bluuebunny/crossref_metadata_2025_split huggingface dataset:
749 Unexpected benefits of pandemic guidelines for the management of epistaxis
Authors: Empey J A , Gogo E , Zuccarelli A , Diver C 
Published: October 2021

Abstract

Aim
The Royal Victoria Hospital adopted ENT UK’s pandemic guidelines for the management of epistaxis. We aimed to reduce ENT referrals, in-patient admissions and staff exposure to COVID-19 whilst maintaining patient safety. This involved collaboration with ED to promote the use of absorbable packs and pharmacological alternatives over rhinoscopy & rigid endoscopy with cautery +/- non-absorbable packs.

Method
Data was collected on patients presenting with epistaxis over a six-week period beginning March 2020 and the same period in 2019. Key factors recorded were number of presentations, ENT referrals, admissions, and their durations, along with management and outcomes. ENT provided training to ED staff and produced video resources for the "My ED" app. Feedback from ED and patient data was gathered to improve training and assess effectiveness.

Results
Pre-pandemic, 48% of ED epistaxis presentations were referred to ENT vs. 28% following the guidelines introduction. In 2019 49% of referrals were admitted vs. 42% in 2020. The average in-patient stay was reduced from four nights to one. Re-admission rate remained similar from 22% in 2019 to 20% in 2020. These results were achieved following repeated improvements to the training sessions.

Conclusions
The ENT UK guidelines, when supplemented with ED collaboration, are effective at reducing ENT referrals and admissions. In addition to reducing COVID-19 exposure, the guidelines offered an improved patient experience (less invasive intervention, reduced/removed in-patient stay) with no loss of efficacy. This, combined with a reduced treatment cost of ∼£2,000 per in-patient, suggests the guidelines have long-term value out-with a pandemic setting.
1201 The Impact of a Spinal Best Practice Tariff on Compliance with The British Spine Registry
Authors: Rajgor H , Habbebulah A , Gardner A , Jones M 
Published: October 2021

Abstract

Aim
The British Spine Registry (BSR) was introduced in May 2012 to be used as a web-based database for spinal surgeries carried out across the UK. In 2019 NHS England and NHS Improvement introduced a new Best Practice Tariff (BPT) to encourage input of spinal surgical data on the BSR. The aim of our study was to assess the impact of the spinal BPT on compliance with the recording of surgical data on the BSR.

Method
A retrospective review of data was performed at a tertiary spinal centre, Royal Orthopaedic Hospital Birmingham, between 2018-2020. 3587 patients were included in our study. Data was collated from electronic patient records, theatre operating lists and trust specific BSR data.

Results
1684 patients were eligible for BPT. In 2018-19 269/974 (28%) records were complete on the BSR for those that would be eligible for BPT. Following introduction of BPT in 2019, 671/710 (95%) records were complete having filled in the mandatory data (P &lt; 0.01). Patient consent to data collection also improved from 62% to 93%. Email details were present in 43% of patients compared with 68% following BPT introduction.

Conclusions
Our study found that following the introduction of a BPT, there was a statistically significant improvement in BSR record completion compliance in our unit. The BPT offers a financial incentive which can help generate further income for trusts. National data input into the BSR is vitally important to assess patient outcome following spinal surgery. The BSR can also aid future research in spinal surgery.
601 The Effect of the COVID-19 Pandemic on Hip Fracture Mortality in The South West of England
Authors: Spolton-Dean C , Kent B , Ball T , Middleton R , Marusza C , Hinsley H , King A , Ayeko S 
Published: October 2021

Abstract

Aim
High perioperative mortality rates in surgical patients suffering concomitant COVID-19 infection have contributed to a fall in elective and urgent surgery. However, data and debate have centred around post hoc infected cases, without the context of the rest of the surgical cohort, and without comparable historical control groups. We aimed to address this by studying patients with a neck of femur fracture. This common condition has a stable incidence with good prospective data collected routinely for the National Hip Fracture Database (NHFD).

Method
We analysed NHFD data for all hospitals within our region over a 3-month period, covering the height of the first outbreak and compared this with the same months in 2019.

Results
The incidence of hip fracture was stable (463 in 2019, 448 in 2020). 30-day mortality was 6.26% in 2019 and 7.14% in 2020 (p = 0.595). In the second cohort, 14 patients tested positive for COVID-19 perioperatively. Of these, 3 died (21%) compared to 29 who tested negative (p &lt; 0.001). Mean time to operation reduced by 1.90 hours, with a significant drop in patients waiting over 36 hours (190 to 85, p &lt; 0.001). There were no significant differences between gender, ASA grade or pre-operative AMTS.

Conclusions
We have confirmed high perioperative mortality for those with COVID-19 infection but have not shown a statistically significant difference in overall mortality from hip fracture during the initial phase of the pandemic. We argue from this data set that the hypothetical risk of surgery during this pandemic may have been overestimated.
92 Increased Proportion of Alcohol-Related Trauma in A South London Major Trauma Centre During Lockdown, A Cohort Study
Authors: Brown O , Smith T , Gaukroger A , Tsinaslanidis P , Hing C 
Published: October 2021

Abstract

Background
Alcohol has been associated with 10-35% trauma admissions and 40% trauma-related deaths globally. In response to the Covid-19 pandemic, the United Kingdom (UK) entered a state of ‘lockdown’ on 23rd March 2020. Restrictions were most significantly eased on 1st June 2020, when shops and schools re-opened. The purpose of this study was to quantify the effect of lockdown on alcohol-related trauma admissions.

Method
All adult patients admitted as ‘trauma calls’ to a London Major Trauma Centre (MTC) during April 2018 and April 2019 (pre-lockdown; N = 316), and 1st April – 31st May 2020 (lockdown; N = 191) had electronic patient records analysed. Patients’ blood alcohol level and records of intoxication were used to identify alcohol-related trauma. Trauma admissions from pre- and post-lockdown cohorts were compared using multiple regression analyses.

Results
Alcohol-related trauma was present in a significantly higher proportion of adult trauma calls during lockdown (lockdown 60/191 (31.4%), versus pre-lockdown 62/316 (19.6%); (Odds Ratio (OR) 0.83, 95% CI 0.38 to 1.28, p &lt; 0.001). Lockdown was also associated with increased weekend admissions of trauma (lockdown 125/191 weekend (65.5%) vs pre-lockdown 179/316 (56.7%); OR -0.40, 95% CI -0.79 to -0.02, p = 0.041). No significant difference existed in the age, gender, or mechanism between pre-lockdown and lockdown cohorts (p &gt; 0.05).

Conclusions
UK lockdown was independently associated with an increased proportion of alcohol-related trauma. Trauma admissions were increased during the weekend when staffing levels are reduced. With the possibility of subsequent global ‘waves’ of Covid-19, the risk of long-term repercussions of dangerous alcohol-related behaviour to public health must be addressed.
37 Accuracy of Venous Thromboembolism Risk Assessments in The Trauma and Orthopaedics Wards of The Gloucestershire Royal Hospital
Authors: Njim T , Hafez A , Omar I 
Published: October 2021

Abstract

Introduction
Venous thromboembolism (VTE) risk assessment is crucial for patients undergoing orthopaedic surgery. An accurate risk assessment leads to patient stratification into risk groups for appropriate VTE prophylaxis.

Aim
To evaluate the accuracy of VTE risk assessment in the orthopaedic wards of the Gloucestershire Royal Hospital (GRH).

Method
We used the drug charts available on the wards of GRH which follow the NICE Clinical guideline [CG92]. We identified four variables out of the 19 questions that assess thrombosis risk: age, BMI, presence of infection/inflammatory conditions and surgery to the lower limb. Drug charts from the 10th of November to the 15th of November 2020 were assessed for completeness and accuracy. The number and accuracy of drug charts with VTE risk assessments on admission and 24 hours after admission were assessed.

Results
Fifty-seven drug charts with VTE risk assessments were identified over this period. Only 66.7% of VTE risk assessments were complete on admission and 21.1% were complete 24 hours after admission. Accuracy of assessment on admission was 92.1%, 86.1%, 81.6% and 79.0% for age, BMI, categories of surgery to the lower limbs and presence of inflammation, respectively. Accuracy of assessment at 24 hours was 91.7%, 83.3%, 50.0% and 91.7% for age, BMI, surgery to the lower limbs and presence of infection/inflammation, respectively.

Conclusions
VTE risk assessment upon admission and at 24 hours is relatively low and needs improvement. A further enquiry is necessary to evaluate the reasons for defective VTE assessment.
94 Audit of Management of Shoulder Dislocations Against BOA Traumatic Anterior Shoulder Instability Guidelines
Authors: Varasteh A , Hakim Z 
Published: October 2021

Abstract

Background
Traumatic anterior shoulder dislocation is associated with a high risk of shoulder instability, reduced functional outcome, and recurrence. We conducted an audit to assess the direct management, review in fracture clinic, and definitive imaging of patients with anterior shoulder instability in Southport and Formby Hospital.

Aim
To identify compliance with the 2015 BOA Traumatic anterior shoulder instability guidelines.

Method
Identified all patients from 01/01/2019 to 31/12/2019 who had shoulder dislocation coded for their diagnosis. We used imaging, scanned notes, and clinic letters where available to identify the clinical information. We excluded patients with a false diagnosis code, and those with non-local post codes from the analysis.

Results
We identified 67 patients who had an anterior dislocation. 88% of patients had x-rays in both AP and Lateral. We identified that 8.9% of patients had pre-reduction x-rays in AP only, 11.9% had no pre-reduction x-rays, and 1.5 % had no post reduction imaging. 79% of patients were seen in clinic within 6 weeks but only 40.3% were seen by a shoulder specialist and only 43.3% had appropriate imaging. 16.4% of patients were not given fracture clinic follow up.

Conclusions
Although most patients were managed acutely according to the guidelines, the follow up and subsequent investigations of these patients can be improved. One method we suggest is renaming fracture clinic days from consultant names to sub-specialty clinic names. In addition, a dedicated session to review the guideline with senior orthopedic surgeons cold improve the compliance as well.
988 A Quality Improvement Project; Improving the Quality and Safety of Handover During COVID-19
Authors: Chawla M , Said Noor M 
Published: October 2021

Abstract

Aim
The World Health Organisation (WHO) positions effective handover, in its top five patient safety solutions. During our District Hospital Trust’s COVID-19 response, an unprecedented reorganisation of all teams occurred. All surgical and medical speciality junior doctors were re-deployed and split into 4 zones to cover the hospital. In this quality improvement project (QIP), we sought to understand our trainees’ thoughts on this new multi-zonal handover process and aimed to identify risk-reduction measures to aid better patient care.

Method
The opinions of trainees on the new handover system were obtained using an online Likert scale survey. Following the responses, a new morning and night handover proforma was developed. This was used trust-wide and a post-intervention repeat survey was conducted to assess the new changes.

Results
The primary survey received 31 responses with feedback illustrating mixed effectiveness of the existing handover process. Free text comments highlighted issues surrounding “safety”, “poor organisation”, “poor continuity of care” with one serious incident reported. Post-intervention of a new handover proforma, a repeat online survey received 25 responses. Results were significantly more positive with &gt;84% of responses being in the “strongly agree to agree” category, including for “continuity of care”, “organisation”, and “safety”.

Conclusions
This QIP illustrates a good example of a low-cost intervention to create a better handover system and aid hospitals during time of crises. For us, it managed to reform the handover process and ultimately improved our patient care. Forthcoming, we would like to create a national best practice guide for effective handover.
1144 How Much Does Colorectal Enhanced Recovery Program Education Affect Knowledge of Newly Joined Junior Doctors? A General District Hospital Re-Audit
Authors: Dorra A , Alhammali T , Arnob A , Murtaza M , Essa N , Fahmy W 
Published: October 2021

Abstract

Aim
Aim of the study is closing the audit loop on knowledge of colorectal Enhanced Recovery Program (ERP) among newly joined junior doctors in a general district hospital. Original audit showed shortage of awareness and knowledge among newly joined junior doctors. The recommendation was educating them regarding ERP and re-auditing.

Method
Education through a 30-minute power point presentation, on colorectal ERP, was done among newly joined junior doctors. This was followed by a 12-point questionnaire for testing the knowledge of colorectal ERP protocol among 5 newly joined junior doctors (Senior House Officers, Foundation year 2 and Foundation year 1) in our surgical department in August 2020.

Results
The responses showed an increase in doctors’ knowledge to 90 % (re-audit) from 52.9% (original audit). An increase of about 40% in their knowledge. The average score of their knowledge was 10.8/12 (90 %). One doctor (20 %) scored 12 out of 12 (12/12), two (40 %) scored 11/12 and two (40 %) scored 10/12.

Conclusions
The study showed that education of newly joined junior doctors resulted in a substantial improvement in their level of knowledge of colorectal ERP, almost up to the local hospital guidelines target (100 %). The study recommends this education to be an integral part of their induction program not only locally but also nationwide. It highlights the impact of education on colorectal ERP implementation.
1232 Trust-Wide Assessment of Delirium in Post-Operative Elective Surgery
Authors: Sundar S , Biggs S , Abraham M , Cook J , Watts N , Price R , Brack M , Brown N , Dixon L , Crowther O , Trenaman R , Quinn D , Hall W , Younie S 
Published: October 2021

Abstract

Aim
Delirium is an acute change in cognition and associated with adverse patient outcomes. The incidence of post-operative delirium after elective non-cardiac surgery is unknown. We aimed to assess the incidence of post-operative delirium in this group and the effect on patient outcomes.

Method
Patients aged 65 and over who underwent elective non-cardiac surgery were identified on post-operative day three. Delirium screening was performed in real time using the validated 4-AT assessment tool. A retrospective review of the patients’ preoperative and perioperative record was conducted to collect demographics and identify risk factors for delirium. Outcome data was collected at 30 days. Patients with a positive delirium score (&gt;4) underwent a more in-depth assessment and managing teams given a delirium management pack.

Results
75 (39 male) consecutive patients were screened over a period of 4 months. Median age 77 years and 18% had frailty assessed as “vulnerable”. The majority of patients (37.3%) underwent thoracic surgery, followed by hepatobiliary (17.3%), gynaecological (17.3%), colorectal (12%), maxillofacial (9.3%) and ENT (4%). 5.3% (4) of patients had a positive 4-AT screen. No patients had a formal delirium screen or diagnosis in the initial 48 hours. The median length of stay for patients with a positive screen was 8.5 days (IQR 7.5-12) compared to 8 days (IQR 5-13) for patients with a negative screen.

Conclusions
Reassuringly, rate of post-operative delirium following elective operations in our Trust are low (5%). Larger numbers of patients are required to assess the impact this has on patient outcomes and identify correlation with risk factors.
1302 Ratio of Adenoma Detection Rate to Polyp Detection Rate
Authors: Rajain S , Adam A , Amarnath T 
Published: October 2021

Abstract

Introduction
Colorectal cancer is the 3rd most common cancer in the UK. The higher Adenoma Detection Rate during colonoscopy is associated with reduction in the mortality incidence of colorectal cancer. Endoscopists with less than 20% ADR is directly proportional to higher risk of the development of an interval Colorectal cancer. The aim of this study was to calculate the Adenoma Detection Rate and Polyp Detection Rate for each endoscopist to assess the performance of the unit as well as individuals.

Method
A retrospective analysis was conducted for patients who had colonoscopy in a period of 3 consecutive months at a primary care hospital in England. This study included collecting the data through patient’s histology reports and medical records. The primary outcome was total Adenoma Detection Rate and Polyp Detection Rate and its ratio for each endoscopist.

Results
913 colonoscopies were done by 16 different endoscopists out of which 279 patients with polyps were considered for the study. It was observed that half of the total endoscopists were found to have ADR more than 20%. 4 endoscopists had ADR between 15-20% whereas below minimal rate (less than 15%) ADR was recorded by the other 4 endoscopists.

Conclusions
Lower ADRs are associated with higher rates of interval cancers. An improvement of the ADR of 1% prevents 3% people from colon cancer which can be achieved by maintaining the aspirational adenoma detection rate more than 20%.
1405 Improving Documentation of Per Rectal (PR) Exams in An Acute Surgical Unit
Authors: Deeny D 
Published: October 2021

Abstract

Aim
A PR exam is routinely performed as part of the complete examination of surgical patients. The General Medical Council (GMC) has provided guidance on the use of chaperone during intimate exams stating that consent should be obtained, and a chaperone offered to all patients and documented accordingly. We aimed to assess and improve our documentation of PR exams.

Method
Data was collected prospectively from surgical admission documentation. The number of patients with consent and presence of chaperone documented during PR exam was recorded. Following a period of data collection, a proforma was implemented with education on correct documentation as per guidelines. A second audit cycle was performed where formal inclusion of the sticker in the admission booklet was implemented.

Results
20 patients were included in the initial data collection, 95% of which had incomplete documentation of PR exam on admission. A sticker was designed to prompt accurate documentation and inserted into the acute admissions booklet. Following this, 50% of PR exams were correctly documented. The remaining 50% without documentation had no sticker in the admission booklet. The second intervention included changing the hardcopy of the admission booklet. Following this, 80% of patients had consent documented and 90% had documented chaperone.

Conclusions
GMC guidelines state that documentation of consent and the presence of chaperones during intimate medical examinations are crucial. The implementation of a prompt in our admissions booklet has greatly improved our documentation in PR examination.
319 Systematic Review of Safety and Oncological Outcomes of Irreversible Electroporation in Renal Tumours
Authors: Hilton A , Kourounis G , Georgiades F 
Published: October 2021

Abstract

Introduction
Thermal tumour ablation techniques are effective alternatives to nephrectomy for small renal masses (SRM). Thermal effects limit their use in tumours adjacent to vital structures. We review safety and oncological outcomes of irreversible electroporation (IRE), a novel non-thermal ablation technique, in SRMs.

Method
MEDLINE, EMBASE, and SCOPUS databases were interrogated up to 29/11/2020 for studies reporting safety and oncological outcomes for SRMs in humans treated by IRE.

Results
Of 224 results screened, 10 met the inclusion criteria. In total, 83 patients were identified. Except for one cohort study (n = 41), remaining studies were case series of n &lt; 10. Follow up was &lt;12 months in 7/10 articles (Range 3-34 months). 10/10 articles reported safety outcomes. There were no 30-day mortalities. The most reported adverse events were transient haematuria (11/83) and asymptomatic perirenal haematomas (7/83). 62/63 patients with reported length of stay were discharged within 24 hours. No significant long-term changes in renal function were reported. 7/10 articles reported oncological outcomes. Only 1 article assessed histopathology outcomes. Remaining studies used CT, PET, or MRI for assessment. 4/7 (57%) patients with histopathology outcomes, showed complete response (CR). 43/55 (78%) patients with imaging base outcomes, showed CR. No mortalities were reported due to SRMs.

Conclusions
Initial findings support IRE as safe and feasible in managing SRMs. Results from larger studies with longer follow-up are needed to evaluate oncological outcomes and compare these with other ablation methods. Discrepancy between CR rates in histopathology vs imaging assessment could indicate higher sensitivity of histopathology for assessing outcomes.
474 Effectiveness of Platelet Rich Plasma in the Treatment of Recalcitrant Shoulder Pathology
Authors: Hadi H , Asaad O , Kucera M , Arealis G 
Published: October 2021

Abstract

Aim
To assess the outcome of platelet rich plasma injections (PRP) in patients with recalcitrant shoulder pathology using steroid injections as a control.

Method
This was a pragmatic retrospective analysis of patients treated for recalcitrant shoulder pathology between October 2018 to March 2019 with either PRP or steroid injection.

Results
In the PRP group 10 patients (n = 15) had previous steroid injections and 7 had previous surgery. 2 progressed to shoulder replacement. 5 have progressed to arthropathy. 4 patients were discharged due to improving symptoms. In the steroid group 2 patients (n = 15) were lost to follow up, 0 had previous surgery and 1 had a previous steroid injection. 6 were discharged due to improving symptoms. The average time to discharge post procedure was 241 days for PRP and 173 days for the steroid group. No complications were noted in either group.

Conclusions
Our findings show that PRP injections are a safe and effective treatment for cases of recalcitrant shoulder pathology leading to a 27% success rate for patients who have required steroid injections or arthroscopy in the past. In patients with arthropathy, PRP only has a short effect and should only be offered to patients that are unable to have surgery either due to high risk or patient choice. PRP requires a centrifuge machine and an operating theatre, thus incurring higher costs compared to steroid injections which may be given in clinic. Steroid injections should therefore remain the first line of treatment for recalcitrant shoulder pathology.