bluuebunny/crossref_metadata_2025_split huggingface dataset:
985 Improving the Accessibility and Quality of Junior Doctor's Rotas During the Covid19 Pandemic
Authors: Gowda A , Smith K 
Published: October 2021

Abstract

Introduction
Rotas are an important part of a Junior Doctors working life. Having an up to date and accessible rota is important in enhancing Junior Doctor’s working lives in addition to being vital for work force planning and patient safety. During the Covid19 pandemic, rotas have changed several times making it difficult to track changes. Prior to our project, Junior Doctors found it neither difficult nor easy to access rotas at work (2.84 out of 5), found it fairly difficult to access rotas at home (2.38 out of 5) and the rotas they had access to were only average in being up to date (2.69 out of 5). Our project looked to improve this.

Method
Data was collected by surveys sent to Junior Doctors in the surgical department. PDSA Cycle 1 involved implementing surgical rotas on Microsoft Teams. PDSA Cycle 2 involved having other speciality rotas on Microsoft Teams. Our aims were to improve accessibility of rotas both at home and in the workplace whilst improving how up to date the available rota is.

Results
After the surgical rotas were on Microsoft Teams, rotas were easy to access at work (4.64 out of 5), fairly easy to access at home (4.24 out of 5) and were mostly up to date (4.41 out of 5). This has led to an improved satisfaction amongst Junior Doctors.

Conclusions
Currently the surgical department in Derby is using our solution for rotas. Medical staffing is in the midst of implementing this in the Medical speciality.
1038 Patient’s Experiences and Lessons Learned Following Establishment of a New Regional Day Procedure Centre in Response To COVID-19 Pandemic
Authors: Gilmore C , Coulson R , Graham V , McAllister I 
Published: October 2021

Abstract

Aim
Due to the impact of COVID-19 on elective services an exclusive day procedure centre has been established for the region. This study aims to review the patient experiences of the service.

Method
A 26-question feedback survey assessed patient outcomes, complications, and experiences. All patients who underwent hernia repair from September to November 2020 were contacted 6 weeks postoperatively by telephone to participate.

Results
Over 10 weeks, 55 patients underwent unilateral inguinal hernia repair. 49 patients completed the survey, 5 patients were not contactable, and 1 patient declined to participate. Overall high levels of patient satisfaction were reported, when asked the question “Rate the overall experience (out of 10) from the time you were contacted to proceed with surgery to now?” The average patient reported score was 9.5. Results indicated excellent use of written patient information leaflets. 92% (N = 46) of participants had a travel time of less than 60 minutes and 94% (N = 45) of those contacted reported the centre as a convenient location. Qualitative responses described pain at 48-72hrs following the procedure when local anaesthetic had worn off, to the detriment of overall patient satisfaction.

Conclusions
A dedicated site for day-surgery can be successful during the period of COVID-19 restrictions. High levels of patient satisfaction reported. However, lessons learned include need for improved education regarding postoperative analgesia; the effects of local anesthesia and patient directed follow up via the well-established local surgical hub.
1077 TELP In Urology: Hindrance or A Help During Covid-19 Pandemic? A Closed Loop Audit
Authors: Henderson L , Birse E , Nalagatla S , Reid S 
Published: October 2021

Abstract

Aim
TELP (Treatment Escalation/Limitation Plan) form is a novel clinical decision-making tool introduced during the COVID-19 pandemic in our health board to provide a standardised patient management plan in case of patient deterioration. A closed loop audit of its compliance in Urology patients was performed.

Method
Patient medical records were analysed over two periods (Cycle 1: 5/10/20 - 11/10/20 and Cycle 2: 23/11/20 – 29/11/20) for all Urology patients in our institution. Cycle 1 audit findings were presented at the Departmental Education Meeting. During Cycle 1, an anonymous questionnaire was sent to all Urology Medical and Nursing staff to gather their opinion on TELP.

Results
In total 100 patients were analysed. 66 were male and 34 females. Age ranged from 15 to 91 years. TELP form completion rate improved from 48% (Cycle 1) to 68% (Cycle 2), however, correct completion remained poor at 11.1% and 16.7% in Cycle 1 and Cycle 2 respectively. Commonly, there was no reporting of ‘discussion with patient or family’ or ‘patient capacity’. Majority of patients with a completed TELP had one to four underlying co-morbidities and were emergency admissions (65%). The questionnaire reported barriers to compliance including, time for completion, document size, and the feeling it was inappropriate for certain patient groups. Most felt it did not represent patients’ wishes (73%) or improved discussion regarding escalation status (50%).

Conclusions
TELP forms have sub-optimal correct completion rates and may not always represent patient’s wishes. Inherent barriers to its use need to be addressed, given limited resources during the COVID pandemic.
1219 Patient Satisfaction with Virtual Orthopaedic Clinics During the COVID-19 Pandemic
Authors: Shah Y , Shah K 
Published: October 2021

Abstract

Background
The COVID-19 pandemic has elicited the need to deliver consultation appointments remotely due to social-distancing measures, as well as some individuals having to shield. Virtual clinics are not a familiar setting for orthopaedic surgeons or their patients, but it is a necessity in the current climate and potentially also in the future.

Aim
This study aims to determine patient satisfaction of virtual orthopaedic consultations, during the COVID-19 pandemic and for the future.

Method
A 10-question survey assessed the satisfaction level of both new and follow-up patients towards virtual clinics for consultations with orthopaedic surgeons.

Results
Based on 100 patients who completed the surveys in a 6-month study during the pandemic, it was found that a majority (90%) of patients reported being satisfied (either very satisfied or satisfied) with the telephone clinics and would be content on having virtual clinics in the future.

Conclusions
Many patients view virtual clinics as an acceptable substitute for face-to-face appointments, specifically during the pandemic. However, it was also reported that a majority of patients would still prefer a physical examination as well. If virtual consultations are to persist beyond the COVID-19 pandemic, further exploration would need to be carried out to determine the efficacy.
1342 Screening Patients’ Temperature in COVID-era Outpatient Clinics: An Overreliance on Unreliable Devices?
Authors: Allman M , McKenna M , Leopard D , Backhouse S 
Published: October 2021

Abstract

Aim
The Covid-19 pandemic continues to impair patient access to hospital clinics. One way of enabling outpatient services to continue safely is to screen for pyrexia by checking patients’ temperature prior to their clinic appointment. Infrared tympanic thermometers (ITT) are commonly used as a surrogate marker of core temperature. Non-contact infrared cutaneous thermometers (NICT) are increasingly favoured as they require no direct contact with patients. The aim was to measure the concordance of temperature readings between ITT and NICT on patients attending ENT outpatient clinic at one hospital.

Method
Body temperature was recorded using ITT and NICT on 63 sequential patients. Agreement was tested using a Bland-Altman plot with 95% confidence interval and paired T-tests.

Results
Mean body temperature was significantly lower (p &lt; 0.05) for the NICT [36.3 °C (95% CI 36.2 °C-36.4 °C)] compared with the ITT [36.6 °C (95% CI 36.5 °C-36.7 °C)]. The NICT measured on average 0.34 °C (95% CI 0.33 °C-0.35 °C) lower than the ITT. The Bland-Altman plot showed moderate agreement of the two methods (SD 0.46 °C; limits -1.25 °c to 0.57 °c); however, disagreement was greater at higher and lower temperature extremes.

Conclusions
Screening patients for pyrexia aims to help prevent spread of COVID-19. False negatives result in a missed opportunity to break the chain of transmission. A significant proportion of false negatives may reverse any intended benefit. NICT are convenient but may be more susceptible to false negatives when assessing for pyrexia and may provide little more than false reassurance when used for pyrexia screening.
1464 Breaking Tradition – A Rural DGH’s Experience of The Management of Acute Appendicitis During the First Wave of the COVID-19 Pandemic
Authors: Zahari F , Byrne H , Roslan F , Ali M , Mitrofanova O , Da Silva Bento E , Rao M 
Published: October 2021

Abstract

Aim
Acute appendicitis (AA) is the most common abdominal surgical emergency in the UK and traditionally, operative management is the mainstay of treatment. However, during the first wave of the COVID-19 pandemic, ACPGBI discouraged laparoscopy, due to potential risks of aerosol viral transmission. We aimed to review clinical outcomes of patients treated for AA at our DGH prior to and after the change in ACPGBI guidance.

Method
The first 30 patients treated for AA prior to (Group A) and following the update in ACPGBI guidance (Group B), were identified.

Results
Group A: 7% managed conservatively vs 93% operative management. Group B: 74% managed conservatively vs 26% operative management. No statistically significant difference was seen in the rate of post-operative complications, or readmission. In Group B, of those managed conservatively and then readmitted, 75% underwent an operation (RR &lt; 1.00). The average length of stay (LOS) of those managed conservatively in Group A was 3.5 days vs 2.4 days in Group B (p &lt; 0.05). Statistically significant differences in LOS were also observed in patients who underwent surgery - Group A 5.5 day vs 8.25 days in Group B (p &lt; 0.001).

Conclusions
In conclusion, the change in ACPGBI guidance in the early stages of the COVID-19 pandemic, saw statistically significant differences in LOS at our DGH. A shorter LOS in those conservatively managed in Group B could be explained by hospital bed pressures. An increase in LOS for Group B patients with operative management is understandable, as only cases of complicated AA, or those readmitted underwent emergency surgery.
1544 The Doctor Will Call You Now – Patients’ Perspective of The Implementation of Telephone Clinics in the COVID-19 Era
Authors: Chawla A , Byrne H , Rao M 
Published: October 2021

Abstract

Aim
During the first wave of the COVID-19 pandemic, clinical guidelines advised the implementation of remote consultations with the aim of preventing viral transmission. Guidance included the introduction of telephone clinics and in March 2020, these were initiated for General Surgery at our rural DGH. The aim of this study was to review patients’ perspectives of these remote consultations.

Method
Using telephone clinic schedules, the first 100 patients of the telephone clinics were retrospectively identified. A survey was created using Google forms and questions covered patient demographics, as well as patients’ opinions on the organisation and efficacy of the clinic. The survey was completed via a telephone conversation with each patient between June to August 2020.

Results
72 patients consented to participate (age range: 24-80 years; 65% female). 44% of consultations were follow up, with 23% of patients having their initial appointment remotely. Although 82% of patients were able to discuss all concerns, nearly half of patients (43%) felt not having a face-to-face appointment affected their consultation. 78% of patients preferred remote consultations during the pandemic, but beyond this specific situation, 53% felt that in the future they would still prefer a face-to-face consultation. 57.6% of patients rated the newly implemented telephone consultations as 10/10.

Conclusions
The majority of patient feedback was positive. However, outside of the COVID-19 pandemic, our patients would prefer the traditional face-to-face consultation format. This outcome has been demonstrated in other similar studies worldwide, as it enables patients to be examined by and meet their surgeon prior to potential surgery.
1569 Paediatric Upper Limb Fracture Manipulation in A Children’s Emergency Department: Practice Changes During The COVID-19 Pandemic
Authors: Derias M , Amen J , Morrissey N , Alexander-Harvey G , Porter J , James Kyle , Crompton T , Maripuri S 
Published: October 2021

Abstract

Background
Trauma theatre time is valuable and previous studies reported cost of £24.77/minute. BSUH Children’s emergency department (CED) guidelines were implemented in December 2016, allowing reduction of forearm and distal radius (DR) fractures in CED using 70% nitrous (N2O) sedation. Due to COVID-19 pandemic and the risks associated with aerosol generating procedures as well as staffing levels, CED shifted to using 50%N2O with or without intranasal fentanyl.

Method
Relevant fractures presenting to CED from Feb-Dec 2020 were identified and compared to previous years. Demographics, treatment modality, timings, and outcomes were reviewed for 275 patients.

Results
In 2017-2018, 56% were manipulated in CED under 70%N2O (compared to only 3% in 2016). The main barrier identified was shortage of doctors trained in sedation to supervise use of 70%N20. In 2020, 101 patients were suitable for manipulation in CED. 64 had DR fractures, 37 midshaft fractures, 65 were male. Mean age: 10 years. 92 patients (91%) were manipulated in CED/fracture clinic. One was under 70%N2O; the rest used 50%N2O with or without intranasal fentanyl. 8 (9%) had manipulation under GA. Of those manipulated in CED, 3 were re-manipulated in clinic for cast problems. A typical MUA takes 30minutes indicating a saving of £743 per case; therefore, £68,356 over the study period.

Conclusions
Paediatric upper limb fracture manipulation in CED under N2O is effective and provides significant cost savings. Due to changes related to COVID-19 pandemic, considerably more patients in 2020 were safely treated in CED/clinic. Using 50%N2O improves uptake due to lower staffing requirements.
1706 Is A “COVID-19-Free” Hospital the Answer to Resuming Elective Surgery During the Current Pandemic? Results from The First Available Prospective Study
Authors: Gammeri E , Cillo G M , Sunthareswaran R , Magro T 
Published: October 2021

Abstract

Background
Resumption of elective surgery during the current coronavirus disease 2019 (COVID-19) pandemic crisis has been debated widely and largely discouraged. This prospective cohort study aimed to assess the feasibility of resuming elective operations during the current and possible future peaks of COVID-19 pandemic.

Method
Data were collected during the peak of the first pandemic in the United Kingdom on adult patients who underwent elective surgery in a “COVID-19-free” hospital from April 8 to May 29, 2020. The study included patients from various surgical specialities. Non-elective and pediatric cases were excluded. The primary outcome was 30-day mortality postoperatively. Secondary outcomes were the rate of COVID-19 infections, new onset of pulmonary symptoms after hospitalization and requirement for admission to the intensive care unit.

Results
309 consecutive adult patients were included in this study. No patients died nor required intensive care unit admission. Operations graded “Intermediate” were the most performed procedures. One patient was diagnosed with COVID-19 infection after being transferred to the nearest local emergency hospital for management of postoperative pain and was successfully treated conservatively on the ward. No patient developed pulmonary complications. Three patients were admitted for greater than 23 hours. Twenty-seven patients (8.7%) developed complications. Complications graded as 2 and 3 according to the Clavien-Dindo classification occurred in 14 and 2 patients, respectively.

Conclusions
This prospective study shows that, despite the severity and high transmissibility of novel coronavirus 2 diseases, “COVID-19-free” hospitals can represent a safe setting to resume many types of elective surgery during the peak of a pandemic.
90 Penetrating Abdominal Trauma: Comperative Study Between Operative and Conservative Management
Authors: Shalaby A , Ibrahim M , El Faioumy T , Elmessiry M 
Published: October 2021

Abstract

Aim
to Assess the feasibility and safety of selective non-operative management in penetrating abdominal injuries and to identify a protocol for selection of patient’s candidates for non-operative management.

Method
In this comparative study 40 abdominal stab victims (admitted to Emergency Department of Alexandria Main University Hospital) were selected during 6 months period where 20 patients were suitable for non-operative management according to strict selection criteria whereas the other 20 patients were operated according to clinical and/or radiological indications or on basis of department protocol, the results were compared in view of final outcome.

Results
In our study, 15 patients were assigned for operative management according to selected clinical and/or radiological indications only 3 of them (20%) had non-therapeutic laparotomies, On the other hand, five patients were explored on basis of department protocol in violation of our indications for exploration; four of them (80%) were non-therapeutic. So, the rate of non-therapeutic laparotomies was significantly higher when done mandatory without selected clinical and radiological indications.

Conclusions
Assessment of vital signs together with abdominal examination are the most important and dependable tools in decision making in penetrating abdominal trauma patients. Patients with shock on admission (but responding to resuscitation), proved low grade solid organ injury (by CT), and proved intraperitoneal collection (by US or CT) could be managed conservatively regarding that they remain vitally and clinically stable. If failure of conservation occurs, it is usually during the 1st 24 hours after admission.
447 Evaluation of JPI System as Prognostic Tool in Cases of Perforation Peritonitis
Authors: Singh N , Singh B J , Sharma A , Khalsa M S , Singh H 
Published: October 2021

Abstract

Aim
Perforation peritonitis is a commonly encountered condition in surgical practice in any hospital. One of the reasons for high mortality in these conditions is lack of risk stratification resulting in delay in providing adequate management, although a number of scoring systems are available to stratify these patients according to severity, but most of these cannot be used in developing countries like India due to their dependency on sophisticated investigation which are usually lacking in most parts of these countries. This study aims to evaluate a simple scoring system for peritonitis.

Method
Fifty cases with diagnosis of peritonitis coming to Government Medical College, Amritsar were stratified according to Jabalpur peritonitis Index and their outcome was examined.

Results
Mortality steadily increases with increase in JPI score. Patients with JPI score of &lt; 9 and &gt;9 had mortality rate of 2.5% and 60% respectively)(p &lt; 0.01) and similarly morbidity of 30% and 80% (p &lt; 0.0001).Duration of pain &gt;24 hours, age &gt;50 years, mean SBP &lt;100 mmHg, serum creatinine &gt;1.5 mg/dl, respiratory rate &gt;24/min, heart rate &gt;110/min and feculent exudate intra operatively were found to be independently significant factors in predicting the mortality among the study population. For a score of 9, the sensitivity was 85.7%, specificity was 90.7% and positive predictive value for mortality is 40% and negative predictive value of 97.5%.

Conclusions
This study proves that JPI scoring system is a simple and effective tool for assessing the morbidity and mortality in patients with peritonitis.
1078 Enteric Duplication Cyst in An Adult: Presenting with Diarrhea and Vomiting
Authors: Wintrip D 
Published: October 2021

Abstract
Intestinal duplication cysts are rare disease entirety, most commonly presenting in childhood. The incidence is 1:4,500 births, with a slight male predominance. They can occur anywhere along the alimentary tract, 35% occur in the ileum and 10% in jejunum. Diagnosis can prove challenging as they can present with a vast variation of symptoms and mimic other pathologies.
A 29-year-old male presented to A&E following a collapse. He had been suffering of diarrhoea and vomiting with lower abdominal discomfort. The patient was otherwise fit and well and no surgical history. On physical examination his abdomen was generally tender with no peritonism but was tachycardic, tachypneic but normotensive. His blood pressure dropped to 70/56, heart rate 130 and temperature increased to 41.2 degrees. A CT abdomen and pelvis with contrast was subsequently performed while on intensive care. There was a huge fluid-filled structure almost filling the entire pelvis and right side of the abdomen measuring up to 18cm in transverse diameter and 38cm longitudinally. The fluid filled structure appeared to communicate with a loop of small bowel in the right iliac fossa. There was no sign of obstruction.
Due to the CT findings and the patient’s clinical status a laparotomy was performed. A large congenital duplication cyst was seen which was adherent to 40cm of the small bowel. The section of bowel was 130cm distal to the DJ flexure. The small bowel including the cyst was resected and hand sewn end-to-end anastomosis performed.
1111 Shifting the Paradigm of Abscess Treatment – From Theatre to Clinic
Authors: Newitt L , Stewart C , Wei R 
Published: October 2021

Abstract

Aim
Treatment of skin and soft tissue abscesses forms a substantial part of the emergency general surgery workload. Abscesses account for approximately 2% of presentations to Accident and Emergency, with 0.9% of patients requiring surgical intervention. Incision and drainage is often performed in theatre and may necessitate admission to hospital, impacting bed space and theatre availability. This study aims to identify if the introduction of a clinic-based abscess service could reduce the number of abscess drainages in theatre without compromise to clinical outcomes.

Method
Retrospective data was collected for patients undergoing abscess treatment at Musgrove Park Hospital (Taunton) in September 2019. Subsequently, a Nurse-led abscess drainage pathway was initiated in Emergency Surgery Ambulatory Clinic (ESAC) encompassing initial assessment and drainage at the bedside. Prospective data was then collected for abscesses drained in theatre and ESAC during September 2020 and compared with data from 2019.

Result
22 abscess drainages were performed in September 2019 vs 25 in September 2020. 8 cases were carried out in theatre during September 2020, with the rest being treated in ESAC. Of those who were treated in clinic (n = 17), admission was prevented in 16 patients. Readmission rates were similar between ESAC (16%) and theatre (18.1%).

Conclusions
A clinic-based abscess service is achievable and prevents unnecessary use of theatres and hospital admissions, with comparable re-presentation rates. A nurse led approach also relieves pressure on Doctors during busy surgical on calls. Nonetheless, a larger data set would be needed to consolidate the findings from this study.