bluuebunny/crossref_metadata_2025_split huggingface dataset:
361 Is Adrenaline Safe for Use in Digital Blocks? Changing Departmental Perceptions
Authors: Chu O , Mustafa Q , Mills R 
Published: August 2024

Abstract

Aim
We aimed to improve the understanding and perception of safe local anaesthetics with adrenaline injection in fingers among a cohort of registrars and consultants.

Method
Guided by the Plan-Do-Study-Act framework, we designed a survey looking at the key aspects of safe administration of adrenaline in fingers i.e., dose, mechanism of action, administration and toxicity. We collected data from registrars and consultants within the T&O team, developed and implemented evidenced based teaching at a local meeting within the hospital department. We repeated the survey following the intervention to assess changes in understanding and perception of adrenaline injection in fingers.

Results
The number of surgeons involved in two phrases were 13 and 11. Only 38% of the surgeons would consider injecting local anaesthetics with adrenaline into digits before the intervention. Understanding of safe adrenaline injection in fingers before the intervention was generally suboptimal. 64% correctly identified the safe maximum dose of adrenaline with local anaesthetics injection. 46% and 23% were able to identify the mechanism of actions and optimal time of haemostatic effect. The majority (92%) identified phentolamine as an agent to reverse the effect of adrenaline. Following the intervention, understanding of the 4 areas have significantly improved to 82%, 64%, 64% and 100% respectively. Perception of adrenaline injection in fingers has also shifted. 91% of registrars and consultants would use adrenaline with local anaesthetics in fingers injection.

Conclusions
This intervention effectively improves surgeons’ understanding and therefore the likelihood of using this safe technique in the selected group of patients’ cohorts.
405 Giant Cell Arteries: Diagnostics
Authors: Naseer A , Elkorety M , Anton J , Sarin S 
Published: August 2024

Abstract

Aim
Giant cell arteritis (GCA) poses a risk of severe ischaemic complications such as irreversible blindness which mandates early recognition of condition. We aimed to evaluate effectiveness of ultrasound doppler (USD) in diagnosing GCA compared to temporal artery biopsy (TAB) and American College of Rheumatology (ACR) score.

Method
This retrospective study included patients with suspected GCA who had consecutive TAB and USD examinations performed over course of three years (2017-2022) which was correlated with ACR score. The data was also analysed to assess further management.

Results
There were 64 patients over this period who had both studies performed (22 were excluded as they did not have TAB) with 64% having an ACR score ≥3. Twenty males and forty-four females with a median age of 77 years (IQR 84-67). Overall, 81% patients had a negative USD result. Comparing USD results with TAB gold standard, there was sensitivity of 63% and specificity of 84%. Comparing USD results with ACR as gold standard, there was sensitivity of 20% and specificity of 83%. Forty percent patients with negative doppler result were continued on treatment mainly due to improvement of symptoms in response to steroids.

Conclusions
US Doppler has high specificity and low sensitivity which makes it time-efficient, cost-effective and allows for the implementation of fast-track management pathway for majority patients. In certain circumstances, as cases of low clinical suspicion and positive doppler result, an additional test (TAB) would be required to confirm the diagnosis and cases where clinical suspicion is high with negative doppler, TAB should be considered.
423 Implementation of Standardised Consent Forms for Hip Fracture Surgery: A Quality Improvement Project
Authors: Singh S , Bompalas P , Pang J , Hinton A , Genena A , Mohamed R , Modi N 
Published: August 2024

Abstract

Aim
Informed consent is pivotal for patient care. We assessed the quality of written consenting for surgical management of neck of femur fractures (NOFF) at a UK District General Hospital. This resulted in the development of standardised consent forms to promote best clinical practice.

Method
A retrospective review of consent forms for 50 consecutive patients admitted with NOFF from July 2023 evaluated legibility, documentation of procedure name, benefits, risks, and consenter details. Standardised consent forms endorsed by the British Orthopaedic Association were used as a standard and a guide for our standardised consent forms, introduced in September 2023. We reviewed the compliance with the new forms for inpatients with NOFF in October 2023 (n=21).

Results
On consent 1 forms (n = 37), nearly 60% lacked documentation of benefits (pain relief and mobility), and 78% missed more than 5 risks. All forms were legible and 98% completed by speciality registrars or consultants. Venous thromboembolism was documented on all forms. Chronic pain, stiffness and death were missed on most forms. Procedure name was the only documentation found on consent 4 forms. The new standardised forms included both consent 1 and 4 forms and were utilised in 86% of cases. Users of the new form also included foundation year 2 doctors who clerked the patients on admission.

Conclusions
Standardised forms prevent oversight of crucial procedure risks, facilitate time efficiency, and instil confidence in junior team members to consent. Future steps aim to extend this standardised approach to other common orthopaedic procedures, like wrist and ankle fracture fixations.
478 Improving the Prescription of Key Medications for Inpatients Admitted to the Royal Cornwall Hospital with an Acute Sore Throat: A Quality-Improvement Project
Authors: Merchant H , Lambert A 
Published: August 2024

Abstract

Introduction
The regular administration of intravenous antibiotics, analgesia, steroids, and adequate venous thromboembolism (VTE) prophylaxis is important when managing patients with an acute sore throat. Therefore, a quality-improvement project, aiming to improve the prescription of these medications within the Royal Cornwall Hospital (RCHT) Ear Nose and Throat (ENT) department, was undertaken to enhance patient recovery and reduce length of stay (LOS).

Method
Electronic drug charts of adult patients admitted under ENT with an acute sore throat from March to May 2023 were consulted. Information on whether patients had been prescribed regular analgesia, antibiotics, steroids (if indicated), adequate VTE prophylaxis and their LOS was sought.

Results
A total of 58 patients were included. The majority (59%) were male, and the mean age was 29. The most common diagnoses were Tonsillitis (43%), followed by Quinsy (30%) and Supraglottitis (10%). The mean LOS was 1.2 days. Regular analgesia was prescribed for 52% of patients on admission, and 78% during their inpatient stay. Regular antibiotics were prescribed for 73% of patients on admission, and all patients during their inpatient stay. Regular steroids were only prescribed to 42% of patients that needed them, and 69% of patients were prescribed VTE prophylaxis.

Conclusions
These findings indicate a need to improve the prescription of regular analgesia, antibiotics on admission, VTE prophylaxis and steroids if indicated. An Acute ENT Sore Throat electronic prescribing protocol has subsequently been developed and disseminated amongst RCHT junior doctors. A second cycle of data-collection will be undertaken to examine the subsequent effects on patient care and LOS.
649 Retrospective Audit into Management of Periprosthetic Joint Infections as per National and International Guidelines
Authors: Chaudhary A , Harrison R , Przybylo M 
Published: August 2024

Abstract

Aim
The main aim of this quality improvement project is to improve care of patients with peri-prosthetic joint infections (PJI), by assuring appropriate diagnostics are sent and antibiotics recommended are as per Pro-Implant and British Orthopaedic association (BOA) guidelines, which are international and national guidelines.

Method
Retrospective analysis of all tissue samples received for patients with periprosthetic joint infections during August 2022 and August 2023 from patients across Manchester. There were 68 samples (17 patients) in total with peri-prosthetic joint infections out of 197 samples (62 patients). These were all compared to standards set by the Pro-Implant and BOA. Multiple criteria were compared by analysing clinic letters and Labcentre documentation.

Results
The results show a 100% compliance in discussion of PJI diagnosis with microbiologists, correctly labelling samples, and CRP analysis. However, we struggled with making diagnosis as per guidelines, sending more than 5 samples and discussing discharge antibiotic plans with microbiologists. Furthermore, we didn’t utilise sonification, PCR and histology to aid diagnosis. We also struggled with meeting the appropriate interval time between stages of two stage exchanges.

Conclusions
In conclusion, there is room for improvement in certain criteria’s’ as per the guidelines:Engagement with orthopaedic stakeholder to explore barriers to compliance.Dedicated MDT compromising of orthopaedic surgeons, infection doctors.Creation of an intraoperative pro-forma for suspected PJIs’ to act as a reminder to surgeons and allow clear documentation.Availability and awareness of guidelines to orthopaedic teamFunding for PCR, sonification and histopathologyJoint follow up clinic with microbiologist to improve patient follow up plans.
668 Analysis of Delays in Pathway Causing Negative Clinical Impact: Time for Change
Authors: Borra P , Lau J , Marla A , Parthiban S , Butler P , Ponniah A 
Published: August 2024

Abstract

Background
Skin cancer rates in the UK are 250,000 annually and are due to increase by 60% in the next decade. This increased demand may lead to delays in treatment and therefore adverse patient events. The objective of this study is to quantify delays and identify the main causes.

Method
Over the last 10 years the skin cancer service has grown from 200 referrals/month to approximately 750. A deeper analysis of data from 2021 to 2023, consisting of 26,114 referrals to the Royal Free Hospital was conducted. Pathway breaches were collected prospectively and analysed using root cause analysis.

Results
1326 referrals required treatment for suspected skin cancer. 657 patients breached the two-week diagnostic wait. Results for the root cause analysis identified the main causes for delays as being administrative delay (26%), inadequate capacity (12%), medical delays (9%) and patient initiated delay (7%), etc. 87.9% of patients who had missed the 31 day treatment target also missed the two week wait (2WW) target for their initial appointment.

Conclusions
Administrative issues account for the majority of pathway delay, specifically within the 2WW referrals. Missing the 2WW target significantly increases the risk of a patient missing the treatment targets which may lead to clinical harm. Inadequate capacity in clinics and diagnostics cause delay in our pathway suggesting that the current infrastructure is not sufficient to meet patient needs. This analysis has identified the key issues which need to be addressed to optimise patient transit through the treatment pathway.
799 Improving Delivery of Post-Operative After-Care Advice Following Laparoscopic Procedures
Authors: Ravikumar K , Srivastava K , Burrows L , Murphy Lonergan R 
Published: August 2024

Abstract

Aim
Patients undergoing laparoscopic surgery lack sufficient post-operative after-care instruction from the surgical team to facilitate recovery and reduce re-presentation. Our project aims to evaluate the impact of a standardised post-operative care leaflet compared to existing methods.

Method
A needs analysis was conducted via semi-structured interviews with healthcare professionals to explore existing procedures. From this, we produced a leaflet detailing important information surrounding post-operative care, addressing FAQs and red flags. Eighteen patients were presented with the leaflet pre-discharge and invited to collate questions for the surgical team based on its content. Patients were surveyed before and after reviewing the leaflet, including estimating confidence levels on completing activities of daily living and seeking help post-discharge.

Results
Needs analysis suggested a leaflet would relieve time pressure on the surgical team to relay instruction verbally and facilitate faster safe discharge. Following our intervention, 93% of patients felt confident in managing at home on discharge (an increase of 46%, p&lt;0.05). Notably, patients also felt better prepared to manage bowel movements and recognise when to seek additional help; both factors aligned with the needs analysis findings. 94% of patients wanted the leaflet as part of their care plan, citing reasons such as increased awareness, health empowerment, practicality, and pictorial references.

Conclusions
Patients perceive existing after-care information to be insufficient. The implementation of a post-operative advice leaflet for patients following laparoscopy, arms them with the knowledge and safety nets needed for speedy recovery. It additionally benefits staff as a time-saving device, by providing an efficient framework for after-care discussion.
1102 Maximising Safety on Surgical Ward Rounds with a Concise Ward-Round Template: A Quality Improvement Project
Authors: Vaughan-Burleigh S , Ejide C 
Published: August 2024

Abstract

Aim
Concerns raised at clinical governance meetings highlighted incomplete ward round documentation and near miss events in prescribing. Checklists have demonstrated improved patient safety and ensure standards of care are maintained. We evaluated documentation and prescribing accuracy in a baseline audit and sought to improve these with the implementation of a concise ward-round template.

Method
We identified essential patient safety orientated criteria for ward round documentation from trust and departmental guidelines. Compliance with criteria was assessed by audit before and after the introduction of a standardised ward-round template. A root cause analysis was performed to identify reasons for errors between cycles and to optimise the design of the ward-round template. A poster promoting the template was circulated to junior doctors and the results presented in clinical governance. Each cycle included fifty consecutive patients.

Results
The baseline audit identified no ward-round documentation in 8% of inpatient days. Prescribing errors with near misses were identified in two cases. Poor documentation and communication were the most significant contributing factors in root cause analysis. After implementation of a ward-round template all inpatient days had a ward round entry, 96% using the template. Documentation of essential criteria improved from 32% to 93% (p&lt;0.05) and there were no prescribing errors. Compliance with VTE guidelines improved from 70% to 98% (p&lt;0.05).

Conclusions
This quality improvement project implementing a ward-round template improved documentation of essential patient safety orientated criteria and compliance with trust guidelines. Adherence to the ward round template was high several months after implementation, suggesting that ongoing use is viable.
1277 Audit: Patient-Controlled Epidural Analgesia vs. Continuous Infusion
Authors: Salloum L Al 
Published: August 2024

Abstract

Aim
Investigating and quantifying continuous infusions require post-operatively. Determining the agent of choice in epidural top-ups. Investigating Diamorphine dosing in epidural infusions peri-operatively and post-operatively.

Method
Retrospective cross-sectional study. A comprehensive literature review utilizing PubMed, where exclusion criteria involved including only ‘free full text’ and publications released in the last decade. Data from operations requiring continuous analgesic infusion from the previous year was collected via spreadsheet software, and statistically analysed.

Results
In a study of 70 surgical patients receiving peri-operative and post-operative epidural analgesia, the average duration of epidural use was 3 days, with an average of 1.77 top-ups per patient. Of these patients, 36 required top-ups, primarily using Levobupivacaine (53.98%) and Diamorphine (46.02%). Levobupivacaine frequency increased with more top-ups, whilst fewer top-ups were required with Diamorphine. In intra-operative continuous epidural infusion, Diamorphine doses of 10mg were most common, with 15mg as the second preferred dose, correlating with lower top-up frequencies.

Conclusions
Introducing patient-controlled epidural analgesia (PCEA) in our surgical department would allow manual Levobupivacaine dosing to be replaced by patient self-administration, reducing clinician input by 54%. This hybrid approach, termed 'continuous infusion with demand dosing,' involves a background infusion set by the anaesthetist and supplemented by patient demand. PCEAs offer immediate pain relief and a dose-sparing effect of ∼47% of local anaesthetic. Transitioning from continuous epidural infusions to PCEA could significantly reduce healthcare staff intervention in post-operative pain management by at least 50%, simplifying the process and potentially introducing a Diamorphine dosing protocol for enhanced safety and consistency.
976 A Cost-Effective Wireless Laparoscopic Camera System for Enhanced Utilisation of Minimal Access Surgeries in Developing Countries
Authors: Saranga K G V , De Silva H M S S 
Published: August 2024

Abstract

Aim
This study addresses the limited availability of laparoscopic surgery in resource-constrained settings like Sri Lanka, primarily due to cost and instrumentation complexity. The aim is to develop a cost-effective method by replacing the monitor and video processor units of the Standard Laparoscopic Stack System with a wireless digital camera.

Method
At a tertiary care centre in Sri Lanka, a team designed a metal adapter capable of holding a wireless digital camera with an adjusted focal length. The camera was mounted on the laparoscope using this adapter, and the study evaluated image resolution, system flexibility through testing in a dummy and a live patient and cost analysis was also done comparing our system with the Standard Laparoscopic Stack System.

Results
The new system achieved an outstanding cost reduction of 98.7% compared to the existing setup. The live images produced were of comparable quality, demonstrating the feasibility and effectiveness of the modified camera system. The approach ensures that while achieving substantial cost savings, there is no compromise in the quality of diagnostic laparoscopic and cystoscopic surgery.

Conclusions
The newly developed wireless system, featuring an innovative adapter and modified camera, proves to be a practical and cost-effective alternative to the traditional Standard laparoscopic Stack System. Beyond significant cost reductions, this innovation simplifies the laparoscopic setup, enhancing flexibility and manoeuvrability during surgeries. The wireless design not only overcomes financial barriers but also revolutionizes the accessibility and usability of laparoscopic procedures in resource-limited healthcare environments.
558 The Importance of Bowel Evaluation Before Reversing Ileostomy in Cancer Patients: A Single Centre Experience
Authors: Vimercati M , Khan A , Hawezi J , Raman S 
Published: August 2024

Abstract

Aim
Water-soluble contrast enema (WSCE) is a well-recognized imaging modality to determine the feasibility of ileostomy reversal, giving a good baseline of anastomotic conditions, prior to reversal. The aim of this study was to evaluate the role of WSCE as a sole imaging modality to investigate anastomotic integrity prior to reversal.

Method
For this study a retrospective database was set including patients who underwent ileostomy for colorectal cancer in a single high-volume institution, between January 2016 and December 2022. Patients who had ileostomy for other reasons than cancer, were excluded. Primary outcomes assessed were reversal rate and overall survival. Secondary outcomes assessed were rate of WSCE imaging and complications.

Results
A total of 256 patients with colorectal cancer underwent resective surgery followed by a loop ileostomy. Median observed follow-up was 36 months (18.3-53.5). A total of 48 patients [men 33 (69.0%); mean age 68.4 years (SD 11.8)] were suitable for reversal, with an overall reversal rate of 18.7%. 30-day mortality after index procedure was 0%, with an overall survival of 93.8%. WSCE as a sole preoperative imaging was performed in 93.7% of the cases. Only two patients underwent additional colonoscopy or computed tomography (CT) prior to reversal. In terms of complications, 6/48 patients (8%) had parastomal hernia requiring further surgery.

Conclusions
Enema as a sole imaging modality prior to ileostomy reversal is associated with acceptable early and mid-term outcomes, making it an acceptable alternative to other imaging techniques. The incidence of postoperative complications is extremely low. Patients will still require rigorous oncological follow up.
734 Perceptions to Gamification in Surgical Simulation Training
Authors: Shoker J , Avrova A , Lestas F , Burke J , Harji D 
Published: August 2024

Abstract

Aim
To explore surgeon and surgical trainee perceptions to gamification in surgical simulation training.

Method
A mixed-methods questionnaire, generated through steering-group expert consensus, was conducted nationally with surgically inclined medically trained professionals, ranging from medical student to consultant grade.

Results
20 participants (70% male) were surveyed. 70% were aged 25-35, 25% aged &lt;25, 5% aged 36-45. Gamification meant “making something like a game” to the majority of participants. Minor themes included the ideas of “fun” and “rewards” or “points”. 10% had “no idea”. 90% had used games for fun previously. For 65%, this was via a mobile platform, while for ≥75% this was via console. 90% self-report as very or extremely competitive. 100% think the use of gaming platforms of virtual simulators are useful for surgical training. 90% think gaming platforms or virtual simulators are useful for warming up before performing a procedure. The most common reasons for this were: it's a patient “safe environment”, “fun”, improving and theatre competition. The commonest reason against was no protected time. 80% think competition on simulators would improve the motivation to practise in a virtual environment during/after their learning curve. Aspects of surgical training thought beneficial to gamify were technical skills and laparoscopic surgery. ≥60% of participants would want to see gamification achieved through leader boards/competition, tiered task difficulty and/or task based incentives.

Conclusions
Gamification is perceived as useful in surgical simulation training and for warming up, due to it offering a patient safe environment and fun. Barriers include a lack of protected time.