt to the new restrictions, the daily ‘’Trauma Meeting’’ for the Trauma & Orthopaedic department was conducted utilising Microsoft ‘’Teams’’. We present our experience of the ‘’Teams Trauma meeting’’ at Colchester hospital, Essex, UK.

Method

All T&O department members (both clinical and non-clinical) were provided with a secure Teams link and could participate from any location.

Results

Both clinical and management members joined the meeting allowing for real coordination, especially in allocating extra theatre space. Due to shift work patterns, the virtual trauma meeting allowed personnel who were off shift to participate while being off site, eliminating the need to commute to work. We noted improved case discussions with specialist teams. Teaching was provided to junior clinicians who were off shift. Previous trauma meetings were reliant on a single screen to view radiology investigations, this made viewing details difficult from members seated at a distance. The virtual meeting resolved this issue. T&O members can now participate in the meeting from a location of their convenience rather than being limited by office space. Members have expressed satisfaction with the current set up and desire to continue utilising ‘’virtual meetings’’ in addition to in-person attendance post pandemic.

Conclusions

The ‘’Teams Trauma Meeting’’ is a safe, convenient, and reliable method of handover and case discussion in T&O. We hope to expand to include medical students attending their T&O rotation, providing teaching while observing Covid-19 restrictions.
344 Interval Ultrasound Scanning in Idiopathic Pancreatitis - Are We Following Up Patients Appropriately?
Authors: Pringle H. , Ghandour O. , Okocha M.
Published: February 2022

Aim

Acute pancreatitis of unknown cause requires investigation to identify reversible causes of the disease before classifying it as truly idiopathic. This study reports on the follow-up of patients in a district general hospital (DGH) who were diagnosed with acute pancreatitis of unknown cause compared to the gold standard evaluation of the disease by interval abdominal ultrasound scan (US) or outpatient endoscopic US.

Method

Inclusion criteria was all patients discharged from the DGH with a diagnosis of acute pancreatitis and no cause described on the discharge summary from 1st January 2021 to 30th June 2021. The primary outcome was outpatient abdominal US follow-up. Secondary outcomes included an endoscopic US booked as an outpatient. Patients with gallstones identified on imaging or with another identified cause of the acute pancreatitis were excluded.

Results

50% (12 out of 24) patients did not receive follow-up US or any other imaging. Of the patients who did receive follow-up imaging 50% (6 out of 12) had a magnetic resonance imaging (MRI) abdomen or magnetic resonance cholangiopancreatography (MRCP) and the remainder 50% had an abdominal US. 12.5% of patients (3 out of 24) had an outpatient endoscopic US requested.

Conclusions

Management of patients with acute pancreatitis is costly at an estimated £303 per night. To reduce likelihood of future unnecessary admissions, patients require appropriate investigation to have any reversible causes identified and managed. In a system which has suffered bed shortages and significant financial restraints we need to ensure these patients are not lost to US follow-up.
348 The New Normal? – a Survey of Patients’ and Clinicians’ Satisfaction of Remote Consultations During the COVID-19 Pandemic
Authors: Byrne H. , Roslan F. , Kasbia H. , Alzuri H. , Kazi S. , Sheikh F. , Ahmed J.
Published: February 2022

Aim

Remote consultations (RC) were implemented during the COVID-19 pandemic with the aim of preventing transmission of the virus. We conducted a survey to assess patients’ and clinicians’ satisfaction of RC.

Method

Two online surveys were created for patient and clinician feedback, and each recorded a cohorts' opinions on various aspects of RC. The surveys were distributed to Urology, General and Vascular surgery departments at three NHS trusts. Patient feedback was collected over the phone, whilst clinicians completed the survey online.

Results

Overall, responses from 99 patients and 22 clinicians were collected. 89.9% of patients were either ‘satisfied or very satisfied’ with RC, compared to 77.2% of clinicians who practiced RC. 93.9 % of patients felt they were able to discuss all their concerns during their RC. However, outside of the COVID-19 setting 50% of patients and 59.1% of clinicians would prefer face to face consultations. Both cohorts reported adherence to social distancing and convenience as key advantages of RC; furthermore 68.2% of clinicians thought RC were economically beneficial. 100% of clinicians felt the inability to examine patients was a disadvantage of RC and 33.8% of patients agreed with this.

Conclusions

The majority of feedback from patients and clinicians was positive for RC. However, in future approximately 55% of both cohorts would prefer face to face consultations. Looking forward, we believe RC can form a part of routine practice in selected groups of patients, where it could potentially save time and money without compromising patient or clinician satisfaction.
351 Oral Opioids vs Patient Controlled Analgesia: Efficacy of Analgesia Post Lung Resection and Association with Postoperative Bronchoscopy and Bronchial Aspiration – a Single Center Observational Retrospective Study
Authors: Dey A. , Khan N. , DiChiara F.
Published: February 2022

Aim

Respiratory complications arising from disrupted evacuation of bronchopulmonary secretions are frequently encountered following anatomical lung resections. In cases refractory to mucolytics and chest physiotherapy, definitive management usually entails bronchoscopic aspiration. Pain is an important precipitating factor for sputum retention impeding mucociliary clearance and productive cough. Opioids remain the mainstay of postoperative analgesia but can also promote retention of secretions due to their anti-tussive properties and ventilatory depression. In this study, we aimed to review the efficacy of oral opioids against patient-controlled analgesia (PCA) in immediate post-operative period. We further explored if use of PCA predisposed to post-operative bronchoscopy.

Method

A retrospective case note analysis was conducted for all 329 patients undergoing lung resections (lobectomy, wedge resection, segmentectomy, pneumonectomy, metastasectomy both via thoracotomy and VATS approach) between May 2016 and December 2019 in a Thoracic Surgery Unit under a single consultant surgeon.

Results

Of the 329 patients undergoing lung resections, 46.8% patients received oral opioids and remaining 53.1% received PCA for immediate postoperative pain management. Pain scores at rest were documented for 48.02% patients – scores calculated at 10.39+/-8.7 hours after completion of surgery were 1.023+/-0.754 for the PCA cohort and 0.904+/-0.756 for patients receiving oral opioids (p = 0.131). 13 patients were noted to undergo bronchoscopy to aid in secretion clearance. Univariate analysis failed to establish a correlation between use of PCA and incidence of post-operative bronchoscopy (p = 0.603).

Conclusions

PCA is not associated with significant sputum retention necessitating bronchoscopic aspiration. It, however, does not offer superior analgesia for static pain compared to oral opioids.
368 Challenges Moving to a Fully Electronic System: An Audit
Authors: John H. , Donnachie D. , Shapev M.
Published: February 2022

Aim

In October 2020, our hospital moved to an all-online clinical record keeping system, resulting in clinicians becoming responsible for electronically requesting follow up appointments at the time of each clinical encounter. We aimed to ensure that with the introduction of the new computing system, appropriate follow up was booked and all members of staff were proficient in utilising this new system.

Method

Operative notes were reviewed to obtain the requirements for follow up, specifically for wound assessment clinic (WAC), hand therapy (HT) and outpatient clinic (OPC). Patient charts were then reviewed to ascertain if planned follow up happened, was booked, or was requested. We re-audited this 4 months later, following departmental education.

Results

In the first week of using the new electronic system, 100% of required WAC (24/24) and HT (13/13) follow up appointments were completed, however 14% (4/27) of required OPC appointments had not been requested.

Following departmental education, the re-audit found similar results, however the 12% (4/31) of cases where OPC follow up was not requested, it was not specified in the operation note whether or not this was required.

Conclusions

When introducing new clinical systems there is potential for unfamiliarity with use to impact on patient care, even after trust-wide training. It is important to bear this in mind and continue to audit and educate staff, implementing appropriate safety netting systems. Detailing the follow up plan in operation notes, including when follow up is not required, improves communication between staff and ensures required follow up is not lost.
372 Efficacy of Enhanced Figure of 8 Percutaneous Repair of Failed Closed Soft Tissue Mallet Finger
Authors: Alsadoun L. , Eltentawy T.
Published: February 2022

Introduction

Chronic tendinous mallet finger injuries are commonly treated with an open operative fixation.

Aim

To evaluate a new technique of closed reduction and fixation using a percutaneous figure of 8 suture for treating closed tendinous mallet finger injury.

Method

We conducted a retrospective analysis of prospectively collected data of 8 consecutive patients, undergoing percutaneous fixation of chronic mallet finger injuries. All patients had failed conservative splinting of duration 10.5 weeks (9–12 weeks) with a residual extensor lag of the distal interphalangeal joint greater than 30 degrees. Surgery was performed using a minimally invasive technique using a 3–0 proline suture in a percutaneous figure of 8 pattern, by going through the periosteum on both sides and providing rigid hyperextension. Patients were kept in a splint for 7 days followed by full mobilisation under supervision of hand therapists.

Results

The average age of our cohort was 51 (40–62 years old). At an average of 6.2 months All patients achieved correction of deformity to less than10 degrees. The overall functional outcome was good to excellent in all patients with no incidence of recurrence at last follow up. There was no instance of skin necrosis or wound complications in any of the patients.

Conclusions

The new figure of 8 percutaneous technique is an effective, safe, and minimally invasive approach for closed tendinous mallet finger injures. This needs further validation by analysing outcomes in a larger cohort.
376 Prognosis in Patients Presenting with Non-Reactive Pupils with a Chronic Subdural Haematoma
Authors: Edwards B. , Zolnourian A. , Sadek A.R.
Published: February 2022

Introduction

Chronic subdural haematoma (CSDH) is a common neurosurgical pathology which is increasing in prevalence due to the ageing population. Predicting neurological outcome from defined metrics following surgery for CSDH is key to defining a neuroprognostic tool. Non-reactive pupils, due to coma, is recognised as an indicator of raised intracranial pressure (ICP) and poorer neurological outcome. There remains limited evidence defining its exact effect on outcome in patients with CSDH.

Method

Data from 1278 patients surgically managed for CSDH between 2009 and 2019 were retrospectively reviewed. Those with a GCS of 8 or less pre-operatively were identified (n = 77). These patient’s pupillary response at presentation, inpatient mortality, and Glasgow Outcome Score (GOS) on discharge were recorded from electronic and paper notes.

Results

8 patients (10.3%) had a non-reactive pupil at presentation. 4 patients with an unreactive pupil died as inpatients (50% mortality) versus 2 with bilaterally reactive pupils (2.8%) (p<0.01). Overall, only 1 survivor with non-reactive pupils had a good neurological outcome (GOS 4 or 5) meaning 7 or 87.5% had a poor neurological outcome (GOS 1-3) (p = 0.03). This compares to 35 patients or 50.7% having a poor neurological outcome in the bilaterally reactive pupil group. There is a statistically significant difference in mortality and morbidity in patients with a non-reactive pupil.

Conclusions

An unreactive pupil is a poor prognostic indicator of morbidity and mortality in patients presenting with CSDH.
383 Introduction of a Burns Admission Proforma to Improve Patient Admission Clerking and Management
Authors: Rose A. , Carter J.
Published: February 2022

Introduction

Patients who suffer burns present with a variation in the cause, depth, and size of their burns. A number of factors are important in determining the successful management of these patients such as age, cause, time since burn, first aid, co-morbidities, medication, burn size, depth and area, associated injuries, and social circumstances. Appropriate documentation, assessment, and examination in order to guide treatment is therefore imperative to good management and positive outcomes. We performed an audit of admission documentation to our burns unit and introduced a proforma to determine whether there was an improvement in important assessment criteria in order to enhance patient care.

Method

We retrospectively assessed burns admission documentation in 25 patients recently admitted against important assessment criteria. We then introduced a burns admission proforma to the unit and collected the results of 25 further patients in which the proforma was used.

Results

Introduction of the proforma showed an improvement in documentation, examination, and recorded management in almost all areas assessed, excluding allergies where there was a reduction.

Conclusions

Use of a proforma is beneficial in enhancing patient admission documentation and assessment, therefore directing appropriate management by focusing on all areas of patient care. However, the content of the proforma results in adherence to the assigned assessment parameters with limited deviation. Therefore, it is important when using a proforma to include all areas which are important to assessment otherwise they may be overlooked. Their use could be expanded to local emergency departments to ensure appropriate initial assessment, resuscitative management, and referral.