bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optimization urban transportation system based on trends using suitable algorithm
Authors: Salim N A , Subiyanto  , Rachmat S K , Anantyo A 
Published: August 2024

Abstract
The operation of public transportation, especially within the scope of urban transportation, has become a highly significant issue in maintaining the smoothness of urban mobility. Nevertheless, situations during peak hours and the occurrence of special events tend to lead to an increase in the number of passengers utilizing urban transportation services, thereby inducing varying demand. The primary focus of this paper is to present a more adaptive approach by developing updates to conditions at each stop, which can provide flexibility and periodic implementation of optimization. To achieve this goal, we propose the application of the Holt-Winters Exponential Smoothing method, considering aspects of level, trend, and seasonal components when conducting forecasts. This method evaluates actual data, previous component values, and predetermined parameters, aiming to generate more accurate forecasts and adeptly address the existing seasonal patterns and trends within the time series data. The findings of this research will offer practical guidance to decision-makers in optimizing the operational schedule of urban transportation, while taking dynamic factors into account. Overall, this paper holds the potential for a positive impact on service enhancement by adjusting the timing of urban transportation deliveries according to prevailing conditions.
Forecasting Agricultural Waste Composting Maturity Through Machine Learning: A Mini Review
Authors: Pradnya Irene Nindita , Hasanah Uswatun , Asri Sarwi , Imani Nadya Alfa Cahaya , Auralita Kakalia Putri , Enjelita Anggun 
Published: August 2024

Abstract
The effective management of agricultural waste through composting is essential for promoting sustainable waste practices and enhancing soil quality. Forecasting the maturity of compost is of utmost importance to assess its suitability and efficacy in enhancing soil as an amendment. Recently, the application of machine learning methods has risen as a robust solution for projecting compost maturity, showcasing enhanced precision and efficiency in contrast to conventional techniques. This article seeks to offer a comprehensive summary of the present research landscape concerning the utilization of machine learning in foreseeing the maturity of compost derived from agricultural waste. It provides insight into the methods used, challenges faced, and prospective paths for future investigation.
Combination of adsorption using activated carbon and advanced oxidation processes (AOPs) using O3/H2O2 in decreasing BOD of tofu liquid waste
Authors: Wulansarie R , Fardhyanti D S , Ardhiansyah H , Nuroddin H , Salsabila C A , Alifiananda T 
Published: August 2024

Abstract
The tofu industry is one of the industries that is growing rapidly in Indonesia, which has an impact on the abundance of liquid waste it produces. In general, liquid waste from the tofu industry has a Biological Oxygen Demand (BOD) of 5,000–10,000 mg/L, Chemical Oxygen Demand (COD) of 7,000–12,000 mg/L, Total Suspended Solid (TSS) of 6,000–8,000 mg/L, and a pH of around 4-5. Based on the Regulation of the Minister of Environment and Forestry of the Republic of Indonesia No. 5 of 2014, states that the maximum level of COD is 300 mg/L, BOD level is 150 mg/L, TSS level is 200 mg/L, and pH is 6-9. Several methods that have been carried out in previous research for tofu liquid waste treatment are ozonation, Advanced Oxidation Processes (AOPs) based on O3/H2O2, adsorption with activated carbon. In this study, a combination of adsorption using activated carbon and the O3/H2O2-based AOPs method was carried out for tofu wastewater treatment by reducing BOD levels. The best result is the combination of AOPs and adsorption which is able to degrade BOD levels to 64%.
54 Improving Responsible Opioid Prescribing on Patient Discharge
Authors: Wombwell A , Bowyer D 
Published: August 2024

Abstract

Aim
There has been a 15-fold increase in opioid prescribing between 1992-2012. Interestingly, the duration of the first opioid prescription, rather than the strength, is more likely to be associated with misuse in post-operative patients. GPs are unaware on discharge, of the quantity of opioids dispensed (in Australia). We undertook an audit of current opioid prescribing habits on patient discharge (in a regional Australian hospital), with the aim to increase the number of GPs that receive details of the quantity of opioids prescribed, by including this in the discharge letter.

Method
We completed a closed-loop 3-cycle audit. The first cycle involved auditing the discharge letters from the ward for 3 consecutive weeks, in order to determine how many of these included the opioid quantity prescribed on discharge. Following this, we instigated change, by publishing a weekly reminder to the team. We then re-audited the discharge letters for another three consecutive weeks. The third cycle of the audit, included putting a poster in the doctor’s office, followed by re-auditing another three consecutive weeks.

Results
Initially, 3% of discharge letters included the opioid quantity that the patient was discharged with. In the second cycle, this increased to 27%, and in the third cycle this improved again to 53%.

Conclusions
This audit has shown an improvement with each audit cycle, resulting in more responsible opioid prescribing. This will contribute to reducing opioid-related harm in the community, whilst providing community doctors with information that they can use to continue responsible opioid prescribing.
283 Blood Transfusion Documentation in Surgical Patients - Are We Doing It Correctly? an Audit on the Blood Transfusion Documentation in Surgical Patients at a District General Hospital in the United Kingdom
Authors: Pal S , Feyang Limbu D , Pangeni A , Shrestha A 
Published: August 2024

Abstract

Aim
Transfusion of blood products is commonly indicated in surgical patients, especially in patients with gastro-intestinal bleeding, gastro-intestinal cancers, and trauma patients. However, the documentation regarding blood transfusion in these patients often does not meet the guidelines. The aim of this clinical audit was to improve the blood transfusion (BT) related documentation in patients of general surgery (GS) at a district general hospital (DGH) in the United Kingdom, in accordance with the national guidelines (Administration of blood components: a British Society for Haematology Guideline) and the local trust guidelines.

Method
For the 1st-cycle of the audit, we did retrospective study of all adult patients admitted under GS in our DGH from 01.07.2023 to 15.08.2023 who received BT, and their electronic records were assessed with regards to documentation regarding the following criteria: decision to transfuse, patient's consent and understanding, post-transfusion effect and discharge notes. Following this, we had a discussion with the junior doctors in the department, who do this documentation, to make them aware of the BT guidelines, and to improve adherence. The 2nd-cycle included retrospective data collection from 01.09.2023 to 15.102023.

Results
BT-documentation during the 2nd-cycle showed significant improvement to adherence above 80% in most of the criteria where it needed improvement in the 1st-cycle.

Conclusions
This clinical audit successfully improved the BT-documentation adherence to the guidelines, showing that through simple educational methods, the documentation practices could be improved significantly. Our plan for subsequent improvement includes posters in the departmental resource room to increase the awareness, and to re-audit in December 2023.
317 A Trust-Wide Assessment of Follow-Up Care & Success Rates for the Conservative Management of Urinary Stones
Authors: Ullah H K , Olaniyi O , Muoka O 
Published: August 2024

Abstract

Aim
A re-audit to determine the effectiveness and quality of follow-up care in conservatively managed ureteric/renal colic patients. This is by assessing the proportion of cases that had timely follow-up appointments with imaging studies in accordance with the BAUS (British Association of Urological Surgeons) recommendations.

Method
Retrospective study with data collection over 12 months(1st January 2021 – 31st December 2021) from anonymised patient data, PACS, discharge documents and patient portal.

Results
A total of 116 (68 males/48 females) urinary colic patients were admitted during this period and 46% were treated nonoperatively. The mean age of patients was 48 years with a higher incidence in males. Specifically, while 60% of patients had successful conservative management, 31% were unsuccessful and 9% were lost to follow-up. Furthermore, just 7% had a follow-up appointment within 28 days while 45% were followed up in three months & 20% beyond this. Finally, 88% of these patients had follow-up imaging done but only 51% had it within 28 days as per BAUS recommendations. CT-Renal was the imaging modality in 81% while ultrasonography was used in the remainder.

Conclusions
This re-audit showed that conservative management continues to remain a viable option for stones &lt;5mmwith more distal stones also having better success rates locally. We did not meet the 95% national objective for follow-up imaging & appointments within four weeks however, we did make some progress from the prior cycle. Our recommendations include setting up virtual stone clinics & streamlining local follow-up procedures.
343 Distal Radius Fracture Emergency Analgaesia and Management Audit
Authors: Winder J , Mamoowala N , O’Malley O , Jayatilika L , Sreenivasan S , Abdelmegid O , Mason L , Graham S 
Published: August 2024

Abstract

Aim
To audit analgesia used in the initial management of patients with Distal Radius Fractures (DRFs) that require manipulation against the current standards.

Method
Standards used were 2018 British Society for Surgery to the Hand (BSSH) guidelines, which recommend intravenous regional anaesthesia and haematoma blocks when manipulating DRFs. Data collection using survey dissemination at 2 tertiary centres included adult patients presenting between 13/08/2022 and 26/11/2022 with DRFs. Exclusion criteria were open fractures, multiple fractures and major trauma. Patient factors and management, with corresponding pain Visual Analogue Scale (VAS) before, during and post manipulation were recorded. Imaging was reviewed to determine radiographic measurements on presentation and in clinic. Data was recorded using REDCap database.

Results
There were 33 mostly female (F:M 29:4) patients included. Only 24.24% had no co-morbidities. Comorbidities included Hypertension (42.42%), Ischaemic Heart Disease (24.24%) and Asthma (21.21%). Most patients (87.88%) received Methoxyflurane (Penthrox), the remainder had Lidocaine haematoma block. Manipulations were mostly performed by staff from A+E (63.64%). Increased pain scores during manipulation were reported in 64.29% of patients, with a median increase of 7 points. Decreased post manipulation scores were reported in 87.10% with a median decrease of 16 points. Further manipulation was required in 27.27%. Operative fixation was required in 21.21%.

Conclusions
In conclusion the current guidelines are not being followed in the centres we audited. Methoxyflurane was used for the majority of patients, with good outcomes. Further data is required from multiple centres across the UK to assess whether guidelines need to be updated.
364 Single Centre Evaluation of Enhanced Recovery After Surgery (ERAS) Protocol for Elective Colorectal Surgical Procedures
Authors: Gujjuri R , Welch J , Farrugia A , Sarma D 
Published: August 2024

Abstract

Aim
Enhanced Recovery After Surgery (ERAS) have proven to be the safest and most effective standards in managing elective colorectal cancer patients pre-, peri- and post-operatively. This audit assesses the compliance to ERAS protocol in a single centre.

Method
Retrospective data were collected on 87 patients undergoing elective colorectal surgery in a single centre between January to October 2023. Rate of compliance to selected pre-, peri- and post-operative audit standards as defined in the ERAS protocol was assessed. Outcomes of ERAS discharge success (% discharged before day 6 post-op) and length of stay were also collected.

Results
Eighty-seven patients were found to have undergone elective colorectal surgery between January and October 2023. Laparoscopic (64.4%) and robotic (21.8%) surgery were the most common operative methods with right hemicolectomy (33.3%) and high anterior resection (26.4%) comprising the most common operations. The compliance to pre-operative criteria was 63.2%, intra-operative criteria was 78.5%, and post-operative criteria was 59.8%. The overall compliance to ERAS protocol was 65.4%. Mean length of stay was 6.2 days and 60.9% of patients were deemed to have a successful ERAS discharge.

Conclusions
This audit illustrates that improvements are required to ensure better compliance with the ERAS protocol in our department. Pre-operatively, this can be facilitated by providing patients with carbohydrate drinks. Post-operatively, this can be achieved through prompt discussions regarding analgesia, opioid prescribing and by ensuring appropriate prescribing of nutritional support. A second cycle post-intervention will allow a review of our chosen outcomes to ensure we are optimising post-operative outcomes for elective colorectal patients.
371 Anticoagulation Management in Urological Surgical Patients
Authors: Mancuso R , Haider M U , Abbasi M , Sami M 
Published: August 2024

Abstract

Aim
Anticoagulation management in urology surgery involves a trade-off between decreased risk of venous thromboembolism and increase of risk of bleeding which ultimately affects patient’s quality of care and complication rate. This audit is intended to review the current anticoagulation management of the uro-surgical patients, audited against local policies at Kingston Hospital NHS Foundation trust:” VTE assessment in adults “and “guideline for the interruption of anticoagulant and antiplatelet drugs before surgery and invasive procedures”.

Method
Data have been collected retrospectively via computer archives. The sample encompasses elective adults patients undergoing urological surgical procedures. The sample consisted in 167 adult patients, operated between January 2022 and July 2023.

Results
97% (162/167) were appropriately assessed for the risk of VTE.2.9% (5/167) were not assessed. 0% (0/40) uro-surgical patients on chronic anticoagulation were stratified for the risk of bleeding and thrombosis before the surgery.
127/167 analysed patients were not included as were not on anticoagulation medication at the time of surgery.62.5% (25/40) received a proper anticoagulation bridging plan.
37.5% (15/40) patients were discharged without bridging plan. 5% (2/40) patients were check-listed for Anticoagulation bridging.
0% (0/167) were assessed for the VTE risk at 24h as per protocol.

Conclusions
Overall, the audit showed substandard management of anticoagulation bridging in uro-surgical patients. Patients were not appropriately stratified for their individual and procedure-based bleeding risks. The anticoagulation bridging was not appropriately completed for all the patients. The post operative management including the checklist at 24 hours VTE re-assessment was not done for any of the admitted patients. Improvements are urgently needed.
372 Imaging in Gynaecomastia: Audit of Imaging Practice at BHRUT to Establish Guidelines
Authors: Pestrin O , Agilinko J , Basharat S , Ali T , Wahab T 
Published: August 2024

Abstract

Aim
Our study aim was to audit our imaging practice against national standards to formulate guidelines and standardise practice.

Method
The authors performed a retrospective data collection of imaging and pathology for clinically suspected gynaecomastia in our breast unit between January and December 2023, using hospital radiology and pathology computer information systems. Data included clinical history, clinical, ultrasound and mammographic scores. Patients with clinical suspicion of malignancy (written on imaging request or P4/P5) were excluded. Descriptive statistics were performed.

Results
A total of 148 male patients had been referred for imaging with P1 (19), P2 (113), P3 (11) or no P value (34), clinical history stating or querying gynaecomastia. Ultrasound was performed in all patients. All P1 and P2 patients were U1 or U2, and M1 or M2 if mammogram was performed (0/19 P1 patients, 20/113 P2 patients, 4/11 P3 patients). In P1, P2 and no P value patients, 6/166 patients underwent ultrasound-guided biopsy (5/6 B2 gynaecomastia, 1/6 B1 benign angiolipoma). In P3 patients, two biopsies were performed: B2 gynaecomastia in one patient, but one biopsy (M4U4) revealed B5b invasive carcinoma.

Conclusions
The findings support guideline formulation where imaging is not indicated for typical (P1, P2) gynaecomastia. Imaging should, however, be performed where there is any doubt at all about the clinical diagnosis. The probability of finding cancer when performing imaging of clinically benign findings in the male breast is negligible. Routine imaging of gynecomastia should be discouraged.
432 Perioperative Antithrombotic Agent Use in Cutaneous Surgery: A Complete Audit Cycle
Authors: Nagra R S , Gujjuri R , Salibi A 
Published: August 2024

Abstract

Aim
Management of antithrombotic therapy prior to cutaneous surgery is a contentious topic with mixed opinions. The primary of this audit was to analyse the incidence of post-operative bleeding following cutaneous surgery in our minor operations theatre over two audit cycles. Secondary aims included measuring the standards outlined by BSDS and BSH peri-operative antithrombotic guidelines and assessing bleeding by risk.

Method
A single centre retrospective review of all patients undergoing cutaneous surgery on established antithrombotic therapy between 8/9/22 - 31/10/22 (cycle 1) and 10/7/2023 to 15/09/2023 (cycle 2) was conducted. A poster 'cheat sheet' containing antithrombotic agent advice was displayed in the department, forming the intervention.

Results
A total of 165 patients underwent cutaneous surgery with continuation of their antithrombotic agent. A reduction in post-operative bleeding from 8.6% to 7.4% in the second cycle was observed. The most common agent associated with bleeding in both cohorts was a DOAC, 33.3% and 42.9%, respectively. Overall, high risk operations had a proportionally higher incidence of post-op bleed compared with lower risk; 26.7% versus 4.6%, respectively. We recommended aspirin monthotherapy was not ceased before surgery, this improved from 80% to 71.4%. Equally we saw an increase in pre-op INR from 75% to 100% for warfarin users.

Conclusions
Patient factors, indication for antithrombotic agent and risk of the procedure should be all considered when listing for surgery, to help determine how the antithrombotic agent should be managed. Postoperative bleeding increases the risk of delayed wound healing, graft/flap failure and wound infection, and therefore should be considered.
686 National Audit Assessing the Imaging of Acute Pancreatitis at Mater Dei Hospital, Malta
Authors: Formosa D , Catania S , Caruana C 
Published: August 2024

Abstract

Aim
The aim of this audit is to assess the imaging of acute pancreatitis (AP) in patients admitted to Mater Dei Hospital, Malta using the Royal College of Radiologists (RCR) recommendations as standard.

Method
Retrospective data of patients admitted with AP between 1/1/22 and 31/12/22 was collected. Timing of initial CT (at least 72 hours after symptom onset), CT report inclusion of prognostic factors, and timing of ultrasonography (US) of the gallbladder (within 24 hours of diagnosis) were analysed.

Results
187 patients were included in this study. 99 patients were investigated with a CT scan during their admission, with only 25.3% of these patients being scanned at least 72 hours after developing symptoms. 74.7% of CTs were done within 72 hours of symptom onset. 47.3% of patients who had an early CT received a further CT or MRCP scan in the same admission. 24.2% of CTs mentioned all 3 key prognostic factors outlined in the RCR recommendations: pancreatic necrosis, free intraperitoneal fluid, and peripancreatic fat stranding. Only 20.2% of patients had an US examining the gallbladder within 24 hours of diagnosis.

Conclusions
Results show that CT scans are being performed too early in the clinical course of AP, with little reliance on US as a quick, non-invasive, and inexpensive first-line scan. Early CTs in AP generally do not alter management and risk missing complications. Our aim is to improve local practices through multiple educational sessions addressed towards emergency doctors, general surgeons, and radiologists.
759 Lost in Translation: Breast Surgery Pathology Reporting Audit
Authors: Szepietowski O , Cope P , Blacker S , Anbhalagan V , Lawn A , Kothari M 
Published: August 2024

Abstract

Aim
Accurate and consistent reporting of surgical specimens is essential to guide appropriate clinical decisions in management of patients with breast cancer. In 2017 NHS England consolidated pathology services with hub and spoke networks which aimed to improve efficiency and reduce variation in service delivery. Following a Serious Incident within our well-performing breast unit, it was clear that strengthening communication by standardised reporting in merged services improves patient safety. An audit was performed to review reporting consistency.

Method
The Royal College of Pathologists (RCPath) guideline 'Pathology reporting of breast disease in surgical excision specimens' describes a dataset that 90% of reports should include. We reviewed breast cancer operations from October to December 2021 at one unit and analysed reports for inclusion of guideline components. Margin and lymph node re-excisions were excluded.

Results
Of 126 reports 65 were included. Procedures were wide local excision (65%) and mastectomy (35%). Specimen type, histological grade, and presence of invasive disease were well reported but other items were inconsistently documented, including date of surgery (0%), core biopsy site identified (1.5%) and presence of microinvasion (4.3%).

Conclusions
There was variation in the pathology reporting of breast cancer. Multi-disciplinary team clinical decisions are based upon these results and error could arise if components are omitted or incomplete when reports are published. Investigating incidents drives change that makes services robust and enhances patient safety. Service improvement considerations need not be onerous or impact tight demand and capacity needs. We propose implementation of a streamlined reporting proforma that includes RCPath core dataset components.