bluuebunny/crossref_metadata_2025_split huggingface dataset:
986 Is the NELA Section on the CEPOD Form Completed for General Surgical Patients Upon Emergency Theatre Booking? - a Closed-Loop Audit
Authors: Noor M , Fernandes E , Hirri F , Hunter M , Richardson J 
Published: August 2024

Abstract

Aim
The National Emergency Laparotomy Audit (NELA) mandates the assessment of all emergencies surgical patients for inclusion in its database based on specific criteria. Fulfilment of these criteria prompts the addition of patient details and pertinent clinical information to the NELA database.

Method
In an initial audit, 50 CEPOD forms were retrospectively reviewed to assess the completion of the NELA section. A re-audit involving 40 CEPOD forms was conducted prospectively over a span of 10 days, following interventions aimed at improving NELA completion rates.

Results
The initial audit revealed that only 42.7% of the CEPOD forms completed by the general surgery team included the NELA section, indicating substantial room for improvement. Discussions with junior doctors and nurses highlighted various reasons for non-completion, notably a lack of understanding among newly rotated doctors regarding the significance of NELA. Consequently, interventions were introduced:Formal emails were sent to all surgical junior doctors.Informal discussions were held with surgical junior doctors and nurses.Posters were placed in proximity to where CEPOD forms were collected.
Upon re-audit, the completion rate significantly increased to 87.5%, marking a substantial overall improvement of 44.8%.

Conclusions
Enhancing awareness among doctors and nurses resulted in more than a twofold increase in completion rates. Therefore, it is recommended to discuss about NELA with each new batch of junior doctors at the commencement of their rotations to increase awareness and emphasise the importance of NELA. Moreover, conducting a larger-scale study over an extended period is advised for a more comprehensive evaluation.
1293 Audit of Initial Management of Lower Gastrointestinal Bleeding as per the British Society of Gastroenterology Guidelines
Authors: Gibbs A , Rutherfurd A , Sivakumar N , Zehra S , Zohdy M , Marimuthu K 
Published: August 2024

Abstract

Introduction
Lower gastrointestinal (LGI) bleeding is a frequent presentation to acute surgical teams. It can range in severity from mild to life-threatening, and most commonly presents with haematochezia. This data explores the implementation of the British Society of Gastroenterology’s guidelines at a District General Hospital lacking a management pathway for LGI bleeding.

Method
Data was collected on all patients presenting to the Emergency Department with per rectal (PR) bleeding. This was retrospectively collected from July to August 2023. Data collected included shock index at presentation, details for Oakland Scoring, hospital admission, complications, and follow up.

Results
All minor LGI bleeds (Oakland score of ≤8) were discharged with no readmission within 28 days. In July, four of 45 major bleeds were unstable, with one undergoing CT angiogram, compared to two of 27 in October with one undergoing CT angiogram. Of the 45 major bleeds in July, 32 were admitted (71.1%) and 13 were discharged (28.9 %), 5 without endoscopy. In October, 15 of 27 major bleeds were admitted (55.6%) and 12 discharged (44.4%), all with endoscopy. In July, three patients (23.1%) were re-admitted within 28 days, compared to one patient (8.3%) in October.

Conclusions
Despite integration efforts, there was minimal improvement in Oakland Scoring compliance, with many major LGI patients discharged. Nonetheless, all major bleed patients in cycle 2 had follow-up endoscopy organised and fewer patients were readmitted. This study could be improved upon with improved integration efforts for Oakland Scoring and Shock Index, such as providing the algorithm in a portable online format.
748 Case Report on Anatomical Factors That Increase the Complexity of Septal Myectomy Surgery
Authors: Hampson S , Kassouf M , Springthorpe T , Tully L , Yates M , Rathwell C , Shipolini A 
Published: August 2024

Abstract

Background
Hypertrophic cardiomyopathy (HCM) is the most common heritable cardiac disease characterised by myocardial hypertrophy in the absence of alternative causes. Most HCM patients have left ventricular outflow tract (LVOT) obstruction due to systolic anterior motion of the anterior mitral valve (MV) leaflet and interventricular septum thickening. Septal myectomy coupled with MV repair or replacement can resolve this obstruction.

Case
We present a 42-year-old female referred for septal myectomy and MV intervention. Preoperative investigations revealed significant obstruction, mild aortic regurgitation (AR), pectus excavatum with posterior displacement of the heart and a narrow ascending aorta (2cm in diameter). The latter complicates LVOT access and increases the risk of aortic valve (AV) damage during retraction.
The multidisciplinary team (MDT) decided against replacing the AV and MV due to the patient's young age and warfarin-associated risks. When going on bypass the patient experienced atrial fibrillation and progressed to ventricular fibrillation (VF) following electrical cardioversion.
The procedure was extended due to an unexpected subaortic membrane resection and the need for a maze procedure. Also, post-bypass imaging showed obstruction resolution but worsening of the AR (moderate), which prompted the MDT to opt for an AV replacement.
However, it became apparent that the complexity of her anatomy would require extensive surgery, leading to the decision to not proceed. There was prolonged weaning off bypass the second time because the patient developed persistent VF.

Clinical lessons
In conclusion, a thorough assessment is required by a specialist MDT team to determine the optimal treatment for complex HCM patients.
1302 Chyle Leak as a Cause of Neck Swelling Following a Right Hemithyroidectomy for Multinodular Goitre: A Case Report
Authors: Sarsam T , Kassab N , Watts S 
Published: August 2024

Abstract

Background
Chyle leak (cl) secondary to inadvertent thoracic duct injury (tdi) is an exceptionally rare complication of a right hemithyroidectomy.1 tdi occurs in 0.5-1.4% of patients undergoing a thyroidectomy, 1and of those, only one fourthare attained following right sided neck surgeries,2as the terminal thoracic duct (td) typically terminates in the left side of the neck.3,4,5 anatomical variations of the terminal td are well renowned, and a right sided terminal td has been previously described. 4,6 although a few cases have reported cl following right sided neck dissection, to ourknowledge, this is the first study to describe a cl following a right hemithyroidectomy alone.

Case report
We present a 72-year-old gentleman who was referred to endocrinology with a persistently low t4 on a background of normal tsh. Incidentally, he was found to have a bilateral large thyroid goitre associated with chronic dyspnoea and dysphagia. He was planned for a total thyroidectomy, however, due to intraoperative difficulties, he underwent a right hemithyroidectomy only. Four days later, he re-presented with neck swelling and breathlessness. Re-explorative surgery identified serosanguinous fluid which later tested positive for chylomicrons, confirming a chyle leak, likely from a right sided terminal td. Generally, he demonstrated a good response to conservative treatment.

Conclusions
Complex anatomical variations of the td exist and thus cl should be well-recognised as a differential diagnosis of neck swelling following both left- and right-sided neck surgeries. Head and neck surgeons should consider consenting patients undergoing right sided neck surgeries for a cl.
144 Title: A Repeat Cycle Closed Loop Audit Reviewing Emergency Department Referrals for Nasal Trauma to a Major ENT Centre; Practice Standards for Safe Care
Authors: Kennard B , Bickerton R , Parker-Conway K 
Published: August 2024

Abstract

Background
Facial trauma is a very common presenting complaint In Emergency care, referrals to ENT Emergency clinics (EC) without proper assessment risks complications and unnecessary clinic appointments. Complications that can follow nasal trauma include, septal haematoma, infraorbital nerve trauma and nasal blockage.

Aim
To assess clinical practice when reviewing nasal trauma and provide education and guidance to assist these reviews.

Method
A closed loop 3 cycle audit reviewed the documentation of clinical reviews for patients referred to ENT EC with nasal trauma. Cases were reviewed for assessment of septal haematoma, Infraorbital nerve trauma and airflow symptoms. Data was collected, analysed, and presented at the ED departmental teaching and morning board rounds. Data was then re-audited. A new trust guideline was uploaded to the ED guidance application and data was Re-audited. Each period of data collection covered 31 days.

Results
A total of 137 patients were included. Prior to the first intervention referrals were 26% higher than in both repeat cycles. Documentation of septal haematomas and airflow symptoms improved fractionally, increasing from 79% to 85% and 32% to 33% respectively. Infra-orbital nerve status was reviewed in 5% more patients after implementation of new trust guidelines.

Conclusions
Complications of nasal fractures are poorly assessed. Small improvements can be made with departmental teaching, but these changes will likely be temporary given the high staff turnover in ED. Implementation of clear guidelines can promote lasting change. This study demonstrates the benefit of continued education and pathway development on precision care while reducing burden on outpatient clinics.
1241 Complications in Negative Appendicectomy in Order to Aid Risk- Benefit Counselling: A Single Centre Study
Authors: Buraimoh B , Mohamedahmed A Y , Bhattacharya P , Rout S 
Published: August 2024

Abstract

Background
Acute appendicitis is a common surgical emergency that affects 5.7-50 per 100, 000 a year in developed countries [1]. In the United Kingdom (UK), we have a high negative appendicectomy rate up to 15% [3][4].

Aim
To establish the complication rate of negative appendicectomy in a District General Hospital. To identify the demographics of appendicectomy patients.

Method
A retrospective analysis of patient notes was performed on all patients who underwent an appendicectomy from: 09/01/2021- 22/12/2021.

Results
Patients who underwent an appendicectomy for any indication other than acute appendicitis and patients who had an incomplete set of notes were excluded. A total of 210 patients were included in the study. Of the patients included, 17% underwent a negative appendicectomy (NA) which resulted in 0% post-operative complications at 30 days. These NA patients were comprised of 70% females and 30% males. Positive appendicectomy patients had a complication rate of 8%. Therefore, the overall complication rate was 8%. Mortality rate was 0%. Operative findings differed compared to histology with 27% of all appendix’s appearing normal intra-operatively but 9% of all appendix’s resulting in normal histology. Male patients represented 59.5% of patients and 40.5% were female.

Conclusions
These findings demonstrate that though the NA rate was high, these patients did not have any recorded post-operative complications. Females represent highly in this group in keeping with current literature. The histology findings highlight the importance of clinical diagnosis. This study therefore validates current UK practice of appendicectomy as gold standard management and will aid risk-benefit counselling in prospective patients.
575 Using Artificial Intelligence to Generate Medical Literature for Patients: A Comparison of Three Different Large Language Models
Authors: Pompili D , Richa Y , Collins P , Hennessey D B 
Published: August 2024

Abstract

Aim
Large language models (LLMs) are artificial intelligence (AI) that use deep learning techniques to understand, summarize and generate content. The potential of LLMs in healthcare is predicted to be vast. This study aims to examine the usefulness of LLMs in generating patient information leaflets (PILs).

Method
Prompts were created to generate PILs for 4 topics in urology (circumcision, nephrectomy, overactive bladder syndrome, and transurethral resection of the prostate). Prompts were given to 3 LLMs: ChatGPT-4, PaLM 2 (Google) and Llama-2 (Meta). PILs were evaluated using a validated assessment checklist by blinded reviewers and a 5-point Likert scale. Readability assessments for leaflets were conducted using the Average Reading Level Consensus Calculator.

Results
PaLM 2 had the highest overall average score (3.575), followed by Llama-2 (3.3375) and ChatGPT-4 (3.08). PaLM 2 generated PILs were of the highest quality in all topics except one and was the only AI to include images. Medical accuracy of leaflets was mixed, with all LLMs generating content containing minor errors and some instances of major error. Readability analysis identified PaLM 2 PILs as the easiest to read with an average reading level of age 14-15 (slightly difficult). Llama-2 leaflets were the most difficult with an average reading level of age 16-17 (fairly difficult).

Conclusions
LLMs can generate PILs that will help reduce the workload on healthcare professionals. However, the content generated requires human input for appropriateness and factual content. The content is also generated at a reading age above the average level for adults.
952 Digitalisation: Does This Improve Doctors' Documentation of Communication with Families? a Quality Improvement Project
Authors: Gill S , Moin S , Berstecher R 
Published: August 2024

Abstract

Aim
The London hospital where this QIP took place recently transitioned to a digitalised system. While appearing straightforward, this transition is imperfect. This QIP focusses on one patient's satisfaction with the hospital experience. If communication with patients’ families is optimised and documented, the doctors/surgeons benefit from medicolegal protection and patients benefit from an improved hospital experience. The question of whether this communication Is happening, but remains undocumented, or not happening at all remains unanswered. We aimed to assess if digitalisation of medical documents affects the number of documented episodes of communication with patients’ family/friends/carers.

Method
Patient notes on the two main surgical wards were screened for written evidence of communication with family/friends/carers of patients. Patient: date of admission; sex; age and diagnosis were recorded. Patients were surveyed for insight. A poster was placed in both doctors’ offices. 1st cycle data was presented at the surgical X-ray meeting, the 2nd cycle data was collected and analysed.

Results
No significant differences in episodes of communication with families/friends/carers were found on either ward (p=0.904 and p=0.24). This was identical in the orthopaedic and general/colorectal patients (p=0.214 and p=0.582).

Conclusions
Overall, there were no significant changes in documented episodes of communication with families after digitalisation. There are faults with the implementation of the digital system in this hospital. We found several solutions, such as mandatory instructive e-learning for a new system. Further, more specific, data is required to assess if communication is happening but not being documented.
697 Updated Surveillance Guidance for Intra-Ductal Pancreatic Mucinous Neoplasm (IPMN) – a 10-Year Cohort Study in a Tertiary Care Surgical Unit
Authors: Shah M , Neelankavil Davis G , Jain S , Dorkeh D C , Ganesh R 
Published: August 2024

Abstract

Aim
To investigate the adequacy of current frequency of surveillance of IPMN in a single tertiary surgical unit.

Method
A retrospective cohort study over a 10-year period (2013-2023), patient age range 30-85 years old. The data collected included gender, age at diagnosis, size(mm) of largest cyst, high risks(HRF) or worrisome features(WRF), and interventions required. Analysis undertaken pertaining to the incidence of IPMN with malignant potential as well as progression of disease on surveillance.

Results
Total of 61 patients On presentation - Cyst size &lt;1cm – 51%, 1-2cm- 33%, 2-3cm- 16% &lt;1cm group - no growth on surveillance scans and no interventions required. 1-2cm group - 35% had HRF, 25% of which underwent surgical intervention. 15% showed WF of which 33% required surgical intervention. 2-3cm group - 20% of patients with WF showed growth in cyst size. 40% of patients with WF - underwent surgery.

Conclusions
The malignant potential of IPMN correlates with the initial cyst size. Guidelines recommend that cysts &lt;1cm should be under 2-yearly surveillance. However, when compared to those with cyst&gt;1cm, none of the patients with cyst size&lt;1cm displayed progression. Therefore, we propose that for patients with an initial cyst size of less than 1cm, who are above the age of 70 and/or Performance status(PS) =&gt;2 – no active surveillance is required. If the PS &lt;2 and patients are less than 70 years old, we recommend 5-yearly surveillance. For patients with cyst size &gt;1cm, we recommend adhering to the current guidance. With this revised guidance, already scarce resources may be better utilised.
1269 Comparing Patient Outcomes for Drain vs Drain-Less Technique in Abdominal Donor-Site Closure Following Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Systematic Review
Authors: Wong P Y , Chansiriwongs A 
Published: August 2024

Abstract

Aim
Deep Inferior Epigastric Perforator (DIEP) flap is the gold standard for autologous breast reconstruction. Conventionally, abdominal drains are placed to reduce seromas, haematomas, and wound dehiscence. However, evidence to support this is lacking. We aim to systematically review patient outcomes following the use of abdominal drains versus drain-less techniques in patients who received DIEP flap breast reconstruction.

Method
Literature search across Ovid MEDLINE and EmBase were performed according to PRISMA guidelines. Patients &gt;18 years old who underwent drain-less DIEP flap breast reconstruction were included. Outcomes considered include postoperative complications (seroma, haematoma, wound dehiscence), length of stay (LOS), and postoperative pain. We included observational studies and randomised controlled trials (RCTs) published in English. Both authors independently performed literature screening, data extraction, and bias assessment.

Results
Search strategy revealed 1 cross-sectional study, 4 cohort studies, and 1 RCT. 580 patients, of which 316 received drain-less techniques, were included. These include donor-site simple direct closure, PTS application, and adhesive use. Postoperative wound dehiscence, seroma and haematoma formation were not significantly different between groups (reported by 6, 6, and 5 studies respectively). 1 of 2 studies showed reduced postoperative pain in the drain-less group. LOS (reported in 4 studies) was significantly longer for patients with abdominal drains. Quality of evidence is low.

Conclusions
Drain-less techniques are non-inferior to abdominal drain in reducing postoperative complications, with benefits of reduced LOS and post-operative pain. Further RCTs are required to investigate the potential of simple direct closure +/- adhesives compared to PTS closure as this could confer shorter operation time.
794 Making the Cut: Assessing the Knowledge of and Compliance to Guidelines for Skin Cancer Excision Biopsy Margins Amongst Junior Doctors in Plastic Surgery
Authors: Pieracci G , Ward A , Baker H , Dupre S , Odili J 
Published: August 2024

Abstract

Aim
Junior doctors in Plastic Surgery commonly perform excision biopsies of suspected skin cancers, but previous studies have shown that they are less likely than dermatologists to perform complete excisions of non-melanoma skin cancers (NMSCs). This study aimed to (i) assess plastic surgery junior knowledge of, and compliance to, BAD guidelines regarding excision biopsy margins, and (ii) explore reasons for incomplete excisions of NMSCs at St George’s Hospital.

Method
A questionnaire assessed the knowledge of excision biopsy margin guidelines for NMSCs in plastic surgery juniors (SHO to Registrar). Teaching sessions were delivered, and posters of schematised BAD guidelines were displayed in procedure rooms. The same questionnaire was subsequently repeated. Retrospective data collection of excision biopsies performed by junior doctors within two 4-week periods was performed to assess compliance with guidelines before and after the interventions.

Results
Junior doctors, particularly those with little-to-no plastics experience, were not familiar with the BAD guidelines (37.5% correctly recalled excision margins, n=3/8). Following our interventions, knowledge of excision margin guidelines improved (62.5% correct, n=5/8), but remained suboptimal. Furthermore, guideline compliance and subsequently rates of incomplete excision improved following the interventions.

Conclusions
Educational measures improved knowledge of and compliance to excision guidelines. However, juniors are often responsible for carrying out excision biopsies independently. This study emphasises the need for better education about BAD guidance, as well as senior supervision to decrease the observed rates of incompletely excised skin cancers and improve patient outcomes.
1128 A Quality Improvement Project on the Understanding of Patients Undergoing Urological Procedures
Authors: Khan F , Gado M , Pai A 
Published: August 2024

Abstract

Aim
In this Quality Improvement project, we aimed to enhance patient understanding of urological procedures. Our approach involved designing a BAUS QR code poster and integrating paperless leaflets into consultations, with the future goal of sustainability.

Method
Initial data collection from 30 patients, through a questionnaire during urology consultations, guided the project. The introduction of QR code posters linked to BAUS leaflets was assessed through a re-audit involving 25 patients.

Results
Results showed that all 55 participants used smartphones, with 71% utilizing them for medical searches. While 56% were initially familiar with QR codes, patient satisfaction remained consistently high before and after the QR code poster implementation.
Among pre-operative patients, 85% received patient information leaflets initially, increasing to 100% patients receiving patient information leaflet post QR code poster implementation. Post-operative patients receiving patient information leaflets was only 40% but incremented to 72% after the QR code poster implementation.

Conclusions
The project demonstrated that QR codes, complementing verbal consultations and paper leaflets, effectively provided information on urological procedures and lifestyle advice. Importantly, this innovation supports the transition to a paperless approach, contributing to long-term sustainability.