bluuebunny/crossref_metadata_2025_split huggingface dataset:
603 Quality Improvement Project: Improving Patient Understanding of Dietary Fibre Content Post-Bowel Surgery
Authors: Smith L , Katsaros P , Eshak A , Mahapatra A , Camilleri G , Qurashi K 
Published: August 2024

Abstract

Aim
Patients recovering from bowel surgery or an acute flare-up of diverticulitis, are advised to adhere to a low fibre diet and then transition to a high fibre diet. Despite these dietary recommendations, patient-friendly educational materials are lacking. This project aims to investigate:Patient and doctor understanding of dietary fibre contentThe impact of a patient-friendly flyer on patient understanding and satisfaction

Method
A questionnaire was given to patient’s post-bowel surgery at Northwick Park Hospital, exploring their knowledge of what constitutes low and high fibre food. A questionnaire was also distributed to general surgical doctors (non-consultants), exploring their confidence in giving dietary fibre advice. Resources from the Association of UK Dieticians were used to create a patient-friendly flyer. QR codes were included, connecting patients to high and low fibre recipes. The same cohort of patients were surveyed after reading the flyer, and their knowledge of high and low fibre food groups was remeasured.

Results
75% of doctors were ‘somewhat confident’, whilst 25% were ‘not confident’ giving dietary fibre advice. The introduction of patient-friendly flyers increased patients’ ability to recognise high and low fibre food by 57.9%. A 72.7% increase in patient satisfaction with the dietary advise was recorded.

Conclusions
This project demonstrates poor patient knowledge of dietary fibre content, a lack of patient-friendly resources and low confidence amongst junior doctors in providing such dietary advise. A patient-friendly flyer significantly increased patient understanding and satisfaction and should be routinely provided to patients upon discharge post-bowel resection.
996 Mobilising Medical School UK University Surgical Societies (SurgSocs) Surgical Teaching in Advance of the UK GMC National Examination Medical Licensing Assessment (MLA)
Authors: Abulhawa Q , Vaghela M , Madume R , Khera G 
Published: August 2024

Abstract

Aim
With the imminent implementation of UK GMC MLA for medical school finals, engaging SurgSocs to design and deliver extra, out of hours, revision focused regional surgical teaching programme for years 3 and 4 medical students.

Method
Working closely in conjunction with two SurgSocs, online teaching was delivered by doctors in training and covered core surgical specialties with a revision focused theme, optimising upcoming examination preparations. In addition, also provided careers guidance and advice on training pathways for aspiring surgeons. Four 60–120-minute sessions were delivered regionally to students who were all members of their respective SurgSocs. An average session had 25-30 attendees.

Results
Online anonymous feedback survey with 14 questions was used to assess quality and content. 40% of attendees responded, of which 90% found the programme excellent and geared appropriately towards their teaching. The programme received high praise for the design of its interactive style of teaching, as well as providing flexibility through its delivery online. Interestingly, some students also noted the programme provided surgical teaching that they may have not had enough exposure to locally in their clinical placements otherwise. All students who provided feedback have expressed interest for sessions to resume next semester.

Conclusions
SurgSoc committee and Surgeons were able to design and deliver a revision themed regional surgical teaching programme. Ensuring high standards of regional teaching is essential within the framework of the new national MLA medical school exit examination. Future collaboration with more SurgSocs would embed this from a regional to national level.
1283 Non-Operative Management of Paediatric Orbital Fractures at a Major Trauma Centre in the UK: A 12-Year Review
Authors: Lopez J , Fan K 
Published: August 2024

Abstract

Aim
The aim of this project is to present an up-to-date review on paediatric orbital fracture presentations and outcomes that are managed non-operatively in a UK major trauma centre over a 12-year period.

Method
Data was collected retrospectively from patients aged 16 and under at the time of injury that sustained an orbital fracture and had been assessed by the Oral and Maxillofacial Surgery Department between 2010-2022 and was managed non-operatively.

Results
25 cases were identified. The median age of patients was 14 years old. 20% (n=5) of cases were female and 70% (n=23) male. The primary mechanism of injury was road traffic collisions occurring in 44% (n=11) of cases. Accidental injury occurred in 40% of cases (n=10). Alleged Assaults accounted for 16% (n=4) of cases. One case was a combined alleged assault and road traffic collision. 32% (n=8) of patients were also found to have an intra-cranial injury. 96% (n=24) of cases had the orbital fracture(s) confirmed on computed tomography imaging. 48% (n=12) of fractures involved the inferior orbital wall. 100% (n=25) of patients had no visual disturbances upon discharge.

Conclusions
Paediatric orbital fractures are rare and require timely assessment to ensure they can be managed appropriately. This study highlights the success of case selection for conservative management. surgical intervention is predominantly done on an urgent basis and clinicians must be acutely aware of cases that can be managed on an operative or non-operative basis. A nationwide review of operative and non-operative paediatric orbital fracture outcomes would aid in establishing guidelines for management.
1224 Signs & Symptoms Predictive of CSF Shunt Dysfunction in Children & Young People Presenting to ED
Authors: Aldabbagh Y , Riaz S , Wiffin R , Hollingworth M 
Published: August 2024

Abstract

Aim
To investigate signs and symptoms in children and young people (CYP), with cerebrospinal fluid (CSF) shunts, presenting to a CYP emergency department (ED) with onsite paediatric neurosurgical facilities; and assess their association with 30-day shunt revision rate.

Method
Retrospective analysis of CYP (&lt;17 years old) with CSF shunts presenting to the CYP ED. Univariate and multivariate analyses were performed to assess the relationship between patient characteristics, presenting signs and symptoms, and 30-day shunt revision rate.

Results
We analysed 107 presentations between 03/11/2021 and 25/10/2022. 42% of patients were female with a mean age of 5.64 years. The most common shunt aetiologies included tumour (30%) and intraventricular haemorrhage (30%). Vomiting (37%), reduced alertness (27%), and behaviour change (27%) were the most common symptoms. 13% of patients underwent shunt revision within 30 days of presentation. No individual sign or symptom was highly sensitive, with the most sensitive being headache (64%) and vomiting (64%). Univariate analysis demonstrated that ≥2 (two or more) previous shunt revisions, fever, pallor, headache, and surgical site swelling, were significantly more common in those who underwent shunt revision (p&lt;0.05). However, only headache and shunt site swelling were independently predictive using multivariate analysis (p&lt;0.05).

Conclusions
CYP with CSF shunts present with complex symptomatology. Number of shunt revisions, headache, and shunt site swelling were predictive of shunt revision at 30 days. Understanding and integrating key predictors of CSF shunt failure into the diagnostic pathway is essential for improving efficiency and minimising the impact on CYP and their families.
254 Establishing Equipoise: Does the Use of Acellular Dermal Matrices (ADM) in Women Undergoing Pre-Pectoral Implant-Based Breast Reconstruction Increase Operative Success Versus Non-Use of ADM in the Same Setting?
Authors: Cook H , Zargaran D , Glynou S P Panagiota , Zargaran A , Akhavani M , Williams N , Hamilton S , Mosahebi A 
Published: August 2024

Abstract

Aim
Breast cancer is the most common malignancy among females in the UK. Surgical management commonly comprises mastectomy and reconstruction, of which implant-based breast reconstruction (IBBR) are most prevalent. Acellular dermal matrices (ADM) are widely used in pre-pectoral implant-based breast reconstruction, however there is limited high-quality evidence supporting their efficacy. This study aims to establish equipoise via an expert consensus survey.

Method
An online survey was designed with a steering group of experts. Questions covered participant information, opinions regarding surgical outcomes with ADM use in pre-pectoral IBBR and opinions regarding available scientific evidence on the topic. The survey was advertised via national and international professional organisations. Quantitative and qualitative analyses were performed.

Results
Thirty-two participants from the UK, Italy and Australia completed the survey. Breast and plastic surgeons from consultant to registrar grade participated. Participants who believed that ADM reduced the risk of short-term complications and implant failure/explantation comprised a minority – 21.9%. Participants who felt that ADM use improved cosmetic outcomes and reduced long-term complications made up a relative majority – 34.4% and 40.6%, respectively. 56.3% of participants felt there was scarce scientific evidence on the topic.

Conclusions
This study provides international expert insight into the lack of consensus on surgical outcomes, efficacy and evidence-base supporting the use of ADMs in pre-pectoral IBBR. Given the growing burden of breast-cancer associated morbidity and the need for reconstruction, this study highlights the requirement for large-scale, prospective, randomised-controlled data to support decisions surrounding use of ADMs in pre-pectoral IBBR.
337 A Review of Autologous Stem Cell-Based Therapy as a Potential Treatment Option for Androgenetic Alopecia
Authors: Lim J S , Cui X , Wai J 
Published: August 2024

Abstract

Aim
Androgenetic alopecia (AGA) is a condition characterized by the gradual deterioration of hair follicles and apoptosis, affecting both males and females. It is the most common form of alopecia, with 80% prevalence in the Caucasian population. The etiology of AGA is multifactorial, involving androgens, genetics, and hormonal miniaturization. The primary androgen responsible is dihydrotestosterone (DHT), which activates pathogenic pathways and leads to the shortening of terminal follicles. Alopecia can disrupt patients' quality of life, causing psychological stress and financial burden. Current treatment modalities are limited, and a therapeutic option that addresses these limitations could be of great significance in plastic surgery in the next decade.

Method
A literature search is conducted across multiple databases: PubMed, Medline Ovid, and Embase. Studies are filtered, and eligible studies are included.

Results
Regenerative medicine would be a potential future intervention for AGA, such as autologous stem cell micrografting and Rigenera®. The bulge area is a crucial source of epidermal and melanocytic stem cells (SC). Rigenera® can extract and isolate these SCs, resulting in a significant 29% ± 5% increase in hair density after 6 months. Other multipotent SCs, such as adipose tissue, bone marrow, and human umbilical cord blood, may also be viable for hair regeneration. Potential benefits include fewer biopsies, a shorter treatment duration, and being unrestricted by the number of donor follicles compared to surgical intervention.

Conclusions
Autologous stem cell therapy shows promising efficacy and should be investigated further to improve the treatment efficacy of AGA.
571 Improving Information Resources and Access to Hand Trauma Patients
Authors: Marar M , Ramjeeawon A , Opel S , Curran T A , Senarath-Yapa K 
Published: August 2024

Abstract

Aim
Over 110 per 100,000 of the population sustain a hand injury every year. Tendon injuries in particular involve a strict rehab protocol with protection of the tendon repair in a splint. A poor understanding of the protocols and compliance with wearing splints can adversely impact the outcome. The variety of media platforms available offers a wealth of mediums for information delivery. The aim of this project was to establish how well we transfer information currently and which medium our patients prefer for information resources.

Method
A survey was conducted for 20 consecutive patients who underwent hand surgery regarding their understanding of pre-operative instructions, the operative procedure, aftercare, and whether they thought a resource to refer back to would have been useful.

Results
Of the patients surveyed, 6/20 patients were unclear of the splint protocol and duration of use. 19/20 expressed that they would value a patient information resource to refer to. With respect to the platform for information delivery, 7 patients preferred an online resource, 6 preferred paper leaflets and 6 expressed a partiality for an audio-visual resource.

Conclusions
This survey has highlighted the importance of patient information resources for hand trauma patients and that surgeons should provide this information via a variety of platforms to embrace both the traditional and evolving digitalized generations. Plans are underway for creating leaflets and videos for each of the following conditions: Tendon repair, fracture fixation, washout of infection, nailbed repair, digital nerve repair, and wound closure.
580 An Assessment of the Adequacy of Initial Photography of Open Lower Limb Injury Patients in the Emergency Department of a Major Trauma Centre
Authors: Roocroft H , O’Grady E , Wheble G 
Published: August 2024

Abstract

Aim
As per BAPRAS/BOAST guidelines, all open lower limb injury patients should have a photograph taken of their injury as part of their initial assessment in the ED. A good photograph helps to triage the injury and can aid with operative planning. These photographs are almost always taken by medical or nursing staff with no medical imaging training and as such quality can be variable. By assessing the adequacy of these initial photographs and determining which factors are impacting this, we hope to develop helpful guidance for non-medical image trained clinical staff.

Method
Open lower limb injury patients identified by review of 2 months of orthopaedic operating lists on Bluespier (1st July – 31st August 2023). Initial patient images reviewed on Careflow and assessed as Adequate or Inadequate. An image is judged as inadequate if (1) the position of wound cannot be determined or (2) the whole wound cannot be seen.

Results
Patients identified in timeframe – 34
Limb affected
Right - 23
Left - 10
Bilateral – 1
Could orientate
Yes - 28
No – 6
Could see whole wound
Yes - 25
No – 9
Adequate – 21 (61.8%)
Inadequate – 13 (38.2%)

Conclusions
Further education of ED staff is required to improve initial photography of open lower limb patients. The authors’ have designed a bespoke information poster to be placed in ED, explaining the importance of adequate photography on admission. Further research will determine if this could be an effective tool.
1032 Sentinel Lymph Node Biopsy for Malignant Melanoma: An Audit Assessing Departmental Compliance with National Guidelines
Authors: Dummer L , Hinchcliffe Z , Wigley C , Hamad M , Unsure Z , Hobday D , Esmaeili A , Al Omran Y , Hamilton S 
Published: August 2024

Abstract

Aim
To investigate and improve local departmental compliance with the current NICE Guidelines (2022) on sentinel lymph node biopsy (SLNB) for malignant melanoma (MM).

Method
Two consecutive audit cycles of all patients undergoing SLNB for MM: Cycle A (1st June-22nd August 2023) and Cycle B (1st September–31st November 2023). Data collected from electronic records (Pathpoint/Cerner), including demographics; T-stage; Breslow Thickness; lymphovascular invasion (LVI); mitotic index; ulceration; intraoperative SNLB assessment and sentinel lymph node positivity. Results of Cycle A were delivered to the department prior to Cycle B. Exclusion criteria: SLNB not for MM (e.g., breast cancer), nodal clearance.

Results
Cycle A: 35 patients included: 20 Females + 15 Males, aged 33–80 years (Mean 62.26 years).
Cycle B: 42 patients included: 15 Females + 27 Males, aged 25–88 years (Mean 60.0 years).
Cycle B summary:
3/42 (7.1%) – no clear indication for SLNB (8.6% Cycle A)
0/42 (0%) - no T stage documented (0% Cycle A)
0/42 (0%) - no Breslow Thickness documented (2.9% Cycle A)
4/42 (9.5%) - no LVI documented (14.3% Cycle A)
4/42 (9.5%) - no mitotic index documented (14.3% Cycle A).

Conclusions
Our department demonstrated successful compliance with NICE guidelines on SLNB for melanoma at 92.6% in Cycle B (91.4% in Cycle A). Documentation of preoperative staging, Breslow Thickness and intraoperative narrative was also satisfactory at 100% for both cycles. Further work is required to ensure histology findings (Ulceration, Mitotic Index & LVI) and node appearance is accurately documented.
321 Improvement of Nasal Spray Technique in Patients in an ENT Outpatient Clinic: A Quality Improvement Project
Authors: Aziz S 
Published: August 2024

Abstract

Background
anagement of allergic rhinitis involves administration of intranasal corticosteroid sprays and efficacy relies on correct technique. Treatment failures result in poor disease control, non-compliance, increased ENT appointments and unnecessary surgeries. The correct technique involves applying the spray to the turbinates (side wall), to reduce inflammation that leads to obstructive symptoms.

Aim
To improve Nasal spray technique amongst patients in an ENT outpatient clinic, using a patient education tool.

Method
PDSA 1: Designed a survey to assess current technique and identify areas for improvement. PDSA 2: First cycle identified 4 key steps for improvement. A leaflet was designed highlighting these steps and handed out to patients who were prescribed the spray. Patients were called 2 weeks later to assess technique. PDSA 3: Leaflet and teach-back method was used to demonstrate correct technique and patients were called back in 2 weeks.

Results
PDSA 1: Only 2% (1/53) of patients used spray correctly and 86.8% of patients administered the spray in the centre of the nose. PDSA 2: 60% (7/11) of patients used spray correctly. PDSA 3- 100% (6/6) of patients used correct technique. Aim of spray to the side of nose was only 5.7% in PDSA 1 which increased to 100% in PDSA 3.

Conclusions
This QIP identified poor nasal spray technique amongst 98% of ENT patients, which may cause treatment failure. Introducing simple and cost-effective interventions, increased the number of people using the spray correctly. These interventions could easily be implemented in ENT and GP clinics, to improve technique reducing repeat appointments and unnecessary referrals.
534 A Retrospective Evaluation of Non-Clinical Limitations to Day Case Urology at a District General Hospital
Authors: McGurk S , Wilson G 
Published: August 2024

Abstract

Aim
This service evaluation aimed to define the rate of &gt;24 hour stay, following planned day case urological procedures, within the setting of our district general hospital main theatres. Of particular interest was the non-clinical reasons patients were admitted for longer than expected.

Method
Retrospective review of theatre schedule and eCare documentation, during January and February 2023. Excluding TURP and Nephrectomy, all other cases were included as potentially day case. Patients with a clinical reason to remain in hospital were not analysed further. All other patients remaining in hospital longer than 24 hours were investigated.

Results
Out of a total of 87 patients, 44 remained in hospital overnight. 19 patients had a clinical reason to remain. Other non-clinical reasons to stay included social circumstances (7), trial without catheter (TWOC) issues (3), patient preference (1). Inadequate documentation limited analysis in 13 patients.

Conclusions
Half of the patients attending for day case procedures in the main theatre were still in hospital at &gt;24 hours. This limits the bed availability for the following morning’s operating, potentially leading to delays, cancellations, and poor patient satisfaction. The majority of these were for non-clinical reasons. Suggested improvements ahead of re-audit include educational sessions with ward nurses to empower nurse-led discharge into the evening, alongside a standardised procedure-specific discharge criteria; highlighting of anticipated day cases to bed managers early; avoidance of TWOC on day of procedure; and updating of patient information leaflets to highlight the expectation of same-day discharge.
537 Optimising Analgesia and Improving Outcomes of Rib Fracture Patients at a Large District General Hospital
Authors: Vasanthakumar S , Park J , Abbotts K , Shaw A 
Published: August 2024

Abstract

Aim
Our aim was to improve outcomes of rib fracture patients at Croydon University Hospital.

Method
We collected retrospective data on rib fracture patients at Croydon University Hospital. Main factors analysed included pre-admission risk factors, number of rib fractures, presence of rib fracture/pain scoring, analgesia, chest physiotherapy/pain team input, complications, and discharge outcomes. New guidelines were developed and circulated, and the project was presented at the surgical/anaesthetic governance meeting. The second cycle assessed the impact of intervention.

Results
In cycle 1, 35 patients were reviewed. Analgesia prescribing was inadequate and only 28% of patients received physiotherapy/pain team input. Rib fracture scoring on admission was performed on one patient and no dynamic pain scoring was documented. Following intervention, 10 patients were reviewed. 30% of patients had their STUMBL (STUdy of the Management of BLunt chest wall trauma) score assessed on admission, and 20% had dynamic pain scoring documented. Paracetamol and codeine remained the most prescribed analgesia, with prescribing rates relatively unchanged. Regular morphine prescribing improved significantly (17% to 60%). Physiotherapy and pain team input increased by 21% and 41% respectively. Average number of rib fractures was 1.5x greater and an increase in hospital-acquired pneumonia was noted (17% to 50%). Average length of stay remained 5 days.

Conclusions
Improvements following intervention include STUMBL scoring, morphine prescribing, and increased physiotherapy and pain team input. However, respiratory complications increased, and length of admission remained unchanged. Further work is needed to improve pain control, including discussions with anaesthetics to increase availability of regional blocks.