bluuebunny/crossref_metadata_2025_split huggingface dataset:
1571 Lower Limb Immobilisation And VTE Prophylaxis Risk Assessment: A Quality Improvement Project
Authors: Potter M 
Published: October 2021

Abstract

Introduction
Temporary cast immobilisation of the lower limb following injury is associated with a 2-3% risk of DVT. NICE guidelines recommend considering pharmacological thromboprophylaxis for those with lower limb immobilisation where VTE risk outweighs bleeding risk. The aim of this quality improvement project was to improve compliance with VTE risk assessment in patients discharged from the Emergency Department (ED) with lower limb immobilisation.

Method
Baseline data on completion of VTE risk assessment forms was collected retrospectively on all patients discharged from ED in lower limb boots and casts over a 3-week period. Cycle 1 included the introduction of a VTE section on the virtual fracture clinic booking form. Cycle 2 included displaying posters around the ED and placing forms inside walker boots. Data was collected following a 3-week period for each cycle.

Results
The baseline audit showed 45% compliance with completion of VTE risk assessment forms. Cycle 1 showed a significant increase in compliance, to 72%. A further modest increase in compliance was seen in Cycle 2, with 78% of VTE risk assessment forms completed.

Conclusions
Baseline compliance with VTE risk assessment for lower limb immobilisation was suboptimal. Integration of risk assessment into the virtual fracture booking form significantly improved compliance. This intervention is to be continued long-term at Harrogate District Hospital.
1600 Assessing Necessity and Cost-Effectiveness of Routine Pre-Thyroidectomy Group and Save Tests
Authors: Karim S , Halliday C , Shah S , Vaughan D 
Published: October 2021

Abstract

Aim
To determine the necessity and cost effectiveness of routine blood group and save tests (G&S) before thyroidectomy

Background
Sub-total or total thyroidectomy is the mainstay of treatment for several thyroid disorders. The incidence of post-thyroidectomy haemorrhage has been reported between 0.36% and 4.3% in the literature. Many patients undergo routine G&S testing in anticipation of a peri-operative haemorrhage requiring blood transfusion.

Method
Retrospective review identified 276 patients undergoing an elective total or sub-total thyroidectomy at a London University Teaching Hospital between February 2018 and August 2020. Electronic medical and transfusion department records were audited to identify patients who had pre-operative G&S tests, pre-operatively reserved blood products and peri-operative transfusions.

Results
261 (94.6%) patients had a valid pre-operative group and save test. 17 (6.16%) patients had a total of 61 units of blood products ordered pre-operatively. Only 2 patients required transfusion.

Conclusions
The blood transfusion rate for elective thyroidectomies at this centre was 0.72%. Routine G&S tests cost the trust thousands of pounds and create unnecessary burden on healthcare providers’ time and hospital resources. We propose that routine pre-operative G&S tests are unnecessary for elective thyroidectomies.
1618 Improving the Clinic Experience for Surgical Patients Visiting the Melanoma Multidisciplinary Team Clinic at Guy’s and St Thomas’ NHS Foundation Trust
Authors: Harbour A , Dhillon D , Geh J L C 
Published: October 2021

Abstract

Aim
The incidence of malignant melanoma has been increasing in the UK over the last decade. Effective melanoma management requires a multidisciplinary team (MDT) approach, often involving dermatologists, oncologists, radiologists, histopathologists, skin cancer nurse specialists and plastic surgeons. Patient waiting times at our melanoma MDT clinic at the St John’s Institute of Dermatology at Guy’s Hospital, London had anecdotally been reported as excessive, specifically for same-day ‘in-clinic referrals’ from dermatology to plastic surgery. We aimed to ascertain the reasons for the delay and implement changes to improve patient satisfaction in the clinic.

Method
A patient satisfaction questionnaire was devised, measuring satisfaction on a numerical scale of 1 (unsatisfied) to 5 (very satisfied) in addition to a clinic staff perception questionnaire on patient satisfaction. Lack of instruction from staff after the dermatology appointment was identified as the predominant factor contributing towards waiting delays to the plastic surgery clinic. This led us to highlight and educate the issue to all team members involved and create a system whereby patients re-reported to the administrative staff after their dermatology appointment to be re-entered into the system.

Results
As a result of this, the mean surgical patient satisfaction score, pre-intervention of 3.83, improved to 4.50 post-intervention. Similarly, mean scores from staff assessing perception of how well the clinic ran and patient waiting times also increased.

Conclusions
The introduction of a new patient in-clinic referral protocol and increased staff education of the issue has improved both patient and staff satisfaction within the clinic’s health care provision.
1631 The Pen is Mightier than the Sword; but the Keyboard may be Better
Authors: Morrison S , Brunt A 
Published: October 2021

Abstract

Introduction
Operation notes ensure patient safety through continuity of care, and act as reliable treatment records. Notes must be legible, accessible, and contain all relevant information. Specific standards are outlined in the Good Surgical Practice Guidelines (2014) by the Royal College of Surgeons of England. Audits in the UK show poor adherence to these standards. Online operative note systems are becoming more common, but variety still exists in operations notes. This work assessed operative note standards in an orthopaedic department and assessed the utility of electronic operative note systems.

Method
This was a prospective quality improvement project. Operation notes for all emergency orthopaedic operations were audited against national standards. An online operation note system was introduced and re-audit carried out following implementation.

Results
Initial audit noted poor adherence to standards. An online operative note system was introduced. A second audit with 96 patients was undertaken. Uptake of the software was low, with 10% of notes being online. 19 of 21 information points showed improved standards adherence with the online system versus other methods. In the remaining 2 areas 100% of notes adhered to standards in both methods. The online system had 100% adherence in 19 data points, and 90% in the remaining 2.

Conclusions
Online note softwares have various benefits, including improved adherence to standards. Other benefits exist, such as databasing of operations for review and audit. These systems appear reliable and beneficial for operative documentation and are easily implemented; however, some work is still required to change old habits and improve uptake.
1632 Improving Excision Margins in Skin Oncology
Authors: Ibrahim Y , Li Z , Vijayasurej K , Malik M , Jones E , Tang L 
Published: October 2021

Abstract

Aim
There are 152,000 new non-melanoma skin cancer (NMSC) cases in the UK every year, and excision and reconstruction of basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) form a significant part of the clinical workload in plastic surgery. In this quality improvement project, we aimed to identify and improve our unit’s compliance of guidelines for excision margins for NMSCs.

Method
A retrospective audit was undertaken in June 2020 to determine compliance with British Association of Dermatology and local guidelines on excision margins for NMSCs. A repeat audit was undertaken in October 2020 following quality improvement interventions.

Results
The first audit cycle examined 66 lesions in total. Guidelines were met in 53% (BCCs) and 50% (SCCs) of lesions. 12% of lesions had unclear documentation of margins. 16 lesions had margins that were too small as according to the risk factors present. These findings were presented to the department, and a new operative note template specifically designed for skin oncology was launched. Key audit findings were displayed along with the guidelines on posters. A repeat cycle was undertaken in October 2020, which examined 52 lesions. Significant improvement was seen with 100% documentation, and excision margin guideline compliance rate of 71% (BCCs) and 79% (SCCs).

Conclusions
Adequate excision margins in skin oncology is vital to ensure complete excision and to minimise the risk of recurrence. Our project demonstrates significant improvement in excision margin compliance through the launch of a specific operative note template and information posters.
1686 Are We Addressing the Syndesmosis in All Ankle Fractures – 2nd Cycle Audit at an MTC
Authors: Arora N 
Published: October 2021

Abstract

Aim
Assess compliance with BOAST guidelines – “Surgery should aim to achieve reduction and stabilisation of the ankle mortise. The syndesmosis should then be assessed and stabilised if unstable.”

Method
103 Ankle ORIF procedures done for closed malleolar fractures in skeletally mature induviduals over a 12-month period used for first audit. Review of Op notes and intra-operative images was done looking for evidence of assessment of syndesmotic stability. Results were presented to the department and specific guidance on assessment of syndesmosis distributed. 84 Ankle ORIF procedures performed in next 12-month period used to re-audit.

Results
In the first audit, 34% cases had inadequate documentation regarding the stability of syndesmosis. This is similar to finding of 32% in a previous audit in 2018. Re-audit after presentation and review of guidelines, showed improved compliance with only 14.3% cases having no documentation of syndesmosis status.

Conclusions
Distribution of evidence supporting assessment of syndesmosis and making all grades of surgeons aware of the relevant guideline led to an improved compliance of more than 85%. There always remains the vulnerability to miss syndesmotic injuries and potentially adversely affect patient outcomes, if not explicitly assessed on table after bony fixation. All surgeons and rotating trainees need to be aware of this requirement.
1702 A Proforma To Improve Documentation of Surgical Ward Rounds
Authors: Armstrong E , Koronfel M 
Published: October 2021

Abstract

Aim
The ward round is an important vehicle in the care of surgical inpatients. Good quality documentation is essential in recording patient progress over time and communicating clearly between multidisciplinary team (MDT) members. This quality improvement project aimed to implement a standardised proforma to improve the quality of ward round documentation, improving MDT communication and patient safety.

Method
Ward round entries from an elective surgical unit at a District General Hospital were retrospectively reviewed using a fifteen-item checklist to assess quality of documentation. These criteria were divided into:
A re-audit was performed following introduction of a ward round proforma using the same criteria.

Results
The pre-intervention arm included 41 entries and the post-intervention arm included 27 entries. Improvements were seen in twelve of the fifteen criteria assessed. The greatest improvements were seen in documentation of management plans; documentation of discharge plan improved from 58.5% to 100%, VTE prophylaxis from 42% to 100% and drain/ catheter plan from 42 to 93%. Documentation of two criteria (signature and bleep) decreased and documentation of date remained at 100%.

Conclusions
The use of a standardised proforma improves documentation of surgical ward rounds, particularly patient’s’ onward management plans. Further modifications to the proforma could aim to improve documentation of bleep and signature.
711 Effect of Roux-En-Y Gastric Bypass on HbA1c As Well As Number of Medications in Diabetic Patients
Authors: Bhandari M , Rao M , Bussa G , Rao C 
Published: October 2021

Abstract

Aim
Roux en Y gastric bypass (RYGB) is known to ameliorate Type 2 Diabetes Mellitus (T2DM) in morbidly obese patients. We aimed to determine both the reduction in the glycosylated haemoglobin (HbA1c) and the number of anti-diabetic medications (including insulin) in diabetic patients undergoing RYGB over a five-year period.

Method
We reviewed data of diabetic patients (n = 530) who underwent RYGB from January 2012 – December 2017, including those with a minimum of a 2-year post-operative follow up (n = 47). Preoperatively, BMI, HbA1c and the number of anti-diabetic medications and the duration of T2DM since diagnosis were recorded. These measurements were repeated at the end of the two year follow up.

Results
At the time of enrolment in the bariatric programme, the median BMI was 42.5 (range, 31.7-61.5) kg/m2, mean duration of T2DM was 58 months and median HbA1c was 59 (37-118) mmol/mol. The mean number of anti-diabetic medications taken, including insulin, was 2. At the end of 2-year follow-up, the median BMI was 32 (range, 24-41) kg/m2 and HbA1c was 41(range, 33-91) mmol/mol. 15 patients (31.9%) still required anti-diabetic medication, 12 of whom had a diagnosis of T2DM for 3 years or more at time of enrolment.

Conclusions
RYGB is strongly associated with a resolution of T2DM in morbidly obese patients. In those who were not resolved, the number of anti-diabetic medications taken and HbA1c were reduced. The impact of the surgery is dependent on the duration of T2DM since diagnosis preoperatively.
739 Pancreatic Cancer and Bariatric Surgery: Narrative Review
Authors: Al-Saadi H , Malallah H , Al-Saadi T 
Published: October 2021

Abstract

Background
Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest types of cancer with an estimated incidence of 8 per 100,000 person-years and mortality of 7 per 100,000 person-years worldwide.

Method
A narrative review of the literature was conducted. PubMed, Web of Science and Cochrane database were searched for all published papers in Pancreatic cancer post Bariatric surgery from 1990 to November 2020.

Results
Epidemiological evidence in the literature has shown that obesity as a risk factor for the development of PDAC is a dose dependent risk. The review found that the risk of developing pancreatic cancer in obese or overweight individuals is 1.5 times higher than individuals with a normal BMI. At the same time, evidence from literature demonstrated that weight reduction by dietary restriction, physical activities, pharmacotherapy or weight reduction surgery reduces risk of PDAC.A total of 24 cases of pancreatic cancer were identified in the literature reported post Bariatric Surgery. The average age at diagnosis was 57.2 years and onset from surgery to diagnosis ranged from 2 months to 25 years. Of the identified cases, 23 cases were post Roux-en-Y Gastric Bypass and one case post Duodenal Switch. The review found that PDAC was the commonest reported pancreatic cancer post bariatric surgery accounting for 85.3%, followed by Neuroendocrine Tumours (NET) 16.7%.
Given the variation in onset of diagnosis, bariatric surgery did not increase cancer risk but rather accelerated the diagnosis of pancreatic cancer.

Conclusions
Along with weight reduction and improving comorbidities, Bariatric surgery reduces risk of obesity-related carcinogenesis.
1055 Performance of Gastric Bypass vs. Sleeve Gastrectomy in Hypertension Remission
Authors: Ricart P , Mahendran V , Eymech O , Wadley M 
Published: October 2021

Abstract

Aim
Bariatric surgery is gradually becoming a surgical field of paramount importance to global health. Our aim is to assess the performance of RYGB and SG in achieving remission of hypertension in bariatric patients. Secondarily, we aim to assess how age, gender, referral BMI, severity of hypertension, and association with T2DM, affects hypertension remission rates.

Method
In this observational, retrospective cohort study, we included 475 out of 505 total bariatric patients operated at the Worcestershire Royal Hospital between 2012 and 2019. Overall, 193 patients (40.6%) where taking anti-hypertensive medications pre-operatively. Hypertensive patients were divided into three categories: Mild (1 anti-hypertensive medication) 44%, moderate (2 anti-hypertensive medications) 39%, and severe (3 or more anti-hypertensive medications) 17%. All patients underwent either a RYGB 52% (101/193) or a SG 48% (92/193). We assessed hypertension remission after 1 and after 2 years.

Results
Hypertension remission rates post-RYGB where 40.0% after 1 year (38/95), and 43.0% (34/79) after 2 years. Rates post-SG where 40.8% after 1 year (31/76) and 43.1% (22/51) after 2 years. There was no statistically significant difference in hypertension remission rates between RYGB and SG, nor with any of secondary variable, including gender, age, BMI, severity of hypertension and association with T2DM.

Conclusions
Our data showed no significant difference between RYGB and SG in hypertension remission rates after 1- and 2-years post-procedure. This provides novel insights into the risk-benefit assessment of the bariatric patient, and helps define the SG as a much simpler, cheaper and safer surgical option for bariatric patients with hypertension as their major co-morbidity.
1129 UK Based Experience of The Elipsetm Intragastric Balloon; Short Term Safety and Effectiveness
Authors: Sandhya A , Oyewole B , Stefanova I , Mangat S , Monkhouse S 
Published: October 2021

Abstract

Aim
Intra Gastric Balloons (IGB) have been used over the last three decades as a minimally invasive, non-surgical weight-loss option. The ElipseTM gastric balloon (EIGB) is a ‘procedure-less’ gastric balloon which can be placed in an average of 20 minutes without the need of endoscopy or sedation. The aim of our study is to investigate the first cohort of patients in uk who underwent IGB capsule and short term follow up.

Method
Single centre retrospective study of the first consecutive 202 patients that had the Eclipse IGB inserted between May 2018 and November 2020. Patients swallow the ElipseTM capsule and pre-inflation x-ray is taken to confirm correct positioning after which the gastric balloon is inflated with 550mls of sterile water and a post-inflation x-ray is taken. The balloon is designed to be in-situ for 4 months and then automatically deflates.

Results
Out of 202 patients 24 were lost to follow-up, 146 patients followed up to an average of 15 weeks, while 26 patients followed up to 4 weeks. Average weight loss at 4 weeks was 6% Total Weight Loss (%TWL) while at last follow up 9.63% TWL. Majority of patients experienced post procedural reflux, abdominal pain, bloating and vomiting. 6 patients had early removal of the balloon due to severe symptoms (4), pancreatitis (1) and hyperinflation (1). 1 had early expulsion at 2 months.

Conclusions
Eclipse IGB is safe and effective in selective patients, however long-term follow is needed to compare it with the other balloons in terms of significant and sustained weight loss.
1268 Pathology Pick up Rate in Routine Preoperative Endoscopy and its Impact on Patients Undergoing Gastric Bypass Surgery
Authors: Ishak P , Ali A , Ugochukwu C , Bakhshi A , Mohamed R , Rankin J 
Published: October 2021

Abstract

Aim
Preoperative OGD in patients undergoing bariatric surgery, has been a subject for debate for decades. The aim of this study is to evaluate the pathology pick up rate in routine preoperative endoscopy in patients undergoing Gastric Bypass surgery (LRYGB) in our unit.

Method
Retrospective review of patients’ records who underwent LRYBG in our unit from February 2009 to March 2020. Patients were divided into two groups according to the presence or absence of symptoms prior to bariatric surgery: Group A (Asymptomatic) and Group B (Symptomatic). Data from prospectively kept electronic OGD reports, CLO test results, histology reports and the changes in management plan were collected and analysed.

Results
114 patients were included in the analysis, 85 (74.56%) were in group A and 29 in group B. OGD detected pathology in 34 patients in group A and 21 in group B (p = 0.004). Those included hiatus hernia (HH) (17.65% group A, 44.83% group B, p = 0.006); stomach ulcer (7.06% group A, 3.45% group B, p = 0.676), H.pylori infection (12.86% group A, 29.41% group B). This led to change of management in 22 patients in group A and 12 of group B (p = 0.157) excluding PPI prescription. Those changes included H.pylori eradication (10.59% group A, 17.24% group B, p = 0.153), HH repair (3.53% group A, 24.14% group B, p = 0.002). There was no cancellation or change in bariatric surgery offered in both groups.

Conclusions
Preoperative OGD has only significantly impacted the bariatric patient’s pathway in symptomatic patients. However, in Asymptomatic patients, OGD could be replaced by cheaper and non-invasive alternatives.
1329 Can One Size Fit All: Is Laparoscopic Roux-En-Y Gastric Bypass the Best Bariatric Procedure for Treating Type 2 Diabetes Mellitus (T2DM)?
Authors: Mahendran V , Ricart P , Robinson S , Perry A , Wadley M 
Published: October 2021

Abstract

Introduction
Bariatric surgery produces superior weight loss and reversal of comorbidities in morbidly obese individuals compared to medical therapy alone. Laparoscopic Roux-en-Y gastric bypass (LRYGB) was traditionally considered to prolonged remission of T2DM compared to other procedures such as Laparoscopic Sleeve-Gastrectomy (LSG). But recently published studies seek to disprove this by emphasising on duration and severity of T2DM before surgery rather than the type of procedure. We aim to verify if the severity of T2DM and type of operation (LRYGB Vs LSG) influence remission rates.

Method
In this retrospective cohort study, 204 patients were diagnosed with T2DM pre-operatively and had undergone either LRYGB or LSG. We used the Individualised Metabolic Surgery Score (IMSS) tool to divide patients into mild, moderate, and severe categories.

Results
Results showed that of the 204 patients 15% (n = 31) had mild disease, 62%( n = 127) had moderate disease and 23% (n = 46) had severe disease. Remission rates in each category were as follows:

Conclusions
We agree that patients with longstanding and severe T2DM have low remission rates after bariatric surgery, probably due to diminished beta-cell reserve. It is in contrary to recent publications which recommend LSG over LRYGB in patients with severe disease. This evidence necessitates further prospective studies before deciding which is the best procedure for patients with severe and longstanding T2DM.
1338 Bariatric Surgery as a Viable Treatment for Idiopathic Intracranial Hypertension: A Case Series
Authors: Mahendran V , Ricart P , Wadley M , Perry A , Robinson S 
Published: October 2021

Abstract

Introduction
Idiopathic Intracranial Hypertension (IIH) is a significant cause of preventable blindness. Patients also suffer from debilitating headaches, pulsatile tinnitus, nausea, vomiting, photophobia, and radicular pain. If IIH continues to rise as predicted, treatment cost will increase to 462.7 million GBP annually by 2030. Weight loss is the only proven disease-modifying therapy for reversal of IIH. Bariatric surgery is an attractive treatment option due to superlative weight loss and reversal of related comorbidities. The case series aims to raise awareness of bariatric surgery as a safe and effective treatment modality for IIH.

Method
The case series consists of a retrospective analysis of four patients with a pre-operative diagnosis of IIH. They were referred to our department for bariatric surgery between January to December 2018. They were followed up for a total of two years.

Results
In our case series, all four patients were females with a mean age of 34 years. Mean BMI reduced from 47.3 kg/m2 before surgery to 30 kg/m2 with an EWL of 76.4% at the end of two years after surgery. They all showed significant improvement or resolution in their symptoms related to IIH, and none of them required further CSF pressure reducing procedures afterwards.

Conclusions
Bariatric surgery is a safe and effective method of treating IIH. It is superior compared to medical management and CSF pressure reducing procedures which have high rates of recurrence.