bluuebunny/crossref_metadata_2025 huggingface dataset:
106 Evaluation of Documentation on Patient Information Around Blood Transfusions, Against NICE Guidelines, in a District General Hospital: A Two-Cycle Review
Authors: Kieu P L , Asaad P
Published: August 2024

Aim

NHS Blood and Transplant state those who “have received blood, platelets, plasma or any blood products after 1 January 1980” cannot donate blood and NICE guidelines recommend to document discussions for any blood transfusions that are prescribed and given. A review of eight hospitals by Safety of Blood, Tissues and Organs (SaBTO) stated 43% of doctors documented that they explained the reason for transfusion to the patient highlighting documentation of these discussions is poor. We reviewed the documentation of blood transfusion discussions in a General Surgical department in a district general hospital and compared it to NICE guidelines [NG24], with the aim to improve documentation by over 20%.

Method

Two full PDSA cycles were performed. The first cycle consisted of a retrospective review of the electronic notes of patients who had been prescribed a blood transfusion by the General Surgical team between Jun-Dec 2021. Documents were compared against NICE recommendations on patient information on blood transfusions. Teaching was delivered in the local Surgical induction from Aug 2022. We subsequently performed a prospective review of documentation between Aug-Dec 2022.

Results

47 patients were prescribed blood transfusion between Jun-Dec 2021 and 23 patients were prescribed blood transfusion between Aug-Dec 2022. After Aug 2022, documentation had improved by 11.7-19.2% across the recommended domains by NICE.

Conclusions

Educating doctors on the importance of documenting these discussions and highlighting alternatives to transfusion is crucial as potential donors will not be able to donate blood if they receive a transfusion.
233 Introduction of the Head and Neck Same Day Emergency Care Service (HNSDEC)
Authors: Bhamra N , Butler J , Narang K , Barraclough J
Published: August 2024

Aim

The development of SDEC (Same Day Emergency Care) has been a priority for the National Health Service (NHS) in the UK, as part of its long-term plan to reduce demand on hospital resources. HNSDEC (Head and Neck Same Day Emergency Care) has been developed to aim to improve patient care and experience as well as reducing demand on emergency and urgent care services.

Method

An unused patient bay on the Head and Neck inpatient ward at The Royal Wolverhampton NHS Trust was transformed into HNSDEC after the procurement of additional equipment and recruitment and training of Advanced Clinical Practitioners (ACPs). Pathways were then developed for treatment of ENT and OMFS patients – both for either same day review or a scheduled review in ‘hot clinic’. Working with informatics, performance metrics have been analysed, and questionnaires were distributed to ascertain patient satisfaction.

Results

Within the first 6 months of opening, we have seen 796 patients with an admission rate of 8.6% across both ENT and OMFS. HNSDEC has been very well received by those within the emergency and urgent care services with positive feedback demonstrating its impact.

Conclusions

In order to continue building on the early success of HNSDEC, we propose that the service be moved to a different location to allow for expansion and to ensure sustainability for the future with a bigger waiting area to improve patient flow. An ongoing focus on inter-departmental collaboration and education to continue to provide the best possible patient care and experience.
572 Introduction and Assessment of an Updated Multi-Modality Induction Program for Rotating Junior Staff in a Regional Plastic Surgery Centre
Authors: De La Cruz Monroy M , Bedri H , Leonard D
Published: August 2024

Introduction

An effective induction is essential for doctors in training, particularly in specialties to which they may have limited prior exposure.

Aim

To assess the confidence of junior Plastic Surgery doctors’ (FY/CT level) in core competencies and optimise our departmental induction program.

Method

Quality Improvement project at the Plastic Surgery Department of Leeds General Infirmary (May-September 2023). Doctors at FY/CT grade in post for a period of 8 weeks were invited to complete an online survey of their confidence with common Plastic Surgery competencies (Cohort A). Analysis of these data guided revision of the departmental induction program including updated didactic and practical sessions, and production of an electronic handbook. Follow up surveys were completed by a subsequent cohort (B) at 3 points: prior and immediately after induction, and 8 weeks post start.

Results

Cohort A and B were comparable in size (5 vs 4) and composition (FY/CT/Trust Grade). Cohort A were 25% “Not confident”, 26% “Somewhat confident”, 38% “Confident” and 11% “Very confident” in core competencies at 8 weeks. Cohort B, 8 weeks following revised induction, were 11%, 13%, 29% and 47% respectively (p<0.00001). Cohort B also demonstrated progressive increase in confidence from immediately post-induction to 8 weeks, citing access to the electronic handbook as a significant factor.

Conclusions

This highlights the importance of appropriate educational guidance tools for the most junior members of the team in order to facilitate their learning experience, role confidence and therefore improve patient care.
600 QIP: Assessing the Financial Impact of Single-Use Ambulatory Flexible Cystoscopy
Authors: Ong A , Sharma V , Tanasescu G , Phan Y C
Published: August 2024

Aim

Single-use ambulatory flexible cystoscopes were introduced at a university hospital with the aim of improving patient care, overcoming issues with the availability of emergency theatres, and reducing the associated financial burden.

Method

The number of procedures listed as “cystoscopy and catheter insertion” or “flexible cystoscopy” on the electronic emergency theatre system “theatreman” were reviewed between 1/3/2019 to 1/3/2021. The second data cycle was between 02/03/2021 to 1/03/2023 after the introduction of the cystoscopes.

Results

Fifteen procedures occurred in the emergency theatre between 1/3/2019 and 1/3/2021. In the second cycle only one procedure was recorded between 2/3/2021 and 1/3/2023. The average cost per operation in the emergency theatre was £2,321.80. Whereas a single-use ambulatory flexible cystoscope cost £222.00. The cumulative emergency theatre cost was £34,827.00 prior to the introduction of the cystoscopes. 46.7% (7/15) of the procedures occurred after 8pm.

Conclusions

The introduction of single-use ambulatory flexible cystoscopes successfully reduced the number of cystoscopies and catheter insertions undertaken in the emergency theatre. This was reflected in a decline in emergency theatre costs. The use of a single-use ambulatory flexible cystoscope was £2,099.80 less than the cost to run an operation in an emergency theatre. The portable nature of the cystoscopes circumvented issues with accessing emergency theatre, reducing the wait-time from diagnosis to treatment. These results suggest that single-use ambulatory flexible cystoscopes are a cost-effective means of improving patient care.
650 Standardised Management of Ureteric Colic: A Quality Improvement Project
Authors: Stevens S , Yadav S , Chakraborty M , Wells H
Published: August 2024

Aim

Ureteric colic is a condition that contributes a significant amount to the workload of both emergency and urological services. The standards of its management are outlined by the British Association of Urological Surgeons (BAUS). We therefore endeavoured to evaluate the effectiveness of our treatment centre in achieving these standards with the aim to develops a new diagnostic pathway to improve the efficiency of managing ureteric colic.

Method

A pre-post intervention study design was used. The first cycle evaluated all ureteric colic cases referred to our department between September-October 2022. Data was extracted using local clinical and radiological software in line with local clinical governance guidelines. We subsequently developed a treatment pathway in conjunction with our emergency department to guide both diagnosis and initial management of acute presentations. The second cycle was performed during September 2023 to assess the efficacy of our pathway.

Results

Of the 37 new acute ureteric colic referrals reviewed during our second cycle, (Mean age: 48 years, Male: Female 2.4:1), 100% received their CT scan within the target window of 14 hours (Mean time: 02:12). 80% had correct Xray imaging performed which demonstrated a relative increase of 30% from the previous cycle (80% vs 50%). Furthermore 75% of patients had non-steroidal anti-inflammatory drugs (NSAIDs) prescribed and 70% had the correct blood tests done (Calcium and Urate).

Conclusions

Our pathway has demonstrated a significant improvement in the efficiency and accuracy of our department’s management of acute ureteric colic.
849 Routine Use of Validated Risk Prediction Model in the Management of Acute Appendicitis in a District General Hospital
Authors: Muthiah A , Bowry M , Francis L , Rahman A , Al-Khusheh M
Published: August 2024

Aim

Acute appendicitis is the most common general surgery emergency in the UK. Currently, there is no optimal diagnostic pathway for managing the right iliac fossa (RIF) pain. The right iliac fossa pain treatment (RIFT) study group has previously performed an analysis of different risk prediction models to search for the most specific one and made a website (appy-risk.org) to calculate risk scores on presentation. We aimed to look into our practice in a DGH and see how compliant we are in documenting risk scores on presentation with acute RIF pain.

Method

A list of patients presenting with acute RIF pain to the surgical assessment unit in September was prepared. Admission clerking notes were reviewed from the electronic patient record to look for the documentation of the appendicitis risk score. Standard statistical packages were used for data analysis.

Results

A total of 95 patients were presented with RIF pain. Of them, 17 were excluded from the analysis for being over 45 years old. Of the remaining 78 patients' records, only 7 (8.97%) had appendicitis risk scores documented in the clerking notes.

Conclusions

The RIFT study highlighted a high normal appendicectomy rate (NAR) in the UK in comparison to other European countries. In our hospital, NAR was 9.74% in the first six months of 2023. We are in the process of implementing a pathway to manage acute RIF pain using a risk prediction model as advised by the RIFT group to reduce our NAR to less than 5%.
885 Reducing Inequalities in Bowel Cancer Screening Access from Primary Care
Authors: Qasim A
Published: August 2024

Aim

Reducing inequalities in bowel cancer screening access by providing translated patient information to 90% of non-responders in a GP practice, in one month. The provision of information regarding the screening process to non-responding patients is a standard expected by cancer research UK, which is why it is vital to ensure that this information is equitable, and patient centred.

Method

Barriers to uptake include a lack of information for groups whose first language is not English. The GP practice is in a deprived area in Harrow, where the four most used languages (Gujarati, Tamil, Romanian and Arabic) are spoken among ethnic minority groups. This first PDSA cycle included the plan to complete a literature review and retrospective data collection from EMIS web, of the percentage of patients aged 60-74 who did not respond to a screening invite in the last 12 months. It was found that in a patient population of 3050, the percentage increased from 10% in 11/22 to 18% in 11/23. The Do part was the addition of translated posters explaining the programme in four languages and distributed via text message.

Results

Act the target was achieved since the proportion of patients receiving translated information increased from 0% to 100%. The software limitation did not allow identification of patients’ preferred language, and it was assumed that contact information had not changed.

Conclusions

Cancer screening education of ethnic minority groups can lead to improved access. A future PDSA cycle is required to assess the intervention’s impact on percentage uptake.
1162 Extended Hospital Stays: Awaiting Social Care Packages - an Interim Challenge or a New Norm?
Authors: Nabavi M , Quraishi M
Published: August 2024

Aim

This study in an Eastbourne DGH urology ward investigates the impact of delayed social care package preparations on patient bed occupancy, emphasizing the prevalence of medically fit patients awaiting social care.

Method

The investigation reviewed Mitchelham Ward patient records from July 1 to August 31. Bed occupancy, categorized into medical and social reasons, required the doctor's 'Medically Fit for Discharge' (MFFD) notation as inclusion criteria.

Results

In July and August, MFFD patients occupied 10.75% and 0.77% of bed days, averaging 5.9%. The observed monthly discrepancy prompts a need for more extensive studies. Medically fit patients in hospitals incur economic burdens and health risks, costing approximately £450 per bed day. The study estimates a monthly expenditure of over £7,000 on patients overstaying in Mitchelham Ward.

Conclusions

The issue of patients awaiting social care packages is rapidly growing nationwide. Locally, addressing this problem requires enhanced collaboration with social care services. Healthcare workers should acknowledge the economic and health risks. Adequate safety measures and specialized care for these patients are imperative to reduce associated health risks. The economic impact emphasizes the urgency of proactive measures at both local and broader healthcare levels.
32 Photogrammetry 3D Models : A Novel Approach to Surgical Medical Education but What About Their Accuracy?
Authors: Aliotta S
Published: August 2024

Surgical teaching and learning of anatomy are mostly based on the donation of human bodies. It is acknowledged that students learn anatomical structures best by dissecting cadaveric specimens or the exploring prosected specimens. However, the availability and accessibility of these specimens is limited due to their confinement to licensed facilities and their short-shelf life. The integration of 3D digitization and modelling in medical education has delivered promising results. Despite the progress in 3D imaging techniques, the accuracy and reproducibility of these models have not been thoroughly investigated. This paper seeks to show the various factors which may alter model inaccuracy and irreproducibility.

Six archaeological bone human specimens were digitized in this study. The photogrammetry models were compared to micro-CT-based reference models and a low-cost 3D laser scan.

Results show that photogrammetry provides overall the most accurate reconstruction of the specimens across all the comparisons. The inter-and intra-observer error was also assessed. Results showed no significant trend in intra-observer variability. In regard to inter-observer variability, a minimal variation was recorded. This is significant as it demonstrates that the data obtained is reproducible and robust, in particular applicable for the repeatability of the same data from different users with minimal overall variability. This paper has highlighted the accuracy of photogrammetry as a useful low-cost tool for the 3D reconstruction of cadaveric models for surgical medical education.
790 Basic Robotic Technical Skills Course (BRITS): A Critical Evaluation of an Evolving Surgical Curriculum
Authors: Ike D I , Asemota N , Jacob A , Okorocha C , Stamenkovic S
Published: August 2024

Robotic-assisted surgery has rapidly advanced, significantly impacting various surgical specialties. Traditionally, robotic training primarily targeted experienced surgeons, but recent data from robotic training programs challenge this paradigm. Robotic surgery offers a conducive environment for both novice and expert training, potentially featuring a shorter learning curve compared to laparoscopic methods.

The Barts Thorax Centre at Barts NHS Trust has conducted six courses, involving over 80 surgical trainees specializing in cardiothoracic surgery, with the participation of more than 12 consultants and senior faculty members.

Each course aimed to enhance participants' knowledge and skills in robotic thoracic and minimally invasive surgery, focusing on three educational goals: 1) assessing participants' pre-course knowledge and skill levels in core aspects of robotic surgical training, 2) evaluating overall course satisfaction and satisfaction with individual sessions, and 3) gauging self-rated improvements in knowledge and skills upon course completion.

The BRiTS' course curriculum has proven effective in introducing essential concepts of robotic thoracic surgery, as indicated by pre-course and post course assessments highlighting the demand for such educational offerings. A well-structured curriculum, combined with dedicated faculty and industry support, forms the basis for successful implementation of robotic surgical training. Participants expressed strong appreciation for the high-fidelity models provided in the wet lab stations, as evidenced in the post-course feedback.

This experience underscores the importance of expanding robotic training opportunities to a broader spectrum of surgical professionals, ultimately contributing to improved patient care and outcomes in the field of robotic-assisted surgery.
795 Elevating Medical Education Through Standardised Bedside Teaching
Authors: Copperwheat A , Kandikattu S
Published: August 2024

Aim

This project aimed to maximise the learning opportunities derived from bedside teaching (BT) through standardised junior doctor (JD) tutor education and increased sessions.

Method

Surveys collected feedback on current BT from medical students and general surgery JDs. Next, a presentation and reference sheet were provided to JDs. Students then received the standard number of BT sessions with Teaching Fellows for the first six weeks, followed by additional sessions from the JDs in the final six weeks. Repeat surveys evaluated the effectiveness.

Results

Before the scheme, students felt sessions with JDs were disorganised. They desired more sessions and increased variety. JDs rated confidence and knowledge an average of 5.8/10, and wished for education on BT. Following the scheme, nearly 100% of students found the extra sessions useful, appreciating the expertise of other doctors. The sessions were rated high for usefulness (8.8/10). 83% of students found the sessions well prepared but many wished for a greater variety of specialties to be covered. All students achieved a grade of Excellent in their OSCE exams. JDs confidence increased to 7.8/10, with 80% feeling an improvement.

Conclusions

In conclusion, the scheme had a positive impact. This was evident from increased student satisfaction, enhanced JD confidence and exam results. However, some areas, such as speciality teaching, require improvement to fully optimise BT as a tool in medical education. It would be advisable for other departments to adopt this scheme as it emphasises the value and importance of BT, which is currently not fully utilised.
31 A Comparison of Deep Learning Artificial Intelligence Methods with Radiologists in Breast Cancer Screening for Guiding Patient Management
Authors: Furness D
Published: August 2024

Background

Breast cancer is the most common type of cancer in women. Mammograms are the most used method of screening; however, this technique has limited sensitivity. According to the USPSTF, the screening age for breast cancer in the US has reduced by 10 years which will produce thousands more images, increasing the demand on radiologists.

Aim

AI algorithms aim to assist radiologists and detect cancers that would have otherwise been missed. The aim of the integration of AI into screening is to enable quicker breast cancer detection, leading to earlier treatment which may include surgery in some cases.

Results

Recent studies which compare the performance of Deep learning, Convolutional neural network (ResNET) models with radiologists in breast cancer screening, have shown an increased accuracy of malignancy detection when radiologists read images in combination with AI than radiologists reading the scans alone.

Discussion

Radiogenomics could be utilised to predict the likelihood of patients developing breast cancer, taking into consideration patient factors and image data, aiming towards precision medicine. However, there are some limitations with the use of AI in the screening programme, such as access to large quality data, data privacy, transparency and explainability.

Conclusions

AI has the potential to shift breast cancer detection to a more proactive than reactive approach, increasing the speed and accuracy of diagnosis and contributing to the establishment of a more patient-centred approach to treatment.

However, more research is needed into this field and ethical considerations must be evaluated prior to implementing AI fully within the screening programme.
352 Systematic Review and Meta Analysis: Transanal Hemorrhoidal Dearterialization (THD) versus Milligan-Morgan Hemorrhoidectomy (MMH) in Grade III/IV Hemorrhoids
Authors: Kazemi N , Mena J , Elzeftawy M
Published: August 2024

In cases of hemorrhoidal disease, when conservative measures fall short in providing relief or in advanced stages of the disease, surgical intervention becomes necessary. This article presents a systematic review and meta- analysis comparing THD and MMH for the treatment of grade III/IV haemorrhoids.

The study included relevant articles that reported outcomes of THD and MMH in patients with grade III/IV haemorrhoids. Data on demographic characteristics, follow-up duration, operation time, grade of haemorrhoids, and post-operative complications were extracted and analysed.

The included studies revealed varying sample sizes and patient ages, with THD and Milligan-Morgan Haemorrhoidectomy performed on individuals aged 48 to 58.8 years. Both surgical techniques demonstrated comparable efficacy in addressing post-operative complications like pain, bleeding, incontinence, and itching. Minor variations in bleeding rates were noted, possibly linked to differences in operation time. Follow-up durations ranged from 12 months to 7.0 years, revealing promising outcomes for THD and Milligan-Morgan Haemorrhoidectomy in pain relief and recurrence prevention. The available evidence showed low recurrence rates and high patient satisfaction with both approaches. THD offers advantages such as reduced post-operative pain and faster recovery, while Milligan-Morgan Haemorrhoidectomy remains a reliable surgical method. Consideration of patient characteristics, surgeon expertise, and individual preferences should guide the choice between the two techniques.

Further research with standardized methodologies, larger sample sizes, and extended follow-up periods is essential for more robust conclusions and comparative effectiveness data. The systematic review and meta-analysis presented here contribute valuable insights for clinicians in making informed treatment decisions.
1085 Power Tools and Hand Injuries
Authors: Gkorila A , Moura F S
Published: August 2024

Aim

Power tools are frequent culprits in traumatic upper limb injuries. The resulting wounds have significant heterogeneity since these depend on the tool characteristics. Wider kerf blades, outward-facing teeth, crushing and avulsion-causing mechanisms may limit the ability of end-to-end repair requiring more complex reconstruction.

Method

We outline the mechanism of action of these tools, allowing hand surgeons to appreciate the injury and facilitate surgical planning.

Results

Angle grinders' handheld nature result in unilateral injuries. As the number of the affected fingers increases, the site of injury moves more proximally. Chain saws injuries are multi-digital, proximal arm open fractures, or amputations with chewed soft tissues. The most common mechanism of injury for most saws is the kickback phenomenon. The cut of circular, mitre, table saws blade comes solely from its teeth, rather than the disk itself. The number and shape of the teeth will determine the resulting cut. The repetitive reciprocating motion of the jigsaw blade will result in multiple small but deep lacerations. Planers' spinning blades remove wood at the depth difference of the in- and out-feed bases, resulting in shallow but extensive cuts. Power drills have the capacity to cause high speed rotating trauma resulting in localised shear and friction burn injury. Sanders are culprits of friction burns, abrasions or lacerations from the tool or the workpiece if not securely fixed.

Conclusions

Hand trauma from DIY machinery can cause not only physical disability but also have devastating psychological impact. We encourage trauma surgeons to learn the different configurations of the tools highlighted herein.
1092 Perioperative Practices and Early Post-Transplant Outcomes in Deceased Donor Simultaneous Kidney Pancreas Transplants (SPK): Results of a National Transplant Access to Theatre (NTACT) Audit
Authors: Borbas B , Mujeeb M , Tanase A , Aroori S
Published: August 2024

Aim

Deceased donor simultaneous kidney-pancreas transplants (SPK) outcomes hinge on donor and recipient factors. Limited UK data on perioperative practices and outcomes prompted the National Transplant Access to Theatre (NTACT) study, aiming to unveil the current landscape.

Method

A prospective audit covered adult deceased donor kidney-only transplants in five UK centres from February to September 2022. RedCap recorded data and analysed descriptively.

Results

Among 29 SPK transplants, 24 were analysed. Preoperative antibiotics were universal, and consultant surgeons led all operations, though only 62.5% were directed by consultant anaesthetists. Central and arterial lines were standard, with 42% using advanced hemodynamic monitoring. Goal-directed fluid therapy, done using static parameters in 62.5% of cases, was common. Post-operatively, 75% were routed to the Intensive Care Unit. Encouragingly, 30-day mortality was 0%, and primary graft function rates were 83% for kidneys, 92% for pancreas. The median hospital stay was 12 days (IQR: 11-18), with a 29% readmission rate and 33% re-operation rate. Notably, readmission rates differed between Donation after Circulatory Death (DCD) and Donation after Brain Death (DBD) organs (17% vs. 41%).

Conclusions

Diverse perioperative practices and notable early complications were observed. While limited sample size precludes statistical associations, this underscores the need for future, more extensive studies.
1144 ‘Lite’ Delisting – Enabling Kidney Transplant for Highly Sensitised Patients in the Deceased Donor Waiting Pool
Authors: Ashton G , Kessaris N , Game D , Dorling A , Barnett N , Shaw O
Published: August 2024

Very highly sensitised patients without living donors are unlikely to receive a transplant due to lack of compatible donors. Lite delisting involves removing certain unacceptable antigens from patients’ profiles registered with NHSBT; to achieve a crossmatch negative, antibody positive offer. This project reviews the delisting programme in our centre.

The lite delisting programme was initiated in 2018. Patients included in this report were those currently active in the delisted programme and those transplanted since the initiation of the programme. Electronic patient records were reviewed to identify the number of organ offers received. For transplanted patients, clinical outcomes were retrieved.

37 patients received a total of 79 deceased donor offers over the time-period. 19 transplants were completed, 18 in the context of delisting (Alemtuzumab induction). 60 offers were declined (19 because of positive crossmatch results). Of the 19 (10 Female, 9 Male; average 44 years) patients transplanted, 18 had reached a 3-month time point post-transplant. Death censored allograft survival at 3 months was 15 (83%); 1 patient died following a period of primary non-function, two were alive with failed allografts (1 explanted for ischaemia and 1 primary non-function). 1/18 (6.7%) was diagnosed with acute antibody-mediated rejection (graft survived); there were no recorded episodes of T-cell mediated rejection. Mean creatinine of functioning grafts at 3 months post-transplant was 165µmol/L (n=15).

Lite delisting is an effective method to allow highly sensitised patients to receive transplants, avoiding the long-term risks of dialysis; although, there are associated risks of transplantation. This methodology could be considered in further Transplant Units.
314 Communication With Parents and Post-Operative Clinical Review by Operating Team in Paediatric Trauma
Authors: Nelson A , Suibhne P M , Madhu R , Kadambande S
Published: August 2024

Aim

Communication is one of the key GMC principles and is particularly important when discussing perioperative plans in paediatric trauma. Parents often have consented to multiple procedures for their child, and it is imperative they are informed post operatively on the procedure performed in theatre. The aim is to identify our compliance with parental post operative communication and clinical review of paediatric trauma patients, and the documentation of this.

Method

Retrospective analysis of all patients ≤18 years old operated in trauma theatres at the Grange University Hospital between August-September and October- November 2023. Data was obtained from online operations systems ORMIS, clinical workstation and telephone calls to parents. Interventions were implemented at local audit meetings to encourage changes in clinical practice.

Results

Post operative clinical reviews and communication with parents improved from 34% in Cycle 1 to 66% in Cycle 2. Excluding patients who were not contactable, 77% of patients were reviewed post operatively during Cycle 2. Despite this improvement, there was overall poor documentation of clinical reviews and parental updates. In Cycle 1, 30% of reviews were documented followed by 57% documented in Cycle 2.

Conclusions

Clinical review of children post operatively is essential, providing an opportunity to explain intraoperative findings, procedure performed and confirm follow up to parents. There is room for improvement in our post operative clinical reviews, and the respective documentation of this. We will aim for 100% compliance of post operative reviews, providing an opportunity to answer questions and reduce parental anxieties, therefore optimising patient care.
629 Demographic and Epidemiological Analysis of Pelvic Wing and Acetabular Fractures
Authors: Zhang J , Bradshaw F , Zhu J , Krkovic M
Published: August 2024

Aim

Pelvic and Acetabular fractures (PAFs) are a significant concern, particularly in older individuals with osteoporosis. This study presents a 6-year retrospective review conducted at a tertiary trauma centre in the UK to analyse the incidence, demographics, and associated factors of PAFs.

Method

Data encompassed pelvic ring and acetabular fractures from January 2017 to January 2023, categorized by Young and Burgess or Letournel classifications. Parameters included age at injury, gender, BMI at presentation, injury mechanisms, and related orthopaedic and non-orthopaedic injuries.

Results

The study assessed 2,128 pelvic fractures, comprising 1,093 pelvic ring fractures and 1,035 acetabular fractures. Acetabular fracture patients were older (average 61.5 vs. 56.4 years) and more frequently male (67% vs. 46%) than pelvic ring fracture patients. Both groups displayed similar average BMI and surgical management rates (49.8%).

Among pelvic ring fractures, Lateral compression type-I fractures predominated at 53.7%, while anterior column and posterior hemitransverse fractures were most common in acetabular fractures (23.6%).

High and low-impact falls were the primary causes for pelvic ring (24.0%) and acetabular fractures (30.8%). Interestingly, almost two-thirds of pelvic fractures occurred in isolation without additional orthopaedic polytrauma. Organ lacerations/contusions were the predominant associated non-orthopaedic injuries, followed by pneumothorax and brain injuries, with fewer other injuries.

Conclusions

This study offers insight into PAFs at a UK trauma centre, particularly in sub-classifying pelvic fractures based on the Young-Burgess and Letournel classifications, a rarity in existing literature. These findings contribute to international comparisons and inform evidence-based policies for healthcare resource planning and postoperative care.
819 Assessing Regional Variation in VTE Prophylaxis Prescribing Practice Following Major Lower Limb Arthroplasty
Authors:   Oswestry Stoke Collaborative for Audit and Research (OSCAR) Group
Published: August 2024

Aim

There is uncertainty regarding optimal post-operative pharmacological VTE prophylaxis regime following total hip and knee arthroplasty (THA/TKA). 2023 International Consensus Meeting on Venous Thromboembolism (ICM-VTE) guidelines recommend low-dose aspirin for 14 to 35 days in TKA and THA patients. Variation in practice may increase prescribing errors and healthcare-associated costs.

Method

This study defines current VTE prophylaxis regimes following primary THA and TKA in a UK-based region. A cross-sectional survey was performed. Training registrars affiliated with the OSCAR collaborative group documented the standard pharmacological VTE prophylaxis regime of named consultant arthroplasty surgeons in four units within the Oswestry-Stoke rotation.

Results

The practice of 29 consultants performing primary THA were documented. 10 different regimes were noted considering agent type and duration. 8 (27.6%) preferred low-molecular-weight heparin (LMWH), 1 (3.4%) aspirin and 4 (13.8%) direct oral anticoagulant (DOAC) alone. 10 (34.5%) used LMWH followed by aspirin or DOAC. 6 (20.7%) used LMWH alone or LMWH followed by aspirin depending on thrombotic risk. 9 different regimes for 30 consultants performing primary TKA were identified. LMWH, aspirin and DOAC alone were preferred by 10 (33.3%), 1 (3.3%) and 4 (13.3%) consultants respectively. 8 (26.7%) used LMWH as in inpatient followed aspirin or DOAC on discharge. 6 (20.0%) used either LMWH or aspirin alone depending on high- or low-thrombotic risk respectively.

Conclusions

Even within a limited geographical region significant variation in pharmacological VTE prophylaxis prescribing exists. A randomised-controlled trial to compare efficacy of agents is required, though challenging due to the numbers required to adequately power this study.
374 Quality of Life Outcomes for Penile Prosthesis Insertion Post-Priapism – Satisfaction Guaranteed?
Authors: Dighero I , Looney A , Naylor K , Mount C , Holden F , Johnson M , Ralph D , Sangster P
Published: August 2024

Aim

Penile prosthesis (PP) insertion is recommended for patients experiencing long-duration ischaemic priapism to restore erectile function. In this setting, decision making is time critical, and clinicians must counsel appropriately. However, there is a paucity of published data on quality of life (QOL) outcomes. Aiming to equip clinicians to counsel in the acute setting, our objective was to conduct the largest study to date assessing QOL outcomes in post-priapism PP patients.

Method

We contacted patients who received post-priapism PP in our department via telephone and completed the previously validated Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) questionnaire. Causes of dissatisfaction were collected anecdotally.

Results

167 patients had PPs inserted post-priapism between 2002-2022. Of these, 39 (23%; implants between 2007-2021) completed our questionnaire. The median age of respondents was 55.7 years with a median time post-priapism event to study date of 9.1 years. At time of contact, 95% (37) of respondents were actively using their device. 82% (32) felt their PP had met their expectations, 74% (29) were satisfied with their sexual experience and the same number reported partner satisfaction. Causes of dissatisfaction related to changes in penis size as well as device choice.

Conclusions

PP insertion is a suitable surgical technique to maintain sexual function in patients’ post-priapism, for whom it can have a positive impact on sexual experience for both patient, and their partner. We noted dissatisfaction related to device choice and priapism complication symptoms. This emphasises the importance of managing patient expectation in regard to pathology and device options.
704 Robotic Partial Nephrectomy Results in Reduced Pain Score and Length of Stay Compared with Open Partial Nephrectomy
Authors: Arbide D , Anbarasan T , Laird A
Published: August 2024

Aim

To assess the use of Robotic-Assisted Partial Nephrectomies (RAPN) in reducing patient-reported pain scores and use of opioid analgesia compared with Open Partial Nephrectomy (OPN).

Method

Data was collected from consecutive patients undergoing OPN between Feb 2019 and Nov 2020 and RAPN between Sep 2022 and Aug 2023. Data included demographics, high dependence and hospital stay, patient reported pain scores and opiate use during in-patient stay. Pain scores were recorded in a Likert scale from 0-10. We standardised opiate use across patients as oral morphine dose per day, then calculated maximum and median daily pain scores and median daily analgesia dose used for the first 2 days post-operation.

Results

OPN and RAPN were performed in 17 and 35 patients respectively. No patients undergoing RAPN required HDU admission while all patients undergoing OPN were admitted to HDU post-operatively for a median 2 days (1-6 days). The median length of stay was shorter for RAPN compared with OPN (2 days and 4 days respectively). The pain scores for all patients were highest on post-operative day 1. The median pain score was 3 and 1 respectively for OPN and RAPN on day one. Most OPN patients had an epidural for the first 48 hours (10 [58.8%]) while RAPNs were managed with oral analgesia. The median opiate use was 24mg on day 1 post RAPN.

Conclusions

Patients undergoing RAPN have less pain than OPN with resultant need for less HDU stay and reduced length of stay overall.
892 Prostate Specific Antigen Density (PSAD) in predicting prostate cancer: A District General Hospital Analysis
Authors: Balasubaramaniam V , Kailasa A , Donev K
Published: August 2024

Aim

PSAD is a marker to predict prostate cancer with levels >0.15 ng/ml2 increasing the chances of prostate cancer. This study aims to investigate the use of PSAD in predicting patients with prostate cancer.

Method

A retrospective audit of patients who underwent LATP under one urologist over a 10-month period (11/2/2022-27/11/2022) were included in the study. Data of PSA levels, LATP histology findings, MP-MRI results and cancer MDT notes were found from the online record system and recorded.

Results

A total of 53 male patients underwent LATP over the 10-month period. The mean age of patients was 71.6 years old. 77.4% (41) patients were diagnosed with prostate adenocarcinoma, 18.9% (10) had benign histology, and 2 patients showed high-grade prostate intraepithelial neoplasia (PIN). The median PSA value for patients with adenocarcinoma is 9.3ng/ml (4.8-300.9). For patients with a PSAD of >0.15 ng/ml2, 78% (32) of patients had adenocarcinoma, 20% (2/10) patients had benign histology, and 50% (1/2) patients had high-grade PIN. With a PSAD >0.10 ng/ml2, there was a 92.7% sensitivity and 33.3% specificity in detecting prostate cancer.

Conclusion

PSAD >0.15ng/ml2 is a good marker in predicting prostate cancer, however, other investigations such as MP-MRI and prostate biopsy should be used to facilitate the diagnosis. A lower PSAD value will increase the sensitivity but reduce the specificity, leading to unnecessary prostate biopsies. Further studies with larger sample size and that compares various PSAD cut-off with prostate cancer should be conducted.
293 Evaluation of Imaging Strategies for Carotid Stenosis in Carotid Endarterectomy Patients
Authors: Musa A M , Gaba K , Nash T , Patterson B , Pemberton M
Published: August 2024

Background

The European Society for Vascular Surgery (ESVS) carotid guidelines recommend the use of duplex ultrasound (DUS), computed tomography angiography (CTA) and magnetic resonance angiography (MRA) in assessing carotid stenosis. ESVS recommends corroborating DUS estimates with a CTA, MRA or a repeat DUS with ideally a second operator.

Method

In this retrospective cohort study of 73 consecutive carotid endarterectomy patients (between June 2022 and June 2023), data were collected from the Picture Archiving Communications System which included the date of each investigation and quantification of the degree of carotid stenosis based on the North American Symptomatic Carotid Endarterectomy Trial (NASCET) method. Spearman’s rank correlation coefficient was used to evaluate the correlation between DUS and CTA estimates of carotid stenosis.

Results

71 symptomatic and 2 asymptomatic CEAs were conducted. Among these, 69.9% (n=51) underwent DUS followed by a CTA, 8.2% (n=6) had a CTA preceding DUS, 1.4% (n=1) underwent sequential DUS, CTA and MRA, 8.2% (n=6) received two DUS scans, with 5 conducted by a different operator and 12.3% (n=9) had only a single DUS. For the 57 patients with both DUS and CTA, in any order, a statistically significant, positive correlation was observed (r= 0.514, 95% CI 0.3075 – 0.7135, p<0.0001).

Conclusions

The imaging strategies recommended by the ESVS are being undertaken in the majority of patients. Only 12.3% of patients did not have a corroborating scan undertaken. Despite the acknowledged operator dependence of DUS, this study found a strong positive correlation with CTA estimates of carotid stenosis.
1135 Atraumatic Profonda Brachii Arterial Pseudoaneurysm
Authors: Nawaz S M A , Harkin S , Hassard R , Lambon R , Sharif A
Published: August 2024

Introduction

Peripheral Artery pseudoaneurysm such as brachial artery pseudoaneurysm are very rare and typically happen after trauma or infections. We present a case of a 70-year-old man who presented with a large atraumatic non pulsatile soft tissue mass like swelling.

Case Presentation

A 70 year old gentleman was referred by GP due to atraumatic swelling in right upper arm which was noticed 2 weeks pre-referral.

Patient was unsure about duration of the noticed swelling, which was mobile, tender and was about tennis-ball size. Neurovascular status of arm was intact with no erythema or skin changes. Initially it was treated as infected pseudo-cyst with oral anti-biotics for 5 days. CT-angiogram demonstrated large well-circumscribed mass lesion mid right upper-arm medial to biceps. On ultrasound this appeared to be associated with a branch of the brachial artery as opposed to the brachial trunk proper, with active bleeding within the haematoma. After MDT discussion, patient underwent surgical repair and intra-operative finding showed brachial profunda artery aneurysm. Median nerve and ulnar nerve were preserved along with brachial artery which was separate from the mass. Histopathology report confirmed the presence of pseudoaneurysm with underdetermined aetiology.

Discussion

Although upper extremity peripheral arterial pseudoaneurysm is rare, they can happen iatrogenically post-trauma. Our case was different than usual as being without any previous trauma and therefore, misdiagnosis is not uncommon.

Conclusions

Presence of pulsation is not always mandatory in painless swellings and a high index of suspicion is obligatory for the early diagnosis of pseudoaneurysm where diagnostic delay could lead to detrimental complications.
1264 Applications of Artificial Intelligence and Machine Learning in Endovascular Neurosurgery: A Literature Review
Authors: Al Hussaini N
Published: August 2024

Aim

The integration of artificial intelligence and in healthcare settings is increasingly growing, although its use is limited in clinical practice. This meta-analysis reviews the current implications of artificial intelligence in endovascular surgery, including preoperative risk-stratification, surgical preparation, and follow-up.

Method

This study was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Through a comprehensive search of PubMed and Scopus from 2017 until 2023. Around 300 articles were gathered and 23 eligible studies on neuroendovascular techniques were chosen to review.

Results

In a comprehensive review of 23 articles on AI applications in endovascular neurosurgery. One study focused on time-effective detection of ischaemic stroke through Viz large vessel occlusion deep learning neural network DLNN. Nine studies reported intracranial aneurysms surveillance implementing ML model by assessing age, hypertension, aneurysm size and previous history. Additionally, three studies utilised DLNN to evaluate the functioning AV fistula maturation with 80% accuracy. Few studies assessed DL algorithm by T2-weighted image analysis to distinguish Moyamoya disease from atherosclerosis.

The da Vinci robotic system has demonstrated a value in improving surgical precision, especially prostatectomies and abdominal surgeries. Although robotic neurovascular intervention is in the early phase, substantial progress has been made, with systems including Magellan and CorPath GRX exhibiting procedures like stroke thrombectomy and endovascular coiling.

Conclusions

The emphasis of artificial intelligence and robotics in endovascular neurosurgery carries transformative power, encouraging growth in surgical performance. AI, specifically deep learning schemes, has shown remarkable efficacy.
Toward accelerated discovery of solid catalysts using extrapolative machine learning approach
Authors: Toyao Takashi
Published: August 2024

Designing novel catalysts is pivotal for overcoming numerous energy and environmental challenges. Although data science approaches, particularly machine learning (ML) approaches, hold promise for accelerating catalyst development, discovering truly novel catalysts through ML remains rare. This is largely due to the perceived inability of the ML models to extrapolate and identify exceptional materials. In this Review, I present our approach taken to tackle this limitation. Specifically, we employed an advanced ML methodology that could make extrapolative predictions. This approach led to the discovery of multielemental solid catalysts for CO2 hydrogenation to CO. The results not only demonstrate the immense potential of ML in catalysis research but also set a new standard for the rapid development of high-performance catalysts.