bluuebunny/crossref_metadata_2025_split huggingface dataset:
481 Improving the Quality of Pelvic Radiographs - Making A Difference One Picture at A Time
Authors: Saleem S , Parikh S , Parratt T 
Published: May 2021

Abstract
Inadequate pelvic radiographs can lead to missed pathology, necessitate repeat imaging, and subsequently compromise patient safety. The audit conducted aimed to assess and improve the quality of pelvic radiographs at our Trust against local and international guidelines.
Retrospective analysis of pelvic radiographs over a one-month period using PACS at Colchester General Hospital was conducted. All pelvic radiographs were assessed according to International Guidelines (EUR 16250EN). Postoperative radiographs were measured against local guidelines. The results were then presented in the departmental meeting and a re-audit was performed in June 2020.
A total of 190 pelvic radiographs were collected in September 2019. From the 23 postoperative radiographs, 9 did not include distal end of prosthesis. During the re-audit in June 2020 the same number of pelvic images were collected. Data showed that only 2 out of 29 postoperative images did not include the distal end of the prosthesis.
The audit demonstrated need for improvement at our Trust. This was carried out through a presentation in the departmental meeting, highlighting areas that needed improvement. The re-audited results from June 2020 have shown an improvement in the quality of pelvic radiographs and have had direct implications in clinical outcomes.
485 Optimisation of The Evening Surgical Handover Process in A Large Tertiary Surgical Department - A Quality Improvement Project
Authors: Brennan P , Holroyd D 
Published: May 2021

Abstract

Introduction
The aim of the project was to improve the quality and effectiveness of the evening surgical handover in a large tertiary surgical department, incorporating up to 150 patients.

Method
Audit standards were derived from GMC and RCSEng guidelines. An initial audit of the evening handover was conducted over a period of two weeks. Following this, a standard operating protocol (SOP) was introduced, with re-audit 4-weeks following implementation.

Results
The initial audit identified an inconsistent format and significant variability. Few handovers commenced with all team members present (11%) and were uninterrupted (33%). A laminated handover SOP checklist was produced and a new proforma was introduced to document tasks or reviews required overnight. A mandatory evening surgical HDU round was invoked and a “watchers” system was introduced to identify patients at highest risk of deterioration.
Re-audit demonstrated significant improvements in all domains to &gt; 85%. ICU referrals overnight decreased from 6% to 2%. Further improvements measures were implemented in the form of a dynamic virtual handover document.

Conclusions
A structured SOP improved the consistency of the handover process. A night review of all HDU patients reduced the rate of ICU referrals. Implementation of virtual handover processes may be required in the COVID-era.
499 Upper GI Surgical Clinic Referrals, Can We Improve Patient Experience?
Authors: Abouelazayem M , Belchita R , Wan A 
Published: May 2021

Abstract

Introduction
With increasing pressure on NHS to deal with long waiting lists, solutions to reduce waiting times are imperative. In the era of the COVID-19 pandemic, we need to reshape the way we look into Outpatient clinic appointments.

Aim
To review all clinic referrals to UGI surgical clinic and highlight any potential pathways that can improve waiting times and patient experience.

Method
Patients referred to UGI clinic over 2 months were collected from Iclip, EPR and EDM. Post-discharge appointments and DNA’s were excluded. Data collected included time from referral to clinic, type of referral, symptoms, investigations, potential pathway, first clinic outcome, and appropriateness of referral.

Results
Total of 147 referrals analyzed. Time from referral to clinic appointment is 51 days. GP referrals represented 73% while the rest from consultant colleagues. The most common symptoms were biliary colic and GORD. OGD and PH manometry were the most common investigations requested. The most common first outcome was pre investigate and clinic follow up. Two potential pathways identified are Biliary colic and GORD pathway. 90% of referrals were appropriate.

Conclusions
Biliary colic pathway and GORD pathway are 2 potential pathways that can cut off waiting times for clinic appointments and improve patient experience in outpatient clinics.
524 Anaesthetic Use and Packing in Subcutaneous Abscess Management: A Retrospective Before and After Analysis Within A Two-Cycle Audit
Authors: Elkadi H , Dodd E , Bolton W , Poulton T , Burke J , Jayne D 
Published: May 2021

Abstract

Introduction
In the United Kingdom, there are no widely used guidelines within the management of subcutaneous abscesses by incision and drainage (I&D) to direct the use of local anaesthesia (LA) vs genal anaesthesia (GA); or the use of wound packing vs no packing.

Method
Two cohorts of patients undergoing I&D procedures were retrospectively identified from attendance records over a 3.5-month period. The first cohort was between 16th October 2018 to 31st January 2019. The second cohort of patients was during the COVID-19 pandemic following the introduction of new RCS guidance (intervention) between 29th March 2020 and 15th June 2020.

Results
Seventy-one patients before and 63 after the intervention were included. There were significantly more procedures performed under LA after the introduction of the intervention (n = 52; 82.5%) vs before (n = 4; 5.6%) p &lt; 0.0001. The incidence of wound packing decreased after the intervention (n = 43; 68.3% vs n = 62; 87.3%) p = 0.00452.

Conclusions
The results demonstrate that during the pandemic, change in practice resulted in more subcutaneous abscesses being treated with LA. The majority of abscesses were packed in both cohorts although the incidence declined after the intervention. Future research should explore the patient satisfaction regarding pain management and the abscess recurrence rate.
546 Patient Opinions on Care Received in Virtual Clinics Compared to A Face-To-Face Clinic Appointments in General Surgery During The COVID-19 Pandemic. A Retrospective Patient Feedback Study
Authors: Fanning S , Palmer H , Sturrock B , Hussain A , Carney C , Jaunoo S 
Published: May 2021

Abstract

Introduction
Virtual clinics were implemented during COVID-19 to reduce patient contact. We identified the need to seek feedback from patients relating to their perceptions on care received at a virtual clinic compared to a face-to-face clinics.

Method
Patients who attended a virtual clinic in General Surgery were selected at random from a database of 627 patients. They were called and asked to complete a google survey which was sent via email. A shorter survey was also conducted over the phone for patients who did not have an email address.

Results
79.6% (n = 43) of patients felt their care did not suffer because of non-face-to-face contact. 63% (n = 34) reported that their symptoms were fully assessed during the virtual clinic. 77.8% (n = 42) did not feel rushed by the virtual clinic, 92.6% (n = 50) answered that they had the opportunity to ask questions. 68.5% (n = 35) answered their care did not suffer by not being examined. 72.2% (n = 39) felt that the outcome of the clinic was not changed because of non face-to-face contact.

Conclusions
Patient feedback on the care received in the virtual clinic was positive. This may suggest that virtual clinics could be utilised in outpatients care with good reception from patients.
553 Quality Improvement: The Implementation of Routine Tertiary Trauma Survey in all Trauma Patients Aged Over 60 Years in a Busy District General Hospital
Authors: Hughes C , Berry A 
Published: May 2021

Abstract

Introduction
Missed injury (MI) in trauma-patients is a widely reported phenomenon, with rates varying from 1.9-39%. Methods exist to reduce the incidence of MI’s such as the tertiary-trauma-survey (TTS). Robust primary and secondary surveys should indeed identify all injuries and facilitate management. However, for trauma patients, there remains an unwanted prevalence of MI. We hypothesized the addition of TTS may reduce the incidence of MI in a District General Hospital (DGH) and reduce associated morbidity and mortality; in particular in those aged &gt;60.

Method
Patient notes for 18 consecutive trauma admissions in those &gt;60 years were audited for admission demographics, timing and outcome of primary, secondary, and tertiary surveys, and occult injury. The TTS bundle was subsequently implemented in all trauma inpatients &gt;60.

Results
In the primary round, 11% (n = 2) had evidence of TTS within 36hr of admission, reflective of exceeding the TARN criterion. TTS is now being utilised and we expect to see &gt;98% compliance.

Conclusions
TTS is now incorporated as routine patient care for all trauma admissions &gt;60. Compliance will be re-audited; aiming to reduce the opportunity for missed injury morbidity.
577 Risk Factors Analysis for Contralateral Neck of Femur Fracture in Elderly Population
Authors: Gurusinghe S , Weerasinghe K , Navaratnam D , Gophinath G , Castejon Morales G , Joachim T 
Published: May 2021

Abstract

Introduction
Neck of femur fracture (NOFF) carries significant morbidity, mortality, and cost implication to the health system. Subsequent contralateral fracture(SCNOFF) further decreases patient performance and increases healthcare burden. The aim of this study was to identify and evaluate potential risk factors and effects of SCNOFF.

Method
Retrospectively analysed NOFF database from 2012 to 2019 was. Inclusion criteria were patients over 60 years with low energy fractures. Polytrauma, pathological and atypical fractures were excluded.

Results
There were 114 patients (4.18%) with contralateral hip fractures out of 2727 total NOFF patients. Mean age was 82 years old for the first hip fracture and 85 years for the second. Average time interval between fractures was 36 months.
During the two admissions, mean decline in Abbreviated Mental Test Score(AMTS) was 0.4, deterioration of Clinical Fragility Score and Charlson Morbidity Index were from 4.5 to 5.9 (P &lt; 0.0001), and from 5.4 to 6.1 respectively. Mobility was dropped by one level. institutional residency was increased from 23 to 46 (P &gt; 0.0014).

Conclusions
There is a drastic decline in clinical frailty, mobility status and increase residential dependency following a subsequent fracture. Our findings demonstrate the importance of emphasizing preventive measures to reduce the incidence of SCNOFF.
600 The Use of a Wide-Awake Local Anaesthesia No Tourniquet (WALANT) Technique in Foot and Ankle Procedures - A Randomised Control Trial
Authors: Borg T M , Tahir M , Heidari N 
Published: May 2021

Abstract

Introduction
Wide awake local anaesthesia no tourniquet (WALANT) is a widely used technique in upper limb procedures that has gained increasing popularity during the coronavirus pandemic. The benefit of WALANT for foot and ankle surgeries is less clear, especially in patients with multiple comorbities. The primary aim of this study was to compare post-operative pain levels in patients undergoing ankle fracture fixation. Secondary objectives included comparison of intra-operative patient experiences, clinical outcomes, and patient satisfaction 1-year post-procedure.

Method
129 patients presenting with ankle fractures were enrolled in a multicenter randomised control trial from February 2016 to January 2020. Patients with medial malleolar, lateral malleolar, bimalleolar or trimalleolar fractures received either WALANT (62 patients) or spinal anaesthesia (67 patients). A 5ml solution of 0.9% saline and 2% lidocaine with 1: 100,000 adrenaline was used for WALANT.

Results
Compared to patients who received spinal anaesthesia, those in the WALANT group experienced less post-operative discomfort and were more satisfied 1-year post-procedure (p-value = 0.003). Surgical outcomes were similar for both groups. Cost analysis revealed that WALANT is significantly more economical.

Conclusions
WALANT is an effective and safe anaesthetic for foot and ankle procedures. Without use of a tourniquet, it reduces post-operative pain and so, eases patient recovery.
627 Improving the Timing of Abdominal Ultrasonography for Women Presenting with Suspected Appendicitis: A Closed-Loop Audit
Authors: Bastola D , Swafe L , Oke T 
Published: May 2021

Abstract

Introduction
Right iliac fossa (RIF) pain in women is a common presentation to accident and emergency (A&E). Abdominal ultrasonography (A-US) is particularly helpful due to the ability to detect various pathologies. The aim of this audit was to reduce delays in performing A-US.

Method
The timing of A-US taking place following referral to general surgeons by emergency doctors was analysed. The data was retrospectively collected between April 2018-April 2010 in two hospitals from the same trust. Posters of the results were put up in the surgical department to highlight the importance of obtaining A-US early on. A re-audit was consequently carried out collecting data between July 2019 - April 2020.

Results
69 females were included in the first audit cycle and 39 in the re-audit. The average time from referral to A-US taking place was 14 hours and 15 minutes in the first audit and 4 hours and 37 minutes in the re-audit.

Conclusions
The A-US findings with correlated histology highlights that A-US plays a role in improving diagnostic accuracy. The results from the re-audit revealed a shorter average time taken for A-US to be performed following referral. There is scope for the development of a pathway allowing emergency doctors to request A-US.
634 Review of Nephroureteric Surgical Service in a District Urological Center
Authors: Chin Y F , Chakravarti A 
Published: May 2021

Abstract

Background
New Cross hospital has been offering radical/partial nephrectomy, nephro-ureterectomy for cancer patients and simple nephrectomy for non-functioning kidney with availability of robotic system facilities since 2016.

Methodology
Retrospective analysis of data collected prospectively between January 2019 and September 2019. All patients underwent nephrectomy/nephroureterectomy and their demographic, comorbidities and surgical outcomes data analysed.

Results
7 underwent lap robotic nephroureterectomy, 27 underwent laparoscopic radical nephrectomy, 4 underwent laparoscopic simple nephrectomy, compared to total of 13 combined cases in 2018. FtM ratio- 1:1.92(13:25). Mean cohort age 64. Mean cohort BMI is 28.3. Mean pre-op HB is 132.9. Average op time for nephroureterectomy is 247 minutes, nephrectomy is 108.2 minutes. Average blood lost is 70mls, no patient of the cohort required any blood transfusion. 1 case sustained splenic laceration had surgical repair, 1 case was abandoned due to extensive bowel involvement. No cases required conversion from laparoscopic to open procedure. Post operatively, 1 patient developed VT, 1 patient had subcut haematoma, Average increase in serum creatinine is 42, and average Hb drop is 10.7. Average admission period were 3.7 days.

Conclusions
Our urological centre manage to perform more laparoscopic nephroureteric procedures as compare to previous year without much decline in terms of patient surgical outcome.
645 An EGS-Led Service for Acute Appendicitis Enhances Surgical Training Whilst Improving Outcomes for Patients: Results of A 6-Month Audit
Authors: Issa M , Sommereux L A , Osuji J , Meredith R , Muhammed M H , Guy R 
Published: May 2021

Abstract

Introduction
Appendicitis is common &treatment by appendectomy is usually undertaken. Variations in diagnostics &imaging are accompanied by high negative appendectomy rates (NAR) of around 20%. This study evaluated the outcomes of appendectomy in a dedicated Surgical Emergency Unit.

Method
All patients undergoing emergency appendectomy between 1stSept 2019&29thFeb 2020 were identified. Demographics, clinical findings, pre-operative investigations, intra-operative findings &post-operative outcomes were recorded.

Results
There were 192 patients (102 [53.1%] female;90 [46.9%] male). Median age was 36 years(range 8-80)with 25 below 14.Some 58.3% underwent imaging (ultrasound 33.5%; CT 32.5%).
Laparoscopic appendectomy (LA) was performed in 84.4% of cases with 11.4% open; conversion from laparoscopic to open was only 4.2%. Some 56% paediatric patients had open appendectomy & 44% laparoscopic with no conversions. Trainees were the sole or first operators in 63% of cases.
NAR was just 5.7%. Some 21(10.9%) patients were readmitted within 30 days of which 8 had a collection; all were treated conservatively.

Conclusions
Accurate clinical diagnosis & selective use of imaging in a dedicated EGS unit optimizes outcomes for appendectomy with low NAR & low complication rates. Appendectomy is effectively undertaken by trainees. LA is safely performed in children.
683 A Quality Improvement Project (QIP) To Increase Compliance with Peri-Operative Antibiotic Guidelines in Colorectal Surgery (CS)
Authors: Carter H , Wood C 
Published: May 2021

Abstract

Introduction
In CS, the correct use of antibiotics is important in order to reduce the risk of surgical site and intra-abdominal infections, whilst balancing risks from overuse of antibiotics. The Commissioning for Quality and Improvement (CQUIN) of 2019/20 identified that antibiotic prophylaxis guideline compliance could be enhanced in CS. This QIP aimed to improve local CS antibiotic prophylaxis and extension guideline compliance.

Method
In December 2019, an educational session was held to highlight the details of the local guideline and prescribing discrepancies. A3 posters of the guideline were created for accessible reference in operating theatres. Perioperative antibiotic prescription data from all colorectal elective cases in January 2020 were extracted and analysed using descriptive methods.

Results
Out of 93 cases in the sample, 70 (75.3%) were compliant with the prophylaxis guideline. However, metronidazole was commonly used in perianal surgery, which is not recommended. 13 cases required extension of the antibiotic course, of which seven were compliant (53.8%). The main issues included: use of agents and course durations which were not indicated; and a lack of antibiotic switch after a pause in therapy.

Conclusions
To further improve compliance with antibiotic guidelines, targeting historic practice, increasing awareness, and making systemic change is required for the next cycle.
684 Use of Overnight Pulse Oximetry and STBUR Questionnaire for Paediatric OSA In A District General Setting
Authors: Rogers A , Fraser L , Geary T 
Published: May 2021

Abstract

Introduction
Overnight pulse oximetry (OPO) is often used to support the diagnosis of obstructive sleep apnoea (OSA) and stratify risk of peri-operative breathing difficulties in children undergoing adenotonsillectomy for OSA. Our objective was to audit our indications for OPO and the impact on subsequent ENT management. We sought to assess the correlation of STBUR (Snoring, Troubled-breathing, Unrefreshed Questionnaire) score with OPO values in these patients.

Method
Retrospective review of 32 OPO reports over a 7-month period. Data collected included age, weight, indication, mean spO2, number of dips &gt;4%, outcome and STBUR score.

Results
The commonest indication (19) for OPO was to assess severity of OSA in children &lt;3 or those with significant comorbidity to determine best setting for surgery; 50% were ultimately managed in a tertiary centre. 10 children underwent OPO due to diagnostic uncertainty but significant parental concern; all studies normal and parents reassured. STBUR score correlated poorly with number of dips &gt;4% (R = 0.0109) and mean nadir &gt;4% (R = 0.0031) Weight poorly recorded (19%).

Conclusions
Referrals were generally appropriate and influenced management in all cases. STBUR scores insufficiently sensitive to stratify severity of OSA. New protocol developed.
699 Pre-Operative Screening and Investigation of Patients with Suspected Non-Alcoholic Fatty Liver Disease Among Bariatric Surgery Patients
Authors: Antypas A , Austin A , Awad S , Hughes D , Idris I 
Published: May 2021

Abstract

Introduction
Non-alcoholic fatty liver disease (NAFLD) is becoming more prevalent. The investigations used to diagnose NAFLD include FIB-4 score, NAFLD score and AST/ALT ratio (AAR). Gold-standard for diagnosis is liver biopsy. Bariatric surgery reduces steatosis and fibrosis in NAFLD patients. However, in undiagnosed NAFLD, it can lead to worsening fibrosis and decompensation of cirrhosis, causing complications.
The aim is to identify how well bariatric patients are being screened for NAFLD pre-operatively.

Method
Database analysis was conducted in the bariatric clinics at Royal Derby Hospital and analysed using SPSS.

Results
392 patients’ data (Overall group) were analysed and compared with those who had an AAR&gt;1 (Abnormal group). Abnormal group had a higher mean AAR, NAFLD and FIB-4 scores. Surprisingly, ALT and AST levels were higher in Overall group compared to Abnormal. Generally, patients were not pre-operatively checked sufficiently (81.9% LFTs, 62.2% ASTs).

Conclusions
A large number of patients could have undiagnosed NAFLD due to the lack of LFT/AST checks as ALT scores alone would miss fibrosis. Using AAR&gt;1 and FIB-4 would allow clinicians to detect fibrosis earlier to carry out non-invasive diagnostic measures, avoiding unnecessary biopsies. Early diagnosis means patients undergoing bariatric surgery with possible cirrhosis will not experience decompensation and associated complications.
703 The Impact of Introducing A Patient Information Leaflet on Patient Experience of Safety Netting for Cauda Equina Syndrome at Lister Hospital
Authors: Sravanam S , Vella-Baldacchino M , Kitson J 
Published: May 2021

Abstract

Introduction
Cauda Equina Syndrome (CES) is a medical emergency. Patients with symptoms should seek medical attention immediately to prevent long-term neurological consequences. At our hospital, patients with back pain due to prolapsed vertebral discs are discharged with verbal advice about red-flag signs of CES. Studies have shown that patients retain only around half the information discussed in verbal consultations. Practice suggests that verbal advice combined with a patient information leaflet (PIL) allows for better safety-netting.

Method
In this study, we designed a new PIL reflecting latest British Association of Spinal Surgeons guidance. We then examined its impact on patient understanding and safety-netting of CES. Fifty patients who attended the Lister Hospital back pain service between September 2019 and August 2020 were randomly selected. Patients received a copy of the new PIL and were asked to complete a short questionnaire.

Results
Out of 26 respondents, over 86% (vs 59%) agreed/strongly agreed that the PIL helped them understand the red-flag signs of CES better. Furthermore, 81% said they felt better informed about CES than at the point of discharge from hospital.

Conclusions
This shows that the use of an effective way of educating patients about the red-flag signs of a medical emergency like CES.