bluuebunny/crossref_metadata_2025_split huggingface dataset:
496 The Use of Virtual Trauma Clinics (VTC) In the Assessment of Acute Hand Trauma; A Service Evaluation
Authors: Creasy H , Westley S , Shah R , Mistry R 
Published: May 2021

Abstract
As a UK tertiary referral centre for hand trauma the current COVID outbreak has led to the reconfiguration of trauma services. We evaluate the impact of our newly introduced VTC on our hand trauma service, comparing a cohort of patients who were managed pre-COVID, with our current revised pathway.
We carried out a service evaluation of all those patients processed by the VTC over 14 days in April 2020 (n = 184). We collected prospective data on timing of referral to assessment and surgery. This data was compared to a matched period in April 2019 (n = 162).
Post VTC there has been a significant reduction in time to clerking and time to surgery (p = &lt; 0.001), with 98.1% being clerked within 1 day of referral. Post VTC 12.9% of patients were discharged directly from VTC, all other patients had definitive treatment in a single trip.
VTC has shown a clear benefit to patients with definitive management provided in a single trip in all cases. Whilst we have been able to clerk patients earlier any improvement in time to surgery depends on theatre staffing and availability, which differed in the two cohorts and certainly will as we move forward into normal services.
506 An Audit of Documentation in Orthopaedic Trauma Meetings
Authors: Jackson T , Chahal J 
Published: May 2021

Abstract
The aim of this audit cycle is to assess departmental compliance with the standards elucidated by the Academy of Medical Royal Colleges, and the British Orthopaedic Association with respect to patient record keeping in regard to trauma meeting documentation.
Specific criteria for the documentation of the information were devised from the audit standards. Over a one-week period in September 2019, patient notes from all Trauma and Orthopaedic the notes for all patients on the week’s take lists were inspected for trauma meeting documentation from the following morning.
A documentation proforma was then implemented and notes were then re-audited after 3 months of the intervention to assess its effect.
Most patients had trauma meeting documentation however it often lacked significant information such as the take consultant, injury, date/mechanism of the injury as well as correct contact details. After implementation of the proforma, there was an improvement to 70% or above for documentation of significant information in almost all established criteria.
Poor documentation often resulted in recurrent calls to the on-call team the following day to clarify diagnoses and plans which were often inadequate or unclear. This was improved through the introduction of a proforma to standardise the documentation present.
512 Trauma Meetings in the Time of COVID
Authors: Hasan R , Dhir R 
Published: May 2021

Abstract
Trauma & Orthopaedics (T&O) has taken a backseat during COVID-19. As the focus has shifted to care of COVID patients, other specialties have adjusted their daily working. At our local hospital, the dedicated Orthopaedic ward was absorbed into the Intensive Care department, necessitating migration to a smaller, shared working space. This project looked at ways of increasing clinical efficiency, patient safety and education within the T&O department.
Members of the T&O department at The Princess Alexandra Hospital were invited to attend daily trauma meetings virtually via Microsoft Teams. In addition, the impact of moving to a larger, dedicated meeting space was assessed. Pre- and post-intervention questionnaires were delivered to assess response.
Post-intervention questionnaires revealed a significant improvement in the perception of ability to see XRs (p &lt; 0.001), quality of handover (p = 0.018), ability to discuss and formulate management plans (p = 0.002), social distancing (p &lt; 0.001), location (p = 0.002) and trauma meetings overall (p &lt; 0.000). The educational value of trauma meetings did not improve as anticipated, however.
Virtual Trauma Meetings are a useful adjunct, allowing clinicians safely contribute to clinical care. In addition, the location of daily trauma meetings is an important factor to consider, both for the safety of patients and for the safety of clinicians.
515 How Has ‘Montgomery’ Changed the Way We Document Risks on Consent Forms for Deceased Donor Kidney Transplantation? A Single-Centre Audit and Re-Audit
Authors: Hussein A M , Callaghan C J 
Published: May 2021

Abstract

Introduction
The 2015 Montgomery case changed the remit of risk discussions required during the consent process. This audit reviewed single kidney transplant (SKT) consent forms to establish which risks are documented, and whether this legal case affected discussions. Following the audit, we introduced a pre-printed consent form and closed the audit loop by assessing its uptake.

Method
Trust paper consent forms for all patients aged 50+ who received a deceased donor SKT in our centre in 2014 (n = 58; pre-Montgomery) and 2017 (n = 70; post-Montgomery) were reviewed to see if 20 perceived ‘gold standard’ risks were documented. A pre-printed procedure-specific consent form including all gold standard risks was then introduced in July 2019. A re-audit reviewed the case-notes of every alternate recipient aged 50+ of a deceased donor SKT from 01/08/19 to 29/02/20 to check if the pre-printed form was used.

Results
Overall, 53% of the 20 ‘gold standard’ risks were documented in 2014 versus 59% in 2017 (p = 0.55). There was a 91% uptake of the pre-printed consent form.

Discussion
This audit established the importance of using a pre-printed consent form to standardise risk discussions We propose that pre-printed procedure-specific forms should be encouraged throughout the NHS to support ‘Montgomery-appropriate’ consent discussions.
522 Audit of Acute Lower Gastrointestinal Bleed Management in a District General Hospital
Authors: Mallick S , Salem R , Payne A 
Published: May 2021

Abstract

Introduction
Acute Lower Gastrointestinal Bleed (ALGIB) is a common emergency surgical referral. This project aims to audit current practice at a district general hospital against new British Society of Gastroenterology guidelines, which gives recommendations regarding assessment (Oakland score), investigation and management.

Method
A retrospective study was undertaken over one year (2019) of patients presenting to A&E or referred via GP with ALGIB. Patients were identified through the coding department. An online proforma was used for data collection, which was analysed with SPSS.

Results
76 appropriate patients identified. Median length of hospital stay was 1 day. 10 patients (13.2%) scored ≤8 (probability of safe discharge 95%), 19 (11.8%) patients scored ≤9 (probability of safe discharge 93%) and 57 patients (75%) scored ≥10. 19 patients discharged the same day, of which 3 (15.8%) scored ≤8 and 8 (42.1%) scored ≤9. 23 patients admitted overnight, of which 5 (21.7%) scored ≤8 and 6 (26.1%) scored ≤9. Of 66 patients classified as ‘major’, 41 (62.1%) did not have a colonoscopy.

Conclusions
Introduction of a scoring mechanism and disseminating guidelines will enable GPs and A&E doctors to safely discharge ALGIB patients with appropriate outpatient investigations and reduce surgical admissions. There is currently poor compliance with inpatient investigations.
538 Patient Satisfaction from ENT Phone Consultations During COVID-19
Authors: Zammit M , Siau R , Williams C , Hussein A 
Published: May 2021

Abstract

Introduction
Telephone consultations (TCs) have rapidly increased in the outpatient setting due to the coronavirus pandemic. We have implemented a quality improvement project to improve patient satisfaction of TCs in our unit.

Method
This was a prospective complete-cycle project, with online patient satisfaction questionnaires sent following TCs in ENT clinics. This consisted of 28 questions including the Medical Interview Satisfaction Scale (MISS-21).
Based on results and a current literature review, a two-pronged intervention was designed, comprising of staff education and application of a model structured TC framework. A follow-up survey was subsequently undertaken.

Results
100 patient questionnaires were collected (April & June 2020). Significant improvements in MISS-21 scores were seen over the two surveys (p = 0.026). An average MISS-21 score of 114.6 (range 49 – 147) was seen in the first survey, with a mean score of 128.5 (range 79 – 142) seen in the second (maximum score of 147). There was a significantly increased preference for TC over FTF appointments over the two surveys (p = 0.021).

Conclusions
We have shown significant improvements in patient satisfaction and an increased TC preference through use of a structured consultation model. Its potential benefits in infection control and impact on outpatient workload may see TCs persist in the post-coronavirus era.
540 Point of Care Testing for Tetanus Immunity: A Systematic Review
Authors: Low R , Young K , Verani L , Cotton D T , Welman T , Moore L , Horwitz M D 
Published: May 2021

Abstract

Introduction
All patients presenting to emergency departments (EDs) with traumatic injuries require tetanus immunity assessments. Inaccurate tetanus vaccination history based on patient recall incurs unnecessary costs on the NHS. Point-of-care immunochromatographic tests (Tetanus Quick Sticks [TQS]) quickly identify tetanus immunity status. We aim to evaluate the diagnostic accuracy and cost-efficacy of TQS to assess their relevance in emergency care.

Method
The systematic review followed PRISMA guidelines. A retrospective search of MEDLINE, Embase, Global Health, HMIC and The Cochrane Library was conducted. Studies were eligible if sensitivity, specificity, or cost-efficacy of TQS were reported. At least two authors independently analysed the data from each study.

Results
12 studies were suitable for inclusion (n = 1,662,865 participants): one retrospective and 11 prospective observational cohort studies. Eight studies assessed diagnostic accuracy with the median sensitivity at 86% (55-100) and the median specificity at 97.5% (1-100). All six studies investigating cost-efficacy reported greater savings when using TQS instead of using vaccination history, due to a decrease in unnecessary tetanus vaccine and immunoglobulin administration.

Conclusions
TQS is a safe diagnostic tool, especially when used by trained operators. TQS widely reduces costs in comparison to traditional vaccination history. We recommend the use of TQS in Emergency Departments throughout the NHS.
541 Investigation of Suspected Prostate Cancer In UK; Evaluation of Local Practice and Feasibility of Moving Towards MRI As First Line Investigation – Re-Audit Following Change of Radiology Staffing
Authors: Lee S , Luk A , Kailash Y , Chaplin B 
Published: May 2021

Abstract

Introduction
NICE recommends MRI as first-line investigation for suspected clinically localised prostate cancer (PCa); previous local audit findings suggest this to be safe and feasible to implement. Recent retirement of radiology staffing however had resulted in MRIs being reported by teleconsultation radiology service. There were concerns on whether this may lead to more missed significant PCa. We performed a re-audit on our prostate MRI and biopsy to assess if this is indeed the case.

Method
All patients with suspected PCa who have had prostate MRI and biopsy simultaneously from April-August 2019 were retrospectively analysed.

Results
222 men were included. 36% of patients with negative MRI had positive biopsies; within this group 25% had significant disease (Gleason grade group ≥2). Compared with our previous audit, specificity for significant PCa has increased (from 34% to 46%), but with a reduced negative predictive value (from 97% to 91%).

Conclusions
If we are to implement MRI as first-line triage for potential subsequent biopsy, it would result in more men not going for a biopsy (from 18% to 25%), a reduction in diagnosis of non-significant PCa (from 21% to 36%), but at an expense of increase in missed significant PCa (from 3% to 9%).
565 Outcome of Enhanced Recovery Programme in Lower Limb Arthroplasties
Authors: Gurusinghe Suranga , Weerasinghe Konara , Aghazawi Laith , Shashidhara Singapura , Rambani Rohit 
Published: May 2021

Abstract

Background
Enhanced Recovery Programme(ERP) is structured process of patient education, appropriate analgesia and early mobilisation. ERP was introduced to address, demand for surgical beds and cancellation of orthopaedic procedures. Objectives of this study were to evaluate efficacy and safety of ERP.

Method
This was prospective study, over three months. Included, all lower limb arthroplasty patients eligible for ERP(all primary arthroplasty patient with lower anaesthetic risk). Pre-medication, intra-operative local anaesthetics infiltration, same day post-operative radiograph, combinations of analgesics, early mobilisation, and discharge back to the usual place of abode.

Results
201 patients, mean age was 71 years (42-87), 22 ASA (American Society of Anaesthesia) 1, 147 ASA 2 and 23 ASA 3 patients. Performed 121 total knee replacements and 80 total hip replacements. Average duration of weight bearing was1.04 days. Mean date of discharge was 1.37days (0-5). 8 patients were re-admitted (0.039%), they were, one with surgical site infection, another one for manipulation, 5 patients, suspected deep vein thrombosis (DVT) (all were excluded DVT). There was no failed discharge.

Conclusions
ERP is very safe and effective way of increasing performance of hip and knee arthroplasties by optimising availability of ring-fencing surgical beds and reducing the hospital stay.
593 The Utility of Routine Operative Swab Culture in Uncomplicated Peri-Anal Abscesses
Authors: Khajuria A 
Published: May 2021

Abstract

Introduction
Despite perianal abscess being a common presentation, certain aspects of its management remain controversial, especially the routine use of intra-operative swab cultures.

Method
A retrospective review of patients that underwent incision and drainage procedures for a perianal abscess over a six-month period was undertaken.

Results
Over 6 months, 50 patients were identified. The male to female ratio was 3:1 and median ASA score was 1. Only 6/50 patients presented with recurrent abscess and 1 patient had history of inflammatory bowel disease. On the basis of operative findings, 39 patients (78%) had uncomplicated abscess (not associated with cellulitis, sinus or fistula); swab cultures were performed in 26 (67%) of these patients. All patients were discharged on the same day; microbiology reports did not impact the treatment and no patients were followed up in clinic post-operatively or presented with recurrence. The number of unnecessary microbiology swabs undertaken in this cohort equates to approximately 52 unnecessary swabs a year. The cost of one swab is £10.10p, which means £520 could potentially be saved annually.

Conclusions
Routine intra-operative swab cultures do not impact management decisions, add to unnecessary costs and therefore should not be undertaken in uncomplicated or first presentation of peri-anal abscesses.
610 Virtual Burns Care in The Era Of COVID-19: A Regional Burns Unit’s Experience
Authors: Hayes J , Clements J , McGarry K , Rashid A 
Published: May 2021

Abstract

Introduction
In response to the COVID-19 pandemic a virtual burns service was established in Northern Ireland to reduce face-to-face consultations to only complex burns or those necessitating hospital admission to the regional unit.

Method
A combination of telephone calls, emails, photography, and Microsoft Teams software was utilised to facilitate a virtual review service. Our initial adoption of the system was audited during April and May 2020. Through Plan-Do-Study-Act (PDSA) methodology an electronic tertiary-referral proforma was established prior to closure of the audit cycle in July 2020.

Results
From the start of lockdown a significant reduction in face-to-face consultations was observed. Given the increasing use of virtual telephone consultation only 19.5% of the unit's total referrals (April, May, and July) were either reviewed face-to-face in dressing clinic or admitted. A target of 100% data point entry (including demographic, clinical, and initial management) for patients entering the virtual service was set. Following implementation of the e-Referral pathway an improvement in both the detail and completeness (95%) of patient referral information was achieved.

Conclusions
Our experience demonstrates that virtual burns care can be safely and rapidly adapted in response to evolving need. The potential role of virtual care post-COVID, in selected patients, is an exciting one.
631 The Time to Therapeutic Serum Levels of Vancomycin in Orthopaedic Patients
Authors: Rankin C , Robinson P , McCann C , Cockburn A , Palenzuela E 
Published: May 2021

Abstract

Introduction
Vancomycin is a commonly used antibiotic in the treatment of deep-seated infections. However, the current dosing calculator utilized in NHS Lothian may not adequately achieve therapeutic vancomycin serum concentrations (VSC), of 15-20mg/L, in a timely manner. We aimed to reaudit the length of time for vancomycin to reach therapeutic levels in orthopaedic patients using the new Lothian calculator. A previous audit loop looked at the current calculator in 2018.

Method
Inclusion criteria orthopaedic patients who were treated with vancomycin at the Royal Infirmary Edinburgh, data collection to finish mid-September. The duration to reach the therapeutic SVC, initial trough SVC and serial levels were recorded. A life-table analysis will be used to examine the data.

Results
First audit had Twenty-three patients. The mean initial trough VSC was 12.7mg/L. The mean duration to therapeutic VSC was 5.2 (± 1.3) days. Statistics not completed for second cycle, but initial data shows improvement in time to VSC.

Conclusions
A delay in reaching therapeutic concentrations was observed in a significant proportion of patients using the current calculator. A more rapid achievement of therapeutic levels is required to maximize the period of antibiotic delivery and subsequently improve patient outcomes. The new calculator pilot will hopefully show that improvement.
633 Surveillance for Head and Neck Cancer Recurrences: Is There Scope for A Tailored Approach?
Authors: Alvi M , Eagles E , Hamilton D 
Published: May 2021

Abstract

Introduction
Detection of cancer recurrence after treatment of head and neck cancer (HaNC) is vital. Current guidelines stipulate that following primary treatment HaNC patients are followed up for five years with a total of 18-24 appointments. This forms a bulk of the HaNC surgeon’s workload. Asymptomatic recurrences are rare. Patients educated regarding worrying symptoms may institute their own follow up. Such open appointment systems may be as effective at detecting recurrences

Method
At a moderate volume HaNC centre we reviewed 98 patients that had completed their five year follow up. We investigated cancer recurrences and whether these were symptomatic or asymptomatic at time of detection. We analysed each recurrence regarding the time since primary treatment.

Results
23 patients had HaNC recurrences. These recurrences were symptomatic in 17 patients and asymptomatic in 6 patients. Five of the six patients from the asymptomatic group had recurrences within two years of primary treatment. The final patient was of a high-risk histological subtype.

Conclusions
Asymptomatic cancer recurrences are uncommon especially after two years of regular follow up. After two years the frequency of appointments may be tailored on a patient-by-patient basis. Patients educated regarding symptoms of cancer recurrences may institute their own follow up.
639 ENT Telephone Follow Up in The Era of Covid-19: A Retrospective Qualitative Analysis Utilising Semi structured focus groups
Authors: Keates N , Mclaren O , Perkins C , Finnie C , Williams R 
Published: May 2021

Abstract

Introduction
Covid-19 and social distancing has triggered a seismic shift in clinical work especially during the first part of lockdown. This work looks to evaluate the experience and opinions of key stakeholders who took part in the process and use this to improve follow up in the future.

Method
3 Focus groups following the same semi structured format discussed key considerations in follow up in general, telephone follow up, key aspects in its delivery and how this could benefit the service provided to patients. The focus groups involved Juniors (registrar level doctors), Consultants and support staff (clinical and non-clinical).

Results
Several themes and subthemes were identified. Key points were that patients were universally in favour of telephone consultations; they find them convenient and enjoy not attending the hospital. All clinicians agreed that although Covid-19 lead us to review New patients via telephone this increased workload as they needed to attend later for an examination and felt it did not provide safe care.

Conclusions
There is certainly an increasing role for telephone follow ups in the wake of Covid-19 which can benefit ongoing patient care and aid in managing the departments follow up capacity. Further work is needed to review this.
678 An Audit of TRUS Biopsy Sepsis Within A District General Hospital Setting
Authors: Tezcan E 
Published: May 2021

Abstract

Introduction
Transrectal ultrasound (TRUS) biopsy is the standard investigation of suspected prostate cancer within the United Kingdom. TRUS biopsy has significant risks of associated complications, the most serious being sepsis. An audit was designed to evaluate the rate of sepsis following TRUS biopsy within a district general hospital setting.

Method
All men who underwent TRUS biopsy over a four-month period between October 2019 and January 2020 were retrospectively reviewed. Standard rate of sepsis for benchmarking was identified as 0.8% as quoted in the European Association of Urology (EAU) prostate cancer guidelines.

Results
88 men underwent TRUS biopsy between October and January. Three cases of TRUS biopsy sepsis requiring hospital admission were identified. The rate of sepsis determined was 3.4%. The average length of stay for the cases was 4.7 days. Oral co-trimoxazole was used as the empirical antibiotic prophylaxis pre-procedure in all.

Conclusions
The rate of sepsis was higher than the figure quoted in EAU guidelines. Routine local audit for TRUS sepsis is necessary to maintain standards and efficacy of prophylaxis, as well as the accurate counselling of patients on the expected risks of the procedure. Consideration should be given to targeted antibiotic prophylaxis based on pre-biopsy rectal swabs.
680 A Virtual Stone Clinic Using an Electronic Database Streamlines the Patient Pathway
Authors: Lee R X N , Heng T C R , Raju J A , Bodiwala D , Scriven S D 
Published: May 2021

Abstract

Introduction
We have set up an electronic database to record patients requiring follow-up, which is reviewed in a virtual stone clinic (VSC). A consultant led VSC is held weekly to review the database and follow-up patients virtually.

Method
Analysis of patients added over a 15-month period was performed. Outcomes included spontaneous stone passage rates, intervention rates and time from initial imaging to VSC outcomes.

Results
615 patients with a median age of 48 years were analysed. Emergency referrals to urology accounted for 85.9% of data. VSC review occurred a median of 5 days after initial imaging. Majority of stones were lower ureteric (64.6%), 28.1% upper ureteric and 7.2% renal stones. Follow up data was available for 557 patients (90.6%). 73.6% of patients passed stones spontaneously.
Median time from investigation to imaging was 21 days. 372 patients were discharged following VSC review. 111 patients were listed for surgical intervention. Median time to intervention was 21 days for ESWL, 62 days for ureteroscopy and 202 days for PCNL.

Conclusions
VSC leads to shorter waiting times for follow-up imaging and interventions in patients with renal stone disease. This is especially evident in the current Covid-19 pandemic, resulting in higher quality of care.