bluuebunny/crossref_metadata_2025_split huggingface dataset:
37 Improving the Management of Post-Operative Hypocalcaemia in Thyroid Surgery
Authors: Collins R , Lafford G , Ferris R , Turner J , Tassone P 
Published: May 2021

Abstract

Introduction
Hypocalcaemia is a frequent, and potentially dangerous, complication of total thyroidectomy [1, 2]. This quality improvement (QI) project was undertaken in a large ENT department in the East of England over a year. The project improved postoperative guideline compliance by optimising the recognition and management of patients at risk of hypocalcaemia. This process focussed on improving parathyroid hormone (PTH) and calcium blood testing, appropriate prescribing and the monitoring and management of hypocalcaemia.

Method
Following a baseline audit the QI process subsequently involved the introduction of a new intraoperative PTH pathway and the amendment of trust guidelines. In addition, there was a focus on improving clinician awareness of guidelines, junior doctor education, communication between operating surgeons and junior doctors and the optimisation of patient handover.

Results
The measurement of PTH at four hours improved from 42.5% to 52.2%. The project saw a significant improvement in the monitoring of hypocalcaemia (from 22.2% to 83.3% for patients with an intermediate risk of hypocalcaemia) and in the prescribing of prophylactic calcium supplements from 7.5% to 43.5%.

Conclusions
By optimising postoperative care this QI project improved patient safety as well as impacting on the duration, and overall cost, of inpatient stay.
45 Easier Recognition and Better Communication of The Surgical Team Across the Hospital
Authors: Narayan P P 
Published: May 2021

Abstract

Introduction
Recognition & communication of a surgical team is of paramount significance especially in catastrophic scenarios- like a crowded trauma call in ED, and ward rounds as surgical patients are dispersed across the hospital. Hence implementing posters across all key wards and special ID could play a key role.

Method
Aim was to improve the recognition & communication of the surgical team by means of posters of surgical members(Trainees/ Trust Grades/ Associates)including their name, designation & bleep; and color coded ID/Lanyard for the surgical team. An online survey was conducted for the surgical team(N = 25) and separately for the nursing staff(N = 40) across the hospital to understand how well the surgical team is recognised across the hospital and how changes would bring about a difference in communication and recognition of the surgical team.

Results
Surgical team was poorly recognised across the hospital(12.5%), and most of the surgical & nursing staff thought implementing the changes would play a key role.

Conclusions
It is vital to have posters of surgical team (trainees/ trust grades) across all key wards and in Emergency, along with unique ID for efficient recognition of Surgical team in urgent scenarios & to develop an effective communication with the nursing staff across the hospital.
49 A Quality Improvement Project to Assess and Refine the Handover Process at Morning Trauma Meetings
Authors: Sadiq S , Tahir M , Nur I , Elerian S , Malik A 
Published: May 2021

Abstract

Introduction
Poor handover between shifts can result in patient harm. This study was designed to evaluate the impact of implementing a handover protocol on the quality of information exchanged in the trauma handover meetings in a UK hospital.

Method
A prospective single-centre observational study was performed at an NHS Trust. Ten consecutive weekday trauma meetings, involving 43 patients, were observed to identify poor practices in handover. This data was used in conjunction with the Royal College of Surgeons’ recommendations for effective handover (2007) to create and implement a standard operating protocol (SOP). Following its implementation, a further 8 consecutive meetings, involving a further 47 patients, were observed. The data was analysed using t-test for quantitative variables and chi-square or Fisher’s exact tests for categorical variables.

Results
An improvement was demonstrated in multiple aspects of trauma handover including past medical history, injury date, results, diagnosis, consent, mark, and starvation status (all p &lt; 0.001). Subgroup analyses showed that handover of neck-of-femur fracture patients including information on baseline mobility (p = 0.04), Nottingham-Hip-Fracture Score (p = 0.01), next-of-kin discussion (p = 0.075) and resuscitation status (p = 0.001) all improved following the intervention.

Conclusions
These results demonstrate that the implementation of a well-structured handover protocol can improve the transmission of critical information in trauma meetings.
54 Patient Satisfaction During A Pandemic – Virtually Impossible?
Authors: Harrington B , Keenan R , Aboelmagd M , O'Malley K , Galvin D , Hegarty N , Connolly S 
Published: May 2021

Abstract

Introduction
Throughout the COVID-19 pandemic we conducted virtual urology clinics for the first time at our institution. We aimed to assess patient satisfaction with the virtual clinic format.

Method
Patients who underwent virtual consultation were contacted by phone and surveyed about their appointment. Convenience, thoroughness, satisfaction, preference and reason for appointment were assessed via questionnaire

Results
77 randomly selected patients were contacted. 63 males (82%), 14 females (18%). Median age 61 years (range 16–86). 62 (80%) reviews, 12 (16%) new referrals, and 3 (4%) post-operative patients were surveyed. 55 (71%) were booked for repeat appointment, 13 (17%) for further investigations, 6 (8%) discharged, and 3 (4%) listed for surgery.
73 (95%) found it convenient, 3 (4%) were neutral and 1 (1%) found it inconvenient. 74 (96%) felt thoroughly assessed and 76 (99%) of patients had all their concerns addressed. 74 (96%) were satisfied with their review, 2 (3%) were neutral, and 1 (1%) was dissatisfied. Going forward, 50 (65%) would prefer virtual follow-up and 27 (35%) would prefer an in-person review.

Conclusions
Virtual clinic is preferable to the majority of patients in our urology service and is deemed convenient, thorough and satisfactory by them. It should be facilitated going forward in appropriately selected patients.
66 Cycle 1: Time for Peripherally Inserted Central Catheter (PICC) Insertion for Patients with Complex Infections in The Trauma and Orthopaedic Department at The Royal Infirmary of Edinburgh (RIE)
Authors: Balfour J , Powell-Bowns M 
Published: May 2021

Abstract

Introduction
Bone, joint and soft tissue infections often require long term antibiotic therapy alongside operative management. Intravenous (IV) access is essential for antibiotic administration and monitoring. ‘Long-lines’ such as PICC provide reliable long-term IV access. Aim: analyse time to insertion of ‘Long-lines’ and effects on patient outcomes.

Method
Standard audit protocol. Data tool was developed, trialled, and tested. Data was collected retrospectively from departmental database and TRAK (Online patient record system) for patients admitted with suspected bone, joint or soft tissues infection from 01/11/19- 29/2/20.

Results
91 patients admitted with presumed infection. PICC requested in 30 patients. Mean time to PICC request from admission was 8.7 days (1-33). 23 patients received PICC. Mean time to PICC following request was 6.7 days (1-15). Mean time to PICC from admission was 15.9 days (4-39). 10 of 30(33.3%) patients had documented missed antibiotics due to lack of IV access.

Conclusions
Large variation in time for patients receiving PICC from admission and from time of request. A significant proportion of patients are missing IV antibiotics due to poor IV access. Improvement in time to ‘longlines’ would reduce incidence of venepuncture in patients requiring IV access in addition to reducing missed IV antibiotics due to lack of access.
75 Treatment Escalation Plan (TEP) Completion Rates in General Surgery
Authors: Shah H , Yazdanian B 
Published: May 2021

Abstract

Background
TEPs ensure every patient has a ceiling of care formally documented, including a DNACPR decision. This pre-empts complications and provides guidance on how to appropriately manage acutely unwell patients. There is no national standard for TEPs. Our aim: to formally document the incidence of TEP completion in general surgery at a local District General Hospital.

Method
A multi-phase, cross-sectional study of 1. Inpatients on three general surgical wards, 2. TEP completion at post-take after a typical on-call cycle.

Results
15.4% of TEPs were completed, of which 75% had a DNARCPR form. For the two post-take ward rounds, 5% and 7.7% of admitted patients had a TEP. Elective surgical/Enhanced recovery patients (ERP) did not have a TEP. Findings were presented locally, and posters placed in the surgical offices. Cycle 2: 19.6% and 10% completion rate for ward and post-take patients, respectively.

Conclusions
TEPs are rarely completed. Minimal improvement in completion rate was noted at cycle 2. TEPs are more commonly completed for patients not for resuscitation. Future aims include editing the surgical clerking proforma and the elective surgery/ERP paperwork to encourage completion, improving patient care. Currently we are arranging similar audits across other NHS trusts to determine if this is a national problem.
81 Getting It Right First Time (GIRFT): Preliminary Results from Incorporation of A Personalised Surgeon Template In Hip Arthroplasty Surgery Documentation
Authors: Sandhu J , Jabr Y , Sidaginamale R , Logishetty R , Cooke N 
Published: May 2021

Abstract

Introduction
Following the publication of GIRFT guidelines for Total hip replacement operative note documentation produced from analysis of medical negligence claims notified to NHS resolutions by NHS trusts, we reviewed our compliance against the 24 criteria. This was a crucial exercise as inadequate documentation had huge medico-legal consequences and adverse outcome on patient safety. We proposed a pragmatic solution of incorporating prepopulated personalised template into ‘Trackcare' system and providing a dedicated desktop installed in surgeon's room for completion of operative notes.

Method
We led a team of 4 doctors to review our compliance against 24 criteria laid out by GIRFT. After retrospectively examining 20 operative records from a spread of consultants in the department. A re-audit following incorporation of personalised surgeon templates was conducted to close the loop.

Results
Our results showed out of 24 criteria; 8 criteria were met with 80-100% compliance while 15 criteria had &lt;60% compliance. The incorporation of personalised surgeon template has raised compliance to &gt; 90-100% in all 24 criteria.

Conclusions
A preliminary review of a single surgeon template has shown that it is simple to use, has excellent compliance, quick to complete the operative notes, advocates patient safety, is user-friendly and is very promising in minimising medico-legal claims for surgeons and the Trust.
83 Closed Loop Audit Examining Documentation of Advanced Trauma and Life Support (ATLS) Secondary Survey in Polytrauma Cases at The Royal Infirmary of Edinburgh (RIE)
Authors: Balfour J , Powell-Bowns M , Leow J , Arthur C 
Published: May 2021

Abstract

Introduction
Secondary survey is a key aspect of the ATLS guidelines in avoiding missed injuries in polytrauma patients. Aim: Evaluate the documentation of secondary survey in polytrauma cases admitted to the RIE A+E department.

Method
Standard audit protocol, retrospective data collection. Polytrauma patients and patients requiring Trauma CT were identified from the local trauma database. Primary outcome was successful completion and documentation of secondary survey. Cycle 1: All patients from 01/01/2015-01/09/2015. Local policy change included an A+E trauma booklet and policy of secondary survey on admission to Intensive Care. Cycle 2 was completed post-intervention for patients presenting between 11/01/2019-29/05/2019.

Results
Cycle 1 (N = 20, N Secondary survey documented=10, mean=50%). Mean time to secondary survey was 8 hours (range 3-49). Cycle 2 (N = 28, N Secondary survey documented=24, mean=87.5%). Mean time to a secondary survey was 4 hours 30 minutes (range=1-21hrs). Significant improvement in documentation (Fisher’s Exact Test, P = 0.017).

Conclusions
Implementation of the secondary survey protocol and trauma booklet significantly improved documentation of secondary survey in the polytrauma patient. Evidence also suggests improved time to secondary survey. However, documentation of secondary survey is not universal indicating further improvement is required in trauma care, as the RIE moves towards becoming a National Major Trauma Centre.
93 Sexually Transmitted Infections Remain Under-Diagnosed and Under-Treated in Young Men Presenting with Acute Scrotal Pain
Authors: Thomas M , Thursby H , Kitchen M , Liu S 
Published: May 2021

Abstract

Introduction
Epididymitis or epididymo-orchitis causing acute scrotal pain in men ≤35 years is a common presentation to primary and secondary care.Most are caused by sexually-transmitted-infections in this age group. Failure to identify or treat STIs in this population may lead to subfertility.We assessed our practice against British Association of Sexual Health and HIV guidelines.

Method
Men (age ≤35) diagnosed at our centre with epididymitis/epidiymo-orchitis between January2015 and January2020 were included (n = 313, age range 16-35). Data collected included microbiological and radiological reports,antimicrobial treatment prescribed and documentation of appropriate advice and follow-up.Patients with previous STI were excluded.

Results
53 (16.9%) patients had mid-stream urine analysed;one identified bacterial growth (e.coli).15/313 patients were screened for c.trachomatis.228 (72.8%) patients had a scrotal ultrasound;167 (73.2%) reports suggested epididymitis.32 patients underwent immediate scrotal exploration;19 were epididymitis,one required orchidectomy.
Advice to attend GU-Medicine-clinic was documented in 48cases (15.3%).20 patients (6.4%) received optimal antibiotic management; 83 (26.5%) received suitable antibiotics assuming non-gonococcal cause.210 patients received inadequate/inappropriate antibiotics.

Conclusions
Management of patients with acute scrotal pain is sub-optimal;most patients were inadequately investigated and most received inappropriate antibiotics which may lead to subfertility.Better education and written patient information on risks of STIs may improve outcomes in this population.
109 Game Changing Magnetic Experience in Rural and Urban Wirral Peninsula - Our Experience with Magseed Localisation of Impalpable Breast Tumours and Axillary Nodes
Authors: Arif T , Vinayagam R , Lund J M , Poonawala S 
Published: May 2021

Abstract

Introduction
Magseed is a novel localization technology in which a tiny seed is inserted to accurately mark the site of breast tumour. These can be detected intra-operatively by sentimag localization system. It aids localization of impalpable breast lesions improving margin clearance rates.

Method
A prospective study of first fifty Magseed localised breast tumour and axillary node excisions in Clatterbridge General Hospital.

Results
A total of 50 patients had 52 Magseed inserted. n = 14 was symptomatic, n = 35 was screen detected and n = 1 was an incidental finding on surveillance mammogram for a B3 lesion. 30 seeds were inserted on the right and 22 were inserted on the left (two were bilateral). 44 seeds were inserted under ultrasound guidance and the rest were targeted under stereo guidance (n = 8). Deployment of two resulted in malposition requiring wire localization. Mean age of subjects was 59.76 (range 31-81) years. Mean time to surgery after magseed insertion was 8.04 (range 1-27) days. Mean weight of the specimen was 48.57(range 10-264) gm. Mean size of the lesions was 20.32 (range 8-65) mm. Redo surgery for margin clearance was performed bringing the re-excision rate to 15.38% (n = 8).

Conclusions
We conclude that Magseed localization of breast tumours is a safe and reliable technique
115 An Audit on Dexamethasone Prescribing Practice on Surgically Managed Metastatic Spinal Cord Compression Patients in the Manchester Centre for Clinical Neurosciences: Lessons Learned in Closing the Loop
Authors: Laurente R , Mohammed R , Elmalky M 
Published: May 2021

Abstract
Metastatic Spinal Cord Compression is a surgical emergency owing to its propensity to cause significant morbidity and mortality. Dexamethasone is prescribed to reduce oedema and promote vascular membrane stabilization. The is done so until a more definitive management has been performed.
This is a retrospective study evaluating the steroid-prescribing practice for MSCC patients in 2018 at a tertiary spinal unit in Greater Manchester. Thirty-three patients who underwent stabilisation were evaluated in terms of both steroid prescribing and weaning practices. Standards used against for both were the NICE guidelines and the Edinburgh/Christie’s guidelines.
Of the 33 patients evaluated, only 1 patient received the correct loading dose of 16mg, whilst 27 went straight to being given 8mg BD. 5 did not receive dexamethasone at all. In terms of discontinuation/weaning, 26 were weaned accordingly and 2 were not weaned to continue as adjuvant treatment.
Dexamethasone prescribing practises has since improved over the past two years. 93% of the patients have been correctly weaned as compared to 38% in the past. In terms of prescription, much needs to be done as almost all the patients evaluated did not get the correct loading dose despite receiving the appropriate maintenance.
116 Patient Long Stay in the Manchester Centre for Clinical Neurosciences Complex Spines Department: Numbers, Reasons, and Recommendations
Authors: Laurente R , Yates J , Siddique I 
Published: May 2021

Abstract
Patient long-stay is one of the main causes of inefficient resource management in the National Health Service. Similarly, delays in treatment and access to social care contributes to the trust’s economic burden but also causes a significant delay in care for society's most vulnerable.
A single-centre evaluation of patient long stay was performed in a tertiary spinal unit in Greater Manchester. The top 50 patients who stayed the longest in an acute spinal bed between 2018 and 2019 were selected for analysis. Demographics, indication for transfer from another trust, overall length of stay, and the main reasons for such were evaluated.
Of the 50 assessed, there was an average length of stay of 46.9 days and the majority were comprised of patients with metastatic spinal cord compression. 74% had delays to surgery due to poor medical optimisation pre-transfer.
41% remained as an inpatient longer than necessary due to non-medical concerns. The main reasons included awaiting placement in a rehabilitation facility, social care issues and delays in repatriation back to their referring trust for ongoing care.
Delays in treatment and length of stay were found to be increased in patients who were poorly optimised pre-operatively and who required complex social and medical care post-operatively.
123 Use of The Induction Mobile Application in A Busy General Surgery Department
Authors: Momin S M B , Ismail S 
Published: May 2021

Abstract

Introduction
Contacting other hospital professionals, or accessing local guidelines is a common task for surgeons, which is usually facilitated by inefficient switchboard and intranet systems. Induction is a mobile application which includes crowd-sourced hospital directories and local guidelines, which could theoretically expedite these tasks. To assess this, we undertook a QIP within the General Surgery department using a bespoke Induction group.

Method
A private Induction group was created with the features mentioned above. We audited Induction against local trust processes (Switchboard and Intranet Trust Guidelines). We estimated cost saving using the 2019 junior doctor pay-scales. We also surveyed our department to evaluate their experiences using the application with a Likert scale.

Results
The timesaving from using Induction compared to current methods was on average 9.93 hours/week accumulated by 16 staff members, giving an estimated cost saving of £10,636.54/year. In a qualitative analysis, respondents rated Induction 4.8/5 for speed and 3.4/5 for completeness of directory, compared to 1.5/5 and 4.5/5 respectively for switchboard. Regarding accessing clinical guidelines, respondents rated the app as ‘easier’ and ‘quicker’ than the intranet.

Conclusions
We have demonstrated significant time and cost-savings using Induction compared to standard practices. Our QIP provides a replicable model to increase efficiency in surgery departments.
129 Recording of the Glasgow Scores in patients admitted to The Great Western Hospital (GWH) with Pancreatitis
Authors: Warner J , Halls M 
Published: May 2021

Abstract

Introduction
Pancreatitis represents a significant pathology in terms of morbidity and mortality and therefore it is important to be able to differentiate between mild and severe episodes. The objective nature of the Glasgow score and ability to predict severity make it a useful guide, however its use within GWH varies greatly.

Method
Both cycles of data collection occurred over one-month periods. Data was collected retrospectively of prospectively recorded data. Intervention implemented following the first audit cycle was a standardised proforma and the biochemistry lab instigated automated analysis of lactate dehydrogenase and calcium. Following this an identical audit was performed. In addition, the presence of CXR on admission and USS within 24hrs of admission was recorded.

Results
During the first audit cycle 44% of patients had a Glasgow score documented on admission, which improved to 63% after the second audit. There was a 17% improvement in USS scanning within 24 hours and a 50% increase in CXR being performed on admission following the second audit.

Conclusions
The changes implemented during the study have increased both the quantity and quality of the data recorded in patients admitted to GWH with pancreatitis. This should function to improve differentiation of those with mild episodes from those with severe.
139 Efficacy of Implementation of a Junior Doctors' Teaching Program on The Secondary Prevention of Peripheral Arterial Disease in Vascular Patients
Authors: Daketsey E , Elkawafi M , Khallaf A , Makar R 
Published: May 2021

Abstract

Introduction
According to NICE Guidelines, the Best medical therapy (BMT) for secondary prevention of peripheral arterial disease includes antiplatelet and statin therapy unless contraindicated. Junior Doctors are usually allocated the job of prescribing patients’ medications. Due to discrepancies in their exposure to vascular surgery in earlier training, we implemented an introductory teaching session for them regarding this BMT and audited the efficacy of this intervention.

Method
A retrospective review of admission and discharge medications of all vascular ward patients from August 12th to 30th September 2019 was done, and the data was analysed via Excel.

Results
Out of 127 patients (median age 70), 67% and 64% had antiplatelet and statin medications respectively,while on admission. 1 in each patient cohort was found discharged without either medication.
The GP of the patient discharged without antiplatelets was contacted to ensure this was rectified. The other patient had refused statin therapy and thus a discharge note to their GP was conducted to reflect this.

Conclusions
A teaching session as part of a vascular departmental induction emphasising the evidence base for antiplatelet and statin therapy can contribute to improving prescription practices of junior doctors starting in the department.