bluuebunny/crossref_metadata_2025_split huggingface dataset:
607 A Close Loop Audit on Proper Documentation of Ventriculo-Peritoneal (VP) Shunt Valve Settings in Operation Note
Authors: Porag R 
Published: October 2021

Abstract

Aim
Re-audit the practice of proper documentation of shunt type and settings in VP shunt surgery in Queen's Medical Centre, Nottingham for the period of 1st November 2019 – 31st October 2020. It is very important as programmable shunt setting could get changed during MRI, causing shunt failure.

Method
It was a retrospective collection of data of patients admitted to Queens medical Centre, Nottingham who had undergone VP shunt procedure. Exceptions: 4 files were excluded from study as they did not undergo VP shunt procedure.

Results
Total number of patients: 98. 4 patients were excluded. Actual sample size 94. Total VP shunt procedure done: 107. In 96 out of 107 procedures the shunt valve type and settings were properly documented. In 11 out of 107 procedures the shunt valve type and settings were not documented. In 33 out of 107 procedures programmable shunt valves were used. All 33 procedures had proper documentations.

Previous audit result
Duration of data collection: 2 years (from March 2016 to February 2018). Sample size 200. Total VP shunts done 247. Proper documentation of shunt valve type and settings were done in 209 out of 247 procedures. In 38 out of 247 procedures shunt valve type and settings were not documented. In 55 out of 247 procedures programmable shunt valves were used. 3 out of these 55 procedures (programmable shunt valves) lacked proper documentation.

Conclusions
There is an overall improvement in the practice of documentation of VP shunt valve type and settings in operative notes after implementing the plan of actions decided on first audit.
618 Management of Rectal Cancer in England And Wales. Is the Rate of Abdominoperineal Excision of Rectum Associated with The Pre-Operative Radiotherapy Rates?
Authors: Nowinka Z , Soussi D , Stanley A 
Published: October 2021

Abstract

Aim
Rectal cancer treatment has improved over the years, but variations in practice remain. Abdominoperineal resection (APER) is associated with significant morbidity and pre-operative radiotherapy (RT) is only recommended for advanced rectal cancer. As such, APER and RT should be reserved for patients with an appropriate clinical need. The aim of the study is to evaluate the association between the rates of APER and RT, and whether any other factors are associated.

Method
Data on rectal cancer cases was extracted from National Bowel Cancer Audit 2019. Primary outcomes were: APER rate, RT rate. Pearson’s correlation coefficient was calculated. The means for APER and pre-operative radiotherapy were plotted on a four-quadrant matrix. The differences were analysed using Mann-Whitney U and Student T-test.

Results
3,764 patients were included. A mean of 25% (95%CI: 10.3-14.9%) underwent APER and an average of 34% (95%CI: 30.5-36.8%) received RT. There was a weak positive correlation between rates of APER and RT (r = 0.356, p &lt; 0.001). 43 (37%) trusts had proportions of both APER and RT below the overall mean, whilst 30 (26%) had both proportions above. No significant differences were found when comparing other variables between the high to low-rate trusts (p &gt; 0.05).

Conclusions
There is a weak positive correlation between the proportion of rectal cancer patients undergoing APER and the proportion receiving RT in trusts across England and Wales. It is unknown whether this finding has a clinical significance and further analysis on trust/surgeon performance and patient demographics is needed, allowing for prevention strategies to be implemented.
623 Completed Audit Cycle of Indications for Excision of Fibroadenomas At A University Hospital
Authors: Beattie A 
Published: October 2021

Abstract

Aim
This audit looked at indications for excisions of fibroadenomas one year on from the first audit cycle and following intervention of presentation and teaching at local departmental meeting. This audit was motivated by a drive to reduce operations on benign breast conditions including fibroadenoma excisions. ABS (Association of Breast Surgery) guidelines advise excision for fibroepithelial lesions (B3) on biopsy, pain and increasing size. Local consensus is excision of fibroadenomas over 30mm on ultrasound.

Method
Patients who underwent surgical excisions of fibroadenomas over 6 months at one hospital were analysed for size on ultrasound, biopsy histology and reason for excision, and compared to previous audit results over 24 months.

Results
Over 6 months, 18 patients underwent excisions. Histology specimens showed 13/18 were fibroadenomas, 4/18 benign phyllodes and 1/18 other benign conditions. This was similar to the previous audit, although there was an increase in the rate of benign phyllodes.
Pre-operatively, 11/18 of patients met the ABS criteria for excision (7/11 were B3 lesions, 3/11 for increasing size and 1/11 pain). 11/18 patients met the local criteria. 2/18 patients met neither criteria. This had improved compared to the first audit cycle.

Conclusions
88.9% of patients met ABS or local criteria, compared to 83.7% previously, and so this had improved following intervention. One outcome from the first audit cycle was patients need greater reassurance about the benign nature of fibroadenomas to avoid unnecessary morbidity due to surgical procedures, and this appears to have improved on re-audit. Both patients not meeting criteria had histology showing fibroadenomas.
646 A Review of The Urodynamic Referral Pathway and The Accuracy of Urodynamic Study Requests
Authors: Breish M , Harding C , Biswas S 
Published: October 2021

Abstract

Aim
Urodynamic studies (UDS) are physiological measurements of voiding and storage function of the lower urinary tract that are commonly performed in clinical practice to investigate bothersome lower urinary tract symptoms. Despite considerable efforts to improve UDS, standardisation of the practice remains to be challenging. This audit thus, presents a review the current UDS referral process and analysis of the clinical details included on urodynamic requests.

Method
This audit included retrospective data from 112 patients between March and Oct 2020, 98 of which had UDS performed. Patient electronic records, referral forms and clinic letters were all used for data collection.

Results
Data shows that 47% of patients were females with average age of 56 years, range (16-86) years. The reason of UDS was clearly stated in 8 referrals only and the clinical examination findings were clearly mentioned in 31% only. More than three quarters of patients (i.e., 77%) had assessment of post void residual prior to UDS, but half of the proportion had no history of relevant medications. In 98 patients who had UDS done, the main findings showed that 4 patients had normal studies, 3 with dysfunctional voiding, 7 had bladder outflow obstruction, 32 patients were diagnosed with detrusor overactivity, 12 had stress incontinence and 7 showed detrusor underactivity.

Conclusions
Finding of this audit clearly suggest a level of unclarity in the great majority of referrals. Evidently, key history of relevant medication is overlooked in half of the referrals. Improvements to the current pathway to UDS is therefore pivotal.
649 Smoking Cessation as A Variable Risk Factor in Head and Neck Cancer
Authors: Kabaso M , Paterson T , Marshall J 
Published: October 2021

Abstract

Aim
Smoking is the leading cause of preventable death and disability worldwide and is a well understood risk factor in a number of diseases, including cancers of the head and neck. In 2019 over half of UK smokers reported interest in quitting, however, continue to do so. We assessed referrals made to the cessation service by the Ear Nose & Throat (ENT) department across the health board with the aim of raising awareness and improving smoking cessation referrals.

Method
Working with the smoking cessation team, we retrospectively assessed the clinical information of all patients referred by ENT over an 8-month period during 2019. The results of which, were presented departmentally with the goal of raising awareness of the service. Posters were also created detailing the referral process to aid junior doctors on surgical wards. Data was then re-audited over the subsequent 9-month period.

Results
Initially, 33 patients were referred over the first 8-month period, averaging 4 per month with 44% of patients already having laryngeal cancer. After our interventions, the total number of referrals increased with 74 over the 9-month period, averaging 8 referrals per month with 28% of patients having laryngeal cancer association.

Conclusions
Overall, there was a significant 135% increase in the number of referrals made, both cancer and non-cancer. The increase made in monthly referrals suggests a sustainable change. The percentage decrease of cancer patients referred and overall increase in number of referrals, represents the reduction of smoking being a risk factor of developing laryngeal cancer in ENT patients.
651 An Audit of Negative Appendectomy Rate at A District General Hospital in the UK
Authors: Al-Hamid Z , Jaskani S , Chattopadhyay D 
Published: October 2021

Abstract

Aim
There is significant variation in management of acute appendicitis across the UK. Despite advancements in imaging modalities, acute appendicitis is still a clinical diagnosis. The primary aim of this study was to determine the negative appendectomy rate (NAR) and secondary aim was to look for the imaging results and hospital readmission rate in case of a normal appendix.

Method
It is a retrospective analysis of all the patients admitted with a suspicion of acute appendicitis from Jan 2018 to April 2019. For data collection hospital medical record was used. Information about patient demographic details, blood results, outcome, operative findings, and histology of appendix if removed, was collected. For Patients having negative appendectomy, hospital admission rate was calculated.

Results
Total 517 patients were admitted with suspected acute appendicitis and only 45.6% (n = 236) patients underwent surgery. Females=52.1%, Males 47.9%. Mean age was 31 years. NAR was 10.6% (n = 25). (Females= 9.3%, Males=1.3%), 8.4% female patients were below 35 years of age. Patients were divided into 3 groups (Normal appendix NA, Uncomplicated appendicitis UA, complicated appendicitis CA). There was a statistically significant difference in inflammatory markers between the groups. In NA group 17/25 patients underwent prior imaging and imaging suggested acute appendicitis in 7/17 patients. Post NA hospital readmission rate was 20%, all of them were females, and gynecology opinion was sought in all of them.

Conclusions
The negative appendectomy rate is at 10.6%, comparable to national database. It is more common in young females due to a range of differential diagnoses.
661 Improving Antibiotic Prescribing in a District General Hospital: A Closed Loop Audit
Authors: Ng Z H , Kamran T 
Published: October 2021

Abstract

Aim
Broad-spectrum antibiotics are effective in decreasing wound infection and postoperative intra-abdominal abscesses for patients undergoing appendicectomy. Compliance with local hospital antibiotic guidelines is important in ensuring antibiotic efficacy and reducing potential for toxicity and antibiotic resistance. The aim was to assess the impact of educational interventions on the adherence to local antibiotic guidelines in patients undergoing appendicectomy at a Scottish district general hospital.

Method
Preoperative antibiotic prescribing in consecutive adult patients aged ≥ 16 years undergoing appendicectomy were audited against hospital guidelines over a four-month period between March 2019 and July 2019. We implemented change through antibiotic prescribing teaching for doctors in the surgical team and anaesthetic team. This change was subsequently evaluated through a re-audit over a three-month period between December 2019 and February 2020.

Results
The baseline audit demonstrated 68.8% (n = 11/16) compliance to local antibiotic guidelines among patients undergoing appendicectomy. The remaining patients had the correct choice of antibiotics, but gentamicin was prescribed in different doses. Gaps in prescriber awareness of antibiotic guidelines were identified. Following departmental teaching sessions regarding antibiotic prescribing and use of the gentamicin dosing calculator, the re-audit showed 93.8% (n = 15/16) compliance with local antibiotic guidelines among prescribers in the surgical team and anaesthesic team.

Conclusions
Education interventions were instrumental in improving adherence to antibiotic prescribing guidelines. This highlights the importance of regular audit and prescriber education in the promotion of antibiotic stewardship in hospitals.
672 Emergency Laparotomy Patients: Is the Current Local Consent Process Compliant with Local and National Guidelines?
Authors: Barghash M , Rehman J , Salimi F , Mansour M 
Published: October 2021

Abstract

Aim
Obtaining valid consent is crucial to patient care. It also minimises the chance for claims regarding legal action for battery, breach of human rights and/or successful clinical negligence claims. In this project, we assessed whether a documented discussion took place prior to signing consent forms and whether consent forms were being completed adequately.

Method
This was a retrospective audit based on the Royal College of Surgeons’ (Good Surgical Practice) guidelines and the local trust policy. We assessed 50 case notes of patients who had a laparotomy from January 2019 to April 2020 in a busy district general hospital in the UK.

Results
We noted that our practice was fully compliant with documenting patient demographics, signatures, and the name of the procedure in consent forms. On the other hand, we found that, in the majority of cases there was no documentation of detailed benefits, risks, alternatives of surgery in case notes where compliance was only 21%. In addition, poor compliance was noted in documenting some of the possible risks e.g., hernia (50% compliance), leak (46% compliance) and ileus (26% compliance).

Conclusions
A detailed discussion with the patient and family including benefits, risks and alternatives of surgery should take place and this should be documented clearly in the case notes prior to signing the consent form.
673 Checklists Are A Spinal Surgeon’s Best Friend - A Post-Intervention Closed-Loop Re-Audit of Post-Operative Care in Patients Undergoing Surgery for Adolescent Idiopathic Scoliosis (AIS)
Authors: Carr H , Honeyman C , Prasad M , Hekal W 
Published: October 2021

Abstract

Introduction
The post-operative care (POC) of paediatric patients undergoing spinal surgery is essential. Initial audits (2015/17) identified shortcomings in POC practice.

Aim
To evaluate improvements in compliance with local AIS guidelines following application of a simple POC checklist. To identify reasons where standards are not met with formulation of an action plan to ensure the AIS POC pathway continues to improve and provide optimum levels of care for our patients.

Method
Data was collected retrospectively for 30 patients over 2 years. Standards assessed were taken from local AIS guidelines consisting of 25 distinct domains (Appendix 1).

Results
Our post-intervention results showed that, 100% compliance within individual AIS guideline domains improved significantly from 12/25 domains (2015), to 21/25 (2019/20). In the domains that did not meet 100% compliance, post-intervention, 2 reached 93.33% compliance and 2 reached 80% (2019/20), a significant improvement upon 2015/17 where several domains were within 20-70% compliance.

Conclusions
The results demonstrate that our intervention, a simple checklist, significantly improved the POC of our AIS patients and current practice is of an excellent standard. Standards were still not met in 2020 for a handful of measures. This was due to patients declining planned antiemetic/analgesic medication or rarely, incomplete documentation by health care professionals who were not yet fully familiar with the new checklist. Other centres offering surgical intervention for AIS may benefit from adopting/adapting this POC checklist and a similar audit may prove useful to optimise care for these paediatric patients undergoing significant surgery.
676 Paediatric Circumcisions- Compliance with RCS Standards
Authors: Rea W , Sturch P , Anjum F 
Published: October 2021

Abstract

Introduction
Variation in regional paediatric circumcision rates suggested some circumcisions were being performed unnecessarily. In 2016, the Royal College of Surgeons (RCS) released a clinical commissioning guide on foreskin conditions to standardise the indications for circumcision. We retrospectively audited the foreskin procedure practice at our urology department and its adherence to RCS clinical commissioning guidance.

Method
We assessed electronic health records for all paediatric patients (&lt;17 years) having undergone a foreskin procedure from 1st Jan 2018 to 1st Jan 2019. Records were assessed for referral source, trial of medical treatment (steroid cream), indication, operative management carried out, daycase or inpatient cases, and histological analysis.

Results
198 patients (mean age 8.7, range 2-16) underwent foreskin procedures in the set time frame. 98.9% were referred from GP surgery, and the remainder directly from A&E. 29.8% had documented trials of steroid creams prior to surgery. 51.5% of procedures were performed for ‘non-retractile foreskin’ and 11.6% for pathological phimosis. 87.4% of patients underwent circumcision and 11.1% had freeing of adhesions. All of procedures were performed as day-case. Histology was sent for 17.3% of circumcisions, with non-specific inflammation being the most common finding (46.7%), followed by lichen sclerosus (40%).

Conclusions
In our series large number of foreskin procedures were carried out over a 12-month period with a minority for the only absolute indication of pathological phimosis We have introduced stringent guidelines in the department since this audit, which will prevent circumcision in children who may otherwise avoid surgery.
701 Resuscitation and Escalation Status Documentation in Acute Surgical Admissions: A Re-Audit Feb 2020
Authors: Chan D M L , Yalamarthi S 
Published: October 2021

Abstract

Aim
Resuscitation and escalation of care are not always in the best interests of all patients. Planning ahead for patient’s escalation and CPR status, along with clear documentation can prevent inappropriate cardiac arrest calls. Previous audits on CPR and escalation status were conducted in 2017, 18 and 19 and the completion of CPR and escalation documentation was 0, 2 and 12% prospectively, with an improvement to 42% after an intervention in the 2019 audit. A re-audit for 2020 is conducted.

Method
A snapshot audit of patients who were admitted or referred to General Surgery between 10-17 Feb 20 were identified, admission record and medical notes reviewed. CPR and escalation status, presence of a DNACPR form, record of discussion with the patient or their family and the medical notes entry were reviewed.

Results
46.6% (34/73) of admissions had CPR and escalation status completed. Out of the admissions, all patients who were deemed not for resuscitation had DNACPR forms in their admission notes. All of these were discussed with either the patient or with their family, and the decisions appropriately documented in their medical notes.

Conclusions
This re-audit had shown improvement in the documentation on escalation and CPR status. This area can be improved further. Our recommendations include: 1. To present this finding in the education meeting and 2. Junior doctors to highlight the documentation to the oncall consultant/ or registrar during the first senior review and 3. To conduct a questionnaire to explore the surgeons’ views on this subject.
635 Expectations and Concerns of Patients Attending a Spinal Outpatient Clinic
Authors: Jones T , Stanley A , McCarthy M J H 
Published: October 2021

Abstract

Aim
Identifying expectations and concerns of patients is vital during clinical consultation in patient-centred healthcare systems. Most spinal surgery is elective and focussed on improving quality of life. Understanding what patients want from treatment at baseline may improve experience and outcomes.

Method
New patient data from the caseload of a single orthopaedic spinal surgeon (from April 2012-18) was analysed with expectations and concerns reported in the outpatient clinic letter (standard practice for surgeon).

Results
Of 940 patients (498 NHS, 442 private), mean age was 58.3 with 46.0% male and 54.0% female. Nearly 1-in-6 patients underwent previous surgery. The most common expectation was ‘reduce pain’ (41.8%), followed by diagnosis (23.0%), treatment options (13.5%), unsure (10.5%). The most common concern was ‘continuation/worsening of pain’ (27.0%), followed by loss of function (15.9%), work-related (8.3%), permanent disability (7.8%). NHS patients were significantly more unsure of expectations (19.7% vs 4.5%, p&lt;.001) and less frequently raised concerns (39.0% vs 18.8%, p&lt;.001). NHS patients had significantly worse Oswestry Disability Index (ODI) scores (46.8% vs 42.0% p&lt;.001), were more depressed (PHQ-9: 11.5 vs 8.9, p&lt;.001) and anxious (GAD-7: 8.2 vs 5.9, p&lt;.001). Private patients were significantly more likely to report problems sleeping (79.4% vs 51.0%, p&lt;.001). Patients concerned about permanent disability had significantly worse ODI (51.0% vs 42.7%, p&lt;.001), PHQ-9 (12.6 vs 10.2 p=.013) and GAD-7 (9.0 vs 7.1, p=.017) scores.

Conclusions
This study identified patient expectations and concerns in spinal outpatient clinic in both healthcare sectors. Future work should explore these findings in context with clinical outcome.
660 Trapeziectomy Versus Joint Replacement for First Carpometacarpal (CMC-1) Joint Osteoarthritis: A Systematic Review and Meta-Analysis
Authors: Raj S , Clay R , Ramji S , Shaunak R , Dadrewalla A , Sinha V , Shaunak S 
Published: October 2021

Abstract

Aim
The challenge of managing first carpometacarpal (CMC-1) joint osteoarthritis is the lack of guidance on which surgical intervention is superior. This systematic review and meta-analysis compares joint replacement (JR) and trapeziectomy techniques to provide an update.

Method
In August 2020, MEDLINE, Embase and Web of Science were searched for eligible studies that compared these two techniques for the treatment of CMC-1 joint osteoarthritis (PROSPERO registration ID: CRD42020189728). Primary outcomes included the Disabilities of the Arm, Shoulder and Hand (DASH), QuickDASH and pain visual analogue scale (VAS) scores. Secondary outcomes, such as total complication, dislocation, and revision surgery rates, were also measured.

Results
From 1909 studies identified, 14 studies (1005 patients) were eligible. Our meta-analysis found that post-operative QuickDASH score was lower for patients in the JR group, indicating decreased disability following this technique (5 studies, p = 0.0002). However, pain VAS scores were similar between the two groups (5 studies, p = 0.22). Interestingly, JR techniques had significantly greater odds of overall complications (12 studies; OR 2.27; 95% CI 1.17-4.40, p = 0.02) and significantly greater odds of revision surgery (9 studies; OR 5.14; 95% CI 2.06-12.81, p = 0.0004).

Conclusions
Overall, based on low to moderate quality evidence, we found that JR treatments may result in better function with less disability with comparable pain (VAS) scores; however, JR has greater odds of complications and greater odds of requiring revision surgery. More robust RCTs that compare JR and TRAP with standardised outcome measures and long-term follow-up would add to the overall quality of evidence.