bluuebunny/crossref_metadata_2025_split huggingface dataset:
1037 Early Detection and Management of Preoperative Anaemia in An Elective Vascular Surgery Cohort
Authors: Tanna S , Walker J 
Published: October 2021

Abstract

Introduction
Iron deficiency anaemia is the most common cause of anaemia in the surgical population. Patients receiving transfusions during major surgery encounter more adverse outcomes compared to those that do not, indicating the early management of pre-operative anemia is likely to reduce major surgical patient morbidity and mortality. Previous studies have demonstrated that 33% of patients undergoing major vascular surgery operations are anaemic (haemaglobin, Hb, &lt;130g/L).

Aim
We aim to reduce the proportion of anaemic patients undergoing major vascular surgery by 50%.

Method
A point-of-care HemoCue machine was used to measure Hb in patients who were referred for elective major surgery in 11 vascular clinics. Patients with Hb &lt; 130g/L were prescribed a 1-month course of Ferrous Sulfate (200mg TDS), and a letter was sent to their GP requesting iron function tests. Post-intervention Hb levels were rechecked following the preoperative anaesthetics review.

Results
11 patients were referred for major surgery, of which 4 were identified as anaemic (36%). The mean Hb concentration was 121.3g/L, which increased to 137.3g/L following oral iron therapy. The mean duration of follow up was 36 days (range 0-94 days).

Conclusions
The implementation of a HemoCue machine to identify and manage preoperative anaemia was successful in our pilot study. Further work should include full integration of our pathway into current vascular clinics without student support. This will enable evaluation of the impact of our intervention on a wider scale.
1054 A Simple Intervention to Minimise the Incidence of The Forgotten Ureteric Stent: Updating the Surgical Discharge Summary
Authors: Wong S , Sehgal R , Goyal A , Allen D 
Published: October 2021

Abstract

Introduction
Ureteric stents are routinely used in ureteric obstruction, however, have considerable morbidity with major complications, such as encrustation, obstruction, urosepsis, and renal failure if left in situ for longer than six months. Despite an electronic stent register, there are still multiple emergency admissions of complications from forgotten stents, as well as those presenting with significant stent symptoms. Often stents are inserted as an emergency procedure with minimal information given on their discharge summary. A discharge template was therefore introduced that could also serve as a patient information leaflet to help minimise the incidence of forgotten stents.

Method
A discharge template was designed based off the trust-endorsed and British Association of Urological Surgeons (BAUS) patient leaflet and distributed amongst the juniors. A total of 28 patients were interviewed via telephone questionnaires – 21 randomly selected pre-intervention and 7 post-intervention from a one-month scale either side of the intervention. The template included: information on stents, common stent symptoms, indications to seek healthcare advice, and contact details to use in the event they are lost to follow-up.

Results
Patients aware that stents should be changed within six months went from 52% to 100%. Awareness of stent symptoms and red-flag symptoms went from 52% to 91%, and 57% to 100% respectively. Those who felt they had sufficient information on the discharge letter to understand their stent increased from 52 to 89%.

Conclusions
Significant improvement in patient understanding of stents and therefore hopefully in appropriate health-seeking behaviour, patient rapport, safety, and improvement in stents removed within target.
1137 Improving the Use of Pre-Operative Skin Antiseptics (Chlorhexidine Pink and Betadine) To Reduce Umbilical Port Site Infections Following Laparoscopic Cholecystectomy and Appendicectomy
Authors: Adnan A , Sange S , Ahmed M , Kanchustambam S 
Published: October 2021

Abstract

Introduction
Approximately 8% of patients who undergo laparoscopic surgery develop port site infections1. This would negatively impact recovery and increase rates of readmission. Patients’ skin is a major source of pathogens that results in surgical site infection (SSI). Therefore, optimisation of antiseptic skin preparations may decrease postoperative umbilical port site infection (UPSI).

Method
A retrospective analysis of 226 cases from August 2019 till October 2020 at East Lancashire Hospital NHS Trust was performed. The first cycle included 122 patients (58 cholecystectomies and 64 appendicectomies), and a further 104 patients (51 cholecystectomies and 53 appendicectomies) after emphasising on using chlorhexidine pink as skin preparation. The presence of UPSIs within 30 days post-surgery was recorded.

Results
In the first cycle, the local preparation that was used in patients with UPSI was chlorhexidine pink (21.4%) and betadine (78.6%). The surgical team were then educated regarding the benefits of chlorhexidine pink over betadine as local skin preparation. In the second cycle, 63.3% used chlorhexidine pink and 36.7% used betadine. After the above implementation, there was a reduction in the rate of UPSI (18.0% to 15.7%) and readmission rates (7.2% to 5.9%) in patients who had undergone laparoscopic cholecystectomy. In patients who had undergone laparoscopic appendicectomy, a similar trend in UPSI rates was identified as well (7.1% to 5.5%) and readmission rates (5.5% to 1.9%).

Conclusions
The incidence of UPSI was reduced with the use of chlorhexidine pink compared to betadine. This may have contributed to the decrease in UPSI cases and led to a reduction in re-admission rates.
1145 Achilles Tendon Rupture Management: Improving Our Pathway
Authors: Onubogu I K , Al-Janabi M , Southgate C , Dhinsa B 
Published: October 2021

Abstract

Background
Achilles tendon ruptures are the most common tendon injury which affect predominantly middle age males. The yearly incidence is 31/100,000, with a rising incidence due to an increasingly active older generation1. Conservative versus operative management options shows no significant difference in rates of re-rupture or length of rehabilitation2. Delays in imaging have been found to delay definitive treatment and led to multiple attendances in the outpatient clinic.

Method
A retrospective analysis was performed patients diagnosed with an Achilles tendon rupture from September 2016 to February 2017 throughout the East Kent Trust. Patients were identified via clinical coding of ED attendance. Following implementation of the pathway in October 2018, a second retrospective analysis of patients identified between October 2018 and March 2019 was performed. Patients with re-ruptures or &lt; 16 years old were excluded from the study.

Results
Following introduction of the pathway, there has been a 100% increase in the number of ultrasound scans performed, with the rupture gap size documented in 50% of these. The time to decision for conservatively managed patients dropped from 8 to 2 days. The number of clinic appointments also dropped from 3 to 2 with the management of patients predominantly in the plaster room.

Conclusions
The pathway has streamlined the process for patients following their injury. The majority of patients are seen by a senior clinician within 72 hours and a treatment plan clarified. The use of surgical care practitioner led clinics have allowed continuity of care for these patients and swift escalation when required.
1159 Ring-Fenced Arthroplasty Unit: The Need of The Hour During Winter and A Pandemic Crisis
Authors: Srikumar B , Perianayagam G R , Narayan P , Pawar R , Antapur P 
Published: October 2021

Abstract

Aim
Winter pressures along with the COVID-19 pandemic, have caused cancellation of elective services, prolonged waiting times, patient dissatisfaction and financial implications. Length of stay (LOS) following joint replacements is variable. The availability of ring-fenced beds and enhanced recovery protocol (ERP) can improve these outcomes. The performance of a stand-alone arthroplasty unit in an acute NHS Trust was assessed regarding safety, LOS and complications.

Method
Patient data was collected for total hip & knee replacements (TJAs) between the months of December to March of 2018-19 and 2019-20. Demographics, ASA, transfusion rates, LOS and 90-day reattendance was analysed. Modified ERP implemented in late 2019 included changes in analgesia and early post-operative mobilisation. The performance was then compared with DGHs within the region.

Results
In 2019-20, of 280 TJAs performed, there was a mean LOS of 43 hours. This shows a reduction compared with LOS of 69 hours in 2018-19, where 288 TJAs were performed. In 2019-20, 74% of cases had early discharge within 36 hours of surgery, versus 24% in 2018-19. This accumulates to 333 inpatient days saved. Note that following ERP modification, 6 patients were discharged on the day of surgery. Surgery related complications within 3 months which required reattendance, were seen in only 2 patients. This unit performed an average of 335 TJA’s in these winter months, the highest average in comparison to other DGHs in the East Midlands region, which had an overall average of 165 cases.

Conclusions
A ring-fenced arthroplasty service with adherence to ERP significantly decreases LOS and increases productivity.
1176 Paediatric Patients Presented with Right Iliac Fossa Pain: Is the Ultrasound Scan Conducted in A Timely Manner?
Authors: Barghash M , Iskandar A , Fawzy S , Ali B 
Published: October 2021

Abstract

Aim
Ultrasound scan is a crucial clinical tool in the management of acute appendicitis in children. That is because it can aid in the diagnosis without exposing the patient to potentially harmful ionising radiation from computed tomography scans. In this project, we were assessing whether children presented with right iliac fossa pain receive their scans on time. In addition, we were exploring whether definitive management and hospital length of stay were affected by the scan delay.

Method
This was a retrospective project in which we assessed case notes of paediatric patients who had an ultrasound scan between September 2019 and September 2020 in one of the district general hospitals in the UK. The project included notes of patients who were below 16, admitted with right iliac fossa pain, and had an inpatient ultrasound scan.

Results
A total of 33 patients met the inclusion criteria. The waiting time ranged from 1 hour to 89 hours with a mean of around 19.5 hours and a median of 14.5 hours. The hospital length of stay ranged from 1 day to 21 days with a mean of around 2.5 days and a median of 1 day.

Conclusions
An ultrasound scan should be conducted within the same day of admission for all paediatric patients presented with right iliac fossa pain.
1250 Introduction of a New Electronic System in Surgery during the COVID-19 Pandemic
Authors: Jacob N , Chaudhary O , Darwish N , Pardoe H 
Published: October 2021

Abstract

Aim
The ongoing COVID-19 pandemic has impacted all aspects of clinical practice. Preventative measures to avoid spread of the virus has included maintaining social distancing, thus making surgical handovers and ward care particularly challenging. The surgical department at PAH were able to reflect on what improvements could be made to the current system during this time, with a particular focus on efficiency and information governance, while also maintaining social distancing. Due to the advancement in information technology, electronic systems have become widely used throughout the NHS and a quality improvement project was introduced to try and improve our department using an electronic handover

Method
A quality improvement project was carried out, with questionnaires sent out pre- and post-implementation to evaluate the impact of the new electronic handover.

Results
Implementation of the electronic handover improved the safety and efficiency of the surgical department, particularly with information governance (p &lt; 0.001), efficiency of ward rounds (p = 0.002) and social distancing. Less doctors were taking lists home (p &lt; 0.001) and fewer doctors needed to return to the MDT room during ward rounds to check key clinical information (p &lt; 0.001). Close to 50% of doctors said that the implementation of an electronic system reduced the need to be in crowded MDT rooms to check patient information.

Conclusions
There were clear benefits to using an electronic healthcare system both for satisfaction of workers and for patient care. The project used pre-existing IT software that was modified through collaboration with the IT department and is something that will continue to be improved in the future.
1368 TED Talks and Fragmin Shots: Venous Thromboembolism Prophylaxis (VTEP) in a busy Emergency Surgical Unit (ESU) - A Quality Improvement Project
Authors: Sharma A , Siddique H , Oyeyipo Y , Sajorda L , Nadeem U , Watfah J , Qurashi K 
Published: October 2021

Abstract

VTE results in &gt; 30,000 deaths/ year. Surgical inpatients are at 25% risk of developing VTE. National guidelines state all surgical admissions must be risk assessed for VTE within 24 hours.

Aim
Evaluate our current practice of VTEP. Create and disseminate interactive tutorials for healthcare professionals (HCPs). Improve patient understanding and adherence to VTEP.

Method
A baseline audit analysed existing VTEP measures. Inclusion criteria: all ESU admissions, age &gt;18. Parameters included ensuring completion of VTE risk assessment (VTERA) proformas; scrutinizing low-molecular-weight heparin (LMWH) and TED stockings (TEDs) prescriptions; observing patients’ TEDs use and reasons for non-adherence. Subsequently, plan-do-study-act (PDSA) cycles were performed.

Results
Baseline [September 2020] (n = 93): VTERA complete: 54%; LMWH (57%) and TEDs (37%) prescribed; 26% wearing TEDs; 42% deemed TEDs unnecessary. PDSA Cycle 1 [October 2020] (n = 68): Educational poster displayed in clinical areas. VTERA complete (73.5%), LMWH (75%) and TEDs (53%) prescribing improved. Only 29% wearing TEDs. PDSA Cycle 2 [November 2020] (n = 55): Implementation of VTE e-learning module and inter-professional educational tutorials. HCPs (n = 25) felt more knowledgeable (pre:3.4/5, post:5/5) and confident (pre: 3.2/5, post: 4.7/5) on VTEP. All parameters improved, except patients wearing TEDs (31%). PDSA Cycle 3 [December 2020]: Initial patient questionnaire (n = 30) revealed - 33% misconstrued LMWH use; &gt;50% deemed TEDs unnecessary. A patient information leaflet was created and distributed alongside TEDs. Upon re-audit (n = 72), we noted significant improvement in patient adherence to TEDs (64%), alongside sustained improvement in all other parameters.

Conclusions
Our initiative highlights the necessity of empowering both patients and the multidisciplinary team in achieving optimum rates of VTEP.
1372 Thrombocytosis and Malignancy: Management in Primary Care
Authors: Choi B , Jegatheeswaran L , Platt E 
Published: October 2021

Abstract

Introduction
The diagnosis of cancer relies within primary care to recognise this possibility in patients. Studies have shown an association of thrombocytosis with cancer, in particular lung, renal, uterine and colorectal cancer. Subsequently, suspected cancer pathways incorporate thrombocytosis in stratifying risk. This quality improvement project aimed to evaluate and improve the approach of GPs at a West London practice in managing thrombocytosis.

Method
A retrospective study evaluated patients with a most recent platelet count of &gt; 450x109/L. Furthermore, a survey was sent to all GPs within the practice to establish their understanding and concerns. Results were presented locally, and intervention applied following the end of the first cycle.

Results
The survey showed 75% (n = 9) of staff were aware of the association of thrombocytosis and malignancy. In absence of specific symptoms, 64% would consider a chest X-ray, 41% a faecal occult blood test and 16% would consider transvaginal USS in women. 28 patients were identified with thrombocytosis. Of these, 4 had underlying malignancy, 3 had an underlying haematological condition. 2 cases had a concurrent inflammatory process. Of the remaining 19 patients, 5 were referred on for specialist service. In the remaining 14, although filed as “to repeat blood test” or “speak to doctor”, 12 had yet to be actioned.

Conclusions
The management of thrombocytosis at a local level in primary care has room for improvement. An alert was designed and created on the online system used by the practice to safeguard missed recalls for blood tests and prompts to consider the possibility of malignancy.
1564 Not all roads lead to Rome! – A Retrospective Insight into a Young Adult Hip Pain Referral Pathway
Authors: Krzak A M , Millar Z , Doran C , Ferreira Bruco M E , Purohit K , Nagrodzki J , van Loggerenberg A , Khanduja V 
Published: October 2021

Abstract

Introduction
Young adult hip pain is increasingly recognized as an early warning sign for development of debilitating arthritis later in life. Two common causes for young adult hip pain are femoroacetabular impingement (FAI) and dysplasia. Yet, no universal referral pathway exists in the UK for young patients experiencing hip pain. Our aim was to investigate the timeline and journey of patients seen in a specialist young adult hip clinic at a tertiary orthopaedic centre.

Method
We conducted a case series using a two-part open question questionnaire given to 40 patients at a young adult hip clinic at a tertiary orthopaedic centre between March and November 2019.

Results
Average time from onset of symptoms to appointment in specialist clinic was 2.9 (± 3.9) years, with range between 1 month and 23 years. Average time between first GP appointment and appointment at a tertiary centre was 2.1 (±2.4) years. A total of 33 (83%) patients were seen in secondary care prior to referral to a specialist clinic at a tertiary centre. Imaging modalities prior to attendance were as follows: 23 (58%) patients had a hip X-ray, 15 (38%) a CT scan, 30 (75%) an MRI scan and 6 (15%) an ultrasound scan of their hip. A total of 23 (58%) patients had corticosteroid injections prior to referral to a specialist clinic.

Conclusions
Large variation seen in our results highlights an opportunity for service improvement and development of a universal referral pathway to improve patient care and reduce burden on other services.
1580 Introduction of Dedicated Boarder’s Bleep and Registrar for Improved Clinical Communication, Management, And Care of Boarder Surgical Patients
Authors: Khan J S , Ekpete N , Elsllabi M , Payne C 
Published: October 2021

Abstract

Aim
Surgical patients are often placed within non-surgical wards due to shortage of beds, however the care of these patients remains under the parent surgical team. Unfortunately, patients outwith surgical areas can frequently feel neglected, with staff often unsure who to contact for reviews. This project aims to improve communication between boarding wards and the surgical team, as well as improving patient care and management.

Method
This prospective study was based on the Model for Improvement Framework approach to quality improvement. Data was gathered using questionnaires from various staff members on non-surgical wards. Outcomes were measured on a qualitative basis.

Results
Qualitative data was collected from 45 nursing staff (NS). Prior to introduction of a designated boarder’s bleep, 25% of NS felt they knew who to contact for queries and reviews, whereas 46% contacted the parent ward and 29% contacted the on-call surgical registrar. Only 46% of boarded patients received daily reviews. Following introduction of a dedicated surgical registrar for boarders, 62% of NS felt they knew who to contact with 48% aware of surgical boarder’s bleep. Daily reviews of patients increased to 65% over the course of the cycles of this project.

Conclusions
Bed shortages can play a vast role in patient care and treatment. This study has effectively demonstrated an improvement in provision of patient care, demonstrating an increase in NS knowing who to contact, as well as a 19% increase in daily patient reviews. Introduction of a dedicated boarder’s bleep-holder has shown improvement in clinical communication and management.
1682 Association between Obesity and Chronic Laryngitis in Women and Their Effects on Phonation
Authors: Al Houssari A 
Published: October 2021

Abstract

Introduction
“Phonation” is the physical process by which the vocal folds produce certain sounds. According to laryngology, there are different factors that can affect our larynx (voice box) negatively, such as: Obesity, benign vocal cord lesions, sex hormones, head and neck surgeries and patients who are suffering from health complications recovered from COVID-19 after a prolonged intubation. These factors could show difficulties in voice, airway, and swallowing.

Aim
This study aimed to investigate the relationship between obesity and chronic laryngitis in which this inflammation hinders phonation and voice/sound output. This investigation in South Korea using data from Korea National Health and Nutrition Examination Survey (KNHANES) collected during 2008 – 2010.

Method
(KNHANES) was a cross-sectional survey of the civilian, non-institutionalized population of South Korea (n = 13,819) aged 19 years or older. Obesity status was measured by using BMI and waist circumference.

Conclusions
Obese women in Korea have an elevated risk for developing chronic laryngitis. Chronic laryngitis itself is a misfortune. Chronic laryngitis (CL) causes excess mucus, a sore throat, a persistent dry cough, loss of voice and phonation and difficulty swallowing. Moreover, obese women will suffer from hormonal imbalances that show changes in their voice tones. Elevated estrogen levels cause gastric acid secretion and GERD in women. To help those patients, it is better to shift into a healthy lifestyle, manage their weight by healthy diet and exercises. In this way, a lot of complications will be lessened such as: GERD that is responsible for benign vocal cord lesions possibility. Some women who suffer from chronic laryngitis and turns into cancer decide to do neck surgery. Otolaryngologists stated common side effects from head and neck surgery include temporary or permanent loss of normal voice, impaired speech, and hearing loss.
679 Introduction of A Robotic Rectopexy Programme with Benchmarking to International Standards in Published Randomised Controlled Trials
Authors: Wilkinson G , Fleming C , Brannigan A 
Published: October 2021

Abstract

Aim
With the evolution of robotic surgery, the adoption of a robotic approach to perform rectopexy, in particular ventral mesh repair (VMR), is gaining popularity. We aimed to audit clinical outcomes following introduction of a robotic rectopexy (RR) programme and compare outcomes to internationally published randomised controlled trials (RCTs).

Method
Consecutive patients undergoing RR from July to December were included. The daVinci Xi surgical system (Intuitive, California) was used for all procedures using a modified left lower abdominal approach. Where VMR was performed, a 4 x 18cm Permacol mesh was used as standard and posterior fixation using ethibond. We compared operative times and 30-day clinical outcomes to international data.

Results
Over a six-month period, thirteen RR were performed (n = 1 sutured, n = 2 resection sutured, n = 10 VMR). All patients were female with a mean age of 60.4 years (SD 14.12). Mean time from 1st consultation to surgery was 10.7 months. Three patients had an external rectal prolapse and ten patients a rectocoele confirmed on dynamic MRI. Seven patients had co-existing urinary symptoms impacting on quality of life. Median docking time was 23 minutes and median robotic operative time was 194 minutes (156 minutes reported). There were no conversions (2.5% reported). Average length of stay was 5 days (4 days reported) and there were no 30-day morbidities (8.6% reported) or readmissions.

Conclusions
Robotic rectopexy can be performed with appropriate operative times and clinical outcomes and offers a superior operative platform for critical operative steps including rectal mobilisation and VMR mesh placement and suturing.