bluuebunny/crossref_metadata_2025_split huggingface dataset:
361 The Automation of Doctors and Machines: A Classification for AI in Medicine (ADAM framework)
Authors: Kazzazi F 
Published: October 2021

Abstract

Aim
The advances in Artificial Intelligence (AI) provide an opportunity to expand the frontier of medicine to improve diagnosis, efficiency, and management. By extension of being able to perform any task that a human could, a machine that meets the requirements of General AI (AGI) possesses the basic necessities to perform as, or at least qualify to become, a doctor. In this emerging field, this article explores the distinctions between doctors and AGI, and the prerequisites for AGI performing as clinicians. With its imminent arrival, it is beneficial to create a framework from which leading institutions can define specific criteria for AGI.

Method
A normative framework was derived from medical ethical literature and current medical technology. Comparisons were made between current capabilities and the traits of doctors ('doctorhood'). A framework was created that could fulfil current patient and doctor considerations for the use of AI in medicine.

Results
This Automation of Doctors and Machines (ADAM) framework is set out across 5 levels. As the level progresses, so do the minimum requirements in the core competencies of knowledge, safety, emotion, and independence.

Conclusions
The development of AI brings with it an exciting era of modern medicine. In order to fully enhance, expand, and regulate this field, the ADAM framework provides a tool to classify its use in medicine. In being able to categorize forms of medical AI, this allows clinicians, patients, and regulators to delineate different forms of AI, and a foundation is created from which governing bodies can set and standardise levels of care.
578 Insights into Patient Satisfaction with Telephone Fracture Clinic Consultations During COVID-19
Authors: Lostis E , Graham S , Pearce O , Kelly M 
Published: October 2021

Abstract

Aim
The COVID-19 pandemic led to an unusually fast pace of change in clinical practice in the UK. An early requirement to reduce outpatient attendances to a pminimum meant that this Trust adopted remote consultations for fracture clinics whenever possible. This study aimed to evaluate patient satisfaction with the new system of telephone consultations to assess its acceptability and guide future decisions.

Method
299 patients who received remote telephone consultations for fracture clinic appointments at North Bristol NHS Trust during the COVID-19 pandemic in early 2020 were retrospectively identified and sent a postal survey. Satisfaction levels were assessed through degree of agreement with statements (9 items), yes/no answers (4 questions) and space for comments. Data was analysed with Excel pivot tables and Chi-squared tests.

Results
131 survey responses were included (43.8% response rate). The majority of patients were satisfied overall with the care they received (82%) and preferred a telephone consultation to a face-to-face appointment during the pandemic (78%). However, only 22% maintained this preference in ‘normal’ (pre-COVID-19) times.

Conclusions
The positive responses to the survey reassure us that telephone consultations for fracture clinic consultations are acceptable to the majority of patients during a pandemic. The results as well as free text comments will help us ameliorate the fracture clinic service to minimise infection risk without compromising on quality of care.
605 Group and Save Sampling in Total Knee and Hip Arthroplasty: Is It Necessary?
Authors: Mepani V , Raheman F , Nasr P 
Published: October 2021

Abstract

Aim
To induce a change in practice with regard to pre-op G&S sampling. This is common practice in elective orthopaedics. Transfusion rates are negligible. Therefore, omitting this practice can reduce the financial burden on the Trust.

Method
Patient's undergoing elective primary total knee or hip arthroplasty over a 1-year period were retrieved from a database. Data regarding pre/post-op haemoglobin levels and transfusion status was obtained from patient case notes and Trust ICE pathology reporting system.

Results
There were a total of 454 patient's (251 undergoing TKR, 203 undergoing THR). Four patient's (1.6%) in the TKR group and 11 patient's (5.4%) in the THR group required transfusion. Of these patient's, 5 had cardiac problems and 6 had pre-operative anaemia.

Conclusions
Routine G&S sampling is unnecessary in the majority of cases and should only be reserved for certain cases (patient's with significant cardiac problems and those with a transfusion history). Patient's with pre-operative anaemia should have optimisation of haemoglobin level prior to the procedure.
657 A Retrospective Cost Analysis of Group and Save Samples Performed Prior To Vascular Procedures
Authors: Akula B , Vijaynagar B 
Published: October 2021

Abstract

Aim
To assess if routine group and save is indicated prior to all vascular procedures.

Method
A retrospective review of all patients who were admitted to vascular ward between 1st to 30th June 2020 was performed using our hospital database. The following data was retrieved: admission diagnosis, preoperative haemoglobin, number, and type of vascular surgeries performed, number of G&S sent and total number requiring transfusion.

Results
Total 81 patients were admitted, all had a G&S on arrival with routine bloods. All preoperative patients need 2 G&S prior to surgery as per trust policy.69 patients underwent surgery.111G&S were processed.51 patients had 1 G&S on admission as they had a previous sample.28 patients had 2 G&S either because they had no previous records or had postoperative complications.2 patients required multiple transfusions so had &gt;3 G&S each. 8 out of 81 patients needed peri-operative blood transfusion. 7 of them had undergone limb or toe amputations and 1 patient had ruptured AAA. The cost of single G&S sample is £30.8. Patients undergoing angioplasty, bypass, carotid endarterectomy (n = 46) did not require transfusion, but the expenditure incurred by performing g&s in these patients was £1570.8

Conclusions
Peri-operative blood transfusion rates were 9.8%. Judicious use of G&S could have saved £1570.8 to the trust. Rationalising preoperative G&S policy would lead to substantial financial savings.
752 Routine In-Hospital Radiographs Following Anterior Cervical Discectomy and Fusion Surgery: Neither Necessary nor Cost-Effective?
Authors: McCabe R , Davis J , Grainger M 
Published: October 2021

Abstract

Aim
To evaluate whether a post-operative radiograph of the cervical spine before discharge is either clinically justified or cost-effective in patients who have undergone an ACDF, despite having satisfactory intra-operative imaging.

Method
A retrospective review of 101 ACDF patients from a single neurosurgical centre. 78 had an in-hospital post-operative radiograph, 23 did not. In 95 of these, it was documented that there was ‘satisfactory intra-operative imaging’. All patients had intra-operative imaging of completed instrumentation. Any post-operative complications were noted, and the length of hospital stay (LOS) recorded. Study parameters also included: levels operated on, whether or not a plate was used with a cage, additional costings to the hospital.

Results
There was one post-operative complication relating to the metalwork in the 101 patients. However, the decision to perform this x-ray was based purely on the deteriorating post-operative clinical picture. In the cohort that had POXR’s, the average length of stay was 66.7 hours. Without POXR, it was 21 hours. The additional cost to the trust of performing the in-hospital radiographs was calculated to be £71,523 per year.

Conclusions
In patients who undergo ACDF surgery with an uneventful post-operative course and satisfactory intra-operative imaging, in-hospital post-operative radiographs serve no clinical purpose and delay discharge. This gives additional cost to the trust, unnecessary radiation exposure and occupies potential bedspace.
774 Paediatric Appendicitis Score (PAS): A Local Trial of a Risk Prediction Pathway
Authors: Darwich A , Lim J , Malik A , Paul S , Verma K 
Published: October 2021

Abstract

Aim
Right iliac fossa (RIF) pain remains the commonest acute general surgical presentation in children. Our centre had been an outlier compared with the national average in terms of negative appendicectomy rates. Thus, we designed and implemented a local pathway for risk stratification and management of children with RIF pain.

Method
The first phase was a retrospective analysis of all appendicectomies performed between April 2018 and March 2019, in children aged five to seventeen years old. Pre-operative inflammatory markers, clinical signs, and histology findings were analysed. Second phase involved designing a pathway utilizing Paediatric Appendicitis Score (PAS), a ten-point scoring system when assessing children with RIF pain. The final phase was a prospective analysis of appendicectomy results performed between August and November 2019, after implementing PAS pathway.

Results
92 cases were recruited in the first phase (mean age 12.3). 22 cases were analysed in the final phase after implementing PAS pathway (mean age 10.9). Our negative appendicectomy rates had reduced from 25% to 15.4%. In addition, we found that 96% of positive appendicectomies had either raised inflammatory markers (WCC or CRP), raised PAS (Score of ≥ 4), or both.

Conclusions
There is noticeable difference in our negative appendicectomy rates since the introduction of PAS pathway. A diagnosis of appendicitis in a child with normal inflammatory markers and PAS score seemed unlikely. Our goal is to continue utilizing the PAS pathway in our department in order to reduce unnecessary surgeries in children.
865 Reducing Delays in Cholecystectomy Surgery of Patients Admitted with Gallstone-Related Disease Within Gold Standard Time Frame Set Out By NICE
Authors: Adnan A , Ahmed M , Vaz O , Sultana A 
Published: October 2021

Abstract

Introduction
As per NICE guidelines, Cholecystectomy Quality Improvement Collaborative (Chole-QuIC) aims for 80% of eligible patients with gallstone-related disease to receive their cholecystectomy within 8 days of presentation1. Only 63.6% of eligible patients at East Lancashire Hospitals NHS Trust (ELHT) had their surgery within the target time. This project was done to identify the reasons behind ELHT not achieving the set target and to implement changes to overcome this.

Method
This was a retrospective review of a prospectively collected data of 444 patients from the ELHT Chole-QuIC database (July 2019-November 2020). Data were analysed in three periods: initial period (July 2019-November 2019), pre-COVID-19 period (December 2019-February 2020), COVID-19 period (March 2020-November 2020). Time to surgery was established. If the 8-day target was not met, reasons behind the delay were recorded.

Results
During the first cycle, the main reasons delays included the patients being temporarily unfit (13.8%), insufficient theatre capacity (13.8%) and variations in treatment plans (11.32%). 8% of patients had re-admissions related to their gallstone disease. Changes were implemented forward included a clear local gallstone disease management pathway and CholeQuIC referral system, increasing theatre capacity, and allocating pre-operative assessment slots. Gold standard cholecystectomy target period improved from 63.6% to 67.4% within three months of changes. However, the figure drastically reduced during the COVID-19 pandemic (36.3%) as elective surgeries were temporarily suspended.

Conclusions
The implementation of a gallstone disease management pathway, a coordinated referral system and additional theatre capacity contributed to the increase in cholecystectomies that were performed within the 8-day national target period.
919 Surgical Voice Restoration – Improving Out of Hours Management: A Multidisciplinary Quality Improvement Project
Authors: Wallace J , McCord J , Roberts B , Browning S 
Published: October 2021

Abstract

Aim
Swansea Bay University Health Board have a caseload of 37 surgical voice restoration (SVR) laryngectomies. These patients are excellently managed during working hours, by a SALT-led service. Concerns were raised regarding the quality of out of hours management: the aim of this project was to identify and address the factors contributing to the difference in care received.

Method
A questionnaire was sent to current junior doctors to assess knowledge and confidence when managing SVR patients. Phone interviews were conducted with SVR patients to discuss the issues from a patient’s perspective. The junior doctor team and SALT team liaised to identify contributing logistical issues.

Results
The junior doctor survey indicated both experience and confidence were low, including amongst senior trainees. 58.3% were unfamiliar with equipment used to change a speech valve. Patient interviews revealed several issues, such as delays to treatment and unnecessary admissions. Logistical concerns included inability to access equipment out of hours and an absence of departmental guidelines.

Conclusions
This project demonstrates a collaborative approach between junior doctors and SALT, to improve the quality of care for a sub-set of patients with highly specialised needs. We identified the contributing factors for the disparity in services and tailored interventions to provide the junior doctors responsible for out of hours care, with the knowledge and skills to provide a better standard of care.
944 Outliers: The Forgotten Patients
Authors: McConaghie G , Osei-Bordom D C , Charan M 
Published: October 2021

Abstract

Aim
It was recognized that surgical wards often have a large number of patients outlied to them. Unfortunately, it was also noted that they often were not regularly seen and so had no daily medical plan. Evidence shows outliers have:
The aim was to develop a means of increasing outlier reviews, plans and awareness of outlier parent speciality.

Method
Medical outliers and outliers from other surgical specialties were included looking at how often care plans were updated and if the nurses knew who and how to contact the patient's named consultant/team. Brightly coloured posters were created to highlight the importance of a patient plan and how to escalate a request. Stickers were created for the notes to highlight outliers and their last plan and their named consultant/team. The effect of the interventions was tracked for just under 6 weeks.

Results
Initial assessment showed care plans were only updated twice a week and nurses were largely unsure who to contact for an individual outlier. With the increased awareness the nurses achieved three reviews a week with patient plans. Importantly, during the review period there were no adverse events, and the nurses reported increased confidence in who to approach. Patients were also discharged earlier and not moved to another ward.

Conclusions
The nurses were empowered, and the patients benefitted from more regular reviews and up to date plans, importantly resulting in fewer adverse events and quicker discharges.
961 ROSE's Proforma: A Tool to Improve Quality and Safety of Surgical Handover
Authors: Mancuso R 
Published: October 2021

Abstract

Aim
Accurate and rigorous handover is paramount in surgery. Human factor can unfortunately affect handovers resulting unsafe for patients. The ROSE’S handover proforma is a structured methodology which has been created according to the RCSEng guidelines to facilitate communication ensuring an effective delivering of information concerning the care of surgical patients.

Method
ROSE is the acronym for REASON, OBSERVATION, SHIFT, ESCALATION and it is made of multiple subparts that cover the majority of the information that need to be shared between team members such as wound care, NEWS score, medications, diagnostic tests, assessments of lines (catheter, cannula, drain, CVC), social situation, deterioration, medical history as required by guidelines of RCSEng. The timing of 40 handovers has been recorded, of these 20 were performed by using the ROSE’s form. A questionnaire has been administered before and after the implementation of the Rose’s handover.

Results
The average time for handover a surgical patient increased from 1.07 to 3.26 minutes with ROSE’s form. The 82.14% of the staff who tried it thought that the form resulted easy to navigate, brief and complete in details. It is a safer practice for the 71.43% of the staff. The quality and the accuracy of the handover given was perceived as improved by the 96.46% of the staff that used it.

Conclusions
A structured surgical handover performed with a written form can be an easy and safe tool that can minimize human factor and technical errors especially out of hours. Clearly further research is needed; however, the preliminary results look encouraging.
1161 Streamlining the Patient Journey for Operative Management During COVID 19
Authors: Skinner H , Williams P , Greenlees G , Ilyas C , Schofield C , Lotia S , Amtul N 
Published: October 2021

Abstract

Aim
Leeds, UK is a high-volume acute surgery unit. Emergency operating was drastically affected by the pandemic and time from admission to definitive procedure significantly increased. This intervention aimed to streamline the patient journey from acute admission to the operating theatre.

Method
An audit considering delays to transfer, theatre access and recovery discharge, along with the criteria used for ‘Hot’ theatre was undertaken. Data was collected prospectively between 02/06/2020-06/07/2020 via a standardised proforma. Preliminary results suggested a geographically remote ‘hot’ theatre was associated with multi-factorial delays so was relocated to more familiar surroundings. This was re-audited between 06/07/2020-06/08/2020 aiming to characterise factors contributing to delay. A dedicated in-hours acute theatres porter was introduced for a trial period. Data was collected retrospectively between 24/08/2020-14/09/2020 and prospectively between 14/09-05/10/2020 via hospital electronic systems.

Results
Initially the average time from patient transfer to leaving theatre recovery was 4h6m55s (N = 52). Relocating theatres reduced this to 2h48m04s (N = 74)- an average reduction of 1h18m51s. The greatest reduction was seen in anaesthetic time between 1h17m54s to 41m29s. The introduction of a dedicated porter reduced the average transfer time to theatre from 36 minutes (N = 53) to 21 minutes (N = 68) (p &lt; 0.05).

Conclusions
Delay to theatre has a high cost financially and in its effect on patient outcomes. Delays are often multifactorial and robust systems are essential to minimise delays. Patients are best served by well-trained, dedicated ‘Acute’ team in familiar surroundings. Long-term implementation of dedicated portering service will save time, money and improve patient care.
1212 A Novel Approach to Alleviating Surgical Anxiety: QI Study in a Primary Care Government Centre
Authors: Peri H 
Published: October 2021

Abstract

Aim
Surgical Anxiety is a challenging problem in the peri-operative care of a patient often leading to poor surgical outcomes and repeated visits by the patient to the hospital. Despite being well documented, in practice, it still remains the most neglected and haphazardly adopted part of patient care. This study aimed to make the overall experience of surgery, safer and pleasant to the patient by instituting a novel, multimodal and easy to follow protocol.

Method
A self-made questionnaire formed the source for data collection from 43 patients listed for elective surgery in a government setup, throughout the duration of their admission and review period. Patient satisfaction rate was assessed by re-audits, post implementation of changes via a Plan-Do-Study-Act (PDSA) cycle. The ease of protocol administration and sustainability were assessed from staff via an audit and it was further simplified to ensure adoption was easy and patient satisfaction rate remained high as well.

Results
Initial audit showed only 49% (n = 21) of patient satisfaction rate at the time of admission. Significant variations of &gt; 90% (n = 39) patient satisfaction rate was noted post implementation of changes after the first PDSA cycle. A second PDSA cycle was instituted to simplify the protocol and post audit &gt;90% acceptance rate from staff were noted.

Conclusions
Shared Decision Making, Peer Support Groups, Adequate knowledge of the treating surgeon, the disease, treatment modalities and complications instituted via a proper protocol helped to alleviate surgical anxiety and prepare a positive patient for surgery.
1255 Crowdedness and Consequences of Long Waiting Time in Public and Private Health Centers Among Patients in Khartoum State, Sudan - 2016
Authors: Ibrahim A , Elkhidir O , A’lam Elhuda D , Elhassan A , Salman M , Ali A , Elkhidir I , Abuzied A , Elhassan M , Mohammed O , Noureddin A 
Published: October 2021

Abstract

Aim
Waiting time (WT) reflects quality of services delivered by Primary health care level. Long waiting time is due to various causes, among which crowdedness is a main cause. This prolonged time has negative impacts on PHC services utilization as well as patients’ outcomes. The aim of this study is to measure the total WT, assess the crowdedness in PHC centers, and to determine the possible consequences of this long waiting time.

Method
Descriptive cross sectional– health institution-based study done in 40 Health centres across Khartoum state using randomized multi-stage sampling. Patients, doctors and lab technicians were interviewed using three different pre-tested structured questionnaires.

Results
A total of 477 patients were included in the study. The average waiting time was found to be 168 minutes. Crowdedness was one of the main causes of delay in waiting time. The lab was the most perceived crowded service (74.4% of the respondents). This long WT had health consequences on patients, ranging from backache, joint pain, and headaches to hypoglycemic symptoms. These symptoms affected patients' willingness to return to the same center. 36.4% of the affected patients were unwilling to revisit the same center.

Conclusions
WT in this study is longer compared to studies from other countries. Crowdedness is one of the main causes of long WT. Due to this prolonged time, patients experienced physical symptoms. It also affected their future attitude regarding PHC centers utilization. There is a need to understand the underlying causes of this issue and address them appropriately.