bluuebunny/crossref_metadata_2025_split huggingface dataset:
543 Improving Outcomes in Patients with Fragility Femur Fractures: A Quality Improvement Project
Authors: Abdolrazaghi S , Vusirikala A , Kelly C , Luker R , McConnell J 
Published: August 2024

Abstract

Aim
To improve compliance with measurable variables of the Best Practice Tariff (BPT) for fragility femur fractures. These include Abbreviated Mental Test Score (AMTS), 4AT delirium screen, Malnutrition Screening Tool (MUST) and Falls Assessment.

Method
Utilising the Plan-Do-Study-Act (PDSA) methodology, a quality improvement project was designed in a UK district general hospital to enhance compliance with four BPT measurable variables. Retrospective baseline data collection commenced in November 2022.
The first PDSA cycle, in April 2023, resulted in the introduction of daily fractured femur reports, identifying patients admitted with a fragility femur fracture and tracking completion of the BPT parameters. The second PDSA cycle, in August 2023, involved teaching sessions at the junior doctor induction and the creation of a fragility femur fracture handbook for junior doctors facilitating accurate completion of BPT parameters on the patient electronic records. Prospective identification of post-intervention patients allowed for comparison of pre-intervention and post-intervention compliance.

Results
From November 2022 to October 2023, 331 patients over 60 were admitted with a fragility femur fracture. Following the PDSA cycles, completion rates for AMTS and 4AT assessments rose from 54.5% to 100% and 16.6% to 97.8%, respectively. MUST assessment completion improved from 82.7% to 100%, while falls assessment consistently exceeded 95%.

Conclusions
The project demonstrated the need to enhance best practices in fragility femur fracture care. Targeted junior doctor education and addressing assessment completion gaps significantly improved BPT compliance, leading to overall elevated care standards. Moreover, meeting BPT criteria contributed to increased revenue, allowing the trust to receive up to £100,000 annually.
684 Improving Day-Case Rates of Transurethral Resection of Bladder Tumours: How Efficacious Is a Solitary Educational Afternoon in a District General Hospital?
Authors: Nabavi M , Quraishi M , Calleja E 
Published: August 2024

Abstract

Aim
Initiatives like Getting It Right First Time (GIRFT) are highlighting the significance of day case Transurethral Resection of Bladder Tumours (TURBTs) in patient care and addressing the national waiting list crisis. Our quality improvement project aimed to assess the enhancement in day case rates of TURBTs through an educational afternoon on this topic delivered to the entire Urological unit including surgeons, nurses, and ward staff.

Method
A 2-stage medical record review was performed (2 months before and after an educational afternoon implement), to evaluate day-case rates and surgical outcomes. Demographics and clinical parameters collected include discharge date, surgeon grade, re-admissions, and post-op complications.

Results
Seventy-two patients were identified in the study period across 4 months with an overall day-case rate of 20.8, undergoing TURBTs. The actual day-case rates decreased from 24 to 18 following the education implement in the middle of the study period. An expected discrepancy in age of patient was identified between day-case(median 63.4)and in-patient cases(median 75.4). Thirty-day re-admission rates were found to be lower in the day-case TURBTs. Mean length of stay was 1.3 days for the cohort.

Conclusions
Our study alludes that a solitary educational implement is insufficient to achieve a paradigm shift to day-case TURBTs. The low day-case rates in our cohort may reflect an elderly co-morbid demographic of the region. Implementing a robust multi-faceted and multidisciplinary day-case TURBT pathway may align us with national averages. We intend to re-evaluate our day case TURBT day-case services following the implementation of this streamline’s bespoke day-case pathway.
805 An Audit on Managing Acute Pancreatitis in the Adult Critical Care Unit in a DGH
Authors: Lau W Y S , Sy H C , Sannapareddy D , Dhokia V 
Published: August 2024

Abstract

Aim
The aim of the audit is to describe current practice in the management of patients with severe acute pancreatitis admitted to ACCU and to improve quality and consistency of care for this group of patients by developing local clinical guidance on the use of antibiotics and nutritional support.

Method
A retrospective case note study of the 2-year period between 01/09/2020 to 31/09/2022 at a district general hospital. All adult patient admitted to critical care with acute pancreatitis was included in this study.

Results
A total of 11 patients were included in our study. 10 patients had antibiotics prescribed during their stay in critical care while one did not as advise by microbiologists. Antibiotic was initiated in 7 cases prior to admission to critical care, with 5 completed the courses of antibiotics which 3 of whom did not have a positive culture or any other sources of infection. With regards to nutrition support, 7 patients were fed via nasogastric tube and 1 with nasojejunal tube. 4 patients were not reviewed by a dietitian during their stay under critical care due to short length of stay over weekend.

Conclusions
This audit suggests the need for a separate management guideline on managing acute pancreatitis patients in critical care settings. Routine prophylactic antibiotics should be avoided. Regular microbiology rounds would be beneficial in improving quality of care. Early initiation of nutrition on patients in hypercatabolic state is a priority in improving care. Daily dietitian review would enhance the quality and consistency of care.
972 Improving Surgical Ward Round Documentation: A Closed-Loop Audit
Authors: Ghosh D , Makanjuola S 
Published: August 2024

Abstract

Background
The surgical ward round (WR) is a critical multidisciplinary process. Adequate documentation of WRs have medicolegal and patient safety implications. Checklists have been known to improve outcomes, but there is no set template recommended for WR documentation.

Aim
This quality improvement project aimed to firstly, identify areas of poor documentation in WR notes and secondly, to improve these areas with the use of a template.

Method
Over three months, 20 dates were randomly chosen with an online random data generator. Variables were identified from literature recommendations. WR notes from 54 patients were analysed (cycle 1). Results were discussed in an expert-led meeting, and templates were constructed. To assess any improvement, 20 prospective WR notes were similarly analysed (cycle 2).

Results
Templates significantly improved documentation of lab findings (p=0.02), investigations (p=0.02) and plan (p=&lt;0.01). For all other variables, no significant change was found. Fluid balance and drug chart reviews were significantly worse after the template introduction. Fluid balance, Estimate Discharge Date (EDD) and nursing presence on the round scored particularly poorly in both cycles.

Conclusions
The use of a WR template improves some aspects of documentation. Further work and perhaps a more robust intervention is required to improve overall WR documentation.
1071 Evaluation of Adhesive Small Bowel Obstruction Management: Insights from a Retrospective Analysis
Authors: Lee S , Ting N , Kok A , Thambi P 
Published: August 2024

Abstract

Adhesive small bowel obstruction (SBO) is typically managed conservatively with early administration of gastrografin within 12 hours of admission. However, at our institution, there is currently no established protocol. Therefore, our study aims to evaluate the variability in SBO management and summarise the existing practices.
This was a retrospective audit between November 2022 and August 2023. Our primary objective was to assess the timing of gastrografin administration and the timing of subsequent imaging.
Our analysis included 49 patients with a mean age of 65.6 years (±16.8 years). The average time elapsed between CT imaging and the first dose of gastrografin was 1 day, 5 hours, and 51 minutes (±8 hours, 33 minutes). The average time between the first dose of gastrografin and follow-up imaging was 7 hours and 37 minutes (range: 2 hours, 58 minutes – 10 hours, 14 minutes). The average interval between discharge date and the first dose of gastrografin was 4.0 days (±3.2 days). Only 22% of patients were referred to a dietitian during their hospital stay, with an average referral duration of 3.5 days (±4.7 days). The average length of hospital stay was 6.7 days.

Conclusions
Our findings highlight an underutilization of gastrografin in conservative SBO management. While follow-up imaging approximated the ideal 6-hour window in practice, there were deviations from this target on several occasions. Additionally, the use of dietitian referrals did not align with management targets. We recommend the establishment of a formalized protocol for SBO management, incorporating guidelines for a 6-hour follow-up abdominal X-ray and timely dietitian reviews.
397 Perioperative Outcomes from Robotic-Assisted Colorectal Cancer Surgery in High BMI Patients
Authors: Wrobel A , Ingham A , Kong C Y , McSorley S , Mansouri D , Chong D , MacKay G , Roxburgh C 
Published: August 2024

Abstract

Aim
Provide insight into the short-term outcomes associated with high BMI patients undergoing robotic-assisted surgery for colorectal cancer.

Method
Retrospective review of colorectal cancer patients undergoing robotic anterior resection or Abdominoperineal resection from May 2021 to March 2023. Explanatory variables were collected including sex, age, BMI, ASA, and TNM score. Outcomes variables were collected: CRP post-operatively, Margin resection, blood loss, unexpected surgical events, conversion to open surgery, return to theatre, length of hospitalization, readmission, Surgical site infections (SSIs), and Clavien Dindo (CD) score. Four BMI groups were formed, as according to the WHO BMI ranges. CRP levels in BMI groups were compared and analysed with laparoscopic and open surgery research.

Results
ASA3 was found to be significant in the high BMI group (P=0.011). No significance between BMI groups and blood loss, length of hospitalisation, conversion to open surgery, readmission, return to theatre, SSIs, and CD score. Intraoperative unexpected events were higher in High BMI groups, 17.6% in Highest BMI vs 6.9% in normal/low group (P=0.072). The CRP range for all the BMI groups was between 50 – 110 mg/L. The highest BMI group did not have the highest CRP levels but experienced a rise on day Four. CRP levels post-robotic surgery were lower when compared to open and laparoscopic surgery.

Conclusions
Robotic surgery for colorectal cancer is safe regardless of BMI, with each BMI group in this cohort displaying similar short-term outcomes. Further research in this field is required, especially focusing on the relation between BMI, robotic surgery, and CRP levels.
201 Interdisciplinary Simulation Based Training for the Operating Room Team - a Systematic Review
Authors: Rathore A , Lennox L , Bickerton M , Baliga S , Gardner T 
Published: August 2024

Abstract

Background
The interprofessional nature of the surgical environment poses unique challenges surrounding patient safety, often due to lapses in non-technical skills. Dysfunctional teamwork dynamics and communication breakdowns within the operating room team are prominent factors giving rise to preventable adverse incidents. Incorporating the most recent evidence, we sought to explore the effects of multidisciplinary simulation on operating room team performance, as well as barriers to program implementation.

Method
A systematic literature search was conducted from January 2003 to October 2023 utilising the following databases: EMBASE, Ovid Medline, ERIC, Cochrane Library, CINAHL and Web of Science. All included studies trained and assessed the surgical multidisciplinary team with simulation-based scenarios in the operating room.

Results
Sixteen articles met the inclusion criteria for the review. A total of 1137 healthcare staff participated in the simulated OR training programs across studies. The majority of participants were surgeons (n = 379), followed by nursing (n = 355). 240 anaesthetists participated along with 163 other staff ranging from operating department practitioners, technologists, and midwives. The six main themes identified were technical skills, communication, teamwork, patient safety, simulation fidelity and barriers to implementing multidisciplinary simulation-based training.

Conclusions
Simulation-based multidisciplinary training for operative teams improves both technical and non-technical skills. Integrating surgeons, anaesthetists and nurses into the training programs allows for improved team cohesion, more effective communication as well as boosting teamwork scores. Major barriers to multidisciplinary simulation are cost and staff availability, which may be mitigated by salvaging consumable supplies and coordinating professional development days with study leave.
319 Validation of Lamb Head Model for Septoplasty Simulation Training
Authors: Tan J Y , Hulse K , Hopkins M , Iyer A , Yaneza M 
Published: August 2024

Abstract

Aim
Septoplasty is one of index rhinology procedures which has a steep learning curve. This study aimed to measure the effectiveness of a lamb head model as a septoplasty simulation model for doctors in the early training stage.

Method
The model validation study was incorporated in a surgical simulation course. A 12-question anonymous questionnaire was used to record the participants’ training grade, experience with septoplasty, the face and content validation data of the lamb head model for septoplasty simulation. A Likert scale from 1-5 was used for the rating.

Results
A total of 14 participants (2 faculty members and 12 participants) attended the simulation course. The response rate of the questionnaire was 64%. The lamb head model passed the pre-set face and content validation thresholds. The median values were 4 for face validity (realism) and 5 for the global content validity (usefulness).

Conclusions
Based on this study, the lamb head is an inexpensive, easily accessible model with high fidelity tissue to simulate open septoplasty for doctors in their early training.
46 The Impact of a Student Led Surgical Conference on Student Knowledge and Interest in Surgical Training
Authors: Vesey M , Dablouk L , Kearney L 
Published: August 2024

Abstract

Aim
To establish the impact of a student-led surgical conference on medical student interest and understanding of surgical training pathways.

Method
The University College Cork Surgical Society organized a two-day conference aimed at medical students. Specialties represented were neurosurgery, cardiothoracic, orthopedic, maxillofacial, colorectal, and plastic surgery. An anonymous digital survey was distributed to attendees following the conference. Ethical approval was obtained from the social research ethics committee. Paired sample T-tests and Wilcoxon signed rank tests were used in data analyses.

Results
48.9% attendees completed the questionnaire (44/90). Students' self-reported knowledge of surgical specialties increased from mean 2.84 ±0.31 to 4.09 ±0.24 (p&lt;0.001). Overall understanding of training pathways increased from 2.52 ±0.39 to 3.66 ±0.35 (p&lt;0.001). Pre-clinical students' knowledge of specialties increased from mean 2.64 ± 0.33 to 4 ± 0.27 (p&lt;.001) and clinical year students’ knowledge increased from 3.75 ± 0.59 to 4.38 ± 0.62 (p&lt;.05). Pre-clinical students' reported understanding of the pathways increased from 2.17 ± 0.4 to 3.5 ± .39 (p&lt;.001). Clinical year students’ understanding of surgical training pathways increased from 3.63 ± 0.43 to 4.5 ± 0.45 (p&lt;0.05). The most frequently perceived barrier reported to a surgical career was the competitiveness of such a career (36.4%), followed by work-life balance (34.1%). Male and female students reported different perceived barriers. 50% students reported they were more likely to pursue a surgical career after the conference.

Conclusions
The study highlights the impact of educational strategies directed at undergraduate level. These have the potential to engage, educate and recruit future surgical trainees.
740 Subspecialty Career Choices in Orthopaedics – What Factors Affect the Decision-Making Process?
Authors: Crowther L , Hughes K , Molyneux S 
Published: August 2024

Abstract

Aim
Orthopaedics has become increasingly subspecialised, nevertheless, reduced diversity in the profession persists. There is limited data on the importance of factors affecting subspecialty career choice among orthopaedic trainees. Aims of this study were to evaluate the importance of factors informing subspecialty career choices of trainees and assess whether these differed between the respondents’ gender and seniority.

Method
An anonymised online survey was designed and distributed to collect demographic information, stage of training and subspecialty career plans of orthopaedic trainees in the four Scottish training regions. Participants ranked the importance of 15 factors covering clinical, academic and lifestyle domains which may influence subspecialty choice on a Likert scale.

Results
From 37 responders, there were 27% junior trainees (ST1-3), 65% senior trainees (ST4-8) and 8% in research posts. Only 30% of junior trainees had selected their subspecialty in contrast to 75% of senior trainees (p=0.02). No significant difference in subspecialty choice was found between men and women (p=0.41) or junior and senior trainees (p=0.21). Most popular subspecialties overall for both genders were arthroplasty (35%), hand & wrist (19%), and trauma (19%). No difference in the importance of each factor was observed between genders or junior and senior trainees. The most important factors on subspecialty choice were interest in field, clinical opportunities, and influential mentor(s).

Conclusions
Most trainees approach completion of orthopaedic training with clear subspecialty preferences. A variety of factors affect this decision. Focus should be on wider subspecialty exposure at earlier stages in orthopaedic training programmes with concurrent mentor provision.
1292 Surgical Immersion in Endoscopy with a Clinical and Leadership Fellow
Authors: Babikir A , Banerjee S , Boulton R 
Published: August 2024

Abstract

Aim
The effectiveness of immersion training in endoscopy for surgical trainees has not been documented previously and we aimed to assess the impact at a busy gastrointestinal surgical unit within London. This involved providing the surgical registrars with a week of endoscopy training every month, during which time their clinical duties would be covered by an appointed clinical leadership fellow – externally funded by HEE.

Method
Surgical trainees currently rotating at Queen’s Hospital Surgical unit are each enrolled in endoscopy immersion and assigned a week per month with prior notice to hand over their clinical duties to the clinical fellow. During the immersion week, the surgical registrar is exposed to hands-on training, simulator access, and interactive sessions with experienced endoscopists.

Results
Three surgical trainees were enabled access since September 2023 to immersion training. Another trainee mentioned performing around 6-7 colonoscopies per day during immersion to a total of 65 in two weeks. A third trainee has attended a total of 8 endoscopy lists in 1 week. He competed 28 colonoscopies and 2 OGD’s, achieving TI intubation in 4, caecal intubation in 18.

Conclusions
The feedback supports the efficacy of immersion week as a valuable adjunct to traditional surgical training. Integration of immersion weeks into the curriculum can potentially optimize the training pathway for surgical registrars allowing them to achieve the required numbers for CCT and building competencies. Study leave blocks for endoscopy training could also be an alternate option.
1058 “A Survey of Medical Students’ Attitudes Towards Sustainable Healthcare”
Authors: Stephen S , D’Souza H , Divekar O , Kanegaonkar R G 
Published: August 2024

Abstract

Aim
With the climate crisis becoming increasingly prevalent, there is growing emphasis on environmental sustainability. The healthcare sector (a significant contributor to environmental impact) is particularly of interest: sustainable healthcare and environmental awareness within the NHS is crucial. Despite this, few medical schools include environmental teaching in their curricula. We undertook this survey to assess environmental awareness and perspectives amongst medical students.

Method
An online questionnaire was distributed to London medical students. Participants were asked demographic data, questions concerning the environmental impact of products and practices in the NHS, and suggested methods to reduce the environmental impact of healthcare.

Results
87% of students stated that the environmental impact of healthcare is of concern to them, 97% agreed that the environmental impact of products should be considered during development. 65% agreed that the environmental impact of a product should influence its use, but 95% agreed that a device being recyclable/reusable would influence their practice. Students felt the factor most negatively impacting the environmental burden of healthcare was ‘disposable plastic items’, mentioned in 57% of responses, and ‘general waste’ in 44%.

Conclusions
A significant majority of medical students find healthcare's environmental impact a concern to them and express a desire to choose the most sustainable options. Whilst the distribution of academic year and the London demographic limited this study, we believe it is the first survey of its kind assessing medical student's attitudes towards the environmental impact of healthcare. With this initial benchmark, we hope that future surveys aim to assess and improve the environmental awareness of doctors in training, as well as the inclusion of environmental teaching in medical school.
210 Assessing the Quality of Guidelines for the Management of Gastro-Intestinal Stromal Tumour
Authors: Askari A , Ebrahim S , Al Habsha O , Zuberi S , Raja H , Jambulingam P , Rashid F 
Published: August 2024

Abstract

Introduction
Gastro Intestinal Stromal Tumours (GISTs) are tumours of the gastro-intestinal tract that arise from connective tissue and they have potential for malignancy. A number of guidelines exist in their management. The aim of this study is to assess the quality of these guidelines.

Method
A search of the literature was undertaken for appropriate guidelines pertaining to the diagnosis and management of GISTs. The AGREE II checklist was used to assess the current GIST guidelines.

Results
A total of nine guidelines were included in this study. The overall median score across all guidelines was 68% (lowest; 50%, highest 89%). Guidelines tended to score highly in Domain IV (Clarity of Presentation, median score 76%) as well as Domain VI (Editorial Independence, 67%) and Domain I (Scope and Purpose, 61%). However, lower scores were noted in the Domain V (Applicability, 39%), Domain III (Rigor of Development, 52%) and Domain II (Stakeholder Involvement, 56%). None of the guidelines scored a unanimous ‘Yes’ vote for clinical usage, and all needed some level of modifying.

Conclusions
Whilst some of the current guidelines for the management of GISTs is of a high quality, there is a need for improvement with regards to the quality of the methodology used to formulate the guidelines and how they can be implemented in daily clinical use.