bluuebunny/crossref_metadata_2025_split huggingface dataset:
416 Hyperlipasaemia In an Adult Hospital Population: A Retrospective Audit Demonstrating A High Proportion of Non-Pancreatic Causes of a Diagnostically Raised Lipase
Authors: Yao L , Briggs C , Labib P 
Published: October 2021

Abstract

Introduction
Serum lipase is considered to be a more specific test than amylase for acute pancreatitis, and a rise of over three times the laboratory upper limit of normal (ULN) is considered diagnostic. This single-centre retrospective audit assessed the accuracy of a raised lipase in confirming acute pancreatitis.

Method
All patients with a raised lipase (&gt;78 U/L) admitted over one month were reviewed. Patients whose lipase was measured &gt;48 hours after admission were excluded. Cross-sectional imaging and discharge summaries were reviewed to determine the cause of hyperlipasaemia. Receiver Operator Characteristics (ROC) analysis was performed to determine the most accurate cut-off value for diagnosing acute pancreatitis.

Results
Ninety-nine patients were included. The most common causes of raised lipase (&gt;78 U/L) were pancreatitis (37%), hepatobiliary (15%), gastroduodenal (8%) and renal (8%) disease. In patients with a lipase &gt;234 U/L (3xULN, n = 46), the most common causes were pancreatitis (70%), drugs (9%), hepatobiliary (9%), gastroduodenal (4%) and renal (4%) disease. ROC analysis showed lipase to have an area under the curve (AUC) of 0.89 (95% CI 0.84-0.96, p &lt; 0.0001). Using the laboratory cut-off of 234 U/L (3xULN), lipase had a sensitivity, specificity, and positive likelihood ratio (PLR) of 86.5%, 77.4% and 3.8. Increasing the lipase cut-off did not improve the specificity without compromising the sensitivity of the test.

Conclusions
A lipase cut-off of 3xULN is an appropriate cut-off for a biochemical diagnosis of acute pancreatitis. However, up to 30% of patients with lipase values above this cut-off may have alternative diagnoses that should be considered.
434 Incidence of Normal Colonoscopy in Faecal Immunochemical Test (FIT) Positive Patients in The Colorectal 2-Week-Wait (2WW) Pathway at A District General Hospital (DGH)
Authors: Al-Habsi R , Divya G S , Hemandas A 
Published: October 2021

Abstract

Introduction
FIT is a quantitative, highly specific test to detect blood in stool for malignant and non-malignant colorectal diagnoses. Incidence of normal colonoscopy following positive FIT is not widely reported. We conducted a retrospective audit to analyse this patient cohort to evaluate diagnostic accuracy and reporting standards of colonoscopy.

Method
FIT-positive was defined as &gt; 10µgHb/g faeces. Using FIT value, patients were separated into Groups 1, 2 and 3: 10-99, 100-200 and &gt;200µgHb/g faeces respectively. Normal colonoscopy was defined as no neoplastic or benign findings reported. Patients referred in the 2WW-pathway after introduction of FIT-testing in October 2019 to the onset of COVID-19 pandemic in March 2020 were included. Data on age, gender, comorbidities and additional investigations were collected.

Results
There were 1072 referrals in the study period; 405 had FIT done, 265 were FIT-positive and had colonoscopy referral. Four patients were excluded after further investigations showed diverticulosis and gastritis. FIT-stratified normal-colonoscopy rate was 13.3% (28/210) overall, and 14.1% (23/163), 16.7% (2/12) and 8.6% (3/35) for Group 1, 2 and 3 respectively.

Conclusions
Our study was limited by the onset of COVID-19 pandemic. In the short study period, 13.3% FIT-positive patients had normal colonoscopy. There are no comparative data in literature for this parameter. Higher FIT-values were associated with lower normal colonoscopy incidence. It is possible that some endoscopists failed to record positive, non-clinically significant findings. We are currently studying larger patient cohorts and in parallel, looking at Bowel Cancer Screening Programme (BCSP) patients.
449 Burden of Epistaxis - Room for Improvement?
Authors: Ash J , Faoury M , Eze N 
Published: October 2021

Abstract

Aim
We conducted an audit at a large tertiary hospital of the measures and information given to patients admitted with Epistaxis. The aim of this audit was to identify factors for prolonged inpatient admissions and elucidate the extent of patient suitable information provided.

Method
A retrospective audit was conducted collecting data over two months on all patients admitted with epistaxis. Data was collected on demographics, co-morbidities, length of stay, discussions with other specialities and the extent (verbal/written) of information given to patients with regard to management of epistaxis in the community and how to reduce the risk of further episodes of epistaxis.

Results
Sixty patients were identified with an average age of 68 years. The patients were inpatients for an average of 41 hours. 10% had a form of haematological disorder, 40% were on warfarin/DOAC and 45% had hypertension. 40% had neither verbal nor written information given about either management or reducing risk. 10% had written information about both. 8% were re-admitted within 30 days of discharge and 17% had previously been admitted with epistaxis in the last 6 months.

Conclusions
Epistaxis is a common inpatient admission in ENT with a significant bed burden on the department. A significant proportion of patients are co-morbid and thus easily understandable trust guidelines on management of epistaxis on warfarin/doac should be available to reduce length of stay. The low proportion of patients provided with information to help self-care is significant and is likely to play an important role in the re-admission rates.
475 An Audit to Assess Contact Information for Outpatient Emergency Trauma Patients
Authors: Hadi H , Smith A 
Published: October 2021

Abstract

Aim
To recognise if there is a discrepancy between contact information on our electronic system and those obtained by the clinician.

Introduction
Patients are clerked during the orthopaedic on-call and discharged with the possibility of requiring urgent outpatient surgery. These patients are contacted by the trauma co-ordinator prior to their operation date. It is common practice in orthopaedics for the clinician to obtain the most up to date contact information during the on-call clerking. There are occasions where patients are unable to be contacted prior to surgery due to insufficient contact information. This audit is to identify if there is a discrepancy between contact information on the electronic system compared to that obtained during the clerking.

Method
Contact information for all patients clerked by the on-call team over 14 days during Nov 2019 were reviewed. They were categorised into 3 groups; ‘clinician obtained further information’, ‘electronic system had more information’ and ‘no discrepancy’.

Results
Data was collected for 71 patients. The results showed that the clinician obtained further information for 18 patients (25.3%). The electronic system had more information in 16 patients (22.5%). There was no discrepancy in 37 patients (52.1%).

Discussion
This audit has highlighted an issue, as the results show 25% of patient contact information is incomplete. Given these patients are seen in the emergency setting, this is the only opportunity to obtain correct information to continue the management of patient care. This is paramount to streamline theatre flow and optimise the use of available theatre slots.
490 5-Year Follow-up of Periocular Primary Basal Cell Carcinoma at Burnley General Teaching Hospital
Authors: Lu Y , Usmani H , Fernando B 
Published: October 2021

Abstract

Aim
(1) To investigate the recurrence rate of periocular primary basal cell carcinoma (pBCC) in Burnley General Teaching Hospital (BGTH). (2) To compare the recurrence rate of periocular pBCC in our centre with the standards published by the British Association of Dermatologists (BAD).

Method
A retrospective cohort study was carried out. Inclusion criterion was all patients undergoing surgical excision of periocular pBCC in BGTH between January 2011 to December 2016. Electronic records were reviewed, and the recurrence rate locally was then calculated and compared with the 2% stated in the BAD guidelines [1].

Results
A total of 197 cases met the audit inclusion criteria over the period of 5 years at BGTH. All of them completed 5 years of follow-up. The mean age of the selected population was 75.7 years (SD 12.77). Male:female ratio was 104:93. Only one case was identified as recurrent primary BCC, which makes the recurrence rate of this audit 0.5% (1/197).

Conclusions
This audit confirmed that the recurrence rate of periocular pBCC after margin section control achieved the standard set by BAD guidelines. The reason might be that reconstruction is performed after the confirmation of marginal clearance. Although the recommended treatment for pBCC is MMS, it is not available in every centre. However, patients need to wait at least one week for the reconstruction after margin section control. The limitation of this audit includes the data of the size and anatomical site were incomplete for all patients due to inconsistent histology reports.
521 Optimising Anaemic Patients for Colorectal Cancer Surgery: Implementation of Day-Case Iron Infusion Pathway and Closed Loop Audit of Anaemia Management in Colorectal Cancer Patients
Authors: Malcolm F , Kaji F , Shelswell L , Plummer B , Speake W , Liptrot S , Coverdale N 
Published: October 2021

Abstract

Aim
Pre-operative anaemia is associated with increased mortality and morbidity in patients undergoing colorectal cancer (CRC) surgery. NICE recommends screening for and treating anaemia in this patient group. Our local guidelines reflect this and advocate the use of pre-operative IV iron provided to patients in the day-case unit. Through 2 audit cycles we assessed whether anaemic CRC patients were prescribed pre-operative iron infusion. Secondary outcome was the requirement of post-operative blood transfusion.

Method
Data was collected between June-August 2019 (cycle 1) and January-February 2020 (cycle 2) for patients undergoing elective CRC surgery. Data collected included haemoglobin levels pre- and post-operatively, pre-operative iron infusion and post-operative blood transfusion rates. Between the cycle’s education regarding anaemia management and further publicity of the iron infusion pathway took place within the department.

Results
In cycle 1 27.5% (11/40) of patients were anaemic; 18% (2/11) of these patients received appropriate iron infusion pre-operatively. In cycle 2 45.4% (20/44) of patients were anaemic; 60% (12/20) received iron infusion. 45% (5/11) of anaemic patients in cycle 1 had post-operative transfusion; none of these patients had pre-operative IV iron. In cycle 2 20% (4/20) of anaemic patient required post-operative transfusion; 3 out of 4 of these patients had not received pre-operative IV iron.

Conclusions
We have demonstrated how education and improved awareness of local services can increase rate of IV iron prescription and reduce the need for post-operative transfusion in anaemic CRC patients. However, these is still room for improvement in management of anaemia within this patient group.
573 What's in A Name? An Audit of Correct Identification of Patients During Ward-Rounds in A Surgical and Urology Receiving Ward
Authors: Sahni D S , McCabe G , Stevenson R P 
Published: October 2021

Abstract

Aim
Clinical governance states that patients should have a named Consultant during their in-patient stay. In our institution, every bed has a whiteboard above it, which mentions the name of the patient and the responsible Consultant. This should correspond with the electronic system, TrakCare. Ouraim was to audit and look into the accuracy of this practice, in order to improve the efficacy of ward-rounds and hence improve patient care and safety.

Method
Data was collected for general surgery and urology receiving wards over 3 consecutive days and was matched to the data available on the electronic system, TrakCare. Intervention was made in the form of verbal and written communication with the nursing staff and junior doctors. Effect of intervention was assessed 2 weeks later.

Results
n = 38 bed-boards were assessed. The first cycle of the audit demonstrated that 7 (18.4%) had either incorrect or no entries. The detailed analysis revealed that of these, 2 had no consultant names whereas 5 were incorrect. The second cycle demonstrated a good improvement with only 1(2.6%) bed-boards having incorrect or no names. The third cycle demonstrated sustainable impact with only 1 (2.6%) missing consultant’s name.

Conclusions
Ward-rounds have been an age-old practice to review patients and are vital to formulate a care plan for patients, particularly in acute settings. It is also important for the patient to know who is providing their care. Wrong or missing entries could compromise patient care and has implications in patient follow up and chasing results. A simple intervention by the nursing and medical staff can improve the quality of care.
576 Audit of Instillation of Intravesical Mitomycin-C Following Transurethral Resection for Bladder Tumour
Authors: McCabe G , Sahni D S 
Published: October 2021

Abstract

Aim
The administration of intravesical chemotherapy (IVCT) following transurethral resection of bladder tumour (TURBT) has been shown to decrease the risk of recurrence and is recommended as standard practice following TURBT for new & recurrent tumours.
Our aim was to evaluate the adherence to this guideline in our trust and if needed, to implement changes in order to improve the patient care.

Method
A retrospective analysis of 25 patients was done and details regarding the time interval between administration, demographic details and disease staging was collected. NICE guidelines were later implemented, and the data was recollected for 24 patients who underwent TURBT

Results
The analysis showed that the mean time between the end point of TURBT and instillation of Intravesicular Mitomycin-C was 7.66 hours. Thereafter, we tried to implement the guidelines by improving communication between the Theatre staff, Nursing staff and the pharmacy. The data was collected for re-audit for 24 patients and it was observed that the interval between surgery and Mitomycin administration had dropped down to 4.67 hours. The 3rd cycle of the audit revealed the interval dropping down further to 4.24hours.The 24hr administration rate was &gt;90%, which was much higher than previous year audits

Conclusions
Engagement with theatre team and pharmacy is required, in order to coordinate the delivery of the IVCT to theatre for administration at the time of surgery. If everyone (hospital pharmacy and theatre staff) is supportive, patients’ quality of care can be improved by following the standardised protocol.
662 Establishing an Acute Extracorporeal Lithotripsy Service in The COVID 19 Pandemic
Authors: Theivendrampillai T , Hart E , Mahesan T 
Published: October 2021

Abstract

Introduction
In England, 40% of patients who present with urinary tract stones as an emergency are actively managed with a procedure, in the majority a stent. This commits them to an inpatient stay, a general anaesthetic and further surgery at a later date. Extracorporeal Shockwave Lithotripsy (ESWL) offers a promising, outpatient alternative especially during the COVID19 pandemic. With COVID19 limiting our ability to provide urgent stone care, we assessed our institutions compliance with Getting It Right First Time (GIRFT) guidelines- which recommends that 10% of patients with acute stones undergo ESWL.

Method
The audit comprised of 2 cycles; collecting data on the number patients that were admitted with renal colic over a 3-month period, and the percentage treated with ESWL. The first cycle collected data from February to April 2020, while the second cycle collected data from May 2020 to July 2020.

Results
The first cycle of the audit revealed that 0 patients were treated with acute ESWL. This required implementation of a referral pathway to Frimley Park Hospital who provided ESWL services. After implementation of a pathway, the 2nd cycle of the audit saw that of 32 patients, 6 patients were referred to Frimley for emergency ESWL (compliance rate: 19%).

Conclusions
With the implantation of a referral pathway, the percentage of patients that we referred for ESWL rose significantly from 0% to 19%, thereby meeting GIRFT guidelines. This audit re-iterates how the pandemic has shifted the way we provide urgent stone care with emergency ESWL in our local trust
696 Are Group and Save Samples Necessary for Common Urological Procedures?
Authors: Mohankumar K , Parish T , Deshpande A 
Published: October 2021

Abstract

Aim
Blood tests are routinely performed as a part of pre-operative assessment (pre-op). We looked at the number of group and save (G+S) samples taken at pre-op and compared that to the number of patients needing blood transfusion having undergone common Urological procedures at our hospital. Our objective was to assess the utility of this invasive procedure in this clinical setting.

Method
Data was retrospectively collected from electronic patient records on 413 patients undergoing elective urological procedures 1st June 2020 to 30th September 2020 at Colchester General Hospital. Major procedures like radical prostatectomies, nephrectomies were excluded. Patients who had G+S samples done prior to surgery were checked. This was compared to the patients who required transfusions.

Results
Amongst 413 patients who underwent an elective urological procedure, 169(41%) were day-case endoscopic, 151(37%) were inpatient, and 93(22%) were penoscrotal procedures. 104(25%) patients had G+S taken, with only 5 patients (1.2%) requiring transfusion. 24(14.2%) patients undergoing day case procedures,79(52.3%) patients undergoing inpatient procedures and 1(1.1%) patient undergoing penoscrotal procedures had G+S tests done. Only 7(1.7%) patients had a baseline haemoglobin of less than 100.

Conclusions
Our data showed that many G+S samples were unnecessary. TURBTs (transurethral resection of bladder tumours) were most likely to need transfusion. Education was fed-back to those running pre-operative assessment clinics that G+S should be considered for TURBTs and those with Hb &lt; 100. We recommend running this audit again to further quantify the G+S tests which could be avoided.
795 Adequacy of Surgical Excision Margins in Lentigo Maligna: An Audit
Authors: Chan K , Maheshwari K , Yousif A 
Published: October 2021

Abstract

Aim
The optimal excision margin for Lentigo Maligna (LM) lesions has been a frequent topic of debate. An audit was carried out to compare the excision margins used for LM excisions with current NICE guidelines, and to assess the adequacy of these excision margins.

Method
A retrospective study was carried out to analyse all excisions of LM lesions in 2018. 33 patients were identified from the plastic surgery departmental database. Patient demographics, the site and distribution of LM lesions, and any history of previous skin cancer were analysed. Patient electronic records, operative notes, and histopathological reports were examined to determine the number of excisions done for each LM lesion along with the peripheral and deep surgical excision margins, and the histological clearance achieved. Complete histological clearance was determined by the Multidisciplinary team for each lesion.

Results
60 cases were identified. 60% of cases were located on the head and neck. The average peripheral surgical excision margin at first excision was 2.3mm. 55% of patients had a 2nd excision. The average peripheral surgical excision margin at 2nd excision was 5.4mm. 70.6% of cases achieved complete histological clearance at 2nd excision. 72.7% of lesions excised at 2nd excision with a 5mm or less surgical excision margin achieved complete histological clearance.

Conclusions
Taking &gt;5mm surgical excision margins did not increase the rate of complete histological clearance for Lentigo Maligna lesions.
825 Hip Fractures in the Emergency Department: Are we keeping to the Big Six Standard?
Authors: Fraser E 
Published: October 2021

Abstract

Introduction
Hip fractures are the most common serious injury in older people (1) with 7364 patients attending the Emergency Department (ED) with a hip fracture in Scotland in 2019 (2). The “Big Six” are key areas in the acute management of hip fractures as outlined in standard 2 of the Scottish Hip Fracture Audit (SHFA): New Early Warning Score; cognition; Water Low Pressure Score; intravenous (IV) access and bloods; nil-by-mouth and IV fluids; and analgesia. In 2019, Ayr ED had a compliance rate of approximately 37.5% with the “Big Six” (2).

Method
One month of hip fracture data (n = 20) relating to the “Big Six” was collected from the Symphony software and audited. Areas where improvements could be made were highlighted to staff, and a further one-month data collection (n = 17) was carried out.

Results
From the first to second round the “Big Six” checklist completion rate increased from 30% to 41% (p = 0.68) and the “Big Six” compliance increased from 60% to 71% (p = 0.5).

Conclusions
In conclusion, compliance increased by 11% with the “Big Six”, however, not to the defined standards identified in the SHFA. Further long-lasting interventions have now been made to ensure that compliance rates continue to improve along with our standard of care.
859 Follow up of distal radius volar plating – No role for post-operative radiographs
Authors: Cheruvu M S , Edakalathur J J , Pickard S J 
Published: October 2021

Abstract

Aim
There is no consensus on the follow up for distal radius fractures after fixation. All patients receive intra-operative image intensifier screening to check the adequacy of reduction and implant position. We propose that if a patient is asymptomatic, you do not require post-operative radiographs.

Method
We conducted a retrospective review of all distal radius fractures operated in our hospital over the last 10 years. Data was collected from electronic records for revision surgery or metalwork removal. Records were assessed for patient symptoms, radiographic findings, and indications for implant removal. Patients had a minimum follow up of 6 months.

Results
900 distal radius fixations were performed over a 10-year period, of which 747 were volar plating. 49 patients had volar plates removed. 14 patients had metal work removal and joint release for stiffness. 6 had the plate removal and carpal tunnel neurolysis with release. 11 implant removals for screw prominence. Other operative indications included reduction failure (n = 2), infection (n = 2) and removal in paediatric patients (n = 3). 47 of the 49 patients for implant removal were symptomatic at follow up. Only two patients had implant removal following isolated radiographic evidence of metalwork mal position.

Conclusions
Intra-operative intensifiers reduce the risk of implant and fixation errors. Routine post-operative radiographs altered the management of only 2 out of 700 (0.3%) patients. We suggest that radiographs have no role in routine post-operative care of distal radius fractures, where patients are asymptomatic with appropriate intra-operative intensifier images.