bluuebunny/crossref_metadata_2025_split huggingface dataset:
692 Does Sleep Laterality Influence Kidney Stone Formation and Clearance? – A Review of The Current Literature
Authors: Yun J W , Saada L 
Published: May 2021

Abstract

Introduction
Stone disease is a common urological presentation that carries significant morbidity. Patients with renal calculi often experience ipsilateral recurrences. Sleep posture has been implicated in conditions ranging from heart failure to glaucoma. We seek a consensus view on the association between sleep laterality and stone disease and discuss its possible clinical implications.

Method
A literature search was conducted on the PubMed database from its inception through to September 2020. Publications assessing the correlation between sleep laterality and unilateral stone formation or clearance were included. 19 results were identified, of which 13 were excluded due to irrelevance.

Results
A review of the literature suggests that sleep laterality is positively correlated with ipsilateral stone formation. Interestingly, a study examining the interaction between sleep laterality and stone clearance following shock wave lithotripsy showed greater clearance of stones in patients who slept on the ipsilateral side.

Conclusions
Sleep laterality may positively influence both the formation and clearance of unilateral kidney stones. The mechanism for this remains unclear. However, sleep posture aids may prove to be a low-cost intervention with potential for both preventative and therapeutic benefit. This would be of particular value in patients with recurrent unilateral stone disease as well as those with a single-functioning kidney.
697 An Evaluation of Patient Outcomes Following Percutaneous Cholecystostomy (PC) For Acute Cholecystitis (AC) At Our Health Board Between 2011-2020
Authors: Maharaj G , Haider S A , De Silva K G 
Published: May 2021

Abstract

Introduction
PC is a radiological intervention used in the management of high-risk patients with AC.

Method
A retrospective study of outcomes following PC, including success rates, complications, AC resolution, readmissions, and subsequent cholecystectomy.

Results
Our database identified 28 patients (14M:14F), median age 73 (range 40-93). 82% were ASA III/IV. Median follow-up was 2 (range 0-8) years. Imaging suggested AC in 61% and empyema in 39%. 86% were calculous. All procedures were USS-guided with 100% success. AC resolution occurred in 89.3%. Of three unresolved, there was 1 death day-1 post-PC (non-procedure related), 1 index cholecystectomy, 1 chronic complicated cholecystitis. 28.6% developed complications, 2 major (1 late biliary peritonitis and 1 cholecystocutaneous fistula with abdominal wall abscess), 17.9% dislodged drain, 10.7% other. 20 patients had bile cultures (70% positive, mainly gram-negative). 17.9% patients were readmitted with AC, 1 had repeat PC. 21.4% had subsequent ERCP. 32.1% underwent subsequent cholecystectomy, 1 laparoscopic cholecystectomy(LC) index, 4 elective (3 LC, 1 open), 4 emergency (2 LC, 1 LC subtotal, 1 failed open with drain insertion).

Conclusions
PC is both safe and effective with significant procedural success rates and resolution rates. There are few major complications but significant morbidities, mainly dislodged drains. One-third of patients have subsequent cholecystectomy.
760 Unilateral Isolated Hypoglossal Nerve Palsy After Shoulder Surgery: A Case Report
Authors: Wei R , Karunaratne D , Sivaji C 
Published: May 2021

Abstract

Aim

Hypoglossal nerve injury is a rare complication in anaesthetic and surgical practice with only a few cases worldwide. This report describes the pathophysiology of this condition and highlights the key managements steps and expected outcomes for clinicians and patients.

Case

An open reduction and internal fixation of a left humeral fracture was performed on a healthy female patient in her mid-fifties under general anaesthesia. Two hours post-operatively, she developed left sided tongue swelling and deviation with dysphagia and dysarthria. Urgent CT head and MRA scans showed no abnormalities, leading to a diagnosis of isolated left hypoglossal nerve injury. Neurology and SALT were both involved in her care, but she ultimately made a full functional recovery after six months without any specific intervention.

Conclusions
A clear history, examination and high index of suspicion are crucial in the diagnosis of a hypoglossal nerve palsy. Cross sectional imaging is necessary to exclude any intracranial lesions, but intervention is rarely required, and patients should expect a slow but complete recovery over a period of months.
766 Endoscopic Surgery for Sporadic Vestibular Schwannoma Resection: A Systematic Review of Surgical Outcomes
Authors: Chiuta S , Raza-Knight S , Alalade A 
Published: May 2021

Abstract

Introduction
Vestibular schwannomas (VS) are benign intracranial tumours originating from the vestibular division of the eighth cranial nerve. The mainstay of their surgical management is microsurgery, other options are radiotherapy or radiological monitoring. Endoscopy (ES) is becoming widely used in neurosurgery and may have a role in improving visualisation and outcomes by enhancing extent of resection, facial nerve, and hearing preservation in VS resection and describe the postoperative outcomes.

Method
The review was conducted according to the PRISMA guidelines and yielded 31 studies for inclusion. Systematic searches of literature databases were done for studies where endoscopic-assisted and/or endoscopic resection of VS were reported.

Results
ES facial nerve preservation rates (median 91.3%, range 39.0 - 100%) were comparable to microsurgical treatment. Hearing outcomes were more variable in ES series and were under-reported. A median gross total resection rate of 97.4% (61.0 - 100%) was achieved in the ES series.

Conclusions
Current data suggest that ES-assisted resection of sporadic VS is not inferior to microsurgical resection with respect to facial nerve outcomes and extent of resection. However, some ES series report poor hearing outcomes, which are under-reported in the literature.
810 Ischaemic Gallbladder Volvulus Within a Parastomal Hernia: Case Report and Literature Review
Authors: Wilkins A , Ikram H 
Published: May 2021

Abstract

Case presentation
An 87-year-old female presented with 24 hours of severe central abdominal pain, preceded by five months of intermittent pain, and weight loss. Surgical history subtotal: colectomy and end ileostomy for ischaemia. Examination demonstrated generalised tenderness and longstanding parastomal hernia.
Abdominal CT demonstrated an oedematous gallbladder contained within the parastomal hernia and emergency laparotomy was performed. The gallbladder was twisted 360 degrees within the hernia and cholecystectomy and suture repair of parastomal hernia were performed.
Literature review: A 2013 review found most cases were diagnosed intra-operatively. Subsequent case reports were reviewed to identify contemporary practice.

Method
A pubmed search for “gallbladder volvulus”, 2012-2019 was performed. Articles meeting the inclusion criteria (gallbladder volvulus, english language, &gt;18 years old, documented preoperative assessment and management) were analysed. Non-human and duplicate cases were excluded.

Results
24/43 screened cases met the criteria, including one within a parastomal hernia. 79% (19/24) were female, 50% (12/24) age &gt;80. Although 96% (23/24) underwent imaging, only 38% (9/24) were diagnosed pre-operatively. One death was reported after non-operative management. 21 cases reported an operative approach with 48% (10/21) completed laparoscopically.

Conclusions
Gallbladder volvulus remains rare and difficult to identify on imaging.
866 A Lateral Approach Is More Likely to Be Successful Than A Posterior Approach for An Injection to Reach the Subacromial Space
Authors: Cheyne N , Jeelani A , Zeiton M , Tablot C , Holt E , Jain N 
Published: May 2021

Abstract

Background
Subacromial injections are common for diagnosis and therapy of shoulder impingement secondary to subacromial bursitis. We evaluated the likelihood of a successful subacromial injection from both the posterior and lateral injection sites.

Method
We reviewed 100 MRI scans of the shoulder and recorded measurements in both the sagittal (representative of posterior injection) and coronal (representative of lateral injection) orientations. We compared these to the lengths of standard needles.
Multiple measurements were taken:

Results
Measuring along the angle of the acromion demonstrated shorter mean distances from the lateral injection site. The distance from skin to mid-point of the acromion) provided mean values of 51.4mm for posterior and 40.1mm for lateral. A standard 40mm (green) needle would reach the midpoint of the acromion in 58% of lateral measurements and 23% from posterior.

Conclusions
Injections are more likely to enter the subacromial space from a lateral rather than a posterior entry point.
953 Role of Routine Preoperative Echocardiograms in Adolescent Idiopathic Scoliosis Patients undergoing Deformity Correction Surgery
Authors: Hassan A , Shah S , Patel M 
Published: May 2021

Abstract

Introduction
Patients with Adolescent Idiopathic Scoliosis (AIS) are often noted to have routine preoperative Echocardiograms (ECHO). The prevalence of ECHO abnormalities and their impact on perioperative outcome is not clear, especially balancing against its costs. The study aims at identifying the significance of routine preoperative ECHO for AIS patients.

Methodology
Clinical records of 295 adolescent AIS patients, &gt;10years age (mean 15.64years), who underwent primary posterior corrective surgery in a tertiary spinal centre, between 2015-2020, were reviewed. Patients with revision surgery, anterior correction, syndromic/neuromuscular scoliosis and/or pre-existent known cardiac comorbidities were excluded.

Results
139(47%) patients had preoperative ECHO. 21(15%) patients showed echocardiographic abnormalities (11 trivial valvular abnormalities, 5 mild root dilatation, 3 mild pericardial effusion and 2 septal defects). None of these patients showed any clinical symptoms/signs or required Cardiology assessment; and none had perioperative cardiovascular complications. Conversely, four(1.36%) patients demonstrated auscultatory murmurs on preoperative clinical assessment. None reported any perioperative complication. The average known cost of an echocardiogram was noted to be £363.

Conclusions
Routine preoperative Echocardiogram for all AIS patients is not recommended or deemed cost-effective. Positive clinical assessment finding could be used as a screening tool for performing ECHO in AIS patients.
978 Acute Appendicitis in The Age of COVID-19 – How Changing Standards Affect Patient Outcomes
Authors: Karagiannidis G , Toma Omar 
Published: May 2021

Abstract

Introduction
The COVID-19 -19 pandemic has forced changes in the management of Acute Appendicitis (AA), such as prioritising conservative management and avoiding laparoscopic procedures. We aim to assess how these changes affected patient outcomes in comparison to routine practice during the same time frame in 2019.
The primary study outcomes are operative intervention, length of stay and hospital re-admission within 30 days.

Method
Retrospective data collection for all patients admitted to Ipswich Hospital with suspicion of AA since lockdown came into effect in England on March 23 up to May 10th, 2020 and the same time frame in 2019.

Results
23 patients were admitted during the lockdown period. 39%(N = 9) were treated conservatively.14 (61%) operatively, of which 71% (N = 10) had open appendicectomy while 29% (N = 4) underwent laparoscopic appendicectomies. The mean Length of Stay(LOS) was 3.83 days. In 2019,21 patients were admitted. 33%(N = 7) were treated conservatively. All appendicectomies were laparoscopic. Mean LOS was 2 days.
Re-admission rates were similar in both groups.

Conclusions
Due to Covid19 a majority of patients requiring surgery underwent open appendicectomies. We noted a significant increase in both length of stay and progression from non-operative to operative intervention rates compared to 2019. The general case load was similar.
71 Electronic Prescribing Promotes Antimicrobial Stewardship In Surgery: A Closed-Loop Audit
Authors: Lee A , Kelly M , Maden C , McHardy J , Elfadl D 
Published: May 2021

Abstract

Introduction
Antimicrobial resistance is increasing globally. Surgical inpatients are more likely to receive inappropriately broad-spectrum and prolonged antimicrobial treatment, against local policy. Electronic prescribing (e-prescribing) has the potential to promote antimicrobial stewardship. We conducted a closed-loop audit to assess the impact of e-prescribing on surgical inpatient prescriptions.

Method
Audit standards (from Public Health England) included: (1) documentation of allergy status, prescriber contact information, antimicrobial indication and review/stop dates; and (2) prescription of appropriate antimicrobials for appropriate durations (IV and total). Prospective data collection occurred over 1-week. The interventions included an educational session, a once weekly microbiology round of surgical inpatients and the introduction of e-prescribing (Cerner©).

Results
Compliance improved significantly between cycle 1 (n = 54 prescriptions) and 2 (n = 59 prescriptions), for: documentation of prescriber contact details (69 vs 100%) and appropriate antimicrobial review/stop dates (17 vs 100%), indications (78 vs 96%), selection (76 vs 90%) and IV and total antibiotic duration (63 vs 93% and 87 vs 100%, respectively); p &lt; 0.05 throughout.

Conclusions
Audit compliance improved significantly, partly because Cerner© prompts clinicians to input contact details, review dates and indications before prescribing. E-prescribing in combination with appropriate education is likely to promote antimicrobial stewardship and should be considered by other Trusts using paper prescriptions.
106 A Retrospective Study Comparing Histopathology Proformas For Anterior Resections Against the Royal College of Pathology (RCPath) Guidelines
Authors: Dardak S , Gooneratne S , Butterworth W 
Published: May 2021

Abstract

Introduction
Royal College of Pathologists (RCPath) published guidance on clinical information needed on histopathology forms accompanying colorectal cancer specimens. Inadequate information can significantly impact the ability of histopathologists to accurately interpret specimens; in turn correctly diagnose and stage cancers. The primary aim of our audit was to evaluate local compliance with the RCPath guidelines.

Method
Histopathology request forms of 50 patients undergoing anterior resections between January 2018-19 were retrospectively evaluated against the RCPath guidelines, ‘Standards and datasets for reporting cancers’ published in December 2017.

Results
Of the 50 patients, the site and type of tumour resection were documented in 94% and 56% of cases, respectively. 48% of cases specified whether the surgery was open or laparoscopic. However only 4% mentioned the preoperative tumour stage, and only 10% recorded whether any pre-operative therapy had been given. Furthermore, no cases reported whether there was a family history of bowel cancer or inflammatory bowel disease.

Conclusions
Information on colorectal histopathology forms is failing to meet RCPath guidelines. Significant information regarding preoperative treatment, associated malignancy risk factors and resection type is absent in over half of cases. This will have detrimental effects on the ability of histopathologists to accurately assess and interpret cancer specimens.
201 Reducing Noise Pollution on a Surgical Ward
Authors: Shah S 
Published: May 2021

Abstract
Noise pollution in surgical wards negatively influence the wellbeing of patients and healthcare professionals. In addition to disrupting sleep and impairing communication, recognised patient consequences include increased pain, increased re-admission rates and post-ICU psychosis. Ambient white-noise machines, sound-absorbing ceilings and retractable screens are purported as noise pollution reducing strategies (NPRS). These are expensive and impractical. We investigated the capacity of various low resource NPRSs.
Noise was measured using “Sound Meter” app at four sites on two identical surgical wards. Ward A and B were designated as study and control ward, respectively. Measurements were taken at three time points (9am, 11am, 3pm) every day during a week. NPRSs were then implemented in ward A and data collection repeated.
Prior to intervention there was no difference in noise between ward A and ward B (83dB and 87dB respectively, p &gt; 0.05). After intervention, ward A was significantly quieter than ward B (64dB and 85dB respectively, p &lt; 0.05).
Restructuring ward environments presents several challenges. However, low resource interventions can have a positive role in reducing noise pollution. As hospitals become busier with resumption of normal services post-COVID-19, staff should be considerate of noise pollution in order to create an environment conducive to high quality patient care.
235 An Audit of The Post-Op Day One (Pod1) Discharge After Bariatric Surgery – The Effect on Length of Hospital Stay And 30-Day Re-Admission Rate
Authors: Sam M 
Published: May 2021

Abstract

Introduction
Discharge protocols after bariatric surgery are multi modal. At the Sunderland Royal Hospital, the standard protocol is POD 2 as long as patient satisfies the entire requirements. With the recent drive towards enhanced recovery after surgery, some consultants introduced the POD 1 discharge protocol.

Method
Using our prospectively maintained bariatric data set POD 1 and POD 2 groups were identified. The length of stay (LOS) and 30-day re- admission was analyzed.

Results
The average LOS was 2 days for POD 2 group. 19 % of patients were discharged on POD 1, 69% on POD 2 and 6% on POD 3 and 4 each. There were no 30-day re- admissions. In the POD 1 group, the average LOS was 1.4 days. 69% were discharged on POD 1, 25% on POD 2 and 6% on POD 4 with no 30-day re-admission.

Conclusions
There was significant decrease in LOS with POD 1 discharge with no difference in 30-day re- admission. Therefore, patients could be potentially discharged safely on POD 1 after bariatric surgery.
415 Improving Preoperative Computed Tomography Staging for Men with Suspected Testicular Cancer
Authors: Stanley S A , Berridge C T , Griffiths T R L 
Published: May 2021

Abstract

Introduction
Neo-adjuvant chemotherapy may be considered for suspected testicular malignancy if widespread life-threatening metastases are identified on computed tomography (CT) imaging. Staging preoperatively enables this and may prevent delays in ongoing oncological care. This project aimed to increase the proportion of staging scans performed preoperatively in the University Hospitals of Leicester NHS trust.

Method
All referrals between 01/01/2016 and 31/12/2018 to the urology multidisciplinary team for suspected testicular cancer were reviewed. Exclusion criteria were applied prior to collecting treatment pathway data for each patient.
Based on initial audit findings, clinicians were advised to request staging CT scans at the first urology clinic appointment. Re-audit was between 01/01/2019 and 31/12/2019.

Results
Initial audit included 95 patients and re-audit included 23 patients. The proportion of preoperative scans increased from 28.4% to 82.6% following intervention. Median time from first ultrasound to CT was reduced from 44 days to 17 days without affecting median time to orchidectomy (27 to 23 days) or oncology appointment (61 days).

Conclusions
Requesting a staging CT scan as part of the first clinic assessment improved the proportion of preoperative scans without affecting time to surgery or oncology appointment.
462 Empirical Antibiotic Prescribing in General Surgical Patients
Authors: Rokkas S , Wells L 
Published: May 2021

Abstract

Introduction
Prescribing antibiotics is common practice on a standard general surgical take, however incorrect prescribing can result in sub-standard care or even patient harm. This audit loop was conducted to assess the adherence to local antibiotic prescribing guidelines to evaluate and improve practice.

Method
Data was collected prospectively against a pre-designed proforma over a 2-week period. Inclusion criteria were patients admitted on the general surgical take and were prescribed empirical antibiotics. This process was repeated after the first audit and a) a questionnaire on prescribing behaviours b) An educational presentation.

Results
Antibiotic indication and bleep number were generally well documented, above 86% and 77% respectively in both audit cycles. Duration of antibiotic was poorly documented overall and requires further improvement. The most significant improvement was in documentation of signature and a printed name. The questionnaire revealed that 70% of doctors were unaware of the importance of printing name as well as a signature on prescription, after educational intervention the rate of printed and signed scripts improved from 23% to 70%.

Conclusions
Significant improvement was noted in doctors printing their name compared to the initial cycle. These results highlight the importance of informing the junior doctors of the benefits of printing their name on prescriptions.
493 Evaluation of Patient Waiting Times for Plain Radiographs Whilst Attending Outpatient Clinics in A Tertiary Orthopaedic Centre
Authors: Hayat Z , Kinene E , Molloy S 
Published: May 2021

Abstract

Introduction
Reduction of waiting times is key to delivering high quality, efficient health care. Delays experienced by patients requiring radiographs in orthopaedic outpatient clinics are well recognised.

Method
To establish current patient and staff satisfaction, questionnaires were circulated over a two-week period. Waiting time data was retrospectively collected including appointment time, arrival time and the time at which radiographs were taken.

Results
84% (n = 16) of radiographers believed patients would be dissatisfied. However, of the 296 patients questioned, 56% (n = 165) were satisfied. Most patients (89%) felt the waiting time should be under 30 minutes. Only 36% were seen in this time frame. There was moderate negative correlation (R=-0.5); higher waiting times led to increased dissatisfaction. Mean waiting time was 00:37 and the maximum 02:48. Key contributing factors included volume of patients, staff shortages (73.7%), equipment shortages (57.9%) and incorrectly filled request forms. Eight (42.1%) had felt unwell from work related stress.

Conclusions
A concerted effort is needed to improve staff and patient opinion. There is scope for change post COVID. Additional training and exploring ways to avoid overburdening the department would benefit. Numerous patients were open to different days or alternative sites. Funding requirements make updating equipment, expanding the department and recruiting more staff challenging.