bluuebunny/crossref_metadata_2025_split huggingface dataset:
543 Improving the Management of Acute Ureteric Colic in A Multi-Centre District General Hospital: A Closed-Loop Audit
Authors: Desai C , Bruce A , Ehsanullah S A , Otite U , Ahmad S 
Published: October 2021

Abstract

Introduction
The British Association of Urological Surgeons (BAUS) released guidance in 2018 regarding the optimum management of acute ureteric colic: a condition which can present as a surgical emergency. Our aim was to review the current practice at our hospital in diagnosing and managing acute ureteric colic and ultimately, implement sustainable change to address any areas of limitations.

Method
The following data was retrospectively collected for of all patients admitted with acute ureteric colic: investigations performed, medications administered, details of surgical intervention and follow-up. 1st Cycle: March 2017 to February 2018. Intervention: Teaching sessions delivered to staff (including doctors and nurses) in the A&E and urology department. 2nd Cycle: January 2019 to December 2019.

Results
268 patients presented to A&E with ureteric colic – 18% increase from previous year. On admission: 60.4% of patients had serum calcium checked, 97.7% had a CT KUB performed within 24 hours and 67.2% were given NSAIDs; this is a 20.4%, 0.4% and 5.2% increase from the previous year, respectively. Only 31.3% of patients had an acute surgical intervention. The average wait time for clinic follow-up was reduced to 41 days following departmental education, but only 26.4% of patients were seen within the BAUS advised 4-week timeframe.

Conclusions
Re-audit showed distinct improvement in the management of acute ureteric colic. Thus, departmental education strategies have had a positive impact. It is recommended that the reservation of one daily elective theatre slot for an emergency operation and a computerised clinic booking system will further optimise our management in line with BAUS guidance.
603 VTE Prophylaxis Compliance on The Burns Unit
Authors: Sayed M A , Murray E , Soueid A 
Published: October 2021

Abstract

Aim
To assess if VTE risk assessments are correctly completed and implemented on the Burns Unit.

Method
2-week prospective analysis of all inpatients admitted to the adult Burns Unit. Data was collected from patient files and drug Kardexs. Variables including TBSA, date of injury, date of admission, date of VTE risk assessment score, correct prescription according to score and implementation were compiled in an excel spread sheet. Audited against Trust and NICE Guideline 89.

Results
The first cycle identified errors in risk assessment completion related to inaccurate BMI assessment and failure to identify the burn as a risk factor. The risk assessment was only re-assessed 71% of the time post operatively or following change in condition. An action plan included re-education of medical staff, reminder posters in theatre and re-designing the burns operation note to include a VTE re-assessment tick box. A re-audit showed an improvement in correct VTE scoring from 65% to 100% and VTE reassessment from 71% to 100%.

Conclusions
Following the first cycle, Wythenshawe Hospital Burns Unit has improved in compliance with the NICE and Trust Guidelines. The two most frequent errors identified on completion of the risk assessment form have not been seen in the second cycle following education of medical staff. All patients should continue to be prescribed the prophylaxis indicated, unless contraindicated. For those patients who cannot wear AES due to a burn to their lower legs, flowtrons and/or enoxaparin should be considered instead. For those patients who refuse treatment an incident form must be completed.
606 AUDIT: IV Fluid Prescribing in Surgical Patients
Authors: Shakir T , Mills E , Koomson A , Iqbal M 
Published: October 2021

Abstract

Aim
A recent change to electronic fluid prescribing has enabled us to evaluate our adherence to recommendations. NICE clinical guideline 174 states that patients should receive 25-30ml/kg/day water and 1mmol/kg/day of sodium, potassium, and chloride with regards to maintenance fluid therapy. We retrospectively audited our practice in surgical patients.

Method
Patients were selected from two surgical inpatient wards in a district general hospital utilising random sampling over a one-month period. Prescribed intravenous fluid (IV) therapy over a 24-hour period was collected; in addition to weight, presence of an acute kidney injury (AKI) and indication for IV replacement (maintenance versus resuscitation).

Results
50 patients were identified during the period. All of them were emergency presentations. Maintenance fluids were prescribed for 76% of patients. No patients had an AKI at time of data collection. The mean weight was 75kg. Overall, patients received a mean fluid volume of 2.3L/day. The mean concentration of electrolytes administered over a 24-hour period were: Sodium 297mmol, Potassium 13mmol, Chloride 237mmol. When adjusting for patient weight, this resulted in a net administration of: Sodium +221mmol, Potassium -62mmol, Chloride +162mmol.

Conclusions
Three quarters of surgical patients were administered maintenance fluids. The electrolyte contents of these fluids were inadequate. Patients received 295% excess Sodium, 216% excess Chloride, and 82% less than the recommended daily requirement of Potassium. We aim to introduce a protocol for maintenance fluid prescribing, in addition to teaching sessions, that would allow for adherence to guidelines and improve patient care.
636 Optimising Operative Capacity for Hand Trauma - An audit
Authors: Shahid S 
Published: October 2021

Abstract

Aim
Assess compliance with departmental and BSSH guidelines for hand trauma. Optimise operative capacity within the department. Promote minor ops experience among the junior doctors.

Method
Retrospective review of the overbooked patients seen in the Hand trauma Unit (HTU) in August 2020 using the eTrauma system and time to operation using the Lorenzo patient record system.

Results

Overall Local Compliance rates

Overall BSSH Compliance rates
Main area of non-compliance was waiting time for tendon operations, with a 30% breech rate (&gt;5 days waiting time).

Conclusions
Interventions before re-audit: On call junior doctor to be based in HTU for the whole day- will allow for minor procedures (nail beds and skin lacerations) to be done at bedside. The above will free up capacity in the minor ops theatre for tendons.
668 Inguinal Hernia Repair: Are We Compliant with The Recommended Consent Process?
Authors: Barghash M , ElGhobashy T , Cheema N , Mansour M 
Published: October 2021

Abstract

Aim
Inguinal hernia repairs are one of the most commonly performed operative procedures in the UK. An adequate consent process gives the patient the autonomy in making decisions related to their care and treatment. In this project, we were auditing whether hernia patients have gone through a standardised consent process from time clinic presentation up to the day of surgery.

Method
This was a retrospective audit based on the Royal College of Surgeons’ (Good Surgical Practice) guidelines and trust local policy. We assessed 50 case notes for patients who had inguinal hernia repair between November 2019 and November 2020 in two of the busy district general hospitals in the UK.

Results
We found that our practice was fully compliant with documenting patient demographics, signatures, and the name of the procedure in the consent forms. Documented discussion prior to surgery was found only on79% of clinic letters. Poor compliance was noted in documenting some of the possible risks in the consent form including testicular atrophy (59%), injury to vas, vessels, and nerves (56%), wound complications (49%), chest infection (24%). Zero compliance was noted in documentation missed hernia and mortality as potential risks to the procedure.

Conclusions
A detailed documented discussion with the patient in relation to benefits, risks, and alternatives of surgery should take place on clinic presentation as well as on the day of surgery to ensure compliance with the consent process.
683 Minimum Data Set in Documentation of Operative Findings in Diagnostic Laparoscopy
Authors: Nakhuda S , Liyanage A , Satchidanand R 
Published: October 2021

Abstract

Aim
Legible, accurate and clear documentation of operative findings is an integral part of patient safety, with guidelines from the Royal College of Surgeons and General Medical Council having clear standards of operative note-keeping. However, a substantial variation in the quality and accuracy of these notes can still be observed in everyday practice. We recognised the significance of a minimum set of data in operative record keeping for diagnostic laparoscopies as a standard, to improve quality and uniformity.

Method
We retrospectively examined 50 diagnostic laparoscopies over 6 months and assessed their operative notes against the guidelines described above. We found that there was no clear uniformity in reporting, subjective descriptions used and a significant amount of under-reporting of operative findings. We developed a proforma as a substitute for the documentation of operative findings which was implemented in the second phase of the audit and the compliance was assessed over a 3-month period.

Results
We found that usage of the proforma was limited (9/22), however those notes using the proforma were compliant with the guidelines for operative note keeping, to a much higher degree than those without. All the operative findings were documented for 100% of those notes which used the proforma; for those using freehand notes, only the appendix was identified to the same standard, which is explained by all diagnostic laparoscopies proceeding to appendicectomies.

Conclusions
Using a proforma as standard record keeping can improve the quality and accuracy of operative notes and thereby help improve safety and quality of patient care.
704 An Audit of Marking of Cutaneous Lesions in A Two-Week Wait Skin Malignancy Service
Authors: Sutcliffe A , Chang C , Sugden P 
Published: October 2021

Abstract

Aim
Clinical photography enhances a medical record and facilitates communication with other professionals involved in care. It is utilised frequently in the management of skin malignancy. The essence of good photography lies in accurate identification of the cutaneous lesion in question. National guidelines and local policy advise the use of circumferential marking to delineate a lesion of interest, and an alphabetical system for marking of multiple lesions. We audited compliance to standards for medical illustrations of cutaneous lesions in the two-week wait skin cancer clinic at University Hospital North Durham.

Method
Prospective audit of patients attending the clinic over a 7-day period (07/09/20-15/09/20). Data was collated from electronic records on a number of variables.

Results
175 patients met inclusion criteria. The majority (n = 160, 89.9%) were referred for a single lesion, the rest for multiple lesions. Hospital clinical photography was obtained in 148 patients (83.2%). Marking was deemed inappropriate in 44.6% of those in which clinical photography was obtained. Of these 66 cases, 12 cases were multiple lesions marked without letters, 52 had an incorrect indicator for the lesion (such as arrows or dots, allowing more ambiguous interpretation), and 8 had no indicator at all. Incidentally, one patient was photographed with dressings covering the lesions.

Conclusions
Compliance with standards for demarcation of skin lesions for clinical photography was found to be poor. This permits the wrong identification of lesions in future treatment episodes and could potentially have a significant impact on care. We propose the introduction of a referral document illustrating correct marking guidelines.
722 Review of The Introduction of Pre-Biopsy MRI Scanning in The Diagnostic Pathway for Prostate Cancer
Authors: Soma A 
Published: October 2021

Abstract

Introduction
The diagnostic pathway for prostate cancer has changed recently with the introduction of a pre-biopsy MRI. This audit aims to identify whether this change helps the University Hospitals of Morecambe Bay NHS Foundation Trust meet the national standard of referral to treatment time of 62 days.

Method
This audit will follow the individual journeys of patients on the previous (05/2017 – 05/2018) and new pathway (08/2018 – 04/2019). In addition, they will be divided based on the treatment they chose – surgery or radiotherapy.

Results
Old pathway:
New pathway:

Conclusions
Comparing the new pathway to the previous, there is a reduced proportion meeting the RTT. One way to combat this is ensuring patients have their MRI scans, if suitable, prior to their first clinic, which shows to be the most effective way to meet the RTT.
764 Is Consent Valid in Common Orthopaedic Surgeries?
Authors: Byrne A , Galhoum M , Prasad R 
Published: October 2021

Abstract

Aim
Consent is at the heart of the doctor-patient relationship. Valid consent should be voluntary, informed and the patient must have the capacity to make the decision. It is the doctor’s responsibility to ensure the patient can make an informed decision. The aim of this audit is to assess the validity of consent within Salford Royal Foundation Trust Orthopaedic department.

Method
We retrospectively reviewed 225 consent forms for four common orthopaedic trauma procedures: 44 wrist ORIF, 48 ankle fixation, 71 hip hemiarthroplasty and 62 fixations with DHS. BOA-endorsed OrthoConsent and SRFT-produced leaflets were utilised as a standard for reported surgical risks and complications. Collated patient consents were compared against these standards. Exclusion criteria included consent four and polytrauma patients.

Results
96 forms were excluded leaving 129 consent forms. In all four procedures, 86%-100% had documented infection, nerve injury and bleeding. Compartment syndrome was not documented for any wrist ORIF patients. CRPS was recorded in only 57% of wrist and 31% of ankle ORIF patients. Wound healing complications was documented in 17% of ankle ORIF. In 71% of DHS and 64% of hemiarthroplasty patients, risk of death was not recorded.

Conclusions
Targets for achieving satisfactory consent form documentation were not met and showed significant variation amongst clinicians. It suggests that patients are not being fully informed of benefits and risks of surgery. Recommendations include the introduction of posters and encouraging printing off patient information leaflets and improving education on valid consent for rotational doctors.
768 Impact Of COVID-19 And BOAST Standards on Surgical Management of Upper Limb Injuries in A Large Teaching Hospital
Authors: Naylor T 
Published: October 2021

Abstract

Aim
During the first peak of the COVID-19 pandemic, the BOA recommended that upper limb surgery for trauma should be avoided if possible, or performed as day-case if unavoidable, to reduce the risk of COVID-19 related negative outcomes. This audit assessed compliance with recommendations and impact on proportion of injuries managed conservatively due to COVID-19 risks, inpatient stay duration, COVID-19 infections, and corrective surgical intervention rates.

Method
Data was collected for all referrals to orthopaedics for upper limb fractures/dislocations at a large NHS teaching hospital in the North West over a 10-week period from April 4th to June 12th. Follow up was performed to 6 months after date of injury. Care was audited against the “British Orthopaedic Association Standard in Trauma: Management of patient with urgent orthopaedic conditions and trauma during the coronavirus pandemic”.

Results
A total of 112 patients were referred. 76% of patients were discharged from Emergency Department, with surgery indicated in 48%. Of those, 11% (n = 6) were not operated on due to COVID-19 risks and 1 patient from this group (16.7%) has required secondary corrective surgery. Surgery was completed as day-case procedure in 50%. COVID-19 swabs were not taken in 46% of referrals, 50% had a negative test and 4% positive. No patients tested positive after discharge following treatment.

Conclusions
Few cases were managed conservatively based on COVID-19 risk, and only 1 patient has required secondary surgery. More upper limb injuries may be managed conservatively, as per BOAST standards, with day-case procedures better utilised as an alternative.
767 Are Full Length X-Ray Radiographs of The Femur Required in Neck of Femur Fractures with Co-Existing Malignancy?
Authors: Ghobrial M , Vaidya A , Thahir A , Krkovic M 
Published: October 2021

Abstract

Introduction
It is common practice that we obtain full-length femur x-ray radiographs in patients admitted with a neck of femur (NOF) and a history of co-existing malignancy. The aim of this retrospective study is to evaluate the type of malignancies associated with NOFs and whether obtaining a full-length femur X-rays changes the treatment plan.

Method
Of the 2416 patients screened, 18% had co-existing malignancy (n = 431). The most common age to sustain a NOF with co-existing malignancy was 81, while 66% of them were females and 34% were males. The most common type of fracture sustained was an intra-capsular NOF (60%, n = 256), followed by inter-trochanteric fractures (31%, n = 133) and then sub-trochanteric fractures (9%, n = 42).

Results
The one-year mortality was 29% (n = 125). One in four of these fractures were associated with a co-existing breast malignancy (25%, n = 107), followed by prostate cancer (13%, n = 55). Bladder, colorectal, skin SCC and lung cancer each contributed 6-7% (mean n = 29). Other cancers contributed to the rest of the 36%. Metastatic cancer to the skeletal system was noted in 7% of the patients(n = 30), resulting in a pathological fracture and 20% (n = 6) of these were contributed by a primary lung cancer. All in all, all of the 30 patients who had distant bone metastasis underwent the treatment they normally would undergo had the leg length femur X-rays not been done.

Conclusions
In our series of patients with NOF fracture and existing skeletal metastatic deposits, the leg-length femur X-rays did not add any value related to the way the fractures were managed.
860 Distal Radius Fracture Management in A DGH Do the Guidelines Fit?
Authors: Thumbadoo R , Patel B , Fennelly J , Kitaoka S , Adamu-Biu F , Chennagiri R 
Published: October 2021

Abstract

Aim
Distal radial fractures are common injuries within adults at a variety of ages. The best treatment option remains a debated subject. The BOAST guidelines aim to guide the initial management of these fractures in the emergency department we audited against these guidelines in a local district general hospital.

Method
A retrospective audit was performed of adult patients with distal radius fractures who attended in December 2019, at a local district General Hospital. Patients were identified by using the Orthopaedic Take lists. Notes were reviewed for patient demographics, quality of documentation of neurovascular status, documentation of fracture information, including further management.

Results
There were 16 cases identified, 87.5% were female with mean age of 63 with over 56 % in the over 65s category. Only 19% of cases had appropriately documented neurovascular status. 57% were lacking specific documentation of each nerve as per BOAST guidelines, as well as 57% had no documentation of radial pulse. With regards to reductions undertaken in ED only 44% were documented if reduction took place. Of the reductions that were documented 66% documented type of analgesia used. 17% used regional anaesthesia as preferred in BOAST guidelines.

Conclusions
Overall compliance with BOAST guidelines was poor. Several areas to improve were seen, for which the recent launch of a new in-house smartphone application is aimed to improve access to BOAST guidelines. There was great difficulty in achieving the BOAST guidance with regards to the use of regional anaesthesia, nationally most A&E departments reduce these fractures under a haematoma block.
1022 Equivalent Management for All Fragility Fractures Occurring in The Older Patient
Authors: Lenihan J , Waseem S , Rawal J , Hull P , Carrothers A , Chou D 
Published: October 2021

Abstract

Aim
Neck of femur fractures (NOFs) are painful and occur in a vulnerable group of our population. Complications occur if their pain is under treated. Optimal management in the United Kingdom is governed by Best Practice Tariff (BPT). This was extended in 2020 without supporting published evidence to include all femur fractures (ROFs).
We sought to compare PRPS for NOFs and ROFs throughout hospital admission.

Method
We performed a retrospective matched analysis of all isolated osteoporotic ROFs to NOFs at our centre between 2018-2019. We analysed electronic patient records for relevant data. Matching criteria included Age +/- 2 years; cognition; walking aids; ASA; and social residence. Primary outcome measure was patient-reported pain scores (PRPS) at set time points. Secondary outcome measures were peripheral nerve blocks (PNB); patient controlled analgesia (PCA); time to surgery; anaesthetic type; length of stay (LOS); weightbearing status and 30-day mortality. Data was statistically analysed.

Results
11 ROFs were matched to 104 NOFs. There was no statistical difference between the two groups for age, sex, nor cognition and no difference in time to surgery; anaesthetic type; LOS; nor 30-day mortality. ROFs were more painful at all time points although not statistically significant. ROFs were more likely to have traction; PCA both pre- and post-operatively and not to weight bear. NOFs were more likely to have a PNB.

Conclusions
ROFs are as painful if not more so than NOFs. Few ROFs receive PNB and require PCA. Better control of symptoms may improve outcomes. We support the extension of BPT.
1053 Comparing MRI Parameters in Quantifying Patellofemoral Instability
Authors: Nagi S , Hing C 
Published: October 2021

Abstract

Aim
Patellofemoral instability is where various stabilising factors of the patellofemoral joint undergo pathomorphological changes. It has an incidence rate of 5.8 per 100,000 in UK and has been associated with osteoarthritis[1]. Variations in the factors that stabilise the patellofemoral joint can be observed on MRI including measurements of the trochlea in relation to the patella, the femur and soft tissue changes. This study aims to compare different measures used to detect and quantify patellofemoral instability on MRIs and to look for any significant difference in their use both in isolation and together.

Method
109 MRI reports of 78 patients diagnosed with patellofemoral instability were reviewed and all quantitative and qualitative parameters reported were inputted in a data table. Quantitative elements known as the Dejour protocol included the trochlear sulcus angle, patellar tilt angle, tibial tuberosity-trochlear groove distance and the Insall-Salvati ratio. Qualitative factors involved facet changes, patellar position, and any damage to soft tissue.

Results
It was found that the Insall-Salvati ratio greater than 1.2 and the patellar tilt angle of greater than 11 degrees irregular ranges had the greatest incidence in the MRI reports found 77.1% and 87.6% respectively in MRIs that reported them.

Conclusions
There is a discrepancy between quantitative parameters in their correlation with patellofemoral instability for the MRI reports observed. [1]: Ye Q, Yu T, Wu Y, Ding X, Gong X. Patellar instability: the reliability of magnetic resonance imaging measurement parameters. BMC Musculoskeletal Disorders. 2019;20(1).