bluuebunny/crossref_metadata_2025_split huggingface dataset:
276 Clinical and Demographic Factors Influencing Length of Hospital Stay in Pancreatitis: A Retrospective Study
Authors: Probert S , Cai W , Sultan B , Khorshid K , Alkistawi F , Karamanakos S 
Published: August 2024

Abstract

Aim
Evaluate the impact of demographic and clinical factors on the length of hospital stay (LOS) following admission with acute pancreatitis over 12-months.

Method
For this retrospective cohort study, we used electronic patient records to identify all patients admitted with acute appendicitis in 2022; 162 admissions were identified. Microsoft Excel was used to collect the data and SPSS was used to analyse the data.

Results
Mean LOS was 8.31 days. The cases were comprised of 85 (52.5%) males and 77 (47.5%) females – sex had no impact on LOS (p=0.690). Average age of the patients was 54.2 years with no correlation to LOS (p = 0.261). Looking at aetiology, gallstones (34.6%), undetermined (31.5%), alcohol (27.2%), hypertriglyceridaemia (3.1%), ERCP (1.9%) steroids (0.6%), trauma (0.6%) and autoimmune (0.6%), we found no impact on LOS (p = 0.915). Increase in LOS is noted with higher Rockwood frailty scores (p = 0.000). 42 patients (25.9%) were made nil by mouth (NBM), resulting in longer LOS (p = 0.002). 8 (4.9%) patients were admitted to ITU and had longer LOS (T = -7.34, p = 0). Only 14 cases (8.64%) had a recorded Glasgow-Imrie Score on admission.

Conclusions
The significant determinants of LOS in this study were pre-morbid frailty, ITU admission and NBM status. While the Glasgow-Imrie score has been found to identify the severity of pancreatitis, use of this score at our centre was poor. By making this mandatory we hope to identify severe cases, allowing prompt resuscitation and more focused treatment to ultimately reduce LOS.
237 Open Lower Limb Fractures: Outcomes from a Major Trauma Centre
Authors: Evans J , Henton J , Jones C , Berner J 
Published: August 2024

Abstract

Aim
This retrospective review describes outcomes of open lower limb fractures in a major trauma centre.

Method
A retrospective review was undertaken of a prospective database of open lower limb fractures over a period of 20 months, in a major trauma centre following the BOAST/BAPRAS guidelines. Data was gathered using a pre-defined proforma to include demographics, injury characteristics, treatment modality and complications.

Results
A total of 186 patients were identified. 132 patients (71%) were directly closed, with 17 (9%) requiring a SSG, 6 a local flap (3%) and 27 a free flap (15%). We recorded major complications in 35 patients (19%), including non-union (8.6%), osteomyelitis (4.3%), amputation (2.7%), deep seated infection (9.7%), subsequent fusion (1.6%) and removal of metalware (7.5%). Our complication rates were higher for free flaps (26%); however, this likely reflects the complex nature of these injuries. 1 of the 6 local flaps (16.7%) developed a complication in comparison to 18.2% of the fractures closed directly and 17.6% of those requiring a SSG.

Conclusions
Open lower limb fractures are challenging to treat, and complications are common. Despite national guidelines, not all major trauma centres have a dedicated team with protected theatres for ortho-plastics trauma. Even though free flaps are required in patients with severe trauma, injuries closed primarily can still present a considerable rate of complications.
304 Scar Assessment of Elliptical Versus Punch Biopsy Excision for Epidermoid and Pilar Cysts
Authors: Mayer F , Daniels R 
Published: August 2024

Abstract

Aim
The aim of this study was to compare the scars of patients who had epidermoid cysts removed using conventional elliptical excision versus removal using a 7.0mm punch biopsy.

Method
Patients were selected from a medium-sized GP practice that offers elective cyst removal. Scars were assessed using the Patient and Observer Scar Assessment Scale (POSAS) 3.0 and photographs were taken. Statistical significance was analysed using the Mann-Whitney U test.

Results
The elliptical excision group included 13 patients and the punch biopsy group included 6 patients. Overall, there was no statistically significant difference in any of the POSAS 3.0 items between both groups. Average patient satisfaction with the scar was 4.85 out of 5 (very satisfied) in the excision group, and 5.0 in the punch biopsy group. Scar size was larger in the excision group (0.70 cm2 [SD 0.81] v. 0.38 cm2 [SD 0.28]) despite cyst volume being similar in both groups (6.88cm3 [SD 6.13] v. 6.47cm3 [SD 4.17]. There was no recurrence in the excision group but one recurrence in the biopsy group.

Conclusions
While this study has relatively few patients, it gives insight into real-world outcomes in a GP practice. The results suggest that the scars from epidermoid and pilar cyst removal are generally well rated by both patient and observer. While removal with 7.0mm punch biopsy resulted in smaller scars, patients did not rate the appearance and function of the scar significantly differently. This information can help patients and operators decide on which method of removal may be most suitable.
486 Disease and Economic Burden of Plastic Surgery-Related Diseases in the United Kingdom: Results From the 2019 Global Burden of Disease Study
Authors: Wong Z Y , Ou K Q , Wong Z N , Faderani R , Kanapathy M , Mosahebi A 
Published: August 2024

Abstract

Background
This study aims to assess the burden and economic impact of disease associated with plastic and reconstructive surgery in the United Kingdom (UK) as it has remained unclear to inform policy and research funding decisions.

Method
Data on the burden of disease were extracted from the Global Burden of Disease 2019 results tool for all available and relevant plastic surgery diseases. The economic burden of disease in UK pounds was calculated based on prior studies. A VSLY of £60,000 per person in the UK was sourced from ‘The Green Book’ published by HM Treasury and inflated using the UK Health Consumer Price Index (CPI). Data are presented as rate or counts with the associated uncertainty interval.

Result
In 2019, the estimated age-standardized incident rates (ASIRs), age-standardized death rates (ASDRs), and age-standardized DALYs (ASDALYs) of plastic surgery related conditions were 361.47 per 100,000, 19.5 per 100,000 and 551.0 per 100,000 respectively. Burn emerged as the leading contributor to the overall disease burden, accounting for 32%, followed by decubitus ulcer (21%) for, breast cancer (17%). The economic burden of plastic surgery-related diseases in the UK amounted to £34.3 billion in 2019, exhibiting a steady increase from £19.6 billion in 2010.

Conclusions
Plastic and reconstructive surgery-related diseases, primarily breast cancer, thermal burns, and malignant melanoma, impose a substantial burden on the UK healthcare system. These findings hold significant implications for national healthcare policy, funding allocation, and research prioritisation.
685 The MISHAP Trial: Managing Injuries - a Study of Hand Appearance and Psychosocial Dysfunction
Authors: Marinescu I , Phoenix E , Geary E , Aljohmani L , McLaughlin D , Dolan R 
Published: August 2024

Abstract

Aim
Over 24 million hand injuries occur globally every year. Patients suffer chronic pain, functional impairment and loss of income, causing significant psychological distress. This study aimed to investigate the functional and psychosocial impact of hand injuries and their association with injury severity.

Method
A single-centre, prospective, observational study was conducted over a six-month period in St.Vincent’s University Hospital. Patients with traumatic hand injuries were assessed for inclusion. Patient-reported outcome measures were collected at two and six weeks postoperatively using the Disabilities of the Arm, Shoulder, and Hand (DASH) scale, Derriford Appearance Scale-24 (DAS-24), Conor-Davidson Resilience Scale-25 (CD-RISC-25), Post Traumatic Growth Inventory-Short Form (PTGI-SF), Hospital Anxiety and Depression Scale (HADS) and Short Form-36 (SF-36). The hand injury severity score (HISS) and demographic data were obtained from medical records. Paired samples t-test and correlation analyses were performed to analyse data.

Results
Data was collected from 62 patients at baseline and 44 (71%) at follow-up. The mean age was 44 (range 20-72) with a male preponderance (89%). The mean HISS was 38 (range 2-204), with 21% scoring severe injuries. HADS, DASH, SF-36 and CD-RISC-25 scores were less favourable than the general population means. Ten and fourteen percent of participants had above-average DAS-24 scores at baseline and follow-up, respectively. HADS, DASH and SF-36 scores significantly improved at the second time point. Scores were not significantly correlated with HISS.

Conclusions
Our patient cohort demonstrated higher-than-average psychological distress and functional disability, irrespective of injury severity, highlighting the need for psychological input in the multidisciplinary management of hand trauma.
698 A Case Series of Limb Reconstruction in the Non-Concordant Patient
Authors: Jageer P , Kiely J , Day S , West C , Bhat W 
Published: August 2024

Abstract

Aim
Substance misuse is common in patients undergoing limb reconstruction secondary to open fractures and fracture related infection. This group risk breaching the social contract with their treating team through reduced engagement with peri-operative care. Potential problems include limited social support, intravenous access, analgesia and withdrawal. These factors may negatively influence the range of treatments offered to this group. We aimed to establish the prevalence and outcomes of the problematically non-concordant cohort in our limb reconstruction population, who we aim to treat equitably even where non-concordance is suspected pre-operatively.

Method
A retrospective study was performed using our prospectively collected free flap limb reconstruction database from December 2021-October 2023. Patient electronic health records were reviewed for demographics, peri-operative details and outcomes.

Results
80 patients were identified, with 8 identified as problematically non-concordant (10%). All patients had a background of substance abuse; smoking (100%), alcohol (75%), IVDU (63%). Pre-operative non-concordance included absconding (43%), staff abuse (57%) and refusal of care (57%). Post-operative non-concordance included smoking (75%), mobilisation against instructions (75%), absconding (63%). No patients had free flap failure. Inpatient stay varied from 8-83 days, average 28. 50% of patients did not attend follow-up.

Conclusions
The expanding horizon of microsurgery means complex reconstruction is offered to a greater range of patients. Surgical teams should ensure that this service is offered equitably, individualising treatment plans to achieve the best outcomes. Risk of non-concordance is usually evident pre-operatively. We advise early involvement of substance misuse teams, discharge support and an understanding team to achieve good outcomes.
751 Efficacy of Liposomal Bupivacaine (Exparel) for Post-Operative Analgesia in Plastic Surgery: A Systematic Review
Authors: Erotocritou M , Krishna V , Khajuria A 
Published: August 2024

Abstract

Aim
This systematic review aimed to identify new evidence from randomized controlled trials on the post-operative applications of Liposomal Bupivacaine (Exparel) in patients undergoing plastic surgery.

Method
An extensive literature search was performed using PubMed, MEDLINE, Embase and Google Scholar to identify studies published between November 1st 2015 and July 31st 2021, investigating the efficacy of Exparel for postoperative pain management in patients undergoing Plastic Surgery procedures. Data on opioid use, patient satisfaction, patient outcomes, hospitals costs and length of stay were collected.

Results
A total of 22 studies were selected out of 5651 identified in our initial search. The data for a total of 2505 patients are included in this review across various plastic surgery procedures (including abdominal reconstruction, breast reconstruction, hand, skin and oromaxilofacial surgery). Liposomal bupivacaine was shown to be safe and led to a reduction in post-operative opioid requirements compared to controls.

Conclusions
LB is a long-acting non-opioid analgesic that has become increasingly more available and more popular for post-operative pain control. The data from this review have demonstrated that it is effective at reducing the opioid requirements post plastic surgery and this is not limited by anatomical site. It appears to be safe and well tolerated by patients. It’s effect on pain scores, treatment costs and length of stay remains controversial. In view of the well-recognised opioid epidemic, LB can be used to reduce opioid analgesia use and revolutionise post-operative analgesia protocols especially in the setting of Enhanced Recovery After Surgery protocols.
200 Outpatient Transurethral Laser Ablation (Tula) of Bladder Tumours: Our Initial Experience
Authors: Mendonca J , Bright E , Mantle M 
Published: August 2024

Abstract

Background
Transurethral laser ablation (TULA) is a safe and cost-effective treatment for non-muscle invasive bladder cancer. We report our experience of establishing an outpatient TULA service at a DGH.

Method
Retrospective review of attendances to the TULA clinic from May 2022 to May 2023. Data were analysed using EZR.

Results
Ninety-seven TULA procedures were performed on 87 patients (45-95 years; median age 79 years; 70.1 % male; median ASA grade 2). Fifty-three lesions were unifocal and 44 were multifocal. Ablations were performed in 79 cases (81.4%), enucleations in 15 cases (15.5 %) and 3 patients (3.1%) underwent both. Of the 66% of patients with recurrent cancer, 62.5% had previously been diagnosed with high-grade cancers. Biopsies were performed in 66% of cases, with muscle present in 9.4% of specimens. Transitional cell carcinoma was confirmed in 21 of 64 biopsies with the commonest stage being G2pTa (45.5%). Two patients were re-admitted within 30 days due to haematuria and 3 patients developed a urinary tract infection within 2 weeks. Eleven attendances were not amenable to TULA either due to tumour size (n=10) or position (n=1). The median pain score reported by 45 patients was 1 (IQR 3). Of the 38 patients who had previously undergone a GA resection, 95% preferred TULA due to reduced pain (52.6%), shorter procedure time (84.2%) and avoidance of inpatient stay (57.9%).

Conclusions
TULA provides a safe alternative for treating superficial bladder cancer with high patient satisfaction rates, thereby reducing demand on inpatient and operative services. Future work involves assessing recurrence rates after TULA.
535 Improving the Quality of Consent Forms and Operation Notes for Laparoscopic Appendectomies Using the Best Practice Standards Outlined in Getting It Right First Time (GIRFT)
Authors: Spurring E , Naqvi M , Wright C , Hatch E , Prys-Jones S 
Published: August 2024

Abstract

Aim
This study aimed to enhance compliance with the Getting It Right First Time (GIRFT) best practice initiative to standardise documentation of consent process and operation notes for laparoscopic appendicectomies.

Method
The documentation of laparoscopic appendicectomy was reviewed to assess compliance with GIRFT's 32 standards (n=15). The initial overall compliance rate was found to be 42%. Haemostasis and estimated blood loss was not documented (n=0). In response, templates were developed based on GIRFT standards, incorporating pre-filled consent form stickers and a digital operation note for electronic upload to patient records. The templates aimed to enhance accessibility and security of patient information by reducing reliance on handwritten notes.

Results
Following the intervention, the overall compliance rate increased to 63% (n=15). Notably, when the GIRFT template was utilised, compliance increased to 98% and haemostasis and EBL was documented in 100% of cases (n=5). However, the incorporation of pre-filled consent form stickers showed limited impact, with only 2 out of 15 cases utilizing them. Despite this, discussions regarding blood transfusion increased from 27% to 36% (n=15).

Conclusions
The implementation of standardised templates significantly improved compliance with GIRFT best practice standards for laparoscopic appendicectomies, particularly when utilizing the provided template. Challenges remain regarding the adoption of pre-filled consent form stickers. Future directions will explore the development of a patient information leaflet to enhance risk communication and promote the consistent use of template-based documentation. The study highlights the importance of tailored interventions to address specific components of GIRFT standards for optimal impact on patient care and outcomes.
587 Preventing Post-Operative Orthostatic Hypotension in Orthogeriatric Neck of Femur Fracture Patients by Encouraging Oral Fluid Intake
Authors: Tsang F S L , Perera T , Solomonsz A 
Published: August 2024

Abstract

Aim
This quality improvement project aims to reduce the length of hospital stay in orthogeriatric neck of femur (NOF) fracture patients by preventing orthostatic hypotension during post-operative patient mobilisation through encouraging post-operative, pre-mobilisation oral fluid intake.

Method
Orthogeriatric NOF fracture patient notes and fluid charts were retrospectively reviewed to establish the pre-intervention baseline post-operative pre-mobilisation fluid intake. A separate cohort of newly admitted geriatric NOF fracture patients were followed prospectively, with an intervention administered one day post-operation to encourage fluid intake. This intervention consisted of a verbal reminder and leaflet encouraging oral fluid intake, along with a verbal explanation and patient information sheet on orthostatic hypotension. Adequate fluid intake was defined as ≥500 ml fluid intake before mobilisation, and a prolonged hospital stay was defined as ≥20 days. This was carried out at the Royal Derby Hospital from July to November 2023.

Results
A total of 41 patients were reviewed. 21 patients were in the pre-intervention group and 20 in the intervention group. The pre-intervention group had 23.8% (5/21) patients with adequate fluid intake prior to mobilisation. This was increased to 95% (19/20) in the intervention group. The pre-intervention group also had 61.9% (13/21) patients with a prolonged hospital stay which was reduced to 10% (2/20) in the intervention group.

Conclusions
Encouraging oral fluid intake post-operatively reduces the risk of postural hypotension, empowering patients to mobilise and recover post-operatively, contributing to earlier discharge. Additionally, it may reduce the risk of post-operative acute kidney injury, an avenue which should be further explored.
703 Elevating Documentation Practices: Examining the Longitudinal Impact of an Electronic Operation Note Proforma in a District General Hospital
Authors: Mushtaq M , Mushtaq Y , Zuberi S , Gurprashad R 
Published: August 2024

Abstract

Aim
This study aimed to enhance the standard of operation note documentation at a district general hospital, in accordance with the guidelines established by the Royal College of Surgeons of England (RCSEng). A new electronic operation note proforma was developed, implemented, and assessed for both its influence on compliance with guidelines immediately after enactment, and for sustaining affects in the following years.

Method
A retrospective review of 50 operation notes was conducted between December 2019 and March 2020, and quantitatively compared to RCSEng guidelines. Another 50 notes were then assessed between August 2020 and December 2020, following implementation of a new electronic proforma. An additional 100 operation notes were then analysed between August 2022 and November 2023.

Results
A total of 200 operation notes were reviewed and each awarded a score out of 19 based on RCSEng guidelines. Implementation of the new proforma showed significant improvement to the average score both immediately after its execution (15.64 vs 17.94; p&lt;0.0001), and in the years following (15.64 vs 17.39; p&lt;0.0001). The latest audit cycle revealed that surgeons who joined the trust after October 2021, scored lower on average than those present during the proforma's introduction (15.43 vs. 17.71; p &lt; 0.0001).

Conclusions
The implementation of a new electronic operation note proforma, designed in accordance with RCSEng guidelines, resulted in a sustained improvement in documentation over a significant time period. The slight discrepancy in scores between old and new members of the team could emphasise the importance of effective communication in ensuring the continuity of quality improvement projects.
938 Prospective Interviews to Comprehend Patient Perspectives on the Digitisation of Ophthalmology Clinics: A Quality Improvement Project
Authors: Papaioannou C 
Published: August 2024

Abstract

Introduction
Artificial intelligence (AI) has revolutionized medicine, enhancing efficiency and patient care. Moorfields, in collaboration with Google Health and DeepMind, employs AI algorithms to swiftly and accurately diagnose retinal diseases from scans and photographs. This improves treatment timelines and optimizes NHS resource allocation. While widespread AI integration is a few years away, it's crucial to gauge patient awareness, trust, and acceptance. This quality improvement project aims to assess patients' understanding of AI and their attitudes towards it.

Method
We surveyed 30 patients at Moorfields Eye Hospital's Medical Retina clinic between December 2022 and January 2023. The questionnaire included ten questions covering demographics, prior AI knowledge, trust in future AI implementation, and factors enhancing confidence and patient experience.

Results
In the cohort, 83.7% were aged 50-79, 60% female, and 40% male. White ethnicity dominated (50%), followed by Black or Black British (20%) and Asian or Asian British (16.7%). While 53.3% felt not confident about AI understanding, 26.7% were very likely to trust AI in treatment. Income correlated significantly with trust (p = 0.015; r = 0.605), showing lower trust in AI among those from deprived backgrounds. Over 80% preferred pre-appointment AI explanations through leaflets/videos for an improved patient experience.

Conclusions
Patients generally lack confidence in understanding AI, yet they express trust in its use in their treatment. Educating patients about AI is crucial for building trust, and this can be achieved through explanatory leaflets and videos.