bluuebunny/crossref_metadata_2025_split huggingface dataset:
718 An Audit of Chaperone Documentation in the Breast Clinic
Authors: Singh P , Marchitelli G , Geropoulos G , Elder K 
Published: August 2024

Abstract

Aim
The General Medical Council and the governing trust (NHS Lothian) for our local hospital provide clear guidance on the role of chaperones within the breast clinic; specifically for all intimate examinations, a chaperone should be offered regardless of the genders of practitioner and patient, and the patient’s response to this should be documented. This entitlement to a chaperone is important in protecting staff and patients. This two-cycle audit reviews the documentation of chaperones in the breast clinic at a single centre, and whether consent to intimate examination is documented.

Method
Documentation was assessed for all adults attending low-risk or new patient clinic in both cycles (from 04-10/07/23, then 13-16/11/23), reviewing the staff grade assessing the patient, whether consent was recorded, and whether a chaperone had been accepted, refused, or not documented. The second cycle was conducted after putting up posters to remind medics to document and remind nursing staff to check this data.

Results
Junior doctor documentation of offering a chaperone increased by 43.7%, although consultant and ANP documentation decreased, by 20% and 34% respectively. When accepted, the chaperone’s name is recorded in all cases, and their grade in 3% more cases following our intervention.

Conclusions
Following intervention to target the lack of documentation in clinic notes, a significant positive change has been affected in junior doctors’ records. This change has however not been seen among consultants and ANPs, highlighting the ongoing need to improve documentation standards, to keep in line with national and local guidelines, and to protect our staff and patients.
752 VTE Prophylaxis and VTE Assessment Form in Plastic Surgery: A Closed-Loop Audit
Authors: Dhannoon A , Teklay S , Caddick J , Richards H 
Published: August 2024

Abstract

Aim
Failure to conduct a risk assessment and administer suitable venous thromboprophylaxis in surgical patients is deemed as negligence. It was estimated that 25,000 deaths in the UK was due to VTE in 2004-2005. Seventy percentage of hospital acquired VTE is potentially preventable with appropriate VTE prophylaxis. The Trust published a form for risk assessment for VTE for surgical patient. Our aim was to examine the departments adherence to the trust guidelines.

Method
All plastic surgery inpatients with a stay longer than 24 h were reviewed for VTE prophylaxis prescription for a period of two weeks. This was followed by presenting the audit results in a departmental meeting and introducing a checkbox to the handover list with posters placed in the doctors’ office. VTE assessment forms were placed in a clear divider and attached to the poster to remind doctors. Two weeks later, a re-audit was undertaken.

Results
In first audit, 22 patients were eligible for VTE prophylaxis compared to 24 in the re-audit. VTE chemoprophylaxis prescribing improved after intervention from 69.5% to 95%. Mechanical prophylaxis increased by 15.8%. Most importantly, the use of the VTE risk assessment form improved from 0 to 70%. Inappropriate chemoprophylaxis prescription reduced from 18.8% to 8%.

Conclusions
Despite the improvement in results after educating doctors and introducing the checkbox, our goal to be 100% compliant has not yet been met. Given the nature of the rapid turnover of junior doctors, a more robust system incorporating VTE assessment in the electronic system and replacing the paper form is required.
783 Routine Pre-Operative Group and Save Testing: Is It Necessary for Laparoscopic Appendicectomy?
Authors: Obayi E , Itaman U , Ibrahim B , Barghash M , Johnson A , Alkurdi Y , Mansour M 
Published: August 2024

Abstract

Aim
Pre-surgical group and save tests are routine but can result in unnecessary expense and theatre delays. The aim of this study is to examine the necessity of group and save testing prior to appendicectomy and evaluate the cost implications.

Method
This retrospective study analysed the records of 200 patients with appendicitis who underwent emergency appendicectomies in a busy general surgery department between March 2021 to August 2022. The study adhered to local clinical governance unit protocol. Patients who had elective appendicectomies or other emergency procedures were excluded. Data was collected on age, gender, number of samples, and requirement for peri-operative transfusion. Comparisons were drawn between patients who underwent laparoscopic, open, or converted emergency appendicectomies.

Results
Of the sample population, (median age 32, 55.5% male), 93.5% had valid pre-operative group and save tests. None required peri-operative blood transfusions. 26% of the patients only required one sample for a valid group and save due to having previous samples in the lab. 55% required two samples. 7% needed a third sample because one initial sample was rejected and 5.5% required 4 samples because the initial 2 samples were rejected. The total cost of these samples was estimated to be £3500.14.

Conclusions
Emergency appendicectomy poses minimal risk of resulting in the need for blood transfusions. Re-evaluating the need for routine pre-operative group and save testing and adopting a risk-benefit analysis approach could have a financial benefit for the NHS.
808 Whose Problem Is the Lower Gastrointestinal Bleed? a Surgical or Medical Admission. - Exploring the Management and Diagnosis of Patients Admitted with a Lower Gastrointestinal Bleeds in a District General Hospital (DGH)
Authors: Davies B L J , Ransome M , Mahapatra R , Mistry P 
Published: August 2024

Abstract

Aim
Lower Gastrointestinal bleeds (LGIB) are a common presentation, with a 10% 1-year prevalence in the UK. The 2015 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report highlighted a deficiency into the care of this patient group. With subsequent guidelines from The British Society of Gastroenterology (BSG) calling for a multi-disciplinary approach to care. Nevertheless, the admitting speciality for LGIB is an area of contention and differs across trusts.

Method
A Retrospective Audit was carried out in a local DGH, exploring the management and diagnosis of LGIB. Clinical practice was compared to BSG standards, admissions under the medical teams and surgical teams explored and comparisons made.

Results
Over a four-month period; the data of 160 patients was collected. Patients presenting as outpatients, with upper gastrointestinal bleeds and with other primary complaints were excluded from the study, leaving 33 patients for analysis.

Conclusions
74% of these patients were admitted under the medical team, with 17% of these needing an inpatient colonoscopy, all performed by Gastroenterologists. Of the 26% admitted under the surgical team, all had outpatient investigations booked, but none required inpatient scopes or surgical management. Despite preconceived ideas, most patients within this study were admitted under medical teams with little surgical input. An MDT approach to this cohort of patients is integral to care, however, consistency and clear pathways are needed to ensure ‘gold-standard’ care. The next steps of this project have included reviewing trust guidelines, discussions between medical and surgical teams alike, and further education.
935 Nil by Mouth in GI Surgery: Are We Starving Our Patients Longer Than We Need To?
Authors: Hern D , Van Zyl M , Rao V 
Published: August 2024

Abstract

Aim
Fluid intake preoperatively reduces postoperative nausea, vomiting and headache, and oral intake allows the patient to be metabolically active to respond better to surgery. However, a known risk to oral intake preoperatively is aspiration. Current guidelines state that a patient should be fasted from 6 hours preoperatively and should take clear fluids up to 2 hours preoperatively. We assessed how long GI patients admitted to the Surgical Assessment Unit (SAU) remained nil by mouth (NBM).

Method
Data was collected throughout November from SAU. Inclusion criteria was GI surgical patients and exclusion criteria was patients on home leave. We used electronic and paper notes to determine how long patients were kept NBM and their surgical outcome. We assumed that a patient was kept NBM from their admission (as per local protocol), until either noted to no longer be NBM, having surgery or being discharged.

Results
50 patients were identified. We found that only 20% of patients kept nil by mouth went on to have surgery. Of the remaining 80%, 60% were kept nil by mouth for &gt;6 hours, with no surgical procedures.

Conclusions
Many patients are kept NBM unnecessarily. We need to reduce this as well as the time patients are starved. Furthermore, clearer documentation is needed for commencing patients NBM, and when they can resume eating. We can move away from the culture of prolonged fasting in surgical patients by improving organisation and planning as well as increasing education on preoperative fasting.
943 Audit of Endoscopy Service Safety in District General Hospital Rated ‘Inadequate’ by the CQC
Authors: Crawford A , Carter-Tai Z , Connor E 
Published: August 2024

Abstract

Aim
In June 2021 the overall CQC rating of Weston General Hospital (WGH) was ‘inadequate’. A wave of changes including a merger of trusts between Bristol and Weston-Super-Mare has aimed at improving services across the board. The endoscopy service at WGH offers inpatient and outpatient investigations to thousands of patients every year. We aimed to evaluate the safety of the service offered over a 12-month period, using measures set out by the Joint Advisory Group on GI endoscopy and other published statistics.

Method
A retrospective review of periendoscopic complications in OGD, ERCP, flexible sigmoidoscopy and colonoscopy leading to re-admission within eight days of procedure or death within thirty days of procedure. Each case was analysed, using paper and digital case notes, for clinical course, outcomes and learning points.

Results
There were a total of 3428 cases between June 2021 and May 2022. There was an overall readmission rate within eight days of 0.002% (1 ERCP, 1 OGD, 4 colonoscopy). There was a mortality rate of 0.0003% (1 case of post-ERCP pancreatitis). A review of cases showed all complications were recognised complications of the given procedure and treated appropriately in a timely manner.

Conclusions
It was concluded that the endoscopy service at WGH was safe and viable. Numbers of readmissions and deaths related to endoscopy were similar to previous audits and well below the published rates of complications in literature.
1168 Documentation During Upper Gastrointestinal Surgery Admission Audit
Authors: Chaudhry A , Chaudhry D , Ghassemi N 
Published: August 2024

Abstract

Aim
Admissions in surgery is one of the most important part of the patient care pathway and sets the trajectory for the rest of their stay. Without good documentation, the decisions made can be missed out and this will eventually lead to deficiency in the patient’s management. In this audit we aim to analyse documentation during admissions and look at ways to improve them.

Method
A retrospective review of documentation done during the admission for 50 random admissions in upper gastrointestinal surgery was assessed using the principles from Take Ten and the Shine Toolkit. Change implemented before second audit cycle: lecture at induction on how surgical assessment unit works, how admission and post-take ward round work, how to document & clarifications of job roles. The percentage of documentation was determined and going to be presented in a local audit meeting.

Results
1st Audit Cycle vs 2nd Audit Cycle as percentage for documentation of History of Presenting Complaint (100%, 100%), NEWS (46%, 54%), Examination findings (96%, 94%), Diagnosis / Impression (94%, 94%), Advise to Patients (0%, 16%), Medication (42%, 54%) and Name of Clinician (60%, 72%).

Conclusions
The documentation during Surgical Admission improved in most areas and thus help lead to more safe and efficient patient care. However, there is still significant work that needs to be done. Further recommendations include implementing the Surgical Assessment for Emergencies (SAFE) Ward Round Tool, using electronic notes and availability of more computer on wheels.
1187 An Audit Assessing the Diagnostic Yield of Ultrasound Imaging for Suspected Acute Appendicitis in Paediatric Patients Against Royal College of Radiologists Benchmarks
Authors: Abi Osman V , Ward M , John V , Nour E , Ahmad A 
Published: August 2024

Abstract

Aim
Prompt and accurate diagnosis of appendicitis in children is crucial to avert the risks of delayed treatment and reduce unnecessary appendectomies resulting from false-positive diagnoses. This audit aimed to evaluate the diagnostic sensitivity of ultrasound imaging in paediatric patients presenting with suspected acute appendicitis at a District General Hospital, seeking to meet or exceed the Royal College of Radiologists' (RCR) recommended target sensitivity of over 85% (1).

Method
In this retrospective study, we analysed the medical records of 102 children aged 2-16 who underwent appendectomies (open, laparoscopic, or diagnostic) over a two-year period. Ultrasound scans and corresponding medical records were reviewed to assess the concordance between pre-operative ultrasound findings and post-operative histopathology results.

Results
Among the 102 patients evaluated, histopathology confirmed appendicitis in 77 cases. Ultrasound correctly identified 52 of these cases, resulting in a diagnostic sensitivity of 67.5%, below the RCR's advised benchmark of 85%. For the 25 patients without histopathological evidence of appendicitis, ultrasound accurately diagnosed 17.

Conclusions
The diagnostic sensitivity of ultrasound for suspected appendicitis in our paediatric cohort was below the RCR guideline, highlighting a need for improvement. To enhance diagnostic accuracy, we recommend additional training for sonographers in paediatric appendicitis imaging and consideration of second-opinion protocols for equivocal cases. Further investigation into a dedicated paediatric ultrasound service may also be another way of to improve quality of scans.
207 Acute Appendicitis and Lung Metastasis – a Rare Combination
Authors: Arora A , Maria Kouvatsou A , Ali O 
Published: August 2024

Abstract

Background
Lung cancer is the third most common cancer in the UK. Although widespread metastasis is common, metastasis to the appendix is rare. Here we present a case of acute appendicitis secondary to a lung metastasis.

Case Presentation
An 84-year-old man was admitted with a two-day history of right iliac fossa and suprapubic pain. He was known to have previous lung cancer treated with radical radiotherapy. Bloods on admission revealed elevated inflammatory markers with WCC 14.73 x 109/L and CRP 71.1mg/L. A Computed tomography was performed which showed acute appendicitis with perforation. An emergency laparoscopic appendicectomy was performed which showed a mid-appendiceal perforation with a localized abscess cavity. His recovery was uneventful, and the patient was discharged on postoperative day 2. Histological analysis revealed an adenocarcinoma in the appendicular lumen and within the muscle wall extending to the serosal surface. Immunochemistry profile was positive for CK, CK-19, TTF1 and Napsin A favoring a diagnosis of lung adenocarcinoma which was rationalized in the lung MDT. The patient remains under the respiratory physicians for close follow up.

Discussion
Lung metastasis to the appendix causing acute appendicitis is uncommon, with only twelve cases of appendiceal metastasis reported in the literature, ten of which presented with a perforated appendix. It may be considered as a differential for the cause of perforated acute appendicitis especially in patients with background of lung cancer.
1059 Giant Fibroepithelial Breast Polyp
Authors: Madume R , Nkuo K , Hamidi Latifi L , Singh Rait J 
Published: August 2024

Abstract

Introduction
Fibroepithelial polyps are common benign skin lesions rarely noted in the female nipple. In this location, they have the potential to ulcerate and cause bloody discharge.

Case History
A 55-year-old female patient presented to a breast clinic with a left nipple lesion present since childhood. The patient self-reported that the lesion had increased in size. Clinical examination revealed a 9 x 7cm lesion with a soft and pliable stem extending from the left nipple. Mammography from 2017 revealed this previously measured 6 x 6cm.
An excision biopsy under general anaesthetic preserving the nipple anatomy was undertaken on 18/8/23. There were no immediate or subsequent complications. The final histology demonstrated the excised specimen weighed 131g and measured 95 x 70 x 60mm with an 8mm base. The specimen was processed and microscopically found to be a giant fibroepithelial polyp (FEP). The central core of the lesion was formed by excessive collagen deposition. Normal dermal structures including blood vessels were still present with no glandular component and there was no evidence of atypia or malignancy.

Discussion
FEP’s are benign dermal mesenchymal tumours also known as acrochordons. They are noted most commonly on the neck, axilla, perineum and thighs but have been found in the vagina, vulva or cervix and present in &lt;2% of cases in the nipple area. FEP’s rarely grow larger than 5cm with larger lesions are rarely reported in medical literature. It is possible to excise these lesions and preserve the nipple anatomy with careful surgical planning.
1208 Surveillance Strategy Following Curative Resection of Colorectal Cancer – What and When?
Authors: China Z , Drmota J , Chowdhury A 
Published: August 2024

Abstract

Aim
After curative treatment for colorectal cancer (CRC), recurrence can occur in up to 11% of patients with stage 1-3 disease. Early diagnosis of CRC recurrence is key to improving prognosis. Different follow up strategies such asdetection of carcinoembryonic antigen (CEA) and CT imaging are available and NICE broadly recommends a combination of CEA and CT testing in the first 3 years to look for recurrence. We present our local data for CRC recurrences, when it recurred and the method of detection.

Method
A retrospective review of all CRC recurrences at our local unit was conducted from 2014 to 2021. Patient demographics, site of primary cancer, staging, surgical procedure for curative treatment, recurrence, surveillance tests and timings were recorded and analysed.

Results
66 patients were identified with CRC recurrence in the 7-year period with the earliest detection occurring at 6 months and latest at 60 months. 12%, 35% and 60% of recurrences were detected in the first 6, 12 and 18 monthsrespectively. 80% of patients had positive CT findings, mostly of lung and liver metastases. 77% had abnormal CEA results, but 91% of these were in combination with CT, MRI or PET imaging. Only 9% of recurrences was detected by CEA alone.

Conclusions
Our data highlights that the majority of CRC recurred within 18 months of initial surgical intervention and CT was the primary modality for detection. Frequent follow up testing is resource intensive and also leads to patient anxiety. We recommend that a follow up CT at 12 months is best placed to detect CRC recurrences.
316 Clinical Significance and Diagnostic Approach for Paediatric Unilateral Tonsillar Enlargement: Insights from a Retrospective Analysis
Authors: Nelson A , Bujoreanu I , Williams M , Gaskin J 
Published: August 2024

Abstract

Aim
Tonsillectomy for unilateral tonsillar enlargement (UTE) in the paediatric population remains a topic of debate among ENT surgeons. The majority of UTE is benign in nature; however, concerns exist around the differential diagnosis of lymphoma which is typically found in the presence of other sinister symptoms. The aim is to identify the common features associated with UTE and malignancy to stratify risk at clinical presentation, allowing for appropriate listing of patients for diagnostic tonsillectomy.

Method
A retrospective case series analysis was performed of all paediatric tonsillectomy specimens, at Bristol Children’s Hospital and between January 2006 and January 2023. Anonymised data included patient demographic details, clinical history including history and histopathological results.

Results
Six (1.9%) lymphoma diagnoses were identified from the 321 patients that underwent tonsillectomy for UTE. Three patients had localised disease to cervical region, and three patients had systemic infiltration of disease with bony disease, oropharyngeal and abdominal disease, mediastinal disease respectively These patients presented with other signs of malignancy in addition to UTE including cervical lymphadenopathy (100%), tonsillar asymmetry (83%), alteration of appearance of tonsil including colour or visible lesion (67%), snoring (67%), dysphagia (50%), recurrent fever (17%) and weight loss (17%).

Conclusions
The incidence of malignancy in our study is low (1.9%), consistent with previously reported literature. In all cases of confirmed lymphoma, the enlarged tonsil appeared grossly abnormal on clinical examination. We suggest tonsillectomy for histology should only be performed in the presence of associated symptoms suggestive of lymphoma.
1029 Incidence of Vestibular Schwannoma on MRI for Patients with Unilateral Non-Pulsatile Tinnitus
Authors: Elmi S N , Etuk K , Farooq E , Ahmad M 
Published: August 2024

Abstract

Aim
This research paper aims to explore the incidence of vestibular schwannoma on MRI for patients with unilateral non-pulsatile tinnitus.

Method
A systematic review protocol was registered with PROSPERO and reported in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses (PRISMA). The search strategy was developed using key terms in the title, which was searched through a total of 4 databases, MEDLINE, Cochrane, EMBASE, and CINAHL up to April 2023. Non-English articles were not included. Studies were screened according to the inclusion and exclusion criteria by three independent reviewers.

Results
9511 papers were identified following a comprehensive literature search. Articles were then filtered for relevance and publication resulting in 96 papers. Following a full text assessment reduced the number of articles suitable for inclusion to 2. 691 patients were included in this review that matched the inclusion and exclusion criteria, with the age range of the patients being from 17-91 years old. The combined sensitivity and specificity of our study were 1.00[Cl:0.59, 1.00] and 0.00[Cl:0.00, 0.01] and PPV of 1.01%.

Conclusions
Vestibular schwannomas are slow growing tumours that are difficult to diagnose and usually manifest clinically in tinnitus, hearing loss and dizziness. Current NICE guidelines say to consider MRI for patients with unilateral non-pulsatile tinnitus however according to our study imaging for patients with unilateral non-pulsatile tinnitus does not appear to be a good indicator for vestibular Schwannoma.