bluuebunny/crossref_metadata_2025_split huggingface dataset:
763 Emergency Ventral Hernias Management at a Large Tertiary Hospital Against World Society of Emergency Surgery (WSES) Recommendations: 7 Years' Experience
Authors: Loizou A , Nwosu L , Wang A , Druziagina M , Mehrotra S , Tomasi I , Botha A 
Published: August 2024

Abstract

Aim
Ventral hernia (VH) is a common condition in general surgery. Management is conservative or surgical (either electively or emergently). Approximately 10% require emergency surgery, which is associated with higher rates of post-operative complications and mortality. This retrospective audit aims to compare performances of emergency VH management at a tertiary hospital in London over the last 7 years against the 2017 WSES. The study focuses on timing of surgery after emergency admissions, co-morbidities, size of the hernia defect, and post-operative complications.

Method
268 patients (excluding those aged &lt;16) with non-elective VH were identified from patient coding, radiology reports, and patient notes between 2016 and 2023. Cases were analysed in detail with single/multiple attendances, from admission in ED to definitive treatment, focusing on the most relevant co-morbidities in patients with VH, and correlated post-operative complications (inpatient/at 30 days/6 month/1 year).

Results
Many patients with a non-contaminated surgical field could have benefited from mesh implant. No evidence on the notes of discussions on single non-elective VH, such as MDT meetings, before operating or opting for conservative management. Patients with multiple admissions, especially those with co-morbidities, had higher rates of post-operative complications.

Conclusions
A great proportion of patients with a non-contaminated surgical field could have benefited from mesh implant. A longer observational period may be warranted for patients who have had abdominal surgery and are co-morbid for early detection of incisional hernias. Implementation of laparoscopic surgery has the potential to decrease post-surgical complication rates. Consider earlier intervention in co-morbid patients to prevent emergency admission.
858 Post Operative Opioid Prescribing in Patients Undergoing Primary Elective Total Hip Replacement (THR): A Closed-Loop Clinical Audit
Authors: Moosavi H , Rowe C , Sakariya D , Raja H , Alsawada O , Solanzo A , Beasley L , Walters R 
Published: August 2024

Abstract

Aim
To assess departmental performance versus NICE NG180 recommendations for post operative analgesia in patients undergoing primary THR.

Method
Local databases were reviewed, and patients selected based on the following inclusion criteria:Elective patients undergoing Total Primary Hip ReplacementNo contraindications to oral intake.Aged 60+
The extracted data were as follows:Immediate post operative regular opioid prescribed on Day 0 (D0).Regular post operative opioid prescribed on D0?How many hours from end of surgery to receiving 1st oral opioid dose?Pain reported on D0 post operative.Pain reported on Day 1 (D1) post operatively.
The initial loop involved data from May 2023-July 2023, with the second cycle reauditing based on data from collected from September 2023-November 2023 following implementation of printed posters of NICE NG180 and face to face education on post operative analgesia.

Results
In comparison to the first cycle of the audit, there has been a 30% increase in the number of purely regular oral opioid prescriptions on D0. A 10% increase in the number of patients receiving their oral opioid dose within 2 hours post operatively is seen between cycles in those with a regular opioid prescription. Whilst the 2-8 hour and &gt;8-hour prescriptions remained at similar percentages for comparative patient sizes.

Conclusions
The interventions implemented after the first cycle have shown improvement in departmental performance. To better this further, we propose creating an electronic prescription order set to help clinicians appropriately manage post operative analgesia requirements in this patient group.
911 Time to Analgesia
Authors: Moolamannil M , Pak H L , Acharya N , Bevan K 
Published: August 2024

Abstract

Aim
According to the Royal College of Emergency Medicine guidelines 2021, patients in pain should receive analgesia within 15 minutes of arrival. It is known that acute surgical patients in pain often have to wait a considerable amount of time to receive analgesia when presenting to the Emergency department (ED). Hence, we wanted to see if starting a Surgical Assessment Unit(SAU) would help improve the time to analgesia for such patients.

Method
A two-cycle audit was conducted, and data was collected retrospectively. Cycle 1 focused on the time to analgesia for acute surgical patients presenting to ED while cycle 2 was for those presenting to SAU. Data was compared on two factors which were: the time between prescription and administration and the overall time taken to receive the first dose of analgesia.

Results
In cycle 1, which was time to analgesia for patients presenting to ED, a total of 253 patients were included. It was noted that the average time period to receive analgesia after entering the hospital was 210 minutes and the average time taken between prescription and administration of analgesia was 51 mins. Cycle 2 was conducted after the start of SAU and a total of 100 patients were included. In this case, the average time to receive analgesia after arrival was 113 minutes while the average time taken between prescription and administration was 18 minutes.

Conclusions
While not yet up to the Royal College recommendations, having an SAU definitely benefits acute surgical patients in terms of providing earlier analgesia.
965 What Did You Say? a Completed Cycle SSNHL Management
Authors: Rai A , Oktay L , Pankhania R , Bartram J 
Published: August 2024

Abstract

Aim
To compare the management of patients with SSNHL in a district general hospital to the ENT UK guidelines.

Method
Data encompassing the management of individuals presenting with (SSNHL) at an ENT centre in both 2022 and 2023 was collected. Data included: investigations, MRI and audiograms, and treatment: oral and intratympanic steroid (ITS) administration. Subsequently, the collected data underwent analysis and was presented to the respective local department for updated information on the SSNHL guidance and treatment pathway, a second cycle of an audit was then conducted.

Results
In an AUDIT involving 35 patients, 92% underwent same-day diagnostic audiograms, and 76% had MRI scans. All patients received oral steroids, with 80% concurrently receiving proton pump inhibitors in the second cycle. Additionally, 52% required intratympanic steroid (ITS) injections, all administered within six weeks. Subsequent audiograms showed that 66% experienced complete or partial resolution of sudden sensorineural hearing loss (SSNHL).

Conclusions
This centre's adherence to national guidelines was higher for same-day audiograms than including MRI in patient evaluations. Most patients received oral steroids, and 52% underwent intratympanic steroid (ITS) treatment, potentially contributing to observed improvements. Literature supports the benefits of successive ITS with oral steroids in sudden sensorineural hearing loss (SSNHL). The ongoing national STARFISH trial may further contribute to evidence on SSNHL management.
980 Audit of the Day Case Laparoscopic Cholecystectomy Pathway in Frimley Park Hospital
Authors: Oyekan O A 
Published: August 2024

Abstract

Aim
To confirm the proportion of patients that stayed overnight in the hospital after their cholecystectomy. To determine the major causes of patients staying overnight in the hospital. To ensure Laparoscopic Cholecystectomy is being performed according to Get It Right First time (GIRFT) guideline

GIRFT recommendation
Anticipated day case rate of 90%. Standard positioning of patient, with slight head up, table rotation towards surgeon. Use intermittent pneumatic compression for DVT prophylaxis. Local anaesthetic to all port sites before insertion of ports (10mls 0.5% bupivacaine*). Use of three 5mm ports and one 10mm port. Low pressure CO2 insufflation (10mmHg). Meticulous washout at end of procedure. Instillation of 30mls 0.25% bupivacaine* around liver and gallbladder. No drains

Method
All cases of Elective Cholecystectomy done within July 1st, 2023, to October 31st 2023 at Frimley Park Hospital was included in the study. Electronic case notes and Operative notes was used to get required data. A total of 107 Laparoscopic Cholecystectomy was recruited

Results
Day case Rate was 45% (58 of 107 stayed overnight), Although 85% eventually went home the morning after the Surgery. Interestingly , 34% of those that stayed overnight had no Clinical indication to stay and was mostly Patient personal preference and delay in Recovery time. No surgeon documented the Pneumoperitoneum pressure used

Conclusions
Use of GIRFT recommended surgical technique. Proper documentation of the reason patient stayed overnight. All patients should be counselled Preoperatively to have someone to pick them once medically fit to go home even if recovery gets delayed to 20.00hrs.
995 The Standard of Evening Handover in the Acute Surgical Department of a Single Regional Centre: A Closed-Loop Audit
Authors: Tiwari A , Hayat M Y , Everett K L 
Published: August 2024

Abstract

Aim
Handover is an important period that represents a potential risk to patient safety. The Royal College of Surgeons of England (RCSEng) have published guidelines on safe handover practice. The aim of this closed-loop two-cycle audit was to ensure general surgery patients at a single regional centre were handed over according to RCSEng guidelines.

Method
Evening handovers were prospectively audited between May 2023 to July 2023 using a proforma adapted from the RCSEng guidelines. A questionnaire relating to junior doctors’ views on the evening handover was disseminated prior to the first cycle. The intervention was an educational guide for foundation doctors on how to effectively hand over surgical patients, based on the RCSEng guidelines. P-values were calculated using a Mann-Whitney U test.

Results
15 evening handovers were audited in the first cycle; of 84 patients handed over, 31% (26/84) met the RCSEng handover ‘minimum’ standard. 13 evening handovers were audited in the second cycle; 84 patients were handed over, the ‘minimum’ standard rate increased to 67% (56/84) (p=0.003). There were 25 responses to the questionnaire, 92% (23/25) were by foundation doctors, 48% (12/25) volunteered wanting more teaching on handovers.

Conclusions
Introduction of an educational handover guide is a useful method to improve the quality of surgical handovers, particularly in regional centres that may have a more complex case mix. This guide was later introduced as part of the ‘induction pack’ for foundation doctors rotating into surgery.
1065 Beyond the Incision: Optimising Secondary Prevention Prescriptions for Vascular Surgery Admissions Through a Closed Loop Audit
Authors: Ekkunagul T , Francis J , Ngwira W , Drever S , MacLeod C , Renwick B 
Published: August 2024

Abstract

Aim
Vascular surgery patients carry some of the highest chronic disease and mortality burden, often driven by atherosclerotic, pro-thrombotic pathophysiology. Cardiovascular mortality risk reduction through secondary prevention by anti-platelets and statins is essential, but studies repeatedly demonstrate deficiencies in initiating such therapies. We aim to improve the identification and initiation of secondary prevention agents for vascular surgery inpatients at a tertiary centre through education and structured handover practice.

Method
A retrospective audit was performed on pre-admission and on-discharge anti-platelet and statin prescribing in vascular surgery admissions from August-October 2023. Education on guidance-based secondary prevention therapies was delivered, and modifications to the daily handover pro-forma were implemented to monitor prescribing. A prospective post-intervention re-audit was subsequently performed on admissions from October-November 2023.

Results
On admission, 70% of the 89 pre-intervention and 49% of the 47 post-intervention cohorts presented with concurrent anti-platelet or anti-coagulant and statin therapy. Pre-intervention, anti-platelets were initiated by discharge in 36% of patients admitted without anti-platelets or anti-coagulants, and statins were initiated in 20% of patients admitted without lipid-lowering therapy. This increased to 55% and 41% of such patients respectively post-intervention. However, 15% and 13% of the pre- and post-intervention cohorts respectively remain discharged on no secondary prevention therapies.

Conclusions
Education and modifications to handover documentation improved the identification and prescribing of secondary prevention therapy for vascular surgery patients in relative terms. Patients without secondary prevention therapies accounted for a significant proportion of admissions irrespective of time-period and there remains further scope to improve secondary prevention prescribing in this high-risk patient group.
1099 Audit of Immediate Discharge Letters in General Surgery in Royal Alexandra Hospital
Authors: Cunningham M , Robertson I , Robertson V 
Published: August 2024

Abstract

Aim
To determine what percentage of immediate discharge letters for general surgical patients meet pre-defined standards.

Method
All immediate discharge letters (IDLs) for patients discharged over a week-long period from two general surgical wards in a single hospital were analysed. Results were compared to the 16 criteria outlined in current Scottish Intercollegiate Guidelines Network (SIGN) guidelines, plus 3 further criteria agreed locally. A template for IDLs was then created and distributed amongst junior doctors writing IDLs after presentation at a local research meeting. Data was subsequently recollected recording the same criteria. Categorical data was analysed using a chi squared test.

Results
n=129 patients were included (n=67 in round 1; n=62 in round 2). Those without an IDL were excluded. On re-auditing, 15/16 (94%) of the SIGN criteria were documented more frequently, however only 5 of these were statistically significant (31.3%, p &lt; 0.05). Results had also improved in all three of the locally agreed criteria, however only 1 of these was statistically significant. Overall, 0% of IDLs prior to the implementation of the template had all SIGN criteria present, rising to 6% after implementation of the template, however this was not statistically significant.

Conclusions
Implementation of an IDL template has improved the quality of IDLs for general surgery patients in the RAH, however further work is required to improve this further and create substantive change in the long-term.
1111 Care of Elderly Patients with Fractured Hips in an Outlying Ward When Compared to an Others in a Dedicated Hip Fracture Ward
Authors: Khin C , Okata D , Kyaw O , Thangaraj S M 
Published: August 2024

Abstract

Aim
Hip fractures are a significant burden in the UK with roughly 80,000 cases reported per year. The standard of care in our unit is for patients to be admitted to a dedicated hip fracture unit. During busy periods, sometimes patients are admitted to outlying wards and we were concerned that the standard of care was not equivalent to those admitted to the specialist unit. We wanted to identify if this had an impact on their care.

Method
A retrospective audit was conducted from our prospectively collected database. All hip fracture patients over 60 in the outlier wards were included. We adopted the REDUCE hip fracture outlier audit tool. We compared to a cohort of patients on the main hip fracture ward over a 4-month period.

Results
During the study period, there were 54 outliers out of total 273 admissions. All outliers were due to a lack of beds in the main ward rather than a clinical indication. 41% of them did not receive surgery within 36 hours. On the first postoperative day, 24% were not mobilised. There was a 2% mortality, and 18% did not receive appropriate bone strengthening treatment before discharge. These outcomes were worse in the outlying ward when compared to the main hip fracture ward.

Conclusions
Patients on outlier ward did not achieve many of the REDUCE targets and performance was not as good as with patients admitted onto the specialist ward. Certain elements of the findings were lower than the key performance index of the national hip fracture database.
1191 Assessing Fluid Prescriptions in Surgical Wards Within Wishaw Hospital
Authors: Lau S , Wong Q N 
Published: August 2024

Abstract

Aim
There were discrepancies of intravenous (IV) fluids prescriptions on the surgical wards within Wishaw Hospital. This audit was conducted to ensure that 100% of IV fluids prescribed are based on accurate assessment of patients, as per NICE CKS guidelines.

Method
The audit was based off the classic 6 steps of an audit cycle. There were 2 rounds of data collection. This took place in general surgical wards in Wishaw Hospital in November 2022 and July 2023. Data collection comprised of assessing requirements of IV fluids & category of fluids required i.e., maintenance, resuscitation or replacement fluids. Thereafter assessing whether these fluids were correctly prescribed for each patient. Intervention was centred around an education session for staff, poster reminders and departmental presentation to increase awareness.

Results
A total of 836 fluid charts were reviewed across 2 audit cycles. First round of data collection yielded 43% of IV fluids were correctly prescribed, whereas second round of data collection had shown a 24% improvement. Reasons of incorrectly prescribed fluids mainly comprises of administering fluids at the wrong rate or having wrong type of fluids prescribed, which has, overall, decreased in incidence in the second cycle.

Conclusions
There was a substantial improvement in fluid prescriptions, however, it is imperative to continue these efforts to improve fluid prescription as, inappropriate fluid prescriptions is associated with higher post-operative mortality. Mandatory teaching sessions on IV fluids should be delivered at the start of each rotation block. Further intervention can include addressing IV fluids more thoroughly in medical school.
1247 A Service Review to Assess the Liverpool Vascular and Endovascular Services’ (LIVES) Compliance to Targets Set by the Society for Vascular Surgery (SVS) Guidelines for the Care of Ruptured AAA Patients
Authors: Iqbal Z , Neequaye S 
Published: August 2024

Abstract

Aim
A ruptured AAA is a true surgical emergency associated with an estimated mortality rate between 30-80% and accounts for approximately 8000 deaths per year in the UK. Early identification with prompt treatment is necessary to improve outcomes and the presence of a pathway for treatment has demonstrated a reduction in the 30-day mortality rate. The Society for Vascular Surgery and NICE guidelines for the care of ruptured AAA patients have recommended a target of &lt; 90 minutes for intervention for transferred patients and &lt; 60 minutes for non-transferred patients (30 minutes for diagnosis time, 30 minutes for transfer time and 30 minutes for door/diagnosis-to-intervention (skin) (30-30-30 model)). We aimed to review/audit our practice to assess our compliance.

Method
OPCS-4 and ICD-10 codes were used to identify patients who underwent an emergency repair from March 2021-23 and patient electronic clinical systems were used to gather time-related data on Cognitoforms' online data collection tool. The data was analysed using MS Excel.

Results
40 patients were identified. 88% of patients (n=35) had an open repair and 12% (n=5) underwent an EVAR. The door-to-skin time (minutes) for transferred patients (n=27): (Mean: 66.9, Range: 18-214, SD: 52.1, 19% compliant) with a transfer time (minutes): (Mean: 142.7, SD: 119.4). The diagnosis-to-skin time (minutes) for non-transferred patients (n=13): (Mean: 116, SD: 95.4, Range: 23-179, 7.7% compliant). An overall 30-day mortality rate of 35% was reported.

Conclusions
The targets set are very challenging to meet, however with ongoing simulation training, education, and further implementation of our local pathway, improvements can be made.
1263 Audit on the Response to Raised National Early Warning Score (NEWS) in a Small District General Hospital
Authors: Poon T K C , Holden A 
Published: August 2024

Abstract

Aim
Primary objective: percentage of patients seen by a clinician within the Trust's NEWS guidelines.

Secondary objectives
time interval for response, escalation to registrar/critical care outreach team (CCOT) and appropriate changes to NEWS monitoring.

Method
Retrospective study with a sample of 60 patients who scored 3+ in a single parameter or 5+ in total score. Events were categories to 3+ (in a single parameter), 5-6 and 7+.
Timeline of the patient's raised NEWS were identified and documentation surrounding the relevant events were used to identify various information include: time of raised NEWS, time of escalation from nurse to clinician, time for clinician to review, escalation to senior clinician/CCOT, changes to NEWS monitoring.

Results
A total of 172 events occurred (NEWS 3+; 48, NEWS 5-6; 90, NEWS 7+; 34). Patients reviewed were 43.75%, 62.22% and 91.18% respectively. The median time for review for patients scoring 5-6 and 7+ were 1.03h and 1.00h respectively. Only 38.46% of patients scoring 5-6 and 20% of patients scoring 7+ were escalated to the registrar on call or CCOT. Changes to monitoring NEWS interval were 85.56% and 91.18% for NEWS 5-6 and NEWS 7+ respectively.

Conclusions
The data was presented at the local meeting to raise awareness. Downfalls of the audit included small sample size and the risk of implementing escalation changes during August handover.
1017 Out With the Old, in With the New? Virtual Reality vs. Cadaveric Based Teaching Materials for Anatomy Education
Authors: Freer F , Ail G , Chan T , Jones M , Broad J , Canale G P , Elston P , Leeney J , Vickerton P 
Published: August 2024

Abstract

Introduction
Traditionally, cadaveric materials have been essential for undergraduate anatomy teaching, offering a crucial 3D tactile learning experience. Immersive virtual reality (iVR) platforms could supplement cadaveric teaching by providing a 3D-virtual environment for anatomical exploration. However, the literature lacks a clear definition of iVR's effectiveness compared to traditional cadaveric materials.

Aim
To compare the effectiveness of iVR to cadaveric prosection in facilitating understanding of regional anatomy for a cohort of undergraduate medical students.

Method
Students participating in a dissection module were grouped by the anatomical region (upper limb, lower limb, abdomen, or thorax) dissected. Within each group, participants were randomised to two circuits with paired iVR and prosection stations. At each station, assessments were conducted using OculusRift™ iVR headsets and Human Anatomy™ application or traditional prosection materials. Responses, recorded in very short answer format, were double marked based on predefined criteria. Data was retrospectively analysed.

Results
Assessment scores from 92 participants demonstrated that overall, students achieved significantly better anatomical understanding using prosection than iVR (MPD=4.51%, p&lt;0.0001). Sub-analysis by anatomical region indicated no significant differences in scores between prosection and iVR stations for the abdomen (p=0.6745), upper limb (p=0.8557), or lower limb (p=0.9973). However, iVR was significantly inferior to prosection in facilitating understanding of thoracic anatomy. (MPD=11.69%, p&lt;0.0001).

Conclusions
Our study found iVR to be less effective than cadaveric prosection for facilitating anatomy education overall. Crucially, we have also demonstrated significant variability in the effectiveness of i-VR teaching for different anatomical regions, which may provide insight into the limitations and potential applications of iVR within the undergraduate anatomy curriculum.