bluuebunny/crossref_metadata_2025_split huggingface dataset:
145 Mind the App: A Guide for the Orthopaedic Senior House Officer on Call
Authors: Patel B , Fennelly J , Frazer S , Ahmed M , Granville-Chapman J 
Published: October 2021

Abstract

Aim
Many senior house officers (SHOs) have little experience in Trauma and Orthopaedics. While junior doctors are encouraged to seek help from the registrar during on call shifts, they are also dependent on a variety of guidelines to assist in the management of common orthopaedic presentations to the Emergency Department. The main issue is that site-specific guidance is not readily accessible on a single platform.

Method
Smartphone and web-based applications were designed summarising the initial management for such conditions for the SHO on-call to use as a quick reference tool. The efficacy of this was evaluated with questionnaires specific to the rating of the application and by two closed loop audits of BOAST standards for the management of distal radius and ankle fractures.

Results
Pre-app implementation questionnaire ratings revealed a mediocre confidence levels and high stress during an on-call shift. Post-app implementation questionnaires demonstrated the app was useful. Future use was recommended use for new SHOs. All responders felt that this would improve stress levels on call. Closed-loop audits for BOAST guidelines for ankle and distal radius fracture management were completed. Improvements were evident for obtaining appropriate radiographs ankle fractures (50.0% vs 77.8%) and positions of manipulated distal radius fractures (80% vs 100%).

Conclusions
This application proved a useful reference tool for junior staff to aid and initiate the management of common orthopaedic presentations to the emergency department. This tool could be used to improve confidence and ensure timely management of patients from the take.
193 Evaluation of the ‘One-Stop Diagnostic Head and Neck Lump Clinic' At A Tertiary Head and Neck Centre
Authors: Rajgor A , Sood S , O'Hara J 
Published: October 2021

Abstract
An urgent neck lump service was introduced at the Freeman Hospital (Newcastle-Upon-Tyne) in 2017. All 2-week-wait urgent head and neck referrals were triaged into this service. The clinic involves clinical examination by a head and neck specialist and if appropriate an urgent ultrasound scan (USS) in clinic +/- a fine needle aspiration for cytology (FNAC). This centralised system means patients can be diagnosed earlier and thus receive treatment swiftly.
This audit aimed to primarily identify: The prevalence/pick-up rate of cancer diagnosed through the clinicThe utilisation of USS/FNACThe time-to-treatment initiation
Data was collated retrospectively through the electronic record system. The initial evaluation was conducted between June-November 2018 (n = 191). The subsequent re-evaluation was performed between September-November 2019 (n = 159), following increased clinic capacity, implementation of methods to increase awareness and a formal triage process.
In the initial evaluation over 6 months (n = 191), 9.9% underwent an USS in the clinic and 9.95% at a later date. 18% of patients underwent a FNAC. 6.8% patients were diagnosed with cancer. The mean time-to-treatment initiation was 36 days.
In the re-evaluation over 3 months (n = 159), 23.2% had an USS in the clinic and 30.2% at a later date. 13% of patients underwent a FNAC. 9.4% of patients were diagnosed with cancer. The mean time-to-treatment initiation was 44 days.
This affirms the benefits of a swift ‘one-stop clinic’. On average, patients diagnosed with cancer had treatment initiation 40-days post-review. Furthermore, even with a triage process only 1 in 10 patients had cancer.
212 Outcomes Of 25-Gauge Pars Plana Vitrectomy Surgery in Primary Rhegmatogenous Retinal Detachment in Pakistan: A Multi-Center Study
Authors: Hussain S Z M , Awan M A , Siddiqui M A R 
Published: October 2021

Abstract

Aim
To evaluate the primary anatomical success and visual outcomes in patients with rhegmatogenous retinal detachment (RRD) undergoing 25-gauge pars plana vitrectomy (25g PPV) surgery in Pakistan.

Method
This is a five-year retrospective, interventional cohort study of 418 consecutive patients with RRD who underwent 25g PPV. Surgeries were performed by two experienced surgeons at tertiary care hospitals in Pakistan. Consecutive patients, who underwent 25 g PPV surgery as treatment for RRD between October 2013-October 2018 were included. We excluded patients who had a history of previous retinal surgery or who did not complete the 4-8 weeks primary outcome visit. Data was collected from the patient’s files by using a pro forma. SPSS version 23.0 (IBM SPSS Statistics, Armonk, NY) was used. A p-value of &lt; 0.5 was considered significant.

Results
We identified 452 patients through coding system of hospitals who underwent 25g PPV surgery between October 2013-October 2018. Secondary retinal surgery and incomplete follow up cases were excluded. A total of 441 patients’ files were reviewed for the study, out of which 418 patients met the criteria for final analysis. Males were in a higher number 284 (67.9 %). The average age was 49±15.8. In our study, 186 (44.4%) patients were phakic at the time of presentation. At 2 months follow up, the primary anatomical success rate was 87.1 %.

Conclusions
Surgical outcomes of RRD with 25g PPV surgery in our study were similar to the outcomes reported in the developed world. We propose a prospective multicenter national study to prospectively evaluate the risk factors for RRD surgical failure in the Pakistani population.
246 FRActure Clinic Treatment: a sURvey of patient Experience (FRACTURE)
Authors: Javed O , Khan M , Foxall-Smith M , Hafez A , Mason W 
Published: October 2021

Abstract

Aim
BOAST guidelines on fracture clinics suggest a standard of care that all patients with significant injury should expect to receive in a Trauma & Orthopaedics outpatient setting in the United Kingdom.

Method
A prospective analysis of 358 patients presenting to fracture clinic at Gloucestershire Hospitals NHS Foundation Trust from September to November 2020. Patients completed an anonymous questionnaire based on BOAST guidelines.

Results
Most patients received a written management plan (82%), but only some received a leaflet (36%) and definite information about their procedure (47%). Most patients felt a leaflet (72%) and information about procedures (87%) would be useful. Patients were generally seen early or within 30 minutes of their appointment time (77%), but some waited more than 30 minutes (23%). Most patients found X-rays easily (91%) and rated staff (97%) and fracture clinic experience (93%) as very good or good. Comments included noting an efficient and friendly service, with suggestions on providing more information on waiting times and procedures to be performed.

Conclusions
Our study showed high patient satisfaction with fracture clinic and particularly positive feedback about staff. Areas of improvement include providing more leaflets and information about practical procedures. Following this audit, we will produce leaflets on common conditions and record videos on common procedures such as application of casts, splints and removal of k-wires or sutures, which can be accessed by patients prior to their appointment. The audit could be repeated at a regional or national level to help centres assess the level of care provided.
264 Does the Introduction of Ward Round Stickers Improve Surgical Ward Rounds?
Authors: Sharma V , Fitzpatrick E , Sharma D 
Published: October 2021

Abstract

Aim
With surgical teams in the NHS pushed to their limit under unprecedented demands, simple and effective ways for maintaining standards of patient care are necessitated. This quality improvement project aims to implement user-friendly and coherent ward round stickers as an adjunct to surgical ward rounds to deliver standardised care.

Method
Baseline performance was measured against The Royal College of Surgeons of Edinburgh Surgical Ward Round Toolkit. Five recorded items were studied including: bloods, venous thromboembolism(VTE) prophylaxis, regular medications, observations, and handover to nursing staff. The surgical team was informed of the audit but not over which dates it would be conducted. In the first cycle, data was collected over a 4-week period. Ward round stickers were then implemented, and a second cycle was completed 2 months later over another 4-week period.

Results
Baseline performance recorded from 74 ward round entries showed checking of bloods, VTE, regular medications, observations and handover ranged from 0% to 65%. After the introduction of ward round stickers, a second cycle was performed from 81 ward round entities. There was significant improvement from baseline with compliance in recording all five items &gt; 85%.

Conclusions
This quality improvement project showed that the use of stickers as an adjunct to surgical ward round is a simple and effective way of evidencing good practice against recommended standards.
278 Duration of Prescription of Dexamethasone in COVID-19 Pneumonitis
Authors: Moen C 
Published: October 2021

Abstract

Aim
The RECOVERY trial showed the effectiveness of using 10 days of dexamethasone for patients hospitalised with Covid-19 disease who required oxygen or mechanical ventilation while an inpatient. This QIP sought to measure compliance with this recommendation.

Method
Live data was obtained using University Hospital Crosshouse’s electronic prescribing system (JAC). The audit was limited to patients on Ward 2D, which at time of writing was one of the hospitals COVID 19 wards. The first audit was performed on Friday 13/11/20 at 18:00. All dexamethasone prescriptions had the duration of the prescription assessed (at the time all patients were on oxygen therapy for COVID-19 infection). Patients with a course longer than 10 days with explicit documentation to continue past 10 days were counted as a correct prescription in this audit. For the second cycle results were shared with middle tier doctors working on Ward 2D 16/11/20. Notices were also left on all computers on the ward with the message “Please ensure your patient is only prescribed a total of 10 days of dexamethasone unless an extended course is clinically indicated”. A third cycle was carried out 01/12/20. Notices were left on all computers in the combined assessment unit with the same message as above.

Results
It found most patients were receiving more than the 10 days due to prescription errors (86%). Teaching on the COVID ward resulted in 83% of the prescriptions being correct. Teaching in the receiving unit of the hospital resulted in no change.

Conclusions
Prescriptions of dexamethasone for Covid-19 patients requiring oxygen on ward 2D were found to be longer than the advised 10 days shown to be effective in the Recovery trial. Teaching on the ward was found to be an effective method to decrease prolonged courses of dexamethasone.
310 Cost Savings Through Utilisation Of Procedural Clinics Over Operating Theatres for Skin Lesion Excisions
Authors: Page D 
Published: October 2021

Abstract

Aim
Skin lesion excisions make up a significant proportion of procedures performed by General Surgical teams. A large proportion are performed under local anaesthetic (LA) alone and are frequently performed in a main operating theatre (OT) but would be amenable to been performed in a minor procedures clinic (MPC) which could represent significant savings for excision of lesions in terms of money and better utilisation of OT. The purpose of this study is to evaluate the proportion of skin lesions currently excised under LA in OT that would be amenable to been performed in MPC and calculating the cost saving associated with this in terms of dollars and time in OT.

Method
A retrospective audit was performed of all skin lesion excised in OT at 2 regional hospitals in Queensland between October 2019 and October 2020. Data was recorded for the type of anaesthetic used, type of lesion excised and total time each patient spent in the OT. Cost per minute of both OT and MPC time were estimated using standard costs.

Results
A total of 229 patients had skin lesions excised in an OT in this period. Of these, 102 (44.5%) of them were excised under LA alone and used 4930 minutes of OT time. The dollar saving of performing these procedures in a MPC over OT is estimated to be $147,874.00 (approximately 71% less).

Conclusions
Utilising MPC over an OT for excision of skin lesions under LA represents a significant dollar cost saving and opportunity cost saving.
315 Chaperone Documentation in The Breast Clinic: A Closed Loop Audit
Authors: Maden C , Lee A , Kelly M l , Im Y R , Barkeji M 
Published: October 2021

Abstract

Aim
Intimate examinations are potentially uncomfortable and embarrassing. In addition to offering chaperones routinely, it is also important to clearly document the circumstances, with implications on patient dignity and safeguarding both patients and staff. We aimed to analyse the quality of chaperone documentation in the breast clinic before and after intervention.

Method
Audit standards (GMC and Chelsea & Westminster Trust guidelines): [1] Consent [2] Chaperone use/refusal, and [3] Chaperone role and identity should be clearly documented in the notes. We collected breast clinic data prospectively over one week, then re-audited after interventions including teaching sessions to the breast MDT, introduction of electronic (e)-notes (Cerner©), and creation of an instructional video demonstrating how to create an automatic template to easily document the aspects of chaperone use.

Results
110 patients’ notes were analysed in the first cycle, and 74 in the second. Documentation improved significantly between cycle 1 and 2 for: consent (0% vs. 38%, p &lt; 0.0001), identity of chaperone (12% vs. 35%, p = 0.0003), and role of chaperone (8% vs. 23%, p = 0.0091). Documentation for chaperone use or refusal improved, but this was not significant (27% vs. 35%, p = 0.3305).

Conclusions
Documentation improved significantly for most standards, likely due to the template prompting the clinician. However, documentation remains suboptimal. Possible reasons include forgetfulness in a busy clinic, or shortage of staff available to chaperone. Future recommendations include creating a mandatory template on the e-notes for all breast clinic documentation including a section for chaperone use, role, and identity, and providing more staff such as HCAs for the clinic.
342 A Closed Loop Audit on The Quality of Documented Consent in Orthopaedic Procedures
Authors: Bakhiet A 
Published: October 2021

Abstract

Aim
A thorough discussion of associated risks is essential when obtaining informed consent for any surgery. The consent form serves as a permanent record of the conversation and can have implications as a legal document in court. The aim of this audit was to assess the quality of documentation on consent forms for Orthopaedic procedures.

Method
Prospective data was collected from consent forms for patients undergoing 6 prespecified procedures and compared to British Orthopaedic Association (BOA) guidelines for consent. We analysed how many of the risks had been documented on the form, and whether the incidence of these risk was emphasised. The data was then collated, analysed and presented at a local trauma meeting.
Templates for consent were printed and inserted into consent booklets on the ward to serve as a memory aid. Data was prospectively collected again to complete the audit cycle.

Results
Prior to the implementation of the consent templates, 8% of consent forms mentioned all possible complications, with 12% emphasising the incidence of the main risks. Post intervention, all significant risks were listed in 29% of forms, with 33% listing the risks in a logical order and emphasising their incidence.

Conclusions
The process of obtaining consent is a complex but crucial component of surgical practice, with the consent form serving as an important medicolegal document. This study shows that the use of pre-printed consent templates to aid memory can improve documentation and can be adapted and individualised accordingly for each patient.
398 Outcome of Laparoscopic Cholecystectomy in Patients Over 80 Years Old
Authors: Gumaa D , Hunt A , Karunaratne D , Shresta S , Al-Robaie B 
Published: October 2021

Abstract

Background
Gallstone disease is a common cause of morbidity in old patients. Conservative treatment is usually the first line of treatment due to concerns about the risk of surgery. In our study we are trying to assess the outcome of laparoscopic cholecystectomy in patients over 80 years old.

Method
Retrospective cohort study done in a large district general hospital where good number of laparoscopic cholecystectomy is done every year. Main outcome is Mortality, return to theatre and post op ITU admission. Data collected from patients records.

Results
74 patients in total were operated on. 14 operations were done as emergency (during the same inpatient admission). Indication for surgery varied between cholecystitis, pancreatitis and biliary colic. But the main indication in the emergency group was acute cholecystitis. 55 % of the patients had significant medical background with ASA 3. 30 days mortality was 0 in both emergency and elective groups. 2 patients required ITU admission post op, mainly for premorbid status, and both were in the emergency group. There was only one return to theatre in the emergency group for washout. 90% of the elective group patients were done as day case with no post op complications.

Conclusions
Laparoscopic cholecystectomy is safe operation to be done in the elderly population. ITU admission is mainly because of the patient’s co-morbidities so patients should be selected carefully and have proper pre op assessment.
408 The Swiss Cheese Effect: Following Lower Limb Emergency Admissions Through Hospital
Authors: Daga K , Sara X , Le Blevec L , Khalfaoui M , Charalambous N 
Published: October 2021

Abstract

Introduction
The Swiss cheese model analyses failure in a system: when holes align this creates ‘a trajectory of accident opportunity’. In healthcare this could translate to morbidity and/or mortality of patients. We investigated potential points of failure in treating lower limb injury patients through their hospital journey. Three points were investigated: (1) prescription of venous thrombo-embolism (VTE) prophylaxis, (2) operation note information and legibility (3) time delay in post-operative blood tests.

Method
A total of 105 patients of emergency lower limb surgical patients were identified retrospectively from two centres across the North West Region between the 31/07/20 and 21/11/20. Data was collected on (1) prescription of thrombo-prophylaxis, (2) information recorded, and legibility of operation notes as per RCSEng and (3) time delay in post-operative full blood count when compared to operation note recommendation.

Results
We found that between 10-55% of patients were prescribed anti-embolism stockings versus 100% given chemical anti-coagulation on day 1 of admission. Of a total of 23 data points, the mean number of points missing on operative notes was 4.90 (range: 2-10). A total of 82.5% handwritten operation notes were deemed legible. Post-operative full blood counts were ordered in 83.3% of patients, with the first order ranging between 1-5 days post operatively.

Conclusions
The cumulative effect of having these errors at all three points greatly increases the chance of morbidity/mortality of patients. Our experience demonstrates a failure to meet trust and Royal College of Surgeon’s guidelines. We aim to re-audit this nationally with our planned intervention.
499 A Retrospective Audit on Detection Rate of Clinically Significant Cancer Among MP-MRI Targeted Biopsy – A Single Centre Experience
Authors: Zuling E T , Murali-Krishnan S 
Published: October 2021

Abstract
Men with high serum prostate specific antigen (PSA) typically undergo standard transrectal ultrasound-guided prostate biopsy (TRUS-biopsy) during which 10 to 12 cores are obtained. TRUS-biopsy can cause side-effects including bleeding, pain, and infection. Multi-parametric MRI (MP-MRI) used as a triage test might allow men to avoid unnecessary TRUS-biopsy and improve diagnostic accuracy. According to the renowned PROMIS study, for clinically significant cancer, MP-MRI was more sensitive and less specific than TRUS-biopsy. In this study, we performed a single centre, retrospective audit on the detection rate of clinically significant cancer among MP-MRI targeted biopsy and compare it with the standard TRUS biopsy. Clinically significant cancer is defined as Gleason score ³ 4 +3 or a maximum cancer core length 6mm or longer. Besides, we also compare the rate of clinically significant cancer in MP-MRI targeted biopsy against the PROMIS study. Through this audit, we found that in 2019, there is a 54% (60 out of 112 patients) of clinically significant cancer in MP-MRI biopsy and 41% (26 out of 64 patients) of clinically significant cancer among standard TRUS biopsy. Comparing it with the PROMIS study in which clinically significant cancer was detected in 38% in the MP-MRI targeted biopsy group and 26% in the standard-biopsy group, the adjusted difference in our study (13%) is similar to PROMIS study which is 12%. In conclusion, our study reaffirms that MP-MRI targeted biopsy reduce over-diagnosis of clinically insignificant prostate cancer and improve detection of clinically significant cancer.
531 An Admission Proforma to Improve Clerking Documentation in the ENT Department During the Covid-19 Pandemic: A Full Cycle Audit
Authors: Brown G , Ashton C , Poulios A 
Published: October 2021

Abstract

Aim
Good Surgical Practice states that surgeons must ensure that accurate, comprehensive, legible and contemporaneous records are maintained for all their interactions with patients. It is therefore critical that the clerking document, as the initial record of an admission, meets this standard. During the Covid-19 pandemic, an emergency rota meant that cross-covering of ENT at junior level was increasingly required in our hospital. Understandably, these trainees were less familiar with admitting ENT patients and of departmental standards. Our aim was to evaluate the quality of clerking documentation in our department during this period and investigate whether a standardised admission proforma could improve this.

Method
Clerking documents for all patients admitted in April 2020 were checked for completion of venous thromboembolism (VTE) risk assessment and inclusion of ten key pieces of information as outlined by the Surgical Tool for Auditing Records score. As was standard at this time, all clerking documentation had been completed on blank hospital continuation paper. A departmental admission proforma was introduced before admissions in June 2020 were then assessed identically.

Results
Improvement was noted in all measured parameters with no adverse effects. There was particular improvement in documentation of referral source (28% to 97%), consultant in charge (35% to 90%), name/grade/bleep (25% to 94%) and VTE risk assessment (14% to 78%). Trainee response was positive.

Conclusions
A simple admission proforma can markedly improve the standard of clerking documentation and therefore increase patient safety during a turbulent time. We would encourage other departments to consider developing their own.