bluuebunny/crossref_metadata_2025_split huggingface dataset:
691 Audit of Drug Chart Completion in General Surgery
Authors: Uddin A , Hadjittofi C , Lovett B 
Published: May 2021

Abstract

Introduction
The accuracy of drug charts is crucial for good clinical practice. The General Medical Council states, doctors must keep clear, accurate and legible records, also applying to prescriptions. This audit quantified the accuracy of drug chart completion in a General Surgery Department within a District General Hospital.

Method
Single-centre retrospective assessment of drug charts in November 2019, assigning binary outcomes to each domain: “100% complete” (all details such as drug name, dose, unit, route, frequency, indication, duration, signatures) vs. “incomplete”. After analysis (Microsoft Excel/IBM SPSS v.24), results were circulated locally, followed by re-audit during June-August 2020.

Results
Comparison of audit (n = 22) vs. re-audit (n = 25) drug charts across 17 domains demonstrated higher completion rates for 7 domains: Alerts/allergies (4/22:18% vs. 18/25:72%; p &lt; 0.001), signatures (2/22:9% vs. 17/25:68%; p &lt; 0.001), venous thromboembolism risk assessment (5/22:24% vs. 24/25:96%; p &lt; 0.001), antithrombotic (0/21 vs. 9/25:36%; p = 0.002), regular (1/22:5% vs. 10/25:40%; p = 0.04), as-required (0/21 vs. 5/22:23%; p = 0.020) medication and intravenous fluids (1/16:6% vs. 20/21:95%; p &lt; 0.001). Performance in 10 domains was not significantly different (p ≥ 0.05).

Conclusions
Standard documents like drug charts may appear accurate at first glance. However, when assessed with strict criteria, performance is suboptimal. Simple, cost-effective educational interventions can significantly improve accuracy, with positive implications for patient safety.
695 Analgesic Ladder Compliance by Junior Doctors on Surgical Wards
Authors: Emanuel O , Mahdi S , Bondje S , Tjokarfa J , Dhunna J , Sivarajah V , Jose P 
Published: May 2021

Abstract

Introduction
Analgesia makes up an integral part of the management of the surgical patient. The World Health Organisation “analgesic ladder” details the escalation of analgesics from paracetamol through to opiates. Over the past decade, opiate prescriptions in the UK have increased by 22% to 40.5 million a year.

Method
Drug charts were reviewed on the surgical wards prior to presentation of the trust guidelines to surgical juniors. Inclusion criteria was non-cancerous adults who were not on chronic pain medications and had no known allergy or contraindication to NSAIDs. F1/2s were also surveyed on their knowledge of the trust guidelines

Results
Compliance improved in weak opioids (10.6%) and oramorph (19.1%) but fell in NSAIDs (-2.9%). Paracetamol was prescribed appropriately in 100%. 78% of doctors admitted to not having read the trust guidelines and 89% to not following them despite 100% being aware of the concept of the analgesic ladder.

Conclusions
We saw a tangible improvement in opiate prescribing by surgical juniors. However, the overall compliance to the analgesic ladder is still relatively poor given the doctors are all aware of the concept of the analgesic ladder, suggesting appropriate analgesic prescribing does not rank as highly in importance as it should.
708 Examining the Management of Acute Lower GI Bleeds in Order to Improve Policies and Reflect Safe and Updated Guidance
Authors: Han L , White H , Bosch K , Nair M 
Published: May 2021

Abstract

Introduction
Acute lower gastrointestinal bleeding (LGIB) tends to occur in elderly patients with complex comorbidities. At North Middlesex University Hospital (NMUH), LGIB patients are primarily managed by the surgical department. We amended local policies by integrating aspects of new guidelines published by the British Society of Gastroenterology (BSG).

Method
Handover documentation between November 2019 and January 2020 established patients admitted with LGIB (n = 45). Further data regarding the management of these patients was collated from clinical software and compared to standards set from BSG guidelines.

Results
We found NMUH to be efficient in ruling out upper GI bleeds via 24-hour OGDs and had low surgical intervention rates (0.02%). 40% of patients were transfused with an admission haemoglobin above suggested NICE thresholds, accounting for cardiovascular comorbidities. 56% of patients were discharged without a documented anticoagulation plan. Over 50% of patients did not have BSG recommended inpatient investigations.

Conclusions
Updated Trust guidelines aim to uphold areas that NMUH were shown to excel in, while reiterating NICE transfusion thresholds and include guidance regarding anticoagulant and antiplatelet medications. The Oakland score and shock index have been integrated into local protocols and will aid clinicians in making safe decisions in the management of LGIB patients.
714 Venous Thromboembolism Risk Re-Assessment Within 24 and 72 Hours After Admission (Closed-Loop Audit)
Authors: Aung M 
Published: May 2021

Abstract

Introduction
NICE and Poole Hospital guideline state venous thromboprophylaxis (VTE) risk assessment must be done on admission and at consultant review (within 24hr and 72hr after admission)
Changing from paper to electronic patient records(EPR) system omits some mandatory protocols.
Although VTE risk assessment on admission remains mandatory on EPR, records of re-assessment within 24 and 72hr becomes optional.

Method
100 random patients admitted to the orthopaedic department, before and after implementation of change.

Results
The initial data indicates 0% of recording for re-assessment after admission.
This action led to incorrect dosage and duration of chemical VTE prophylaxis in 20% of the patients.
After presenting the data to stakeholders, an instruction of entering VTE re-assessment on EPR was done by a teaching session and by putting up posters.
A discussion with the IT department resulted in setting up a dropdown-box for VTE re-assessment on EPR.
Re-audit shows a slight improvement in the recording from 0% to 3% for within 24hr and 22% for within 72hr.
Feedbacks indicates an insufficient time, a lack of senior staff member involvement and established workplace culture.

Conclusions
Despite some improvement, more junior and senior staff engagement, including cultural changes, are needed to achieve the national standard.
721 Imaging for Suspected Bowel Obstruction in Pennine Acute Trust (PAT): A Comparison with the National Audit of Small Bowel Obstruction’s (NASBO) recommendations
Authors: Foster K , Shah J , Bandyopadhyay S , Waugh C , Fawzy S , Morris L , Mansour M 
Published: May 2021

Abstract

Background
NASBO recommends Computed Topography (CT) over plain abdominal X-ray (AXR) for the investigation of bowel obstruction (BO). AXR is routinely used within PAT for investigation of BO which may be exposing patients to unnecessary radiation and adding unnecessary cost to the service.

Method
A retrospective audit collected data on patients with CT confirmed BO between July 2019 and February 2020. This looked at the percentage of patients who had both CT and AXR to investigate BO. The cost of these AXRs and the percentage of these AXRs that were normal were also calculated.

Results
A search identified 141 patients with CT proven BO. 81/141(57.4%) patients had both AXR and CT as a part of their initial investigations. Of those patients 26/81(32.1%) had no AXR features suggestive of BO. Only 12/81(14.8%) of those patients had serial AXRs following initial imaging. The cost for one AXR is £34.15 which means £2766.15 was spent on potentially unnecessary AXRs within this period.

Conclusions
PAT is performing potentially unnecessary AXRs which is exposing patients to unnecessary radiation and costing the trust. Plain AXRs do not rule out BO. We have recommended an investigation flowchart to PAT A&E departments to reduce unnecessary AXRs being performed.
741 Manipulation and Reduction of Paediatric Forearm Fractures in The Emergency Department Using Intranasal Diamorphine and Entonox
Authors: Kapoor S , Valand A , Dartnell J 
Published: May 2021

Abstract

Background
Paediatric forearm fractures are commonly encountered in Trauma and Orthopaedics. Currently most forearm fractures are manipulated in theatre the following day, increasing resource burden and delays in management. The aim of this project was to introduce guidelines to reduce fractures in the Emergency Department (ED) using intranasal Diamorphine and Entonox.

Method
197 cases were identified over a 6-month period in 2018 and 2019. 74 distal radial fractures and 123 mid shaft forearm fractures were analysed. Fractures with an intact periosteal hinge or a Salter Harris type 2 were reduced in ED. The pre manipulation and post manipulation radiographs were compared with particular attention to the post reduction angles.

Results
67% of fractures were reduced in the correct setting. A number of fractures reduced in ED required re-manipulation or internal fixation. Overall, there was a 56% reduction in patients undergoing general anaesthetic. There was a reduction in the mean length of stay from 36 hours to 3.5 hours.

Conclusions
Intranasal Diamorphine and Entonox offer a safe method for managing paediatric forearm fractures in ED. Implementation of this method facilitates early access to treatment and early patient discharge. Manipulation in ED offers significant financial savings and reduces demands on the Trauma Theatres.
753 Sesamoid Alignment After MIS Chevron Osteotomy and Its Role to Prevent Hallux Valgus Recurrence
Authors: Edres K A , Abdelghafour K , Felstead A , Adam C , Palmer S 
Published: May 2021

Abstract

Introduction
Incomplete correction of the sesamoid position after corrective osteotomy is a risk factor for recurrence of the hallux valgus deformity. This study was done to report the results of sesamoid alignment after chevron osteotomy.

Method
92 patients (111 feet) had minimally invasive (MIS) distal chevron osteotomy and release of fibular sesamoid ligaments done, sesamoid position was assessed in the weight-bearing views of the foot, tibial sesamoid position in relation to the mechanical axis of the first metatarsal was classified as grades 0-3 where the normal position was graded (0) and the most lateral sublaxation was graded (3). There were 2 groups; the reduced (grade 0-1) & the dislocated (grade 2,3) groups. Preoperative and post-operative radiographs were compared. Postoperative images were done 6-8 weeks post-operatively to ensure osteotomy healing.

Results
Sesamoids alignment was corrected following the MIS chevron osteotomy; 84 feet (75.7%) were from the dislocated group and 27 feet (24.3%) were from the reduced group pre-operatively improved to 102 feet (91.9%) reduced and only 9 feet (8.1%) dislocated following the procedure with P-value &lt; 0.00001. To ensure inter-observer reliability, images were assessed by 2 observers with Cohen’s Kappa coefficient 0.477.

Conclusions
MIS chevron osteotomy can produce significant improvement of sesamoid position which is crucial to prevent recurrence of hallux valgus.
769 Analysing the Change – Outcomes and Benefits of Clinic-Based Removal of Renal Transplant Stents Using A Disposable Cystoscope
Authors: Chowdary P , Shetty S , Whittaker C , Prasad M , Mohamed I , Khurram M 
Published: May 2021

Abstract

Introduction
Literature is chock-full of data regarding the “when” of ureteric stent removal after renal transplantation. We have attempted to address the “who”, “where” and “how” components.

Method
The Isiris disposable scope was used to remove renal allograft stents from 383 patients in the Transplant Clinic from June 2018 to April 2020. An advanced nurse practitioner was trained in the procedure. The learning curve, incidence of complications, benefits and cost implications were studied, and compared with the cohort having stent removal with a traditional flexible cystoscope in theatres.

Results
There were 14 failures necessitating theatre removal. The transplant-to-stent-removal interval was significantly lower in the clinic cohort with a mean of 38.80 days (95%CI 37.26–40.34) to 46.55 days in theatres (95%CI 43.47–49.62). 11 patients had urgent bedside stent removal. The service was delivered independently by the nurse for 5.3% of the patients in June 2018 and progressed to over 80% by April 2019. Estimated net gain was £919/patient.

Conclusions
Moving transplant ureteric stent removals from a resource intensive all-day process in theatres to a one-stop event in the clinic is a safe and economical model that can streamline flow in patient pathway and inculcate new skills in other members of the multidisciplinary team.
772 Quality Improvement Project – Establishment of The Breast Pain Clinic at Torbay Hospital
Authors: Aribo E O A , Adeboye T 
Published: May 2021

Abstract

Introduction
Breast pain alone should not be imaged. The common misconception that breast pain alone is a symptom of malignancy and the subsequent impact on the Triple Assessment Clinic (TAC), lead to the development of the Breast Pain Clinic (BPC), a holistic service to educate patients and reduce unnecessary imaging.

Method
Retrospective data was collected of TAC attendees between September-December 2018, noting patients presenting solely with breast pain (BPP); number of BPP imaged; and those with positive results.
Prospective data collection of those attending the TAC and BPC were collected between September-December 2019.

Results
Retrospectively 17% (151/888) of TAC attendees were BPP, 23.8% (36/151) were imaged and 97.2% (35/36) had normal/benign changes.
Following BPC creation 7% (67/940) of TAC attendees were BPP, 31.3% (21/67) were imaged all with no positive results. 1% (3/94) of BPC attendees were BPP, all with normal/benign imaging.
96% of questionnaire respondents felt more confident managing breast pain.

Conclusions
The development of a BPC was successful in educating patients and reducing anxiety.
It also reduced the proportion of patients presenting to the TAC with pain and the proportion of patients imaged.
With further education of community practitioners on referral adherence, this service could benefit breast services nationwide.
791 Using Audit Data to Inform and Guide COVID-19 Recovery: A Case for the Re-Introduction of Immediate Breast Cancer Reconstructions
Authors: Hobbs N , Touqan N , Williams K 
Published: May 2021

Abstract

Introduction
During the COVID-19 pandemic, operations performed in NHS hospitals were restricted. Breast cancer surgery remained vital, however, to reduce theatre capacity pressures and re-admission rates the procedures available were rationalised to keep the risk of complications low. Immediate breast reconstruction was stopped.
COVID-19 recovery meant careful reintroduction of complex surgeries, with competing interests from different surgical specialities for theatre capacity within the Trust. The psychological effects of breast cancer are significant. Therefore, it was important to advocate for our patients and ensure the reintroduction of this service.

Method
To strengthen our case, a retrospective audit of all immediate breast reconstruction outcomes was performed for cases during the 12 months preceding COVID-19.

Results
64 patients underwent immediate implant and Acellular Dermal Matrix (ADM) breast reconstruction. Five (7.8%) patients returned to theatre. One (1.5%) returned during their initial in-patient stay due to haematoma. Four patients (6.3%) returned between 3 and 12 weeks following their original surgery date. Infection rates were higher in smokers or those with a BMI &gt;35.

Conclusions
These results were presented to management and the reconstruction services were re-introduced in our Trust with stringent inclusion criteria. We can therefore offer our patients an improved service that considers both physical and psychological health.
844 The Frequency of Formal Audiological Assessment in Patients with Diagnosed Vestibular Schwannomas – A Single Centre audit
Authors: Khan D Z , Posa M , Buttimore J , Bance M , Helmy A 
Published: May 2021

Abstract

Introduction
Patients with vestibular schwannomas (VS) must have formal audiology during their workup, according to multiple national guidelines (including NICE).

Method
This retrospective study sought to audit the percentage of VS cases undergoing formal audiometry at a tertiary neurosurgical centre. An illustrative sample was selected randomly from local databases (2006-2019). Data collected included audiometry types (speech discrimination [SD], pure tone audiometry [PTA]), management pathway (surgery, radiotherapy or conservative) and symptom profile.

Results
200 cases were assessed, 7 were excluded (private patients, patients referred but not formally seen). Of the 193 cases included, 186 (96.4%) had ≥1 Pure Tone assessment [PTA], with 135 (70%) also tested on Speech Discrimination [SD]. The surgical cohort had the highest audiometry rates at 38/38, followed by 116/121 (96%) for surveillance and 32/34 (94%) for radiotherapy subgroups. Reasons for no audiology were: profound hearing loss at presentation (2/7), audiometry at local centres (4/7) and patient compliance (1/7).

Conclusions
Our service is highly compliant (96.4%), consistent across management categories. The rate of SD (70%), a functional measure of hearing impairment, can be improved. Monitoring surgical outcomes via formal audiometry should be standard, particularly surgical approaches that preserve hearing are chosen. Follow-up audiometry regimes can be standardized for those on surveillance pathways.
861 Evaluation of Understanding and Utilisation of Low Potassium Diets in Urology Wards. A Quality Improvement Project
Authors: Swamad M , Quraishi M , Buyungo J , Stephenson-Allen A 
Published: May 2021

Abstract

Introduction
Dietary restrictions are implemented upon renal inpatients considering their predisposition to electrolyte abnormalities from renal failure. A similar affiliation in urology wards is assumed due to similar patient profiles. Minimal awareness exists for low potassium alternatives on the catering menu. We aimed to review the understanding and utilisation of low potassium diets amongst healthcare professionals in our urological wards.

Method
Thirty staff members on our urological wards comprising of doctors, nurses and healthcare assistants were surveyed.

Results
Fifty seven percent were unaware of low potassium diet availability on the ward. None of the patients were offered or remained on a low potassium diet. During the cross-sectional review across 3 days, 25(45%) and 7 patients were identified to have renal failure and hyperkalaemia respectively. Three patients warranted renal replacement therapy.

Conclusions
Our study highlights the lack of awareness and underutilisation of low potassium diets on urology wards. An educational programme is being conducted with the guidance of dieticians and caterers. Ward guidelines will be established in patients with high risk of electrolyte imbalances. Low potassium diets will be emphasised on the catering menu. A subsequent evaluation will be performed to review the improvement in our understanding and utilisation enactments.
880 Improving the Acute Knee Injury Pathway – A Regional Quality Improvement Project in the Oxford University Hospitals
Authors: Kim D , Neal-Smith G , Wood A 
Published: May 2021

Abstract

Introduction
There are many patients being referred from A&E to orthopaedic trauma clinics in OUH for suspected ligament or meniscal damage, without convincing evidence of injury. This has led to demand for providing point of care ultrasound and streamlining of the referral process.

Method
We conducted an audit of all A&E presentations at the OUH receiving a knee XR across 3 months and tracked their investigative and referral progress.

Results:

Conclusions
Only 30% (57/182) patients referred to the Trauma clinic were deemed to have a serious ligament or meniscal injury. It is difficult to assess the extent of knee injury without specialist diagnostic equipment, which includes MRI or point of care ultrasound. This project has resulted in new trial protocols exploring the use of these technologies to improve this pathway.
883 Modified Framework for The Management of Acute Gallstone Disease During The COVID-19 Pandemic
Authors: White A , Brewer J , Efthimiou E , Khwaja H , Bonanomi G 
Published: May 2021

Abstract

Introduction
On 12/03/2020 WHO declared SARS-CoV-2 a global pandemic. PHE and RCS advised non-operative management wherever possible, changing management of acute gallstone disease from early laparoscopic cholecystectomy to conservative treatment and frequent percutaneous drainage. Planning, prioritisation, and implementation of “COVID-Safe” pathways presented multi-factorial challenges throughout the NHS.

Method
Prospective data of patients admitted with acute gallstone pathology was collected at Chelsea & Westminster Hospital (23/03/2020-16/08/2020), and prioritised using Tokyo, FSSA and RCS Guidance. A restructured “Gallbladder-pathway” was implemented comprising trust-wide referral proforma, weekly clinical planning MDT meetings and dedicated theatre lists.

Results
Sixty-eight patients were prioritized as either “Urgent” (25), “Expedited” (12) or “Elective” (31); comprising gallstone pancreatitis (11), acute cholecystitis (53), obstructive jaundice (12) and biliary colic (8). 12 patients required cholecystostomies.
During the “Peak” (23/3/20-02/06/2020) no cholecystectomies were performed, 10 in “Recovery” (02/06/20-06/07/20) in NCEPOD theatre, 21 in “Resolution” (06/07/20-18/08/20) since implementation of the “Gallbladder-Pathway”. Eleven patients (16%) re-presented while awaiting definitive treatment, none critically ill. The highest number of re-presentations was in “Urgent” patients (36%) and those with cholecystostomy (45%).

Conclusions
Early adoption of a modified “Gallbladder-pathway” during the pandemic allowed accurate case stratification, efficient resource allocation and safe care. Our model enabled prompt service recovery and a framework to navigate future disruption.
885 Telephone Consultations During the Covid-19 Pandemic; from the Perspective of One Oral and Maxillofacial Unit
Authors: Chaudhry H , Abiola J 
Published: May 2021

Abstract

Introduction
The Covid-19 pandemic has had a global impact on healthcare. As a result, changes have been made to healthcare provision. In the UK, the focus was changed to urgent and emergency treatment only, and therefore a shift from face-to-face consultations to video and telephone consultations was implemented. Our aim was to look at the telephone consultations in our oral and maxillofacial (OMF) department to identify their effectiveness.

Method
A search was carried out using the electronic patient record for patients booked for consultations in the OMF clinics from the 23rd of March to the 1st of May 2020. Trauma clinics and ad-hoc clinics were excluded.

Results
21 clinic codes were found as suitable for inclusion. 185 consultations were booked during the 6-week period. Of these, 165 were via telephone and 20 face-to-face. A total of 75 consultations resulted in discharge and 110 required further follow up or further investigation. Of the 75 patients discharged, 73 of these were via telephone. The main reason for discharge was delivery of benign biopsy results.

Conclusions
Covid-19 will have long term impacts on healthcare provision. If implemented correctly, virtual consultations carry the potential in making healthcare more accessible.