bluuebunny/crossref_metadata_2025_split huggingface dataset:
962 Simplifying Spines: Updating a Tertiary Centre Spinal Admissions Proforma
Authors: Marei O , Anderson C , D’Aquino D 
Published: August 2024

Abstract

Aim
It has been widely shown that admissions proformas improve the quality of documentation, which is important not only for patient safety but funding secondary to coding within the NHS. The admissions proforma in this busy Tertiary centre was 16 pages long, and frequently not filled out. Therefore, we investigated just how underutilised it was with a view to restructure it, in line with RCSEng Guidance.

Method
Study completed during November and December 2022. 31 proformas identified, and data collated within 46 possible sections over the 16-page document. Analysed using Excel. The document was then changed, using verbal feedback from spinal fellows, junior doctors, and nursing staff.

Results
Average completion rate of 41% over all sections. Admission date and time completed in 15% and 36% respectively. Past medical history completed in almost 90% of patients. Allergies and drug history completed 90% and 100% respectively. Physical examination was recorded in 66% of patients. Imaging and ECGs reviewed in 6% of patients. Registrar reviews were documented in 12% of cases and Consultants on 2%.

Conclusions
There is a clear lack of documentation using the current proforma, and instead senior reviews are recorded on continuation sheets. This leads to difficulty in continuation of patient care, reduced communication and increased time spent on discharge summaries. The new 8-page document will allow clearer documentation, with tick boxes and checklists incorporated to allow easy use for even for doctors providing temporary cover on the spinal unit and will provide a more environmentally sustainable solution.
1038 DrEaMing- a QIP Project for Enhanced Recovery Programme in Post Operative Patients
Authors: Khan N , Singh A , Alnabhan A , Adhya S , Janakan G , Hodge S 
Published: August 2024

Abstract

Aim
Dreaming is a simplified version of an enhanced recovery programme expected to reduce the length of stay and decrease the risk of complications. The Aim of this quality improvement project was to assess the adequate implementation of DrEaMing project in colorectal surgical inpatients.

Method
Twenty-one patients underwent elective colorectal surgery and are candidates for an enhanced recovery programme for July, August, and September 2023 at a tertiary care centre. were selected randomly between June 2023 and August 2023 under the general surgery department. Patient notes, nursing notes and operation notes for each patient were analysed to identify the inadequacy in each of the three limbs.

Results
Free fluids were ordered for 21/21 (100%) patients and were administered for 17/21 (81%). Food was ordered for 16/21 (76%) and was administered on 12/21 (57%) of the patients. Lastly 16/21 (76%) patients were advised for mobilisation and mobilisation was supported in 10/21 (48%) of the patients. The results were discussed in the clinical governance meeting and interventions were advised for better implementation of the DrEaMing project.

Conclusions
There is a deficiency in effective implementation of the DrEaMing project, and this can be rectified with better communication among the nursing staff and the surgeons. Also, in case a patient is not suitable for the DrEaMing project, it needs to be documented by the operating surgeon. By adopting such measures, we can improve the effectiveness of the DrEaMing project and will repeat the cycle of this QIP to confirm our findings.
1185 Improving the Time Between TURP and TWOC: A Quality Improvement Project
Authors: Jones A , Nettleton J 
Published: August 2024

Abstract

Aim
To achieve time between TURP to TWOC of four days or less.

Background
Most trans-urethral resection of prostate (TURP) operations is now done as day case procedures. Catheterisation is standard post TURP, to avoid clot retention and allow bladder irrigation if required. Currently, as patients are being discharged the same day, they are discharged with their catheter in situ. The catheter can be in-situ for longer than necessary, due to long waiting lists of the TWOC clinic.

Method
I performed a quality improvement project with the aim to achieve mean time between TURP and TWOC of four days or less. I reviewed the records 100 patients who underwent TURP between 21/07/2022 and 2/11/2022 in a district general hospital. For each patient, I calculated the time between TURP and TWOC.

Results
The average elapsed time was 9.49 days. The method of organising a TWOC post TURP is to email the urology nurses on the day of the TURP, stating that the patient requires a TWOC. My intervention was to therefore ask the bookings team that when they book in a TURP procedure, they also email the urology nurses to tell them in advance of the patients’ TURP date, that this patient will need a TWOC. Post intervention data was collected: the medical notes of 45 patients post intervention were reviewed.

Conclusions
The average time between TURP and TWOC had decreased to 6.61 days. This is an improvement but has not met the aim of less than or equal to 4 days.
859 RoboticFoundations: A Quality Improvement Programme Developing Robotic Surgical Skills in Foundation Doctors
Authors: Asif A , Floros G , Kaparounaki E , Paine H , Luangsomboon A , Bull A , Walker R , Madhavan A , Singh P , Abbassi-Ghadi N , Preston S 
Published: August 2024

Abstract

Aim
Although many surgical specialties have adopted robotic surgical techniques as standard, basic surgical skills training amongst early-career doctors neglects this paradigm shift. Our tertiary centre has pioneered a longitudinal quality improvement programme focused on integrating Foundation Doctors into robotic surgical teams, such that they are exposed to these skills early rather than during their registrar years. This approach is particularly relevant in preparing Foundation Doctors for a future that is increasingly reliant on robotic surgery, thus addressing immediate and long-term demands in surgical education, as well as leading the extended surgical workforce in this domain.

Method
The programme commenced with an Intuitive platform-based course, which introduced newcomers to being a robotic-bedside assistant. Foundation Doctors progressed from supervised sessions to independent simple tasks, under the guidance of both registrars and consultants. This programme is currently in its data collection phase, focusing on both quantitative and qualitative aspects, such as skill progression, number of procedures performed, and feedback from participants of all stages.

Results
We identified three primary benefits: Foundation Doctors gain hands-on, future-oriented experience, and feel more empowered; senior registrars accrue more console time; and consultants engage in meaningful mentorship — shaping future surgeons of every stage. Preliminary results indicate increased procedural involvement and more motivated trainees.

Conclusions
This novel and structured educational programme offers a beginner-friendly approach to training in robotic surgery, addressing key gaps in the current NHS climate. This model offers a viable and scalable solution for other institutions to further surgical training, aligning with the evolving demands of a robotic future.
1150 The Use of Artificial Intelligence in the Detection of Chondrosarcomas: A Scoping Review
Authors: Ogunmwonyi I 
Published: August 2024

Abstract

Aim
Chondrosarcoma is a challenging primary bone tumour to diagnose radiographically. This review investigates the role that artificial intelligence (AI) may have in improving the diagnostic accuracy of chondrosarcoma.

Method
A review of public databases, including PubMed, Scopus, and IEEE Xplore was performed. Predefined search terms, including but not limited to "chondrosarcoma," “bone tumour” "artificial intelligence," and "diagnosis." were used. The inclusion criteria were research articles and reviews focusing on the application of AI in the detection of chondrosarcoma as applied to various imaging modalities including X-ray, CT scans, and Magnetic Resonance Imaging. Details on the types of algorithms used, dataset characteristics, performance metrics, and any comparisons to traditional diagnostic methods were captured.

Results
The review highlighted that there is a growing body of literature and increasing potential for AI in the identification of chondrosarcomas across different imaging modalities. AI algorithms, including machine learning and deep learning models, showed promising results with improved sensitivity and specificity compared to conventional diagnostic methods.

Conclusions
The Integration of AI in chondrosarcoma detection holds promise for enhancing diagnostic accuracy. Standardised methodologies, larger datasets, and prospective validation studies are needed for robust application. Collaborative efforts between clinicians, radiologists, and AI developers are crucial for translating these advancements into clinically meaningful tools, ultimately improving early detection and management of chondrosarcoma.
546 Effects of Different Weight Loss Programs on Oncological Outcomes Following Curative Resection of Digestive Tract Cancers
Authors: Razzaq A , Niaz O , Seabrook M , Niaz T , Parrott R , Ahmed I , Rao A 
Published: August 2024

Abstract

Aim
The review aimed to investigate the impact of weight loss programs on the long-term oncological outcomes of overweight and obese patients following curative gastrointestinal (GI) cancer resections. Given the association between obesity and heightened risks in cancer patients, the study sought to assess the effectiveness of various weight loss interventions, including lifestyle modifications, pharmacological agents, bariatric surgery, or their combinations.

Method
A comprehensive search strategy utilising MeSH and free-text terms was employed across multiple electronic databases, without language or publication status restrictions. Inclusion criteria focused on randomised controlled trials involving any type of weight loss intervention for overweight or obese patients following curative GI cancer resection. The GRADE approach was intended for risk of bias assessment and primary outcomes encompassed overall mortality, local recurrence, and distant recurrence. Secondary outcomes included quality of life, disease-free survival, overall complication rate and time to recurrence.

Results
Despite the systematic search, no randomized controlled trials meeting the specified inclusion criteria were identified. As a result, the review lacked empirical data to draw conclusions regarding the outcomes of weight loss programs in this patient population following curative GI cancer resection.

Conclusions
The absence of conclusive evidence highlights a critical gap in understanding the impact of weight loss interventions on the oncological outcomes of overweight and obese patients after GI cancer resections. Given the increasing survival rates post-resection with advanced surgical treatments, there is a pressing need to comprehend the potential influence of weight loss programs on recurrence. Large multicentre randomised controlled trials are required to assess these outcomes.
29 Comparisons of Operative Exposure in UK Core Surgical Training a Generation Apart: A Father/son Logbook Comparison in Kent, Surrey & Sussex
Authors: Karanjia R , Karanjia N 
Published: August 2024

Abstract

Aim
Operative exposure during current core surgical training is considered by many to be significantly less than a generation ago. To evaluate this, we compared the logbooks of a father and son, who both completed their core surgical training in the same deanery of Kent, Surrey and Sussex (KSS), 35 years apart.

Method
Nariman Karanjia (NK) and Rustam Karanjia (RK)’s logbook numbers in 1985-1987 and 2020-2022 respectively over 24 months were analysed. NK completed core surgical training at the Royal Surrey Hospital in Guildford and RK at St. Peter’s Hospital, Chertsey, and Worthing Hospital. Only procedures performed as the primary surgeon were included. Total procedure number and core procedure numbers for each specialty were compared. RK’s numbers were adjusted to ensure the same placement length when using direct comparison.

Results
Overall, NK performed 703 procedures vs. RK’s 398, with greater numbers in Trauma & Orthopaedics (T&O) (261 vs. 12) and General Surgery (314 vs. 47) but fewer in Urology (128 vs. 339). When adjusted for placement length, Urology numbers were comparable (128 vs. 127) but NKs numbers for T&O (261 vs. 18) and General Surgery (314 vs. 141) remained far greater. Core procedures were greater or equal in NKs logbook for all three specialties when adjusted for placement length.

Conclusions
Operative numbers were much greater overall and across General Surgery and T&O 35 years ago. Urology numbers were equivalent and likely represent the benefit of a themed core surgical training program.
386 Introduction of a Surgical Mentoring Scheme for Undergraduate Medical Students
Authors: Delaney M , Whiting E 
Published: August 2024

Abstract

Aim
Due to increasing difficulty getting into surgical training and a perceived lack of surgical mentorship for medical students, we established the Surgical Early Mentoring Scheme (SEMS). We aimed to improve surgical opportunities for medical students interested in a career in surgery.

Method
Medical students at a single university teaching hospital were invited to partake. The scheme ran twice, across two different semesters. Students were matched with a surgical mentor, ideally in their speciality of interest. Meetings were determined by the student and mentor. Surveys were distributed before and afterwards, assessing the impact of the scheme and to guide improvements.

Results
Prior to participation, 6.9% of students felt they had a surgical mentor. Students stated that they would benefit from exposure to theatres and clinics, audit involvement, careers advice and application guidance. 44 students participated in the first round of the scheme. The mean number of times they met with their mentor was 0.86. The students reported that the scheme should have started earlier in the term to maximise the opportunities given.
In the second round, 28 students participated. Following previous feedback, the scheme began earlier in the semester. The mean number of times that students met with their mentors was 1.2. Overall satisfaction, usefulness for theatre exposure, audit opportunities, general career advice and training application advice improved from the first round.

Conclusions
The introduction of SEMS has demonstrated improved surgical opportunities for medical students. Through responding to feedback, the scheme has developed between cycles. SEMS can easily be continued for future student cohorts.
50 Tie-Over Dressing in Split-Thickness and Full-Thickness Skin Grafts: A Systematic Review and Meta-Analysis
Authors: Nam R , Fung E , Pang C 
Published: August 2024

Abstract

Aim
Skin grafting is a common procedure used in plastic surgery to repair skin defects. Tie-over dressings are often used in conjunction with skin grafts, but their benefits are debated, and have been associated with limitations and adverse effects. A systematic review is needed to evaluate the effectiveness and safety of tie-over dressings in skin grafting.

Method
Major clinical databases (MEDLINE, Embase, Cochrane, ClinicalTrials.gov, EU Clinical Trials Register and ISRCTN registry) were systematically searched from its inception to 24th October 2022 for studies describing subjects who received skin grafts and subsequently received tie-over or non-tie-over dressing in plastic surgery. Risk ratios of graft take rate, wound infection rate, and haematoma are calculated to compare tie-over and non-tie-over dressing with random-effect model.

Results
A total of 892 entries were retrieved. Of these, 8 met the inclusion criteria and were included for analysis. Full graft take is high in both groups (89% in tie-over vs 95% in non-tie-over). Risk ratio of graft take is 0.95 (95% CI = 0.89-1.02, p = 0.118, I 2 = 0%). Risk ratio of graft failure is 1.41 (95% CI = 0.72-2.74, p = 0.235, I 2 = 0%). Risk of causing complications is higher in patients who received tie-over dressing (RR=1.61, 95% CI =1.03-2.54, p = 0.271).

Conclusions
The results indicate that the additional tie-over dressings may not be beneficial. However, no existing evidence looked into the health economics between tie-over and non-tie-over groups.
133 Gender Differences in Mortality of Hospitalised Stroke Patients: A Systematic Review and Meta-Analysis
Authors: Abdel-Fattah A R , Pana T , Smith T , Pasdar Z , Aslam M , Mamas M , Myint P 
Published: August 2024

Abstract

Aim
Gender differences in mortality after stroke remain unclear in the current literature. We therefore aimed to systematically review the gender differences in mortality up to five-years following ischaemic (IS) or haemorrhagic stroke(HS) to address this evidence gap.

Method
The literature was systematically searched using Ovid-EMBASE, Medline, and Web-of-Science databases, from inception to November-2021. The quality of evidence was appraised using the CASP Cohort-study checklist. Unadjusted and adjusted odds and hazard ratios were meta-analysed separately for IS and HS.

Results
Forty-one studies were included (n=8,128,700; mean-age: 68.5 years; 47.1% female). Thirty-seven studies were included in meta-analysis (n=8,8008,110). Compared to men, women who had IS had lower mortality-risk in-hospital (RR: 0.94; 95%CI: 0.91–0.97), at one-month (RR: 0.87; 95%CI: 0.77–0.98), 12-months (RR: 0.94; 95%CI: 0.91–0.98) and five-years (RR: 0.93 95%CI: 0.90–0.96). Nevertheless, analysis of crude data showed women were at higher risk of mortality in-hospital, at 12-months and five-years (in-hospital, RR: 1.05; 95%CI:1.03–1.07; 12-months, RR: 1.10; 95%CI: 1.06–1.14; five-years, RR: 1.06; 95%CI: 1.02–1.10). After HS, women had higher mortality-risk in-hospital (RR: 1.03; 95%CI: 1.01–1.04) however, no gender differences were found post-discharge.

Conclusions
The gender differences in post-stroke mortality differ by stroke type, age-group, and follow-up. Crude stroke mortality in women is higher than in men and this appears to be driven by pre-existing comorbidities. In adjusted models, women have a lower mortality-risk following IS, independent of duration of follow-up. After HS, women had higher mortality in hospital however, no gender differences after hospital discharge were found.
850 Streamlining Patient Care: Developing an Integrated Proforma for Neck of Femur Fracture Patients Across Multidisciplinary Teams
Authors: Choudhry H , Thiagarajan J , MacDowell A 
Published: August 2024

Abstract

Aim
To create a comprehensive Neck of Femur (NOF) fracture proforma that includes sections for the wider multi-disciplinary team (MDT) such as Physiotherapy, Nursing, Orthogeriatric, Emergency Department (ED) and Orthopaedic teams. To assess the extent of completion of the Integrated care pathway (ICP) by profession. To assess the documentation of Key Performance Indicators (KPI) of a single centre.

Method
57 NOF proformas were collected and analysed to evaluate compliance of each section. Qualitative feedback was obtained from the wider Multidisciplinary team to gauge the practicality of the proforma. Each section underwent scrutiny to assess the documentation of key information relevant to the respective MDT.

Results
Certain aspects, such as time to surgery, nerve block documentation, and NICE-compliant surgery, could not be thoroughly assessed due to insufficient information (less than 50% availability). Documentation scores; ED 5.8/13, Orthopaedic clerking 8.9/13, Nursing 22/29, Physiotherapy 3.5/4. For each KPI; Physio score was 96%, MUST score 89%, mobilising the next day after surgery 86%, Orthogeriatric ST3+ r/v 72 hours after presentation 82%, falls assessment 77%, pre-Op AMTS 75%, surgery the following day of presentation 49%, 4AT post-op score 11%.

Conclusions
A single place proforma for all patient needs can save significant administrative time when it comes to assessing key documentation of the ICP. However, this is only useful if there is adequate compliance to proforma documentation. Education is key as simple factors such as documentation of delirium post-operatively can limit Best Practice. A proforma must be practical, and easily accessible to encourage compliance.
1076 Stop Before You Bier's Block- a Major Trauma Centre's Experience of Improving Intravenous Regional Anaesthesia Safety
Authors: Murdeshwar H 
Published: August 2024

Abstract

Aim
Intravenous regional anaesthesia (IVRA) offers a safe and cost-effective means to perform short procedures on an extremity. Local anaesthetic systemic toxicity may occur if the anaesthetic is infiltrated prior to inflating a tourniquet. This project aims to improve Bier’s block safety in the Orthopaedic department at a major trauma centre.

Method
Root cause analysis performed after a patient safety incident involving the Bier’s block indicated a knowledge gap among Orthopaedic junior doctors, breakdown in communication between the Plaster room team and need for training in managing adverse outcomes. A survey assessing block providers’ understanding of the indications, associated risks and competence in undertaking the procedure was conducted. A poster with an aide memoire highlighting the key steps of the procedure was created and a demonstration was provided. The widely successful “STOP before you BLOCK” approach was applied to encourage a 2-person check of tourniquet inflation and local anaesthetic before proceeding.

Results
The post session survey demonstrated an increase in self-reported confidence levels in performing the block from 3 to 5 on a 5-point scale with 88% reporting a better understanding of the signs and symptoms of local anaesthetic toxicity and its management. 70% responders attributed their increased confidence to the poster intervention and 84% to the “STOP before you BLOCK approach.” The Plaster room technicians reported improved communication among the team with better involvement of individual members.

Conclusions
Procedural competency in IVRA can be improved through adequate training, induction, use of visual cues and effective communication.