bluuebunny/crossref_metadata_2025_split huggingface dataset:
493 Because Who Needs Training? A QIP at Kingston Hospital to Deploy PDPs Meetings for Trust-Grade Doctors
Authors: Mithany R 
Published: August 2024

Abstract

Aim
This quality improvement project ( Completed QIP No. #400 at Kingston Hospital NHS Foundation Trust) aims to investigate the critical role of personal development plans (PDPs) for individuals who are not formally engaged in training programs. The focus is on understanding how PDPs contribute to holistic self-improvement, irrespective of formal training, by fostering self-awareness, goal setting, and skill acquisition.

Method
The QIP employs a literature review and real-world examples of trust-grade doctors to explore the practical benefits of PDPs for non-trainees. The method involves analysing the role of PDPs in promoting adaptability and resilience in the face of a rapidly changing world, emphasizing the importance of lifelong learning that should be equally deployed to trainees as well as non-trainees.

Results
The findings reveal that active participation in self-directed development via Personal Development Plans (PDPs) empowers individuals to adeptly navigate uncertainties, seize opportunities, and make meaningful contributions to both personal and professional spheres. The study underscores the transformative impact of cultivating a mindset of continuous improvement on individual well-being, as well as its broader implications for organizational and societal development. Notably, at Kingston Hospital, a significant shift has occurred, with every doctor now engaging in PDP meetings facilitated by AES, marking a substantial integration of these developmental practices into the medical professional landscape.

Conclusions
In conclusion, this QIP advocates for the universal adoption of PDPs as a fundamental tool for individuals seeking success and fulfilment in dynamic environments, regardless of their formal training status positioning it as a key driver for individual growth within the NHS.
573 Improving Access to Surgical Services for Skin Cancer in Buckinghamshire NHS Trust
Authors: Mishra A , Hamod H , Avent Z , Cobb W , Murray A 
Published: August 2024

Abstract

Aim
Skin cancer is an increasingly prevalent condition that requires early diagnosis and prompt surgical management. Our quality improvement project (QIP) aimed to characterise the scale of skin cancer referrals and operating capacity, streamline our referral triage process, and to develop new patient pathways to improve speed of access to surgical services.

Method
The number of new skin cancer referrals was prospectively collected over the course of October 2023. These were analysed to investigate referral quality, extracting data on necessary clinical information for triage. New surgical streams were designed to accommodate additional cases, including a see-and-treat service and an additional junior-led operating list. Skin cancer procedures over April 2023 were retrospectively analysed to assess their suitability for these new patient pathways.

Results
There were 65 new skin cancer referrals in October 2023. Only 1 referral (1.5%) included key information on anticoagulation status, mobility, and mental capacity. From 110 skin cancer procedures in April 2023, 88 (80%) are suitable for management within the new treatment streams.

Conclusions
Our QIP has identified a significant number of new skin cancer referrals per month, often with inadequate clinical information. The development of new surgical pathways has increased operating capacity and is fit for the purpose of managing our current skin cancer surgical outpatients. Future aims will be to improve the quality of incoming referrals, streamlining the patient pathway, and to evaluate the impact of our new surgical streams on the skin cancer waiting list.
739 Pre-operative Holding Bay in Recovery - Preventing Delays and Improving Trauma List Efficacy
Authors: Cyclewala S , Wieczorek Z , Kulkarni A , Smith J 
Published: August 2024

Abstract

Aim
The evidence from national productivity reports and available publications shows that multifactorial delays to operating start times prevail in Trauma and Orthopaedic theatres with a range of clinical and financial consequences.
This Quality Improvement project was carried out to analyse the scale of the problem at our university hospital and to improve patient flow and Trauma Theatre efficacy by introducing a new Standard Operating Procedure to reduce delays in the start times of the morning Trauma Lists.

Method
The data was collected over a 6-month period using electronic records accessed through Bluespier Patient Manager. The agreed start time and arrival time for each first patient on the morning Trauma List were compared and a median delay time was calculated.

Results
The initial results showed a median delay of 30 minutes with the extreme being 140 minutes. The results were discussed with the Theatre, Anaesthetic and Trauma and Orthopaedic teams and a new Standard Operating Procedure was proposed and introduced. The implemented changes were threefold, the re-introduction of Golden Patient, sending for the patient prior to the morning brief and the use of a Recovery Bay as a Holding Bay for the first patient on the morning Trauma List to reduce the delays resulting from patient transfer.

Conclusions
Collected data confirms that delays in the start time of Trauma Lists are prevailing at Bristol Royal Infirmary. Further data will allow us to determine whether the new Standard Operating Procedure reduced them in a statistically significant manner.
741 Introducing a Ward Round Proforma to Improve Surgical Ward Documentation
Authors: Turgutogullari A , Arbis A , Razi K 
Published: August 2024

Abstract

Aim
To improve surgical ward round documentation in a local general surgery department through a standardised ward round proforma. The General Medical Council and Royal College of Surgeons have published guidance on the importance of accurate ward round documentation and this intervention intends to improve adherence to guidelines.

Method
A prospective study was carried out reviewing ward round documentation within the upper gastrointestinal surgery department at St Peter’s Hospital, Chertsey, in accordance with GMC guidance. 100 consecutive wards round entries were reviewed according to 16 parameters. An online proforma was implemented on Oracle Cerner and presented to the team after results of the audit. The proforma will be introduced for one month where a repeat review will be conducted to determine adherence to ward round documentation guidelines.

Results
The first audit cycle found strong adherence to guidelines with entry time (99%), ward round plan (98%), clinical diagnosis (94%), and current issues (94%). Areas for improvement included examination findings (82%), signature (69%), documentation of the patients’ observations (65%), consultant in charge of patients’ care (19%), and contact number (3%). Implementation of a ward round proforma aims to both save clinicians’ time with auto-populated patient details and improve adherence with ward round documentation across the department.

Conclusions
The project has shown areas for improvement within our department’s ward round documentation. A proforma reflecting these areas has been designed and implemented in our trust with follow-up review planned shortly to review whether sustainable improvement has been achieved.
39 Patient Perceptions of and Postoperative Satisfaction with Colorectal Robotic Surgery: A Qualitative Insight
Authors: Anand A , Mahmood Z , Dixon F , Keeler B 
Published: August 2024

Abstract

Aim
This study assesses preoperative perceptions and postoperative satisfaction amongst patients undergoing robotic-assisted colorectal surgery, in order to optimise preoperative information provision and improve patient experience.

Method
A structured quantitative and qualitative questionnaire was designed, to include questions on preoperative perceptions and prior knowledge about robotic surgery, and postoperative experiential feedback. All patients who had robotic colorectal resection at the host institution were included and had previously consented to potential inclusion in future research. Patients were contacted postoperatively. Quantitative outcomes were assessed using descriptive statistics and qualitative analysis was conducted using a thematic approach.

Results
Of 151 eligible participants, 108 provided complete responses. All underwent colorectal resection between November 2019 and August 2022.The mean±SD age of respondents was 63.1±15.2 years and 55% (n=59) were male. Prior knowledge varied; 73% (n=79) knew nothing about robotic surgery and 9% (n=10) reported apprehension, although others were intrigued (16%) or excited (14%). Four percent (n=4) of patients thought the robot was autonomous. After clinic review 81% (n=88) felt well informed about the robotic aspect. Positive feelings towards robotics were based on a perception of new technology as “better” and trust in surgeons’ advice.
Post-surgery feedback was positive; 71% (n=77) were extremely satisfied and only 14% (n=15) had a neutral or negative experience. Ninety-three percent (n=100) would recommend robotic surgery to others.

Conclusions
Improved patient information leaflets may alleviate preoperative concerns about robotic surgery, but generally this innovation is well received by patients and may indicate that patients actively seek out this modality in future.
345 Identifying Unmet Needs Concerning Luminal Device Insertion in Surgery - a Pan-Speciality Cross Sectional Survey and Qualitative Analysis
Authors: Aloul Z , Mills E , Burke J 
Published: August 2024

Abstract

Aim
Surgical drains and luminal devices play a crucial role across the healthcare sector. Drain placement in elective procedures has been questioned following the adoption of Enhanced Recovery After Surgery guidelines. This study aimed to investigate post-operative issues related to drains and luminal devices across surgical specialties.

Method
Clinicians with professional registration in the UK who insert luminal devices were eligible for inclusion. Data were collected through an electronic questionnaire distributed at a national health technology meeting with predefined questions generated through steering group consensus. A thematic qualitative analysis was performed.

Results
40 participants across 13 specialities responded to the survey. 45%(n=18) were General Surgery; 32.5%(n=13) other surgical specialties, and 22.5%(n=9) were in medical specialties. Thematic Analysis elicited 3 central themes: (1) Indication for device, (2) method of securing device and (3) post-operative issues. The most common indications were prophylactic for anticipated blood loss in 55%(n=22) and therapeutic in 24%(n=10) for drainage or source control. 75%(n=30) of respondents utilised non-absorbable sutures for securing the device. Drain positioning issues were reported in 21% of respondents. Complications of poor wound healing, fistula formation, and infection were common in 22% along with complete drain displacement observed by 1/5. Patient discomfort secondary to drain insertion was reported in 38%.

Conclusions
This pilot study provides insight into the attitudes and practices of a common surgical intervention. These findings presented demonstrate a strong signal that further work is required in this area and will be used to inform future national collaborative studies.
626 Obesity Does Not Affect Peritoneal Dialysis Patency but Is Adversely Associated with PD Peritonitis
Authors: Johnson J , Hayes J , Chalklin C , Ilham M A , Stephens M R , Szabo L , Khalid U 
Published: August 2024

Abstract

Aim
Obesity is associated with adverse outcomes following surgery. Peritoneal dialysis (PD), a form of renal replacement therapy for patients with end-stage renal failure, requires the insertion of a PD catheter. The aims of this study were to evaluate the impact of body mass index (BMI) on outcomes following PD catheter insertion.

Method
Data were collected retrospectively from a prospectively maintained database for all patients who underwent PD catheter insertion within a single health board between 01/01/2016 and 10/07/2023. Primary outcomes were PD catheter patency (defined by successful PD commencement), need for PD catheter repositioning, and PD peritonitis. Patients were followed up for a median of 24 months (range 17 – 31 months). The effect of BMI and various patient factors was analysed using univariate and multivariate regression analyses.

Results
365 patients had a PD catheter inserted over the 7-year period. 276 (75.6%) patients successfully initiated PD, 70 (19.2%) required PD catheter repositioning and 143 (39.2%) experienced peritonitis. When controlling for other variables, BMI did not affect patency or repositioning however patients with a BMI of 30 or more experienced increased episodes of peritonitis. Diabetes was also found to increase the risk of repositioning and peritonitis 2.95-fold (p=0.02) and 1.45-fold (p=0.04) respectively.

Conclusions
Increased BMI is associated with increased episodes of peritonitis but does not affect patency or repositioning. Diabetes was found to be an adverse risk factor for repositioning and peritonitis. A targeted approach in diabetic and obese patients may be required to reduce the risk of PD peritonitis.
931 Core Surgical Training; a Postcode Lottery?
Authors: Myatt A , Tomlinson J , Ismail-Koch H , Bamford R 
Published: August 2024

Abstract

Background
Core Surgical Training (CST) is a national training programme. The curriculum provides surgical trainees with the generic professional and specialty-specific capabilities needed to become higher surgical trainees (HST). However, despite it being nationally approved, the provision of the curriculum is decided at a local level, leading to inconsistencies and variability. The aim of this study was to understand the delivery of training in each deanery in the UK

Method
Two custom prospective surveys were electronically distributed to all CST TPDs. The surveys included a combined total of 40 questions, tailored to collect specific data on the local teaching programme and future improvements they would like to see.

Results
There was 91% response rate. There were substantial variations in regional training. The number of trainees in each region is wide-ranging from 10 to 65 (Median 52, IQR 40). 0/11 regions met all 6 of the JCST quality criteria. 4 regions (36%) met 5 of the criteria. 1 region met only 2 of the 6. 100% of deaneries offered extra mandatory teaching sessions locally, over and above the national teaching programme delivered by CST Hub. 66% of these extra sessions are delivered online. 7/11(60%) of TPDs felt greater standardisation of delivery of CST across the country is needed to improve equity of training.

Conclusions
There is considerable unwarranted variation in CST across England & Wales. Our study suggests not all training opportunities are equal and that trainees are subject to a disadvantage from an early stage in training. Further work is needed to address this.
262 Clean and Green: Sustainability in the Operating Theatre
Authors: Ang K S , Teo H X , Ang K L 
Published: August 2024

Abstract

Aim
Surgical scrubbing is an essential part of surgery, yet it still generates substantial waste. Reducing water waste in scrubbing is important for environmental impact. Our study focuses on assessing the amount of water used during a surgical hand scrub and to determine the percentage of water actively used during the procedure.

Method
Surgical scrubbing was observed in one operating theatre and included healthcare practitioners who routinely performed surgical scrubbing. Participants were not informed of the study to avoid altering their behaviour. The mean flow rate of water was determined by measuring the volume of water collected for 1 minute and using a standard density of 997kg/m³. The total time of water flowing, and time of water being used for each surgical scrubbing episode were recorded.

Results
Thirty-five scrubbing episodes were recorded. The average time for which the tap was turned on during surgical scrubbing was 1min 52s (maximum: 3min 7s; minimum: 1min 2s; SD: 29s). The flow rate of the tap was approximately 7.13L/min, resulting in an average of 13.30L of water used per scrub. The mean time of water being actively used during the procedure was 27s (maximum: 1min 2s; minimum: 10s; SD: 3.76s). The mean percentage of water actively used per surgical scrubbing was 23.61% (maximum: 37.69%; minimum: 51.33%; SD: 2.25%).

Conclusions
Only 23.61% of water is being actively used per scrubbing episode. This reveals the potential to decrease water during surgical hand scrubbing without compromising hygiene practices.
597 Thyroid Nodule Size and Risk of Malignancy: A Systematic Review
Authors: Cotter A , Redmond H 
Published: August 2024

Abstract

Aim
The overall aims of this study were to investigate the relationship between thyroid nodule size and malignancy and to examine the association between FNA results and malignancy in small or large thyroid nodules. Systematic review and meta-analysis of observational studies examining the association between malignancy and thyroid nodule size.

Method
A systematic review was completed using search words ‘thyroid, nodule and size’ in pubmed database. Nodules were subdivided into those equal and greater than 4cm and those below 4cm. Two meta-analyses were completed. and The PROBAST tool was utilized to assess risk of bias within each study.

Results
In total 17 studies were deemed eligible for inclusion. The first meta-analysis looked at the association between nodule size and final histology diagnosis. Sixteen studies were included. A Random effects model meta-analysis was undertaken which also indicated a trend towards a lower risk of malignancy in nodules over 4cm with a risk difference of 0.1 (95% CI -0.01,0.21). However, there was significant heterogeneity with an I2 of 99% therefore caution must be exercised when interpreting the results.
The second meta-analysis compared false negative rates in each of the size categories. Eleven studies were included. Results showed that there was no statistically difference between the false negative rates of nodules less than or greater than 4 cm.

Conclusions
While there is a trend towards larger nodule being less likely to indicate malignancy, thyroid nodule size does not appear to have significant influence on the accuracy of FNA in predicting cancer.
661 Is Routine Pre-Operative Group and Save for Laparoscopic Cholecystectomy Worthwhile: A Systematic Review of the Published Literature
Authors: Akharaekpanya T , Nair A , Nevins E J 
Published: August 2024

Abstract

Aim
Routine group and save (G&S) prior to patients undergoing laparoscopic cholecystectomy is a practice employed by many surgical units, however, the need for transfusion is rare. The aim of this review is to assess the rates of transfusion in patients undergoing LC in the published literature to assess if obtaining routine G&S should continue to be routine practice.

Method
Articles published between 01/01/2003-01/01/2023 available on PubMed, Medline and EMBASE were identified. Search terms included “laparoscopic cholecystectomy,” “group and save”, “blood grouping”, “typing and screening”, “transfusion”, “cirrhosis”, “antithrombotic”, and “antiplatelets”. Only full publication in English directly related to the topic were included. Non-cirrhotic and patients not on antithrombotic (ATB) medications were classed as “low risk” patients.

Results
Twenty publications from 8 countries met inclusion criteria with a total of 27,500 patients. Among 23,185 low-risk patients, only 329 (1.42%) received blood transfusion. This rate was even lower in the elective low-risk cohort. In the hight risk cohorts, 3,232 cirrhotic patients were included and blood transfusion rate ranges from 0% for Childs-Pugh class A to 34.74% for Child-Pugh class C. And total of 1,083 patients on ATB were included but only 18 (1.66%) received blood transfusion.

Conclusions
Very few patients undergoing LC required transfusion, even in the high-risk cohorts. Considering that routine G&S for LC carries a high financial, and environmental cost the authors believe that routine pre-operative G&S for LC should not be required unless there are patient specific concerns such as Childs-Pugh class C cirrhosis.
24 Lumbar Spine Fusion Surgery Versus Best Conservative Care for Patients with Severe, Persistent Low Back Pain: A UK Cross-Sectional Survey of Clinicians and Their Views Regarding Equipoise to Randomise Patients in a Future Trial
Authors: Bada E , Gardner A , Beard D , Ahuja S , Window P , Foster N 
Published: August 2024

Abstract

Aim
People with severe, persistent low back pain (LBP) may be offered lumbar spine fusion surgery if they have had insufficient benefit from non-surgical treatments. However, NICE (UK) guidelines recommended not offering surgery for adults with LBP except within a randomised clinical trial (RCT). This survey aims to describe UK clinicians’ views regarding equipoise for randomisation of participants in a future RCT comparing lumbar spine fusion surgery to best conservative care (the FORENSIC-UK trial).

Method
An online cross-sectional survey was shared with clinical professional groups in the UK involved in the management of adults with severe, persistent LBP. The survey had 7 sections covering the respondents' demographics, five hypothetical case vignettes of patients with varying presentations, a series of questions regarding the preferred management, and whether or not each clinician would be willing to recruit the example patients into future RCTs.

Results
There were 73 respondents (potential response rate of 9.13%) comprising 39 orthopaedic spine surgeons, 17 neurosurgeons, 2 pain specialists and 15 allied health professionals (AHPs). Most (84.7%) chose conservative care as their first-choice management for all five case vignettes. Over 50% reported willingness to randomise three of the five cases to either surgery or best conservative care (BCC), indicating equipoise facilitating the future RCT. Transforaminal interbody fusion was the preferred approach for spinal fusion (36.4%) and for BCC, combined program of physical and psychological therapy (48.5%).

Conclusions
This survey evidence that there is equipoise about the role of lumbar spine fusion surgery and BCC for a range of patients with persistent LBP.