bluuebunny/crossref_metadata_2025 huggingface dataset:
1134 Audit on Timeliness of Imaging in Bicep Tendon Ruptures
Authors: Devashetty A
Published: August 2024

Aim

This audit aimed to assess the time interval between the date of injury and the acquisition of imaging for patients suspected of bicep tendon ruptures. The primary objective was to identify areas for improvement in reducing delays and optimizing the diagnostic timeline.

Method

A retrospective analysis was conducted on a cohort of 28 patients presenting with suspected bicep tendon ruptures between January 2022 and September 2023 at Basingstoke North Hampshire Hospital. Electronic medical records were systematically reviewed to extract data on the time elapsed from the reported date of injury to the date of imaging, encompassing modalities such as ultrasound and magnetic resonance imaging (MRI).

Results

The audit revealed considerable variability in the time taken to obtain imaging from date of presentation, with an average duration of 7.8 days. The average time from date of presentation to surgery performed was 23.2 days. Notably, delays were mainly due to patient unattendance and scheduling appointments for scans.

Conclusions

The findings underscore the importance of streamlining the diagnostic pathway for bicep tendon ruptures to reduce the time between injury and imaging/surgical procedure.
1167 A Closed Loop Audit to Benchmark Care for Emergency Department Attendances with Renal Colic
Authors: Dehbokri A , Mayer C P , Ariyanayagam D
Published: August 2024

Aim

Benchmark care against the NICE Standards for assessment and management of Renal Colic patients. Produce patient leaflet highlighting stone diet. Re-audit and assess care for renal colic patient, following he introduced changes in first cycle including patient leaflet & renal order-set. Highlight areas that may need improvement and improve the awareness clinicians.

Method

Using electronic system and notes, care for the most recent 150 patients attending St Heliers and Epsom A&E, coded on system as “Ureteric Stones”, was benchmarked against NICE guidance during two cycles (2022 & 2023) as bellow:CTKUB request, completion, and report timeTime between arrival, prescription, delivery & choice of analgesiaTime between arrival and Urological intervention.Proportion who had bone profile requested.Proportion that received stone diet advice as per documentation.

Results

100% CTKUB was reported within 24HRs (97.9% cycle 1). 71.9% of total patients received NSAIDS as analgesia in cycle 2 (54.5% cycle 1). 100% who required surgical intervention, had it within 48HRs in cycle 2 (70% cycle 1). 94.7% had calcium requested in cycle 2 (77.9% in cycle 1). In cycle 1, only 8.7% received dietary/fluid advice, this is improved to 39.4% in cycle 2.

Conclusions

Department currently successful in meeting the NICE quality standards for timing of CTKUB and Surgical management of ureteric stones. We have improved by 17.4% in prescribing appropriate analgesia and by16.8% improvement in serum calcium requests. Department improvement by 30.7% in giving patient advice regarding lifestyle and dietary changes for secondary prevention.
1227 Impact of Night Shift on Junior Doctor Driving : Two Third of Doctor Did Not Feel Safe to Drive Post Night
Authors: Islam M F , Noor M , Rahman N , Chakraborty M , Tanzum F , Islam M S
Published: August 2024

Aim

Over the last decade, the loss of three doctors' lives has highlighted the challenges faced by junior doctors commuting after night shifts. This audit explored how demanding schedules affect their driving performance, aiming to identify risks and enhance safety for both doctors and the public.

Method

A ten-question multiple-choice questionnaire was distributed to 120 junior doctors of all specialties.

Results

showed that 82.35% prefer driving, 14.29% use public transport, and 9.5% opt for alternative means like cycling or walking.

Two-thirds of doctors (64.2%) feel unsafe driving post-night shift, with varying frequencies: 30.56% often, 29.63% occasionally, 25.93% rarely, and 13.88% always.

Coping mechanisms include 62.91% consuming caffeinated drinks, 19.68% using public transport, and 15.38% napping. However, 30.95% struggle to find a nap spot. For those unable to find one, 46% nap in cars, 28.3% in On-Call rooms, 21.5% in doctors' offices, and 3% even ask colleagues to stay in their place after hospital.

Challenges after night shifts include 32.94% hitting the curb, 20% sleeping at the wheel, 18.8% getting honked, 16.4% swerving, 4.7% in the wrong lane, 4.81% receiving tickets, and 2.35% crashes.

Junior doctors attribute tiredness to consecutive nights (64.1%), excessive workload (60.68%), 12-hour shifts (63.25%), inability to rest (55.56%), and understaffing (41.9%).

Conclusions

Include adopting a 2-night pattern (62.71%), providing quiet rooms (50.85%), implementing 30-minute breaks every 6 hours (44.9%), improving staffing (43.2%), and considering an 8-hour shift. Future plans involve discussions with management, collaboration with the chief registrar, and contacting the local BMA representative to advocate for improved working conditions.
426 Nasopharyngeal Malignant Melanoma Masquerading in the Gallbladder: The Importance of Histological Assessment
Authors: Nagra R , Zaman S , Mohamedahmed A Y , Torrance A
Published: August 2024

Introduction

Metastatic malignant melanoma (MM) of the gallbladder (GB) is a rare entity which is often diagnosed late, leading to a poor prognosis. The disease may present insidiously as acute cholecystitis or remain asymptomatic. Optimal management remains unclear but surgical resection is considered the mainstay of treatment for this condition.

Method

A retrospective review of the electronic medical records of a 47-year-old patient who was diagnosed with metastatic MM of the GB was conducted. Data points included patient demographics, clinical features on presentation, radiological imaging, GB histology reports and outcomes was retrieved.

Results

This patient initially presented to our emergency department with a a protracted course of generalised abdominal. The patient was initially diagnosed with acute cholecystitis resulting in an emergency laparoscopic cholecystectomy. Following an emergency laparoscopic cholecystectomy, the histology incidentally revealed a melanoma with an unknown primary. Subsequently this was traced to the nasopharynx. Due to the presence of concurrent liver metastasis, systemic immunotherapy with palliative intent was commenced following a multi-disciplinary team discussion.

Conclusions

This case highlights the importance of sending all resected GB specimens following cholecystectomy for routine histological analysis. We argue against selectively choosing which specimens to send to histology based on radiological and/or intraoperative macroscopic inspection of resected tissue alone as this can delay or prevent the detection of sinister pathologies such as malignancy. We argue in favour of early detection in order to initiate early treatment to improve prognosis.
583 Use of LICAP Flap Reconstruction in a Breast Cancer Patient with Cosmetic Implants Undergoing Breast Conserving Surgery
Authors: Arisoy H , Sabaratnam R , Boland M
Published: August 2024

Introduction

The Lateral Intercostal Artery Perforator (LICAP) flap has emerged as an alternative to implant-based or free tissue transplantation techniques in breast reconstructive surgery. This technique uses a pedicled flap to replace lost volume. This reconstructive method provides acceptable recovery times, lower rates of flap size morbidity, and better aesthetic satisfaction of patients compared to other methods.

In this study we describe a case of LICAP flap surgery in a patient with a previous history of aesthetic breast implants.

Case Presentation

A 49-year-old patient with bilateral aesthetic breast implants presented to the emergency department with a six-week history of an anterior neck lump. Radiological and histological investigations of this lesion revealed a primary carcinoma of the parotid gland with lymph node metastasis.

A staging whole-body scan for this lesion showed additional areas of increased uptake in the right axilla and breast. Dedicated radiological imaging demonstrated a 1.5 cm mass and multiple abnormal axillary lymph nodes. Biopsies confirmed a concurrent Grade 2 Intraductal Carcinoma of the right breast with metastatic axillary lymph node involvement.

A two-stage LICAP reconstructive approach was taken with no postoperative complications. The patient also underwent parotidectomy and neck dissection. Six months post-operatively, the patient remains well, having successfully navigated additional chemotherapy and hormonal suppressive therapy.

Conclusions

This case contributes to the evolving landscape of LICAP flap utility in BCS, emphasising its role as a low-risk and viable option. It underscores successful oncological management and the achievement of favourable aesthetic outcomes, including in complex scenarios with need for preservation of existing implants.
616 A Rare Biliary Duct Anatomical Variant Encountered During a Routine Cholecystectomy
Authors: Liyanage D , Wilson P
Published: August 2024

Cholecystectomy, a common surgical procedure, faces complexities due to variations in biliary anatomy. Although bile duct injuries are uncommon, their potential for morbidity necessitates careful consideration. In this report, we present a case featuring a rare anatomical variant of the biliary duct, previously unreported in the literature.

A 53-year-old female, suffering from persistent biliary colic symptoms, underwent elective laparoscopic cholecystectomy. During the closure phase following gallbladder resection, the surgeon identified a small hole in one of the hepatic ducts, prompting intervention with a T-Tube. Subsequently, the patient was referred to a tertiary centre for in-depth evaluation and management.

Intraoperative cholangiography (IOC) conducted revealed a unique anatomical configuration, illustrating a right posterior sectoral duct draining into the left hepatic duct (Huang type III), connected to an accessory cystic duct, the Duct of Luschka. Despite unsuccessful attempts at intraductal stenting, the decision was made for biliary reconstruction via hepatico-jejunostomy, resulting in the patient's full recovery with no postoperative complications.

Currently, there are no clear guidelines regarding routine mapping of anatomical variations using imaging techniques such as IOC. The evidence in this area remains controversial due to the balance between the potential prevention of biliary duct injuries and the cost-effectiveness of such measures. More research is needed in this area, but at present, such considerations are made on a case-by-case basis.

This case underscores the challenges posed by unexpected anatomical variants during routine cholecystectomy and highlights the importance of adaptability in surgical management.
1033 A Rare Case of a Dog Bite Leading to Bilateral Lower Limb Amputation
Authors: Jones A , Moore P , Frewin R , Vardhan V , Kulkarni S
Published: August 2024

Introduction

Capnocytophaga canimorsus is a Gram- negative bacteria which is present in the normal gingival flora of both cats and dogs. C. canimorsus is a rare cause of bacteraemia in humans, occurring usually after animal bites, and can have devastating consequences for patients.

Report

This report describes the case of a 65-year-old female patient who presented acutely unwell six days after being bitten on the hand by a dog. Her blood culture flagged positive and further analysis by 16S rRNA PCR confirmed the organism as C. canimorsus. She suffered consequences of overwhelming sepsis, disseminated intravascular coagulation (DIC) and bilateral acute limb ischaemia requiring bilateral major lower limb amputations.

Discussion

A Dutch national surveillance study found the incidence of C. canimorsus to be 0.67 cases per million, however, with the incidence of dog bites doubling between 1998-2018; the incidence of C. canimorsus is likely to increase more than previously reported. A retrospective review of patients in a Helsinki ICU cohort between 2005 and 2014 found 65 patients with C. canimorsus; only three of these required lower limb amputation. Early prophylactic treatment with antibiotics after suffering a dog or cat bite could prevent serious complications associated with this bacterium.
1245 Management of Hypothermic Cardiac Arrest with Cardiopulmonary Bypass
Authors: Bowdren K , Downes A , Doddakula K
Published: August 2024

Aim

Hypothermic patients are at major risk of cardiac arrest. Accidental hypothermia is an unintentional drop in core temperature below 35 °C. Cardiopulmonary bypass may be used to rewarm patients in the surgical setting.

Method

A 48-year-old male was found after attempting suicide by carbon monoxide inhalation and Diazepam overdose. Recorded temperature on arrival of paramedics was 26 °C. He initially had a recordable blood pressure, but on transfer to the ambulance developed ventricular fibrillation secondary to rescue collapse, and CPR was commenced. One unsuccessful DC shock was delivered. The man was intubated, LUCAS machine was applied, and external warming measures were carried out. He arrived in resus over 2 hours after being found, with persistent ventricular fibrillation. Core temperature remained at 27-28 °C despite warming techniques. Cardiothoracic Surgery were contacted for consideration of a cardiopulmonary bypass to rewarm the patient. The patient was cannulated peripherally via the left femoral artery and vein, allowing the LUCAS machine to continue until institution of cardiopulmonary bypass. He was cardioverted from VF to NSR and rewarmed until temperature was 36.4 °C. He was weaned off bypass after 130 minutes and transferred to cardiac ICU.

Results

Extubated after 2 days with no neurological deficits. Self-ventilating and haemodynamically stable by day 3. Discharged from Cardiac Intensive Care Unit 7 days post-op with no neurological deficits to inpatient psychiatric unit.

Conclusions

Hypothermic arrests warrant continuous CPR as chances of survival and favourable neurological outcome are higher than for normothermic arrests.
1289 Rare Case of a Patient with Simultaneous Incarcerated Epigastric Hernia and De Garengeot Hernia: A Case Report
Authors: Lakshmipathy G R , Ball W
Published: August 2024

Case Presentation

66-year-old lady presents to surgical unit with main complaint of epigastric pain and swelling. She noticed lump in both groins. She had no previous abdominal surgery and has no past medical history.

Examination and bloods

Patient had irreducible tender swelling in epigastrium. Additionally, there was irreducible hot tender swelling in right groin. Left groin had soft reducible swelling. C-Reactive protein was 57 and white cell count was 7.9.

Imaging

CT Abdomen and Pelvis showed incarcerated epigastric hernia with omental fat and right inguinal hernia containing inflamed appendix.

Operative findings

Epigastric hernia had a 2cm defect containing pre-peritoneal fat. Right groin hernia constituted inflamed appendiceal tip within the femoral canal.

Management

Initial management included IV fluids and IV antibiotics. The first half of the operation involved mesh repair of epigastric hernia. The second half of the operation involved an incision for inguinal hernia repair and standard appendicectomy through dissection of lacunar ligament and desarda’s repair to the inguinal canal. Patient was discharged on the first post-operative day.

Conclusions

De Garengeot’s hernia is femoral hernia containing appendix with incidence of 0.15-5% of all femoral hernias. Systematic reviews demonstrate lack of clarity on whether inflamed appendix herniates or herniated appendix develops inflammation. In this case, appendicitis was confined to the tip raising possibility of the latter. Perhaps, strangulation at femoral canal prevented appendicitis to track up the rest of the appendix, which may explain the predominance of patient’s epigastric symptoms. Careful examination is necessary in patients with multiple hernias to guide appropriate operative management.
185 Examining the Efficiency of Diagnosing and Managing Necrotising Otitis Externa (NOE) Using a Departmental Management Algorithm
Authors: Hassan Haleem A
Published: August 2024

Aim

The audit aimed to evaluate a new NOE treatment algorithm's proficiency and the benefits of combining CT and Technetium Scan in comparison to CT alone for diagnosing and managing NOE.

Method

Patients admitted to Portsmouth Hospitals University NHS Trust between July 2021, and July 2023, with a possible or confirmed NOE diagnosis were examined. Among 37 identified patients, 33 were included, excluding those diagnosed with Squamous Cell Carcinoma. Patient records were analysed with the NOE algorithm to evaluate its effectiveness in diagnosing and managing NOE.

Results

Out of 33 patients (23 males, 10 females, mean age 77), 41% were diabetic. Ear swab results indicated 69.6% with pseudomonas, with 86.9% sensitive to Ceftazidime or Ciprofloxacin. NOE was confirmed in 60.6% (20/33) through CT. 7/13 patients with negative CT results underwent Technetium imaging, yielding a positive result in 4/7 of those cases. One patient was diagnosed with NOE via MRI. Technetium-negative patients received topical therapy and outpatient review. 25/33 radiologically diagnosed NOE patients and 3/33 with high clinical suspicion received 6 weeks of extended antibiotic therapy. 24/28 NOE-treated patients had an ENT follow-up in an average of 5.6 weeks. No recurrences or NOE-related mortalities were identified during follow-ups.

Conclusions

Technetium imaging influenced management in 30% of cases with a negative CT, making up 12% of the total study population. Without it, these patients might have overlooked extended antibiotic therapy, risking NOE complications. The algorithm was mostly adhered to, successfully identifying, and managing NOE patients with extended antibiotics, demonstrating no recurrence with no mortality since implementation.
1171 An Unusual Approach - Left Transorbital Approach to Repair of Lateral Sphenoid Wall CSF Leak Under Image Guidance
Authors: Ali D
Published: August 2024

Aim

To present a case where transorbital and endonasal approaches were taken simultaneously to repair a cerebrospinal fluid (CSF) leak.

Background

The initial management plan for a sinus CSF leak is conservative management, as leakage stops within 1 week for 70% of patients suffering from a traumatic leak.

However, in cases where the CSF leak does not heal spontaneously, surgical options must be explored as if left untreated patients run the risk of contracting meningitis.

The most common approach taken is the endonasal approach whereby a septal flap is used to seal the leak. In cases where the location of the leak is difficult or impossible to reach endonasally, another approach can be considered such as a transorbital approach. In this case a 60-year-old lady presented with a CSF leak preceded by a recent episode of meningitis. She had a previous left sided CSF repair endonasally 4 years prior.

Imaging revealed a meningo-encephalocoele from a left persistent sternbergs canal – After discussion in MDT a transorbital and endonasal approach was taken to repair the defect, with fat and fascia taken from her thigh.

Conclusions

A transorbital + endonasal approach is a safe, minimally invasive approach which can be used as an alternative to endonasal only approach in order to target and manipulate pathology within the skull base.
1257 Literature Review: Precision in Parathyroid Surgery: Unveiling New Frontiers with Robotic Assistance and Indocyanine Green Fluorescence Imaging
Authors: Al Maawali S S
Published: August 2024

Aim

This review delves into the effectiveness of indocyanine green (ICG) fluorescence for visually identifying hyperparathyroidism in robot-assisted parathyroidectomy, utilising FireflyTM technology. Concurrently, a comparative analysis between robot-assisted and open parathyroidectomy to discern clinical nuances between the two approaches.

Method

In a cohort of 37 primary hyperparathyroidism patients (open parathyroidectomy n=31, robot-assisted n=6), both groups used pre-op localization and IOPTH assays. ICG was selectively administered in robot-assisted. In another literature, BABA robotic parathyroidectomy (n=22, Dec 2013–Aug 2015), Firefly in da Vinci Si guided ICG for parathyroid identification. Post-op days 0, 1, 2, and 14 monitored parathyroid hormone levels. Propensity score matching formed a control group for age, gender, tumour size, and operation type, assessing parathyroid functionality.

Results

The robot group exhibited persistent fluorescence in pathologic parathyroids under near-infrared vision. Post-removal, IOPTH normalised in all robot group patients. Despite a superior cosmetic outcome, the robot group experienced longer hospital stays (3.0 ± 0.0 vs. 1.8 ± 1.2 days, p < 0.001) and extended operation times (152.5 ± 23.6 vs. 91.1 ± 69.1 min, p = 0.001) compared to the open parathyroidectomy. After 6 months, both groups demonstrated normalised PTH, calcium, and ionised calcium levels. However, in BABA robotic thyroidectomy, ICG group had significantly less inadvertent parathyroidectomy than the control (0% vs. 15.9%, P = 0.048).

Conclusions

Robot-assisted parathyroidectomy with ICG facilitates precise identification of pathologic glands, offering a superior cosmetic outcome. However, clinical outcomes do not surpass those of conventional open parathyroidectomy. This review explains the nuanced approach to PHPT surgery, integrating robotics for enhanced precision and patient outcomes.
179 The Predictive Role of APACHE II Score in Patients with Peritonitis at National Hospital Abuja
Authors: Situ O , Badejo O , Gwaram U
Published: August 2024

Aim

This study assesses the predictive role of APACHE II in surgical outcomes of patients managed for peritonitis in Abuja, Nigeria.

Method

This is a prospective study of consecutive adult patients managed for peritonitis by the general surgery unit of National Hospital Abuja (NHA) within a 19-month study duration (September 2020 through March 2022). Patient characteristics and treatment outcomes were recorded in a structured proforma and analysed using the SPSS, version 25. The accuracy, sensitivity, specificity, and threshold of the APACHE II were derived from the ROC curve analysis and its coordinates.

Results

There were 54 patients with peritonitis during the study period with a male-to-female ratio of 2.6:1. Complicated appendicitis and trauma were the two leading causes of peritonitis. This study's mortality and morbidity rates were 13.0% and 63.0%, respectively. APACHE II score at admission positively correlated with the likelihood of post-operative mortality, morbidity, number of post-operative complications, ICU admission and length of hospital admission. The average APACHE II score of patients in this study was 7.1±5.2. APACHE II best-predicted mortality by the ROC curve at a threshold point of 9 (sensitivity of 85.7%, specificity of 70.2%, accuracy of 86.8%, P-value 0.002). At a threshold score of 6, APACHE II was significantly associated with the occurrence of post-operative morbidity (sensitivity of 74.3%, specificity of 73.7%, accuracy of 75.2%, P-value= 0.043).

Conclusions

This study confirms that APACHE II score at admission can predict the outcome of surgery within the first 30 days post-surgery among adult patients who had peritonitis at NHA.
226 CT Tractography as a Last Option for Penetrating Abdominal Wall Injurieswith Equivocal Contrast CT findings
Authors: Ewedah M , Bassiony M , Asal M
Published: August 2024

Aim

The goal of this study is to evaluate the effectiveness of using CT tractography as an option in the management of penetrating abdominal trauma. Does CT Tractography function as a useful technique for assessing patients with Anterior Abdominal Stab Wounds (AASW)?

Method

The study included 82 patients admitted to the trauma centre at Alexandria Main University Hospital in Egypt who had penetrating anterior abdominal wall injuries, were in stable condition, and had a contrast CT scan of the abdomen and pelvis that was inconclusive about peritoneal penetration.

Results

A total of 57 patients underwent exploration after showing positive findings of contrast leak into the peritoneal cavity. 25 patients with CT Tractography results that demonstrated no leak into the peritoneal cavity were treated conservatively without the necessity for surgical intervention.

Conclusions

In the study, CT tractography correctly identified 100% of the patients who needed laparotomies, and none of the patients without peritoneal penetration required surgical intervention during follow-up. The examination of patients with AASW can be done efficiently by CT tractography.
818 Acute Appendicitis: Why the Wait? – a Retrospective Analysis of Timings Associated with the Most Common Emergency General Surgery Operation
Authors: Marks B , Karim M H , Jones R
Published: August 2024

Aim

Getting it right first time (GIRFT) analyses hospital data nationally, identifying areas to improve patient care. Their latest report suggests reducing appendicectomy length of stay (LOS) could result in significant cost savings, proposing a benchmark figure of 36.2% being discharged within two days. GIRFT data shows James Cook University Hospital discharges only 25.7%. Additionally, the World Society of Emergency Surgery recommends performing all emergency appendicectomies within 24 hours of admission. Our aim was to identify delays in patient care to meet these two standards.

Method

Emergency appendicectomies performed between 01/06/2021 and 30/05/2023 were included, with admission data for 354 patients being analysed. Calculations were performed to provide the following metrics: time to decision to operate, admission time to theatre arrival, time from decision to operate to theatre arrival, post-operative LOS; and total LOS. We further reviewed pre-operative imaging and histology to differentiate between uncomplicated and complicated appendicitis.

Results

33.5% of patients were discharged within 48 hours of admission, with a median LOS of 2.4 days. 78.2% had an operation within 24 hours of admission. Median post-operative LOS was 1.4 days with a notably large third quartile (1.4 - 3.1). Within this quartile 60.7% were found to have uncomplicated or normal histology.

Conclusions

Our audit demonstrated a discrepancy from the GIRFT data; however, it identified opportunities to decrease LOS, especially in the uncomplicated appendicitis sub-group. It is important to remember that LOS is only one factor in providing high quality patient care, however, timely flow is important to running an effective emergency general surgery service.
1084 Clinical Audit of Surgical Site Infection in Emergency General Surgery Unit at London North West University Healthcare NHS Trust
Authors: Asogwa A , Anyaele N , Ilham A , Mazhar M
Published: August 2024

Aim

To reduce the rate of wound infection in surgical patients in Emergency General Surgery Unit of Northwick Park Hospital. To access adherence to national guidelines by Emergency General surgery unit. To access the rate of Surgical site infection in Emergency General surgery unit at Northwick Park Hospital. To check if the rate of Surgical site infection in Emergency General surgery unit is in line with the national standard.

Method

This was an audit of NICE guideline((NG125)) undertaken in a retrospective manner. Data was collected through questionnaires and patient hospital records. Questionnaires where populated by contacting patients for feedback.

Results

Nice prescribed a target of 100% in the categories audited. The only exception is perioperative showering that NICE recommended should be carried out whenever possible.

Pre-op Nose Swab 61%

Perioperative showering 44%

Theatre Wear 100%

Informed to remove all jewelleries 97%

Informed about pre-op antibiotics 66.67%

Informed about intra-op antibiotics 14.29%

Informed about closure method 77.14%

Post op wound dressing services 44%

Wound dressing education 49.29%

Post op surgical site infection 6.76%

Conclusions

Overall, Northwick Park hospital maintain a commendable adherence to NICE guideline. This is evident from the very low rate of surgical site infection observed. Strict adherence could be seen in areas that are routinely recommended by NICE. Shortcomings recorded are due to failure in certain levels of communication than non-adherence to guidelines. To ameliorate this, it was concluded that checklist with all the shortcomings should be discussed with every patient and given leaflets to cover these before discharge.
1178 A Study to Audit the Breach of CEPOD Guidelines in Emergency General and Colorectal Surgeries
Authors: Blinkhorn-Conroy O , Hussain I , Rahman K R , Wong Sik Hee J R , Tun San N , Norwood M
Published: August 2024

Aim

Is to audit any breach of local CEPOD guidelines by comparing the time of booking to the time of surgery, for emergency general and colorectal operations.

Method

The audit was done by gathering data about theatre booking time, comparing it to when the surgery took place, and calculating whether time to surgery breached the CEPOD guidelines or not. Study was conducted in the general and colorectal surgery department in Leicester Royal Infirmary, over a span of 2 weeks. All general surgical abscesses, appendicectomies, and emergency bowel operations were included in the study.

Results

A total of 90 emergency cases were selected for this study. These included 30 abscesses (perianal, perineal, gluteal, etc) of which 27% breached the CEPOD time to surgery. 33 appendicectomies (laparoscopic and open combined) were recorded, and 30% breached CEPOD time to surgery. There were 27 emergency bowel operations divided into 21 colorectal and 6 upper GI surgeries. Out of the colorectal operations, 67% required bowel resection, and 43% needed a stoma. 33% of all colorectal surgeries breached the CEPOD time to surgery guidelines. As per CEPOD categories, 18% of category 2, 31% of category 3, 26% of category 4, and 37% of category 5 breached the CEPOD guidelines. Overall, 28% of cases breached the CEPOD category.

Conclusions

This audit reveals there is scope of improvement in adhering to CEPOD guidelines while booking emergency general surgical cases.
1268 Evaluating the Use of Prophylactic Antibiotics in Patients with Chest Trauma
Authors: Attafi W , Noble A , Morrison T
Published: August 2024

Aim

Current evidence on the use of prophylactic antibiotics for patients with rib fractures is heterogenous, reflecting the complexity of chest trauma. This audit aims to assess the use of prophylactic antibiotics for patients with traumatic rib fractures.

Method

Radiological reports were used to identify injury severity, presence of pneumothorax and flail segments for all patients admitted to a DGH with trauma management capability. Rib scores were calculated, and admission records were assessed to determine if antibiotics were given. An electronic patient database was used to identify the presence of significant co-morbidities such as Asthma or COPD and associated complications.

Results

Of 6,991 patients admitted between September 2022-23, 109 were treated for traumatic rib fractures. 33 (30.2%) were given antibiotics during admission. Average rib score for those given antibiotics was 7.69, with an average age of 74.4. 2 (14.3%) patients with flail chest received antibiotics. 15 (13.8%) patients had a history of Asthma or COPD and 5 (4.59%) of these received antibiotics. The average hospital stays of patients admitted with rib fractures was 7.9 days for those who did not receive antibiotics versus 6.4 days for those who did.

Conclusions

The decision to administer antibiotics continues to be guided by clinical correlation, inflammatory markers, and radiological severity, rather than via a prophylactic approach. Our data shows patients administered antibiotics experienced a shorter average hospital stay. It remains crucial to approach each patient on an individual basis, considering a comprehensive set of factors for optimal rib fracture care.
203 Peer-to-Peer Surgical Suturing, an Initiative to Inspire the Next Generation of Surgeons?
Authors: Singh Sokhal B , Swift C , Lindley J , Zope P , Rao V
Published: August 2024

Background

Royal College of Surgeons defines the surgical knowledge students require. Studies suggest there is a lack of surgical skills teaching resulting in medical graduates not having the surgical competencies as per General Medical Council guidance. The benefits of early exposure to practical skills are well recognised but underutilised in medical students.

Aim

This study evaluated the effectiveness of peer-led surgical skills sessions organised by a university surgical society, focussing on students' confidence in surgical theory, knot tying, and suturing.

Method

The suturing sessions were conducted by trained medical students from a university surgical society, trained by consultants. Attendees were medical students with limited prior exposure to surgery and suturing. After each session, feedback forms with Likert scales were distributed to assess students' confidence in various aspects of surgical skills.

Results

Feedback forms from 27 participating students were analysed. Remarkably, 100% of students reported that the sessions met their learning objectives. The mean confidence in identifying surgical equipment increased from 3.6 (range 1-10) before the session to 8.4 (range 5-10) after the session. Similarly, students' confidence with suturing ability rose from a mean score of 2.7 (range 1-7) to 8.0 (range 5-10), and their confidence with surgical knot tying improved from a mean score of 2.9 (range 1-10) to 7.9 (range 4-10) after the session.

Conclusions

This initiative underscores the efficacy of peer-led-teaching in basic surgical skills to medical students. Future research may explore the integration of surgical training into the formal medical school curriculum, further enhancing students' surgical competencies and readiness for clinical practice.
406 A Service Review of the Tongue-Tie Clinic and Its Outcomes
Authors: Barrie E , Winter G
Published: August 2024

Aim

The surgical management of ankyloglossia is a widely debated topic. The purpose of this project was to carry out a service review of the tongue-tie clinic in NHS Grampian looking at parental expectations and experiences, as well as outcomes focussing on breastfeeding rates, following tongue-tie division.

Method

This study was carried out over 5 months and split into pre-and post-clinic data. Pre-clinic questionnaires were completed by parents/carers and post-clinic telephone calls were conducted between 6 weeks - 5 months post-clinic for patients who underwent frenulotomy.

Results

The pre-clinic cohort included 129 participants. In regard to feeding problems, 73% (n=94) experienced latch issues, 56% (n=72) maternal discomfort and 31% (n=40) milk spillage. 63% (n=81) thought that tongue-tie division would improve feeding, 35% (n=45) thought that latch would be improved and 3% (n=4) thought that future speech issues could be avoided. Additionally, 60% (n=77) were given support prior to clinic by the infant feeding team, 54% (n=70) by health visitor, 53% (n=68) by midwife and 5% (n=6) by speech and language therapy.

The post-clinic cohort included 82 participants. 77% (n=63) who were breastfeeding before the procedure continued to breastfeed after. 1% (n=1) experienced post-procedural issues and 84% (n=69) experienced an improvement in feeding.

Conclusions

This service review provided a thorough analysis of the tongue-tie clinic by gaining information on the experiences of different participants. Additionally, the outcomes were shown to be positive as breastfeeding rates post-tongue-tie division remained high and feeding was improved with no issues for the majority of patients.
532 Patient Journey Posters Reduce Pre-Procedural Anxiety in Day Surgery
Authors: Patrick S , Patel R , Hanibal G , Murphy Lonergan R
Published: August 2024

Background

Multi-factorial anxiety is common prior to undergoing a surgical procedure and may contribute to poor post-operative outcomes. Aside from operation-related concerns, anxiety may be driven from uncertainty relating to procedures, logistics and reporting arrangements on the day, therefore improving patient understanding of the peri-operative pathway can reduce this anxiety.

Aim

To explore patients’ understanding and emotion surrounding the peri-operative pathway prior to surgery. To implement patient guides to improve understanding of the peri-operative pathway.

Method

We opportunistically sampled day surgery patients in waiting room prior to their procedure via a structured questionnaire. We undertook quantitative and thematic analysis of results, focusing on patients' emotions and understanding. We produced a poster displaying the departments and areas a patient will move through in their peri-operative pathway, with a text-explanation of what occurs at each stage, from the consent process to recovery. Patients were followed up with another questionnaire to assess the usefulness of the poster.

Results

Following intervention, there was an increase in percentage of patients understanding of the peri-operative journey. Most patients reported anxiety in trying to locate the surgical department before surgery, as well as the recovery process. Patients reported pre-procedural information was brief and unclear, therefore reading a guide with images of the areas helped reduce anxiety.

Conclusions

It is evident that patients feel unsure and anxious about peri-operative journey on the day of their operation. Patients particularly want more information on recovery and the discharge process. Having a past procedure in day surgery was correlated with reduced anxiety.
715 Outcome of Surgically and Conservatively Managed Spinal Cord Herniation
Authors: Whittle C , Roy D , Hollingworth M , White B
Published: August 2024

Aim

Spinal Cord Hernia (SCH) is a rare cause of progressive myelopathy and pain relating to protrusion of the cord through a dural defect. We describe the characteristics and outcomes of surgically and conservatively managed patients treated at our institution.

Method

A retrospective case review of patients treated from 2005 to 2021 was conducted and combined with contemporary telephone follow-up using objective measures of disability and pain (the Spinal Cord Independence Measure and Numerical Analogue Pain Scale).

Results

42 patients were included in our review (mean age 52.4 years; SD = 15.1 years). The mean time from symptom onset to diagnosis was 3 years (SD = 5.43 years). 64% of patients were female, and 88% had a neurological deficit at presentation. Surgery was performed in 52.3% of patients. Brown-Séquard syndrome at presentation was a predictor of receiving surgical management. Patients treated surgically were more likely to develop postoperative paraesthesia, weakness, and sphincter abnormalities. We acquired contemporary telephone follow-up in 64% of patients. Spinal Cord Independence Measure scores in the surgically and conservatively treated patients were equivocal at 82.6/100 and 85.1/100 respectively (95% CI [17.360, -22.493]; p = 0.396).

Conclusions

Patients with spinal cord hernia face a prolonged period between symptom onset and diagnosis. Minimally symptomatic patients can be managed conservatively, and many may improve or stabilise. Early post-operative weakness is common, but most patients remain independent and improve beyond or return to their pre-operative status.
737 Zero Percent Posterior Capsule Rupture (PCR) Incidence: Inaugural Year Analysis at a New NHS Cataract Hub
Authors: Vilkelyte V , Roberts H
Published: August 2024

Aim

The objective of this audit was to evaluate the incidence of posterior capsular rupture (PCR), a widely accepted safety measure of cataract surgery, within the inaugural year of operation at a novel high volume low complexity cataract unit known as the Centre of Eye Excellence, located within Nightingale Hospital under the Royal Devon University Healthcare NHS Foundation Trust.

This specialised unit is led by a team of four senior cataract surgeons, comprising three consultants alongside a dedicated cornea fellow from the Royal Devon and Exeter Hospital. The consultants conduct a full-day surgical list on alternate weeks, while the cornea fellow performs a weekly full-day list.

Method

Retrospective data from the first 12 months of operation (1/9/22 to 1/9/23) of the four surgeons at the Nightingale Hospital was collected using the 'Blue-Book' theatre log and cross-checked against each surgeon’ personal complication audit with respect to posterior capsule rupture/vitreous loss/anterior vitrectomy. Patient information was documented in Excel and supplemented by patient notes.

Results

Between September ’22 and ’23 there were 1099 cataract operations performed at the Nightingale Unit. There were 0 cases of posterior capsule rupture/vitreous loss/anterior vitrectomy identified from the four surgeons.

Conclusions

The audit reveals no cases of PCR/vitreous loss/anterior vitrectomy at the Centre of Eye Excellence, Nightingale Hospital in its opening year. Nightingale's successful first year highlights high-quality cataract surgery for patients.
1222 Successfully Showcasing How Digital Clinical Innovation and Enterprise Can Be Used to Improve Complex Challenges Facing the NHS - 'Creation of the ViewOP Application to Improve Theatre Utility and Efficiency'
Authors: Ayirookuzhi S , Aydemir C , Alhalabi O , Alahmad A , Lee V
Published: August 2024

Aim

Solve a persistent complex challenge facing the NHS. The NHS faces persistent challenges related to surgical theatre utility and efficiency as highlighted in the NHS Improvement report ‘Operating theatres: Opportunities to reduce NHS waiting lists’ (Briggs, 2019). With passive surgical theatre costs of up to £28,000 daily these issues contribute to delays in operations and strain waiting lists (Andersen, 2023).

Method

ViewOP is a digital clinical innovation enterprise developed by a group of 3rd year medical students in response to this challenge by increasing communication between theatre staff, wards, and porters through a web-based application prototype developed for both desktop and mobile devices.

It utilises 4 core features that integrate seamlessly to provide improved communication and increased theatre efficiency and utility.Real time push notifications: These notifications provide instant updates on surgical schedules and patient statuses.Surgical scheduling conveyor belt system: Quick at a glance notification of the surgical schedule.Traffic light patient flow system: A simple universal user interface system to track and move patients from pre-op to post op recovery.Integrated checklists: A comprehensive pre, intra and post op checklists that provide comprehensive and integrated checklists that promote patient safety and surgical success.

Conclusions

Working closely with Buckinghamshire Health Research and Innovation Centre and the Buckingham Enterprise and Innovation Unit using Google's 'Design Sprint' methodology we have successfully created, showcased, and pitched a prototype application and have secured £1000/- of funding to advance the development of this application.
667 Enhanced Recovery in Cranial Surgery (ERACraS) – a Single-Centre Qualitative Improvement Study
Authors: Abul M H , Sescu D , White M A , Robson M , Ferguson J , McDermott F , Kaliaperumal C
Published: August 2024

Aim

To establish an Enhanced Recovery After Cranial Surgery (ERACraS) protocol for patients as part of a quality improvement project (QIP) with the intention of reducing hospital length of stay (HLOS), similar to the evidence-based Enhanced Recovery After Surgery (ERAS) protocol.

Method

This QIP was carried out in the Department of Neurosciences (DCN), Edinburgh, over two four-month periods. A total of 40 patients over 18 years of age undergoing elective craniotomy surgery under a sole neurosurgeon were invited to take part in this QIP. Subsequently, data was retrospectively collected through our institution’s online documentation system.

Results

19 patients received conventional perioperative care (pre-ERACraS group) during December 2021-March 2022, and 21 received care according to the novel ERACraS (ERACraS group) during June-September 2022. Regarding supra-tentorial surgery, there was a reduction of 73% in HLOS in the ERACraS group. No change was observed in infra-tentorial surgery. Overall, the ERACraS protocol reduced HLOS by 50% in cranial surgery.

Conclusions

The QIP data from ERACraS in our unit has shown that implementing ERAS protocols is feasible. A reduction in HLOS has implications for patient morbidity, mortality, and quality of care. We endeavour to collect long-term data by collaborating with neurosurgical units across the UK and Ireland to validate its feasibility and sustainability as part of a major QIP in neurosurgical practice. This can be potentially adopted by neurosurgical centres across the globe in a safe and sustained manner.
276 Clinical and Demographic Factors Influencing Length of Hospital Stay in Pancreatitis: A Retrospective Study
Authors: Probert S , Cai W , Sultan B , Khorshid K , Alkistawi F , Karamanakos S
Published: August 2024

Aim

Evaluate the impact of demographic and clinical factors on the length of hospital stay (LOS) following admission with acute pancreatitis over 12-months.

Method

For this retrospective cohort study, we used electronic patient records to identify all patients admitted with acute appendicitis in 2022; 162 admissions were identified. Microsoft Excel was used to collect the data and SPSS was used to analyse the data.

Results

Mean LOS was 8.31 days. The cases were comprised of 85 (52.5%) males and 77 (47.5%) females – sex had no impact on LOS (p=0.690). Average age of the patients was 54.2 years with no correlation to LOS (p = 0.261). Looking at aetiology, gallstones (34.6%), undetermined (31.5%), alcohol (27.2%), hypertriglyceridaemia (3.1%), ERCP (1.9%) steroids (0.6%), trauma (0.6%) and autoimmune (0.6%), we found no impact on LOS (p = 0.915). Increase in LOS is noted with higher Rockwood frailty scores (p = 0.000). 42 patients (25.9%) were made nil by mouth (NBM), resulting in longer LOS (p = 0.002). 8 (4.9%) patients were admitted to ITU and had longer LOS (T = -7.34, p = 0). Only 14 cases (8.64%) had a recorded Glasgow-Imrie Score on admission.

Conclusions

The significant determinants of LOS in this study were pre-morbid frailty, ITU admission and NBM status. While the Glasgow-Imrie score has been found to identify the severity of pancreatitis, use of this score at our centre was poor. By making this mandatory we hope to identify severe cases, allowing prompt resuscitation and more focused treatment to ultimately reduce LOS.
237 Open Lower Limb Fractures: Outcomes from a Major Trauma Centre
Authors: Evans J , Henton J , Jones C , Berner J
Published: August 2024

Aim

This retrospective review describes outcomes of open lower limb fractures in a major trauma centre.

Method

A retrospective review was undertaken of a prospective database of open lower limb fractures over a period of 20 months, in a major trauma centre following the BOAST/BAPRAS guidelines. Data was gathered using a pre-defined proforma to include demographics, injury characteristics, treatment modality and complications.

Results

A total of 186 patients were identified. 132 patients (71%) were directly closed, with 17 (9%) requiring a SSG, 6 a local flap (3%) and 27 a free flap (15%). We recorded major complications in 35 patients (19%), including non-union (8.6%), osteomyelitis (4.3%), amputation (2.7%), deep seated infection (9.7%), subsequent fusion (1.6%) and removal of metalware (7.5%). Our complication rates were higher for free flaps (26%); however, this likely reflects the complex nature of these injuries. 1 of the 6 local flaps (16.7%) developed a complication in comparison to 18.2% of the fractures closed directly and 17.6% of those requiring a SSG.

Conclusions

Open lower limb fractures are challenging to treat, and complications are common. Despite national guidelines, not all major trauma centres have a dedicated team with protected theatres for ortho-plastics trauma. Even though free flaps are required in patients with severe trauma, injuries closed primarily can still present a considerable rate of complications.