bluuebunny/crossref_metadata_2025_split huggingface dataset:
1080 An Audit on Compliance with Recommended Duration of Surgical Antimicrobial Prophylaxis in St. Vincent’s University Hospital, Dublin, Ireland
Authors: Ho N X , Clarke L , Collins P M , Fitzgerald S , Sheehan S , Paul T , Treacy G , McNicholas S 
Published: October 2021

Abstract

Aim
Surgical site infection (SSI) is a common healthcare-associated infection, and a frequent cause of post-operative morbidity. SSI comprises any infection of the operative incision, cavity or involved organ, that occurs within the 30-day post-operative period. Antimicrobial prophylaxis is critical in reducing SSIs. Our aim was to assess adherence to the recommended surgical antimicrobial prophylaxis guidelines in St. Vincent’s University Hospital (SVUH), as part of the hospital antimicrobial stewardship programme. Compliance of surgical services was measured against the recommended regimens described in the SVUH Antimicrobial Guidelines.

Method
Data on duration and choice of prophylaxis were prospectively gathered on inpatients undergoing elective surgery during a three-week period between August-September 2020. Patients undergoing transplant procedures, inpatients in the intensive care unit, and patients who moved off-site postoperatively were excluded.

Results
Eighty-one patients were included. Sixty-four (79%) were compliant with prophylaxis duration, while seventeen (21%) were not. Reasons for extended prophylaxis included three (18%) cases where there were intra-operative complications and five (29%) cases of routine prescribing of an additional 24-hour coverage. Nine (53%) did not document the reason for extended cover.

Conclusions
Compliance with recommended duration of prophylaxis improved in comparison to prior audits. Among patients receiving extended prophylaxis, documentation of the indication was poor. Patients with evidence of post-operative infection may be better served with targeted antimicrobial therapy rather than extended prophylaxis. One reason for extended prophylaxis may be due to difficulty accessing guidelines on recommended prophylaxis duration, hence a targeted smartphone application was introduced to improve accessibility.
1100 A Closed Loop Audit Comparing Admission Rates Post Transurethral Resection of Bladder Tumour (TURBT) Before and After Day Case Procedure Was Made the Standard Goal
Authors: Miller S , Hunter-Campbell P 
Published: October 2021

Abstract

Aim
To assess the impact of making day case TURBT the standard goal.

Method
We performed a closed loop audit on the effect of listing all TURBTs as day case from the 1st December 2019. Data was collected retrospectively on all TURBTs from December 2018-March 2019, and from December 2019-March 2020 after implementing the change in protocol. Data collected included patient demographics, procedure and admission details, complications, and readmission rates.

Results
In total, 133 resections were included. Prior to the change in protocol, 36% of TURBTs were performed as day case. Of those admitted, 74% were due to haematuria, and 2% were planned. 8% were readmitted within 28 days and required urology input. There was 12% readmission rate overall. The rate of bladder perforation was 3.8%.
Post intervention, 64% of all TURBTs were performed as day case. 82% of admissions were due to haematuria, and 14% were planned. The rate of bladder perforation remained low at 1.6%, and readmission rate was 3% with no urology input required.

Conclusions
TURBT is the standard endoscopic procedure for the diagnosis, grading and removal of bladder tumours. The use of day case surgery pathways has been emphasised to help reduce lengths of stay and streamline patient care. The British Association of Day Surgery (BADS) recommends that 60% of TURBTs could be performed as a day case procedure. This study shows that this recommendation can be exceeded through a simple and low-cost intervention, whilst maintaining a low complication rate.
1114 Getting it Right First Time: An Audit of Length of Hospital Stay for Mandibular Fractures
Authors: Mitchell F , Parmar J 
Published: October 2021

Abstract

Introduction
GIRFT is a Department of Health programme, created to improve efficiency by providing data that gives departments a national standard to encourage reflection and service-improvement. The 2016 document in Oral and Maxillofacial Surgery, suggests the national average length of stay for isolated mandible fractures was 2 days, 1 day pre-operatively and 1 day post-operatively. This Audit aimed to investigate if all admissions in our trust met this standard, as a short stay reduces costs and improves patient experience.

Method
Data was collected for all isolated mandibular fracture admissions between January – September 2019, with 89 patients identified. Date of admission, surgery and discharge was recorded which allowed calculation of pre-operative, post-operative, and total stay.

Results
78% of patients had surgery within 24 hours of admission. Admissions on a Saturday were most often delayed, with a mean pre-operative stay of 1.60 days and total stay of 2.55 days. Commonly the reason for delay was not recorded, or due to lack of theatre space. 92% of patients were discharged within 24 hours post-operatively. The average length of stay met the 2-day standard, with Monday admissions having the shortest average stay of 1.45 days.

Conclusions
Whilst the majority of patients are treated and discharged within 2 days, improvements and future audit would assist to get closer to the 100% target. Saturday saw the highest number of admissions, which also had the longest average length of stay. A dedicated weekend trauma list would reduce wait times but may be limited by staffing and theatre space.
1132 How Much Are Junior Doctors Aware and Knowledgeable of Colorectal Enhanced Recovery Program? A General District Hospital Audit
Authors: Dorra A , Alhammali T , Arnob A , Murtaza M , Essa N , Fahmy W 
Published: October 2021

Abstract

Aim
Aim of the study is assessment of awareness and knowledge of colorectal Enhanced Recovery Program (ERP) of newly joined junior doctors at a general district hospital. ERP is an essential evidence-based element of surgical colorectal patients’ management during preoperative, operative, and postoperative periods. Junior doctors play an integral part in patients’ management. Local hospital guidelines require 100 % awareness and knowledge of ERP among surgical team members.

Method
A questionnaire of 15 points for assessment of awareness (1 point) and knowledge of Colorectal ERP (14 points) among 8 newly joined junior doctors (Senior House Officers, Foundation year 2 and Foundation year 1) was developed in our surgical department in August 2020.

Results
The responses showed that average score of doctors’ knowledge of ERP was (52.9 %). Two doctors (25%) scored 9 out of 14 (9 /14), two (25 %) scored 8/14, one (12.5 %) scored 7.25 /14, one (12.5 %) scored 7/14, one (12.5%) scored 6/14, one (12.5%) scored 5 /14. Regarding awareness of ERP, 5/8 doctors were aware of ERP (62.5 %).

Conclusions
The study showed presence of a variable average level of awareness and knowledge of ERP among newly joined junior doctors. This was less than local guidelines target (100%). The study recommends education (power point presentation) for improving awareness and knowledge of ERP among newly joined junior doctors. This is to be followed by re-auditing and closing the audit loop.
1135 Improving Surgical Discharge Summaries
Authors: Oyewole B , Liu C , James N , Sandhya A , Ma J , Jethwa P 
Published: October 2021

Abstract

Introduction
Discharge summaries are a means of communication to the patient, the GP and for medical records. An initial audit showed surgical discharge summaries contained misleading information and sometimes omitted relevant information. Changes were implemented to improve the accuracy of surgical discharge summaries.

Method
The initial audit assessed the accuracy of discharge summaries over a two-week period and the re-audit was conducted after implementation of change over a similar time period. Data was extracted from electronic patient records (EPR). Change implementation included educating the surgical team on the need for accurate discharge summaries. The EPR team was notified of the intrinsic error in the PowerChart system which is widely used in various NHS Trust.

Results
Incidence of misdiagnosis or misleading diagnosis in discharge summaries reduced from 42% to zero, lack of relevant investigations decreased from 7% to 1%, No follow up status reduced from 23% to 10% (usually post appendicectomy patients which are not routinely followed up but this needs to be stated in the discharge summary for clarity), at both initial audit and re-audit all patients had relevant surgery or procedures done included in their discharge summaries while the rate at which relevant medications were not stated in the discharge summary decreased from 4% to zero.

Conclusions
Discharge summaries are vital for record keeping and are usually the only written information a patient receives regarding their hospital stay. It is important that errors in EPR systems be flagged up for review.
1138 Complete Cycle Audit of Adults with Incapacity Documentation
Authors: Tang C C 
Published: October 2021

Abstract

Aim
The Adults with Incapacity (Scotland) Act 2000 sets out the framework for regulating intervention in the affairs of adults who have impaired capacity. A certificate of incapacity should be completed for those deem incapable to decide on their medical treatment. We aim to improve the accuracy of adults with incapacity documentation to 90% over 6 months period and

Method
Data was collected over three months, focusing on 3 domains:
The results of first cycle were discussed on the departmental meeting. Education flyers were sent to everyone in the department and put up in the doctors’ room. Data was collected again after 6 months with the same inclusion criteria.

Results
The percentage of patients with a patient with incapacity certificate has dropped to 34% from 50%. Completion of capacity assessment remained 100%. Attempt to contact relevant others has increased from 52% to 92%. Accuracy of documentation has improved to 77% from 44%.

Conclusions
The proportion of patients with a patient with incapacity certificate is in keeping with the prevalence of delirium in surgical wards. Interactive discussion and flyers improve compliances with completion of adult with incapacity certificate. Routine training should be included in departmental teaching to ensure future compliances.
1148 Analgesia Prescribing in Acute Surgical Admissions - Dual-Centre Cross-Sectional Study
Authors: Makhort A , Gavrila A , Hill F 
Published: October 2021

Abstract

Aim
Pain is a common presenting complaint of acute surgical inpatients and has a great impact on their subjective wellbeing and the perception of care they receive if not addressed promptly and efficiently. It is also a common cause of patients’ complaints if not properly addressed. We set out to evaluate if analgesia is prescribed locally in accordance with WHO analgesia ladder and NICE CKS analgesia guidelines for mild-to-moderate pain.

Method
We performed cross-sectional studies of adults aged 16 and over, admitted under general or vascular surgery in two DGHs (2018-2020) with complaints of pain on admission. 30 patients were included in both studies with an average age 53/56 years. We undertook notes review, checked observation charts and drug charts for pain grading and analgesia prescribing following initial clinical assessment.

Results
In the first study, average pain score of 6 was obtained. Only 19/30 patients (63%) had regular analgesia prescribed. Only 2/30 (6%) were started on regular weak opioids, with further 8/30 (26%) on as required/PRN weak opioids. 17/30 (56%) patients had PRN Oramorph prescribed. Only 2/30 (6%) were started on PRN NSAIDs despite only 46% having cautions/contraindications. 5/30 patients with pain scores of 9-10 not had any regular analgesia prescribed. Comparable results were achieved in the second hospital we audited.

Conclusions
This study shows significant under-prescribing of analgesia, especially regular analgesia for surgical patients with moderate-severe pain and skipping of weaker opioids/NSAIDs in favour of Oramorph. There is significant scope for improvement following educational session implementation to junior doctors.
1152 “A Hypoxic Dilemma”- Compliance with Oxygen Prescriptions on The Acute Surgical Take
Authors: Shaladi A , Jesuthasan J , Martin G , Allu J , Shah A 
Published: October 2021

Abstract

Aim
British Thoracic Society Guidelines state that all patients admitted to hospital should have oxygen targets prescribed to promptly start oxygen therapy should clinical deterioration occur. We aimed to assess oxygen prescribing compliance for new surgical patients.

Method
We assessed prescription of oxygen in patients admitted on the surgical take, once weekly for 8 weeks looking at target values, route of administration, frequency and appropriate signing and dating. A re-audit was performed after presenting the initial results at a department meeting.

Results
61 patients were included. Out of 61, 8 patients had COPD. Only 9 patients had adequate oxygen prescriptions with all the criteria completed. After re-audit, 50 surgical take patients’ drug charts were reviewed. 42 out of 50 patients had correctly completed oxygen prescriptions.

Conclusions
Correct oxygen administration in high-risk patients is vital in their management, particularly during clinical deterioration. A discernible improvement in prescriptions was noted in this study.
1205 Clinical Audit Demonstrating an Increase in Referrals to The Ophthalmology AMD Clinic at University Hospital Southampton
Authors: Laali S 
Published: October 2021

Abstract

Aim
To demonstrate if the introduction of OCT imaging by a national optician chain across its 740 stores in UK (followed by other chains) would increase in referrals to the wet AMD clinic. Secondly to assess if the direct increase of referrals would have an impact on the clinic workload.

Method
Retrospective review of all referrals made to the AMD service via optometrists/opticians throughout 2018. Total numbers of referrals that were proven to have nAMD requiring injections Inclusion; direct optician referral or GP referral via an optician. Exclusions: Ophthalmologist, Eye Casualty, other clinics and nAMD not requiring injections.

Results
Opticians were responsible for 62.88% (566) referrals out of 900 to the AMD service The second half of 2018 showed an increase in referrals (130 more) but with improved quality since the diagnostic accuracy of the optometrists increased from 22.94% to 37.64% The improved diagnostic accuracy of the optometrists was found to be statistically significant (Fisher’s exact test: p &lt; 0.0003)

Discussion
Increase in patients requiring injections directly increases clinic by initial screen and follow up injections. Medical retina departments faced an increase in false positive referrals. Potentially due to seeing essentially normal findings in a new way (B scan) that are artefacts or misinterpretation of either the image or the normative values

Conclusions
Upon review and presentation of the audit, NHS will invest in an electronic referral system to aid the clinic. Education and ongoing clinical training are essential to the successful launch of an OCT service in the community.
1280 A Retrospective Audit of The Management of Facial Lacerations in The Emergency Department in A Busy South Wales Tertiary Centre
Authors: Ubhi J , Mihailidis T 
Published: October 2021

Abstract

Aim
To assess the management of facial lacerations in the Emergency department at Morriston Hospital using NICE laceration guidance.

Method
We performed a retrospective audit on the management of facial lacerations that presented to Morriston A&E between 5/7/20 - 23/7/20. Two reviewers independently assessed ED documentation from all patients with a coded diagnosis of facial laceration. The criteria assessed included the examination of neurovascular status, consideration of analgesia, risk assessment for tetanus or infection and antibiotic choice. Following this we have implemented a Facial laceration checklist sticker to serve as a clinical tool to examine, risk stratify and to aid documentation.

Results
In this timeframe we assessed 50 patients in total. Prior to any intervention: 37% had documented Neurovascular examination, 58% had no tetanus risk assessed or prescribed, Analgesia was considered in 43% of cases and antibiotics were prescribed in 20% of cases (10% vs 90% for Flucloxacillin vs Chloramphenicol.) We are currently still collecting post implementation data.

Conclusions
With SHO staff rotations in Plastic Surgery, Maxillofacial Surgery and A&E as frequently as on a 4 monthly basis there can be variation in experience when managing facial lacerations. It is therefore important to have quick, clear and accessible clinical tools to support the recognition of complications in facial lacerations. Chloramphenicol was the most commonly prescribed antibiotic which was not within nice guidelines and only prescribed by Maxillofacial and Plastic surgery. This prompts the next step in reviewing literature in order to delineate the grounds for its usage.
1315 Improving Efficiency of I&D of Abscesses Pathway
Authors: Hassan M 
Published: October 2021

Abstract

Background
It is not always possible for patients with abscesses to undergo I&D under GA on day of attendance the majority of patients wait for a space to become available on CEPOD or asked to return the next day. In 2017 an abscess pathway was introduced in TWH to help streamline these patients. This was audited and found to improve wait times from 8hr23mins to 3hrs 59mins, with 78% of patient having their operation in &lt; 6hrs.

Method
Retrospective analysis of 3 months trial of the abscess pathway. (August - October 2019). Patients were identified by searching the Theatre Man theatre database for patients with codes relating to incision and drainage of abscess under the care of the Department of General Surgery. Data was collected on time referred to surgeons, time seen by surgeons, decision to admit/or ask to return and time sent for theatres. Additional information was collected on severity of symptoms and overnight stay in hospital

Results
Of those managed on the abscess pathway:78% received their surgery within 6 hours of arrival (25/32) - the other 7 patients had their operations later than 6 hours due to long CEPOD lists and multiple urgent operations at the same time. Average wait time from arrival in surgical assessment unit is to theatre is 4 hours 43 minutes. 32 patients were managed on the pathway, 29 had same day discharge. Two patients stayed overnight due to late time of operation (10 pm) and 1 patient was pyrexial post op
1320 Evaluation of Routine Group and Save Testing Prior To Appendicectomy
Authors: Fadel M , Patel I , Brewer J , Behar N 
Published: October 2021

Abstract

Introduction
Group and save (G&S) testing is often performed prior to emergency appendicectomy. However, there are no standard national guidelines regarding the routine use of preoperative G&S. We performed a Trust Audit to review the need for G&S prior to appendicectomy in order to recommend new guidelines.

Method
Retrospective review of all patients that underwent appendicectomy at Chelsea and Westminster Hospital between October 2019 and March 2020. We evaluated the existing literature on blood transfusion rate and the need for G&S prior to appendicectomy.

Results
One hundred and seventy-three patients (female 56%, median age 26 years) underwent appendicectomy (94% laparoscopic, 6% open). One hundred and thirty-four (77%) patients had a valid G&S and none of the patients received a blood transfusion perioperatively. The estimated total cost of G&S sampling for laparoscopic appendicectomy over one year in the Trust is £6825 (excluding all other laparoscopic surgery).

Conclusions
Based on the audit findings and literature review, routine G&S testing is not necessarily required for all patients undergoing laparoscopic appendicectomy. G&S should be requested on a patient case-specific basis (for example, chronic anaemia or haematological conditions) with discussions between the anaesthetist and surgeon. This would reduce delays in emergency lists, have financial implications and there is no evidence to support that the routine use of G&S benefits patient outcomes. These recommended guidelines have been presented at Surgery/Anaesthetics Clinical Governance and have been rolled out in the Trust with the aim to perform a re-audit in 3-6 months.
Examining the Combined Estimated Effects of Hearing Loss and Depressive Symptoms on Risk of Cognitive Decline and Incident Dementia
Authors: Powell Danielle S , Brenowitz Willa D , Yaffe Kristine , Armstrong Nicole M , Reed Nicholas S , Lin Frank R , Gross Alden L , Deal Jennifer A 
Published: October 2021

Abstract

Objectives
Late-life depression is a comorbidity that may co-occur in older adults with hearing loss—each has prevalent and independent modifiable risk factors for dementia.

Methods
Using data from 1,820 Health, Aging and Body Composition study participants (74 ± 2.8 years, 38% Black race), we compared the hearing loss–dementia/cognitive decline relationship between those with normal hearing/mild hearing loss and those with moderate or greater hearing loss. Using linear mixed-effects and Cox proportional hazard models, we investigated if the associations between hearing loss and cognitive decline or dementia (Modified Mini-Mental State [3MS] Examination and Digit Symbol Substitution Test [DSST]) differed by the presence or absence of depressive symptoms. Depressive symptoms were defined as Center for Epidemiologic Study—Depression scale 10 ≥10 at one or more visits from Years 1–5. Algorithmic incident dementia was defined using medication use, hospitalizations, and cognitive test scores. Audiometric hearing loss was measured at Year 5 and categorized as normal/mild versus moderate or greater hearing loss.

Results
Having both hearing loss and depressive symptoms (vs. having neither) was associated with faster rates of decline in 3MS Examination (β = −0.30; 95% confidence interval [CI]: −0.78, −0.19) and DSST (β = −0.35; 95% CI: −0.67, −0.03) over 10 years of follow-up. Having both hearing loss and depressive symptoms (vs. neither) was associated with increased risk (hazard ratio [HR]: 2.91; 95% CI: 1.59, 5.33 vs. HR: 1.54; 95% CI: 1.10, 2.15 hearing loss only and HR: 2.35; 95% CI: 1.56, 3.53 depressive symptoms only) of incident dementia in multivariable-adjusted Cox proportional hazards models.

Discussion
Comorbid conditions among hearing-impaired older adults should be considered and may aid in dementia prevention and management strategies.