bluuebunny/crossref_metadata_2025_split huggingface dataset:
3 To Evaluate Lower Threshold of Polyp Size for Tattooing Routinely, A Single Trust Observational Study
Authors: Riad M , Moosvi R , Joshi S , Iordanov I , Gupta S , Cara B , Henrika B E 
Published: August 2024

Abstract

Aim
The goal of the study is to establish the lowest polyp size for clinically effective tattooing routinely.

Method
Retrospective data collection of colonoscopy and flexible sigmoidoscopy for bowel screening and non-bowel screening patients; 450 patients underwent polypectomy of &lt;20mm from September 2021 to September 2022 in MTW NHS Trust. We excluded 20+ mm polyps, known FAP, lynch syndrome and other genetic predisposed colorectal polyps. Histology was obtained from electronic patient records (Allscripts). SPSS version 25.0 was used for the statistical analysis, which also included ROC curve analysis and Chi-Square test.

Results
A total of 450 participants, 288 males (64.0%) and 162 females (36.0%), were enrolled. Polyp sizes: 0-9mm (42.2%) and 10-19mm (57.8%). 8.0% were tattooed. Polyps found in right- hemicolon, transverse, left-hemicolon, sigmoid and rectum accordingly 29.78%, 20.5%, 9.1%, 28.4% and 12.22%. Pedunculated polyps were found in 143 individuals (31.8%), while sessile polyps were observed in 256 individuals (56.9%). Furthermore, in histological analysis, 251 individuals (55.8%) exhibited tubular adenomas and the majority of the cohort (77.6%) presented with low-grade dysplasia. Malignant invasion was detected in 27 subjects (6%). Receiver operating system (ROC) curve analysis indicated that polyp size was a predictive factor for malignancy development, with a cut-off lower point identified at 8.5 mm.

Conclusions
The findings confirm the advice to tattoo polyps bigger than 8.5mm to make tracing and follow- up easier.
181 An Analytical Study: Adult Negative Appendicectomy Rate in Barnsley District General Hospital
Authors: Hussain A , Zeid A , Shiwani M , Ghosh S 
Published: August 2024

Abstract

Background
Patients presenting with right iliac fossa (RIF) pain are common in acute surgical takes; a key differential being acute appendicitis. NA (negative appendicectomy) is defined as histologically confirmed normal, congested, or cancerous appendix. In the United Kingdom, the NA rate (NAR) is more than 20%. Increased NAR leads to increased complications and financial burdens on the National Health Service.

Aim
The objectives of this study were to determine the histopathology proven NAR in Barnsley District General Hospital (BDGH) and assess whether this is in line with the national percentage.

Methodology
Our methodology was based on the RIF treatment (RIFT) audit. This closed-loop retrospective study includes all 155 adult patients attending BDGH, who underwent an appendicectomy between April 2021 and April 2022. The exclusion criteria: previous appendicectomy, right hemicolectomy or colectomy. The results were presented in the BDGH multi-disciplinary team meeting.

Results
17% of patients had a NA. Of which, 54% of patients had a normal appendix, and 19% showed signs of malignancy. 8 patients had pre-operative scans showing appendicitis but were negative on histopathology. Of which, 7 were an ultrasound scan (USS), and 1 was a Computed Tomography (CT) scan.

Conclusions
The NAR improved significantly since the previous cycle, due to changes in practice. BDGH now has low NAR, in line with national rates. Pre-operative CT scans are more sensitive than USS. To further improve, Adult Appendicitis Score [4] will be added to the surgical clerking proforma, and we will re-audit this in a prospective study.
204 Improving the Efficiency and Accuracy of Surgical Procedure Consent Documentation Through Pre-Printed Forms
Authors: Alqasem M 
Published: August 2024

Abstract

Aim
To improve the efficiency of the process of recording the possible consequences of surgical procedures by replacing the standard way of handwriting with pre-printed forms.

Method
The British Association of Urological Surgeons (BAUS) has published the associated risks with each urological procedure. Some are self-limiting or reversible, but others are not. The impact of these risks can vary a lot from patient to patient, However, it is always necessary to mention all these risks in the consent form. For the first cycle, a sample of 50 patient’s consent forms were reviewed randomly and retrospectively from October 2022 to March 2023 in 5 urological procedures (TURP, TURBT, Ureteroscopy, Circumcision and testicular torsion repair). For the second cycle, 50 patients were collected retrospectively for the period of July 2023 - November 2023.

Results
The first cycle showed that 55.5% of the risks which are associated with the procedures were missed. After using the forms, the percentage dramatically decreased to 16.7%.

Conclusions
Our documentation unfortunately showed deviation from the standard practice. By using the pre-printed consenting forms, we showed significant improvement, as the missed risks for the second cycle is only 16.7%, and we aim to make it 0% during the third cycle. The pre-printed consent forms are easy and quick way to consent patient pre-op and this should be the standard practice for all the departments to ensure al the possible consequences are discussed with the patients and thus to optimise patient care.
341 Improving Plastic Surgery Inpatient Referrals at a Major Trauma Centre: A Closed Loop Audit
Authors: Neves S , Lacey H , Bernard K , Kim B , Millard N , Bayley A , King A 
Published: August 2024

Abstract

Aim
Online plastic surgery referrals at the Royal Sussex County Hospital are often incomplete or inappropriate. Establishing reasons for rejection and streamlining referrals will reduce inappropriate referrals and time to assessment and management.

Method
Referrals between July 2020 and February 2023 were audited, and data used to create a new referral form. Changes included a prerequisite referral checklist, wound assessment section and required clinical photography. Prospective audit was performed over 3 months.

Results
1038 referrals were reviewed including 147 rejected referrals (14.2%). The most common reason for rejection was inappropriate referrals (63%), including 31% not requiring surgical intervention and 32% having been referred to the wrong specialty. 41.5% were submitted without clinical photography. Other rejection reasons included patients declining intervention (8.8%), incomplete referrals (7.5%) or duplicates (7.5%). Commonly omitted sections included results (70%), allergies (65%) and medication (16%). Prospective audit after referral form amendments involved 168 new referrals, with 37 rejected (22.0%). The most common reason for rejection remained inappropriate referrals (70.3%, p=0.64). 19% of forms were submitted without clinical photography (p=0.37), despite required confirmation of available photographs. Other rejection reasons included patient declining intervention (10.8%, p=0.09), incomplete referrals (5.4% p=0.07) and duplicates (5.4%, p=0.07).

Conclusions
Streamlining the referral form reduced incomplete referrals and the number submitted without clinical photography. A prerequisite checklist reduced inappropriate referrals. The new wound assessment section facilitated advice to be given to referrers, diverting patients for local management. The modified referral form will ensure continued improvement in efficiency of the inpatient plastic surgery service.
342 Enhanced Trauma Team Activations Reduces Elderly Major Trauma Patients’ Length of Stay by 17.7% (3 Days): A Multi-Centre 8-Year Pre and Post Intervention Study in Trauma Units
Authors: Karamchandani U , Davies J , Varma S , Batrick N 
Published: August 2024

Abstract

Aim
Despite high injury severity scores (ISS), elderly major trauma patients are often not recognised expediently. Previous audit of North West London Major Trauma Network’s (NWL-MTN) TARN data (2015-2017) evidenced lower rates of trauma team activation (TTA) in Trauma Units (TUs) when comparing ISS &gt;15 cohorts. This correlated with outcomes, as TTA patients were assessed earlier, with timelier CT-scans and reduced lengths of stay (LOS). Re-audit evaluated TTA performance after interventions enhancing practice including modified TTA tools, educational initiatives, &gt;40% TTA targets and annual peer reviews, sustained from 2018 onwards.

Method
Retrospective analysis of six TUs from 2018-2022 was conducted. Adult patients ISS 15-45 were included. Annual TTA rates were compared between ‘elderly’ (65+) and ‘non-elderly’ (18-64) cohorts. Mann-Whitney-U tests explored differences in arrival to CT-times and LOS. (Significance at p&lt;0.05).

Results
Re-audit identified 2197 elderly patients (mean-ISS 21); 987 non-elderly patients (mean-ISS 22).
Trauma Team Activation rates
Elderly:2015-2017: 12% (pre-intervention)2018: 18%2019: 23%2020: 34%2021: 34%2022: 30%
Non-elderly:2015-2017: 31% (pre-intervention)2018: 35%2019: 36%2020: 46%2021: 37%2022: 40%
Elderly outcomes
Assessment ≤5mins from arrival by ST3+:2015-2017: TTA: 60.6%; No-TTA: 11.0%2020-2022: TTA: 50.9%; No-TTA: 22.3%
Mean CT-times (p&lt;0.001):2015-2017: TTA: 09.5hr; No-TTA: 20.1hr2020-2022: TTA: 04.3hr; No-TTA: 08.5hr
Mean LOS days (p&lt;0.001):2015-2017: TTA: 13.2; No-TTA: 16.8. Total: 16.42020-2022: TTA: 12.3; No-TTA: 14.1. Total: 13.5

Conclusions
Interventions have been effective with elderly TTA rates almost trebling since 2017. Earlier assessment, investigations and clinical management correlate directly with a 17.7% (3 Day) reduction in LOS.
489 Management of ACL Injuries and the Impact of the Coronavirus Pandemic: A Regional Audit
Authors: Nadeem U , Nowicka M , Freudmann M 
Published: August 2024

Abstract

Aim
15,000 anterior cruciate ligament (ACL) reconstructions are performed annually in the United Kingdom. The aim of this audit was to compare local management of ACL injury at the University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT) to current British Orthopaedic Association Standards for Trauma (BOAST) guidelines. A secondary aim was to understand the effect of the COVID-19 pandemic on the management of ACL reconstruction.

Method
The audit was registered with the local audit department. Lists of patients with ACL reconstructions were obtained across two time periods and data was extracted from the electronic patient record software and PACS. The pre-covid period, was defined between 1st of July 2018 and the 1st of July 2019. The post-covid period was defined between 1st of July 2021 and 1st of July 2022. Microsoft Excel software was used for analysis.

Results
Sixty cases were identified, with a mean age of 28. 37 patients were from the pre-covid period, and 23 patients from the post-covid period. 82% of patients underwent a timely clinic assessment following initial presentation, in accordance with guidelines. 37% of cases had an MRI scan completed within 14 days. 38% of cases were referred for prehabilitation. The average time to surgery was 230.5 days in the pre-covid period, increasing to 353.9 days in the post-covid period. 84% of patients had post-operative physiotherapy.

Conclusions
The results demonstrate poor compliance with current guidance. The COVID-19 pandemic had a significant impact on average time to surgery. An improved multidisciplinary approach is required to improve functional outcomes.
510 Mechanical VTE Prophylaxis in Patients Undergoing Abdominal Surgery
Authors: Sotirakis D 
Published: August 2024

Abstract

Aim
VTE prophylaxis is widely recognized as an essential component to reduce venous thromboembolism. Patients undergoing abdominal surgery have increased risk of VTE. NICE guidelines [NG89] suggest starting mechanical VTE prophylaxis on admission. The purpose of this clinical audit was to assess if mechanical VTE prophylaxis is prescribed to all patients undergoing abdominal surgery on admission and investigate if the prescribed mechanical VTE prophylaxis is implemented.

Method
Two audit cycles were completed. Concurrent study of the data of the first 30 patients undergone abdominal surgery after 03/10/2023 (1st cycle) and 30 patients after 20/11/2023 (2nd cycle) were analysed. Patients having contraindications for mechanical VTE prophylaxis were excluded. Data were collected by reviewing patients’ drug charts and inspecting in person if mechanical VTE prophylaxis was implemented. An action plan between the two cycles was suggested.

Results
Reviewing the drug charts, TEDS were prescribed to all patients included in the cohort (100%) in both cycles. At the first cycle of the audit of the total audit cohort, compliance with NG89 NICE Guidelines (implementation of mechanical VTE prophylaxis) was 77%. The rest 23% of the cohort either were not given TEDstockings or found them unnecessary. At the second cycle of the audit, there was an improvement and the number of patients wearing TEDstockings was increased.

Conclusions
The implementation of mechanical VTE prophylaxis as per NICE guidelines was poorly adhered to at the beginning of this investigation but it was improved after the action plan was implemented.
530 Repatriation of Care for Ambulatory Orthopaedic Trauma Patients Audit
Authors: Barter R , Morgan C , Wilkes I , Matthews E , Sinha I 
Published: August 2024

Abstract

Aim
The safe repatriation of care for non-local ambulatory orthopaedic trauma patients to their local trust is vital. Poor documentation and communication between trusts leads to delayed treatment and poor outcomes. Thorough documentation is required to prove that a satisfactory referral has been made. This audit, with two-closed loop cycles, aimed to improve the repatriation process.

Method
At a London MTC, electronic patient records were reviewed over a one-month period, examining 6 areas to assess referral quality to local trusts (initial data collection, n=17). Interventions were implemented, followed by a re-audit over a further one-month period (n=25), which was then repeated (n=18) after secondary interventions.
Initial interventions consisted of the development of new departmental guidelines (referral pathway, electronic repatriation letter template, patient information e-leaflet). Secondary interventions consisted of educational posters and a doctor tutorial. Audit standards: BOAST Fracture Clinic Services and trust recommendations.

Results
Documentation of: Named local trust in clerking, 65% to 96% to 89%; Evidence of phone referral, 94% to 96% to 100%; SHO/registrar’s name taking referral, 24% to 88% to 94%; Local trust Consultant on-call’s name, 6% to 48% to 83%; Repatriation letter sent to local trust, 0%* to 92% to 94%. Uploading of the repatriation letter to electronic record, 0%* to 40% to 89% (*letter only introduced during initial interventions).

Conclusions
Improvements have been made in all areas, increasing the quality and accountability in referrals to local trusts. We recommend the introduction of formal referral pathways for non-local ambulatory orthopaedic trauma patients to prevent miscommunication and treatment delays.
730 Current Management of Acute Lower Gastrointestinal Bleeding: Experience from a District General Hospital
Authors: Shahdoost-Rad A , Scout E , Foster J 
Published: August 2024

Abstract

Aim
To evaluate current practice at a District General Hospital for the management of patients with lower gastrointestinal bleed (LGIB) in the context of the 2019 British Society of Gastroenterology (BSG) guidelines.

Method
Consecutive patients presenting with acute LGIB over an 8-month period in 2022 were identified from a prospectively-maintained repository. Exclusion criteria included upper gastrointestinal bleeds, ambulatory patients and LGIB whilst already inpatients. A retrospective case note review was conducted using hospital IT systems and patient notes. Patients were categorised as “major” or “minor” bleeds, as per the BSG treatment algorithm. Data was extracted on demographics, investigation, and management of LGIB and compared with the guideline recommendations.

Results
48 patients were included in this study: 25 males and 23 females. Median age was 75 years (range 34-98). 42 patients had a major bleed, of which 17 underwent flexible sigmoidoscopy (40%), three performed as an inpatient. Eight patients underwent colonoscopy (19%), with one performed as an inpatient. Of seven patients who received blood products, five were in line with recommended blood transfusion triggers (71%). Of 14 patients admitted on either warfarin or a direct oral anticoagulant, 12 were appropriately suspended on admission (85%).

Conclusions
We demonstrate adherence to a number of the recommendations of the BSG guidelines for LGIB. At our unit there was a preference for outpatient sigmoidoscopy for stable patients rather than inpatient colonoscopy as recommended in the guideline. This may reflect a weak level of evidence in support of this recommendation.
777 Local Audit Based on MAGIC Study to Improve Abscess Management at Royal Devon University Healthcare Trust
Authors: Shams O , Alexiadis A , Khirfan H , Ragatha R 
Published: August 2024

Abstract

Aim
To assess efficacy of current management approaches of subcutaneous abscess at the Royal Devon University Healthcare Trust (RD&E).

Method
Our audit is based on the MAGIC (Management of Acute surGIcal absCesses) national audit which involved anonymous retrospective analysis of patient records at the RD&E during September – December 2022. We collected data on patient demographics, clinical characteristics, and their management. Furthermore, we conducted a literature review to compare our results to the recommended practice.

Results
31 patients records were analysed whereby 22 underwent surgical intervention (general anesthetic 17, local anesthetic 5) whereby the most common incision type was transverse (n=7). Nine patients were diabetic, two were immunosuppressed, 29 had hidradenitis suppurativa, while 19 had a past medical history of abscesses (n=31). The most common abscess type was pilonidal sinus (n=10). Eighteen patients received antibiotics prior to hospital admission, 12 of whom underwent surgery. Furthermore, 19 patients received antibiotics upon admission to hospital (n=31). Of the surgically treated cohort, 19 underwent packing and six were discharged with antibiotics.

Conclusions
Most subcutaneous abscess are approached surgically. However, postoperative care varies widely, with prolonged packing and frequent use of antibiotic postoperatively. Literature reviews have suggested no benefit of postoperative packing and specified certain circumstances of antibiotic use. Furthermore, clear communication with primary care providers detailing clear postoperative instructions is vital for patient safety and cost effectiveness.
1056 Audit of Compliance with Local Guidelines on Opioid and Laxative Co-Prescribing in General Surgery Patients at the Queen Elizabeth Hospital Birmingham
Authors: Zhan R , Dobrzycka M , Loyala J V , Elserafy A , Tan B 
Published: August 2024

Abstract

Aim
Constipation is a well-known side-effect of opioids, which are often prescribed in post-operative patients already at risk of ileus. Opioid associated constipation can further affect postoperative recovery and delay discharge. University Hospitals Birmingham guidelines suggest patients prescribed regular or as-required opioids for &gt;1 day should be co-prescribed both stimulant and softener laxatives. This audit aims to assess compliance with these guidelines in the General Surgery department at the Queen Elizabeth Hospital Birmingham.

Method
Inpatients under the upper gastrointestinal, sarcoma, and colorectal teams on a single date were identified and included. Retrospective review of drug charts was undertaken to identify patients prescribed opioids for &gt;1 day and those co-prescribed laxatives. Stool charts were reviewed to assess bowel opening and Bristol stool charting.

Results
87% (n=35) out of 40 patients were prescribed opioids. 34% (n=12) of these patients were co-prescribed laxatives; only 17% (n=6) were co-prescribed laxatives with both stimulant and softener action. Bowel motions were charted for 74% (n=26) of patients prescribed opioids.

Conclusions
Compliance with local guidelines on co-prescribing of laxatives with opioids is below expected. Accurate documentation of bowel motions and Bristol stool charting is important in guiding on laxative indication and prescription to prevent opioid associated constipation. Results of this audit will be shared with the department and education provided. Nursing staff will be encouraged to complete bowel charting in patients prescribed opioids. A re-audit will be undertaken after these measures are implemented.
1083 Assessment of Antibiotic Prescribing Compliance: Are We Adhering to NICE Guidelines for Recording Stop/Review Dates in Surgical Wards- A Closed Loop Audit
Authors: Noor M , Szentpali A , Anyanechi E M , Ghosh A , Richardson J 
Published: August 2024

Abstract

Aim
We've noticed instances where general surgical patients received antibiotics without a recorded stop/ review date in electronic prescribing system, potentially exceeding the recommended duration resulting in neutropenic sepsis in one instance . We aim to ensure compliance with NICE antibiotic prescribing guidelines by reviewing our practices and making necessary improvements for better patient care.

Method
Initial retrospective data analysis involved 50 inpatients receiving antibiotics in the surgical ward. For the subsequent re-audit, we implemented interventions and performed a prospective analysis on data from 40 patients over a two-week period in the same ward.

Results
Initial Audit Findings: Only 56% of patients had a recorded stop/review date for antibiotics. Discussions with junior doctors highlighted several reasons:
Lack of Awareness of the NICE guideline of antibiotics stewardship.
Patient Transfers: Patients moving between teams resulted in existing prescriptions without updated reviews.
Paper Documentation: Decisions about antibiotics were documented in paper notes, not reflected on electronic prescribing system.
Based on these findings, we implemented the following interventions: informal discussions and an email to junior doctors highlighting the findings and relevant NICE guidelines, along with placing physical posters in doctors' stations for easy reference. In the re-audit, 61.1% of patients had recorded stop/review dates, indicating more than 10% improvement.

Conclusions
Following discussions with prescribers post re-audit, our plan involves engaging with the electronic prescribing system. We propose adding an option to input review dates and making it mandatory to include stop/ review date when prescribing antibiotics to ensure sustained adherence to NICE guideline.