bluuebunny/crossref_metadata_2025_split huggingface dataset:
887 A Quality Improvement Project: Implementation of a New Epistaxis Pathway
Authors: Vasanthan R , Massoumi A , Forde M , Corbridge O , Sood S 
Published: May 2021

Abstract

Introduction
Epistaxis is one of the most common ENT conditions leading to unplanned hospital admission. This closed loop quality improvement project looked at epistaxis admissions, and whether patients could be safely managed on an ambulatory basis with unilateral intranasal packing, through the implementation of a new epistaxis pathway.

Method
Two prospective cycles at a District General Hospital. First cycle: three-month period (October-December 2018); recorded all patients admitted with epistaxis and the percentage with intranasal packing; criteria for discharge with unilateral intranasal packing created (including normal observations, normal clotting/haemoglobin, only on aspirin, safe home environment). Second cycle (after implementation of new pathway): two months (December 2019 and January 2020); recorded all patients admitted with epistaxis or discharged with unilateral intranasal packing; patient feedback obtained.

Results
First cycle: 31 epistaxis admissions; 12 patients met discharge criteria; average length of stay was 1.4 days. Second cycle: 22 epistaxis admissions; 4 admissions were avoided; 2 admissions were unnecessary according to new pathway; no patient-reported issues with pack at home.

Conclusions
Successful creation and initial implementation of pathway with no adverse outcomes. Approximately £1380 of savings through avoided admissions. Pathway expanded and successfully used during COVID-19 to include patients on anticoagulation as suitable for discharge with intranasal packing.
902 Too Hot to Handle? Acute Cholecystitis (‘Hot Gallbladder’) Management and Compliance with NICE Guidelines in A District General Hospital
Authors: Karim S , Tjoakarfa J , Bondje S , Jokinen T , Adegbola S , Vachlos G , Tewari S , Gupta V 
Published: May 2021

Abstract

Introduction
Current NICE guidelines recommend that patients with acute cholecystitis should be offered laparoscopic cholecystectomy within 1 week of diagnosis. However, the recommendation is often not met within our trust. We aim to investigate our compliance with these guidelines while outlining the complications and cost effects associated with delayed operation.

Method
A retrospective study identifying emergency patients presenting with image proven uncomplicated acute cholecystitis was performed. Hospital coding and finance departments were used to obtain this information.

Results
166 patients were identified within a 3-month period. Of which, 85 patients were diagnosed with acute uncomplicated cholecystitis and fulfilled the inclusion criteria. On average, patients waited 108 days for their cholecystectomies (range 14-281). No patients received a cholecystectomy within 1 week of diagnosis. 33 patients re-presented to hospital at least once and the total number of repeated admissions was 51. The average length of stay during readmissions was 6 days (range 1-27). The total cost incurred for those readmissions was £117,118.

Conclusion

Delayed cholecystectomies for acute cholecystitis increase the likelihood of repeated hospital admissions and place significant strain on resources. Furthermore, it is associated with increased risk of complications. We recommend introducing a weekly ‘hot gallbladder list’ within our trust dedicated for acute cholecystitis.
946 Introduction: Closed Loop Audit Looking at How We Are Complying with Paediatric Supracondylar Fracture (BOAST 11) Management; Results Compared With 2018 To 2019 (Full Cycle)
Authors: Abdalla M , Barksfield R , Islam R 
Published: May 2021

Abstract

Background
Supracondylar fractures. Most common childhood elbow fracture. Can be difficult to manage. Risk of significant complications

Method

Results
• NV documentation, 2018:2019, Improved (36%à45%), Inadequate (45%) in comparison to BOAST guideline.

Night ops
• Appropriate as per BOAST guideline

Surgical technique

Conclusions
Recommendations:
955 An Audit for Reviewing the Soft Food Bolus Obstruction - Optimum Intervention and Referral Direction
Authors: Nargheese N , Peedika T 
Published: May 2021

Abstract

Introduction
Absolute dysphagia secondary to impacted soft food bolus in oesophagus can occur due to various reasons. Existing pathway was ENT if patient points above the suprasternal notch and GI if below or at the level of notch.

Objectives
To assess management in patients with soft food bolus dysphagia and reviewing old pathway.

Method
Data was collected via clinical governance, case notes on track and analysed overall pathway of patients and discussed with the consultants; Paid attention to patients requiring surgical interventions, compared the complications 0f OGD and rigidscopy. Also, effectiveness of Buscopan weighing its adverse effects.

Results
Total of 147 cases were included, 2 patients from upper GI being secondarily referred to ENT, 18 of ENT with GI, 3.8 of 19% complications has risk of perforations with Rigid scope. 2.6% had risk with OGD with no perforations. 2% needed OGD after rigid. 85% underwent intervention after Buscopan.

Conclusions
There is no compelling evidence for Buscopan - to be used only for patient satisfaction. Combining Multiple transfers & complex patient journeys causing delay for treatments with less complications of OGD, soft food bolus should be managed by local gastro/gen surgery teams who can provide timely appropriate intervention, ENT involvement only if airway or pharyngeal concern.
964 Telemedicine: Speedy Triage Tool or Clinical Record?
Authors: Ghareib A , Vinnicombe Z , Visser G , Ra A , Mantella M , Ali F 
Published: May 2021

Abstract

Introduction
St. George’s University Hospitals NHS Foundation Trust is a tertiary plastic surgery centre serving a population of 3.5 million in and around South West London. Telemedicine Referral Image Portal System (TRIPS) is integral to our service, allowing triage of patients in remote locations. During Covid, TRIPS helped in reducing footfall and streamlining out of hospital referrals to reduce unnecessary transfer. The aim of this project was to assess the quality of clinical documentation for emergency referrals to plastic surgery via TRIPS.

Method
We performed a retrospective review of all patients referred to plastic surgery via TRIPS during April 2020. Documentation standards were determined from national guidance. After introduction of a condensed guide, a second review was performed four months later.

Results
In April, 131 referrals were recorded on TRIPS. Only 22.9% of records met the standard. The most common omission was treatment advice. Following introduction of guidance, 215 TRIPS records were reviewed. The quality of clinical documentation improved in all aspects with a compliance rate of 89%.

Conclusions
Although TRIPS remains a useful tool for triage, it is a clinical document and must meet the standards of clinical record keeping. Introduction of clear guidelines improves overall compliance.
989 Improving the Completion of Hospital Anticipatory Care Plans in Orthopaedic Trauma Wards During The COVID-19 Pandemic
Authors: McCann C , Powell-Bowns M , Duckworth A , White T 
Published: May 2021

Abstract

Background
The COVID-19 pandemic has highlighted the importance of the Hospital Anticipatory Care Plan (HACP). New guidance recommends all patients admitted acutely to hospital should have a HACP completed within 24 hours. We aimed to assess how many orthopaedic trauma patients admitted to the study centre had HACP completed within 24 hours of admission.

Method
Departmental Quality Improvement Project (QIP) permission was granted, and standard audit protocol was utilised. Data were collected in a retrospective manner using our trauma database and online patient record system. Educational interventions including staff teaching sessions and dissemination of infographic posters were implemented. Cycle two was repeated in similar fashion.

Results
Cycle one (50 patients): 37/50(74%) had HACPs completed. Of those with HACPs, 18/37(49%) were completed within 24 hours. Median time to completion was 45.3 hours (range 0.4-275.1 hours). Cycle two (58 patients): HACP completion significantly improved (56/58, 97%; p &lt; 0.01), with more completed within 24 hours (50/56, 89%; p &lt; 0.01). The median time to completion was decreased to 4.92 hours (range 0.27-60.6; p &lt; 0.01).

Conclusions
Unit compliance was initially poor however significantly improved with educational measures. Failing to identify ceilings of care early can result in difficult decisions having to be made in critical situations, risking suboptimal patient care.
1002 Calcium administration in Major haemorrhage Protocol
Authors: Akhtar A , O'Connor R , Rosen J , Brooks A 
Published: May 2021

Abstract

Introduction
Calcium gluconate is an essential part of the major haemorrhage protocol (MHP). It minimizes the exacerbation of transfusion coagulopathies due to the citrate preservative. As fifty percent of trauma patients present with hypocalcaemia prior to transfusion, the risk is pertinent. Given the importance of the issue, surprisingly current guidelines remain sparse. We analysed the percentage of patients who received calcium and their hypocalcaemia incidence.

Method
A Retrospective review of red traumas during June to August 2019. The frequency of MHP and the patient’s ionised plasma calcium levels on VBG (1.15-1.26mmol/L) were identified. Our standard stated 100% of MHP should receive calcium. A massive transfusion was defined as 10 red blood cells units in 24 hours or 4 blood products within 30mins.

Results
27 red traumas were accepted to audit, MHP was activated in 85%. Out of these 75% received calcium and on average after 6.4 units of blood products. The incidence of ionised hypocalcaemia in all MHP patients was 67%.

Conclusions
We identified a standard that supplementary calcium should be supplemented in all MHPs. Hypocalcaemia was more frequency than our research stipulated. Improvement needs to be made to meet standards. We recommend incorporation of Calcium gluconate into major haemorrhage pack and transfusion guidelines.
1018 Implementing A Standardised Orthopaedic Admission Pro-Forma to Improve Adherence to The Royal College of Surgeons of England (RCSEng) Best Practice Clerking Guidelines
Authors: Peacock C , North D , Brookes T 
Published: May 2021

Abstract

Introduction
Within our Trust, Orthopaedic patients are clerked in on A&E notes via freehand text. Audit, clinical incidents, and root cause analysis revealed suboptimal documentation. Using RCSEng Best Practice Guidelines we designed, implemented, and evaluated the impact of an admission pro-forma on quality of clerking.

Method
An Orthopaedic clerking pro-forma was designed based on standards set by RCSEng and feedback from Orthopaedic colleagues. First- and second-cycle data collection involving quantitative analysis of clerking against RCSEng domains was conducted before (n = 23) and after (n = 25) intervention. Fisher’s exact test was performed to calculate the statistical significance of our data. A qualitative survey was performed to gain feedback on the pro-forma.

Results
Observations, allergies, and smoking history were omitted in over half of freehand documentations. Medical/surgical history and management plans were well documented regardless. Intervention resulted in statistically significant increases in 7 out of 12 RCSEng clerking domains, most notably allergies (p &lt; 0.00001). Qualitative feedback was positive; 100% of those surveyed stated that the pro-forma ‘improved quality of clerking‘ and ‘benefited clinical decision making’.

Conclusions
Our study demonstrated that implementing an Orthopaedic pro-forma improved adherence to RCSEng best practice clerking guidelines compared to freehand documentation and standardised the process improving the level and quality of documentation.
1024 A Case-Controlled Series Examining the Utility of Nuclear Medicine Imaging in The Diagnosis and Management of Malignant Otitis Externa
Authors: Ringrose T , Crossley E , Biggs T , Hilton J , Graham-Hart L , Pringle M , Buckland J 
Published: May 2021

Abstract

Introduction
This study aimed to assess whether combination modality imaging (CT, and/or Technetium/Gallium) had any additional benefits over single modality imaging (CT) in the management of malignant otitis externa (MOE).

Method
A six-year retrospective case-controlled series was performed including 73 patients presenting with a potential diagnosis of MOE.

Results
CT imaging was undertaken in 69/73 patients, and of these the CT confirmed the diagnosis in 58% (40/69). Of the 42% (29/69) of CT negative patients, 25 underwent Technetium scanning, revealing 40% (10/25) to be negative. These patients were discharged on a short course of topical and oral therapy with no disease recurrence. Gallium scan results, performed at the end of treatment, were more inconsistent, with 47% (25/53) of imaging still positive despite extended intravenous/oral/topical therapy. However,40% (10/25) of these had their therapy stopped without any further disease relapse.

Conclusions
Combination modality imaging, with CT and Technetium, did infer additional benefit over single modality imaging using CT. However, this was not the case for Gallium scanning, used to determine treatment end, which seemed to be poorly representative of residual disease presence. This study was utilised to provide a management algorithm to guide future practice.
25 Operative Delay in Neck of Femur Fracture Management During the COVID 19 Pandemic Lockdown; Reasons and Impact
Authors: Khaleeq T , Patel A 
Published: May 2021

Abstract
All NOF patients beyond 24-hour window over the COVID Lockdown period From April 2020 to July 2020 were identified and causes of delay to theatre were stratified. Manual Data collection over a time period of April 2020 to July 2020, when lockdown was introduced. All patients with NOF who had surgery within 24 hours were excluded. Cases not within 24 hours were included. A total of 70 patients were included in the study. Cause for Delay beyond 24 hours included No list space 30, Medically unfit 20, Anticoagulation 18, COVID related 2 needing ventilatory support. Causes of medical Delay include chest infection (not COVID related), High anaesthetic risk, Cardiac, Anaemia, Electrolyte imbalance. Covid19 accounted for 2 % of operative delays of NOF patients. Other causes include medical optimization, theatre efficiency and use of anticoagulation. However, our study proved there is a vital requirement for robust protocols and pathways in the management of NOF especially during a global pandemic. This is important for the reduction of overall Morbidity and Mortality. Local Strategies should be put in place to address these with the importance of a MDT approach including the Anaesthetic and Orthogeriatic team.
44 Hipec Therapy-A New Development to Fight Cancer; Report Of 3 Cases
Authors: Prakash Narayan P , Dutta R 
Published: May 2021

Abstract

Introduction
HIPEC is highly concentrated, heated chemotherapy treatment that is delivered directly to the abdomen during surgery. HIPEC delivers chemotherapy directly to cancer cells in abdomen. Cytoreductive surgery(CRS) combined with perioperative intraperitoneal chemotherapy is currently a valid treatment option for peritoneal dissemination of gastrointestinal, gynaecological cancers or primary peritoneal neoplasms.

Method
3 patients with peritoneal surface malignancy were selected. PET scan was done for all the patients to assess metastasis and peritoneal carcinomatosis index(PCI) calculated was&lt;20 for all 3 patients They were then treated with CRS+HIPEC therapy with disease-specific chemotherapeutic agents like Cisplatin, Mitomycin and Doxorubicin and Oxaliplatin . Aim was

Results
All the 3 patients had a good post-operative recovery with no recurrence in the follow-up period

Conclusions
HIPEC and CRS plays synergistic role. A complete CRS followed by HIPEC with the disease-specific chemotherapeutic agent at 41-43ºC constitutes optimal treatment for certain malignancies. High regional concentration with low systemic concentration of chemotherapy, increased tissue penetration and thermal enhancement of cytotoxicity are some of the advantages with HIPEC therapy
95 Evaluating The Rate, The Predictors And The Outcomes Of Patients With Negative Appendectomy(NAR)
Authors: Noureldin K , Ayantunde A , Elkholy M , Shah Heer Shah H S , Hatim A 
Published: May 2021

Abstract

Introduction
Appendectomy is associated with complications and negative appendicectomy. We evaluated the rate and predictors of NAR in a cohort.

Method
Patients' data who underwent emergency appendicectomies over a year was analysed. A definition of NA; absence of inflammatory cells in the appendix. The NAR was calculated using (NAR-SDC) and (NAR-STC). Leucocytosis was a total WBC &gt;11000/mm3, elevated CPR &gt;5 mg/L.

Results
372 patients were included. Median durations of symptoms 2 days. The mean admission WBC, CRP and serum bilirubin levels were 12,600 (3000-38000)/mm3, 66.9 (1-323) mg/L and 12.7 (4-38) µmol/L respectively. Laparoscopic appendectomy was performed in 93.5% with a conversion rate of 4.6%.NAR-SDC was 10.2% and NAR-STC was 25.8%. NAR was higher in females than males (39.4% versus 11.1%; p-value 0.0001). Patients with NA were younger (p-value 0.0001), had lower WBC (p-value 0.014), CRP (p-value 0.0001) levels on admission. Female gender, duration of symptoms more than 3 days, lower WBC were found to be predictors of NAR.

Conclusions
NA is a problem in management of patients with acute right lower abdominal pain. Our NAR compared favourably with reported rates. Female gender, symptoms more than 3 days, lower WBC were predictors of NA.
120 Genicular Nerve Radio-Frequency Ablation in The Treatment of Anterior Knee Pain in Patients with Osteoarthritis of The Knee Joint: Systematic Review
Authors: Farrugia M , Tinning C 
Published: May 2021

Abstract
Anterior knee pain is one of the main symptoms in osteoarthritis, resulting from the rich sensory innervation of its capsule. Pain control can be difficult to achieve, with non-responders to conservative and medical therapy often requiring a total knee replacement. Radiofrequency ablation (RFA) is a novel technique that could be beneficial in managing anterior knee pain by targeting the genicular nerves around the knee; however, its routine use is not included in current guidelines.
A literature search identified fifty-two results, which underwent screening using a study protocol and the final literature sources, of varying levels of evidence, underwent critical appraisal and analysis. The primary outcome included the significant improvement of pain scores from baseline, against their respective control treatments.
The ten studies included in the final analysis consisted of seven comparative studies and three non-comparative studies. Literature showed significant improvement in their mean pain scores, all meeting the primary outcome measure. Most studies also showed significant improvement from the control treatments used.
Current literature shows evidence that genicular nerve RFA is an effective and safe treatment modality in the management of anterior knee pain secondary to osteoarthritis. However, the literature available is limited and further comparative studies are required.
134 Quantitative Assessment of Visual Function for Pituitary Macroadenomas: A Practical Scoring Algorithm
Authors: Lee K S , Jeffrey S , Bradley K , Atan D , Williams A , Abhinav K , Teo M , Nelson R 
Published: May 2021

Abstract

Introduction
There is a myriad of existing terms by which visual capacity is recorded. The lack of a standardised categorisation of observations commonly results in ambiguities. We report the utility of a visual function score (VFS) in patients managed by transsphenoidal surgery.

Method
A VFS (expressed as a percentage) with a maximum score of 20 was calculated for each eye using the Snellen VA (40% weighting: score 0-8) and Humphrey Allergan 30-2 automated visual field (60% weighting: score 0-12).

Results
280 patients (560 eyes) underwent transsphenoidal pituitary adenoma resections with complete pre- and post-operative visual function assessment. Mean age 56 years; 56.4% male. 26.1% were treated by endoscopic technique and 73.9% were treated by microscopic technique. Pre-operative vision was normal in 38.0% eyes. All these had full post-operative vision. In patients with pre-operative visual loss (347 eyes), the mean pre-operative VFS rose from 70.8% to 87.5% post-operatively. 43.8% eyes attained full post-operative vision, 28% improved, and 25.6% remained unchanged. 9 patients (2.6%) had worse immediate post-operative vision.

Conclusions
The VFS is a convenient single measure of visual function that may facilitate local and national audit of transsphenoidal surgery. Studies are planned to correlate this with patient reported visual quality of life measures.
137 Giant Lipomas of The Hand; A Case Series and Review of a Rare Tumour
Authors: Abed H , Pickering G , Jose R , Chester D 
Published: May 2021

Abstract

Introduction
Whilst lipomas are the most common tumour of the human body, it is rare in the hand. Less than 50-cases are reported in the literature. We present six-cases from a specialist hand unit, UK, presenting over a 10-year period. All patients had a distinct swelling within the affected hand which was growing in size.

Method
Patients were investigated with MRI and given the benign appearance; no pre-excision biopsies were performed. All excised tissue was sent for histology. Only one patient reported altered neurology of the hand, describing altered sensation within the ulnar nerve distribution of the index finger.

Results
In all cases, the lipoma originated in the deep palmar space from adipose tissue surrounding the deep palmar arch. They all extended distally, along natural tissue planes, encasing neurovascular and tendinous structures. In two cases the lipoma extended into the dorsum of the hand, following the perforating artery between the index and middle metacarpal heads. The lipomas all spread radialwards, penetrating the thenar muscles. The largest was 13x12x4cm in size.

Conclusions
Giant lipoma is a rare cause of symptomatic swelling of the hand. Compression of structures is extremely rare, but careful excision is critical as neurovascular bodies are classically enveloped within the growing lipoma.
220 Choice of UK Medical School Predicts Success in The Intercollegiate Membership of The Royal College of Surgeons (MRCS) Examination
Authors: Ellis R , Scrimgeour D , Cleland J , Lee A , Brennan P 
Published: May 2021

Abstract

Background
UK medical schools vary in terms of factors such as mission, specific curricula and pedagogy. As relatively little is understood about the impact of these differences at a post-graduate level, we examined the relationship between medical school and MRCS success.

Method
Using the UKMED database we analysed data on UK medical graduates who attempted MRCS Part A (n = 9729) and MRCS Part B (n = 4644) between 2007-2017. Univariate analysis characterised the relationship between medical school and first attempt MRCS success. Logistic regression modelling identified independent predictors of MRCS success.

Results
MRCS pass rates differed significantly between medical schools (P &lt; 0.001). Trainees from standard-entry 5-year programmes were more likely to pass MRCS at first attempt compared to those from extended (Gateway) courses ((Part A (Odds Ratio (OR) 3.72 [95% Confidence Interval (CI) 2.69-5.15]); Part B (OR 1.67 [1.02-2.76])). Non-graduates were more likely to pass Part A (OR 1.40 [1.19-1.64]) and Part B (OR 1.66 [1.24-2.24]). Russell Group graduates were more likely to pass MRCS Part A (OR 1.79 [1.56-2.05]) and Part B (OR 1.24 [1.03-1.49])).

Conclusions
Medical programme and medical school are associated with MRCS success. Further research is needed to tease out the relationship between individual factors, medical school and MRCS performance.