bluuebunny/crossref_metadata_2025_split huggingface dataset:
1129 LaCON: A Quality Improvement Project on Laparoscopic Cholecystectomy Operation Notes
Authors: Kapsampelis P , Prce D , Saunders J , Bezzaa S , Gerogiannis I 
Published: August 2023

Abstract

Aim
Accurate and comprehensive operation notes are crucial for patient care, quality assurance and medico-legal purposes. Laparoscopic cholecystectomy (LC) is one of the most common procedures in General Surgery, either in an Elective or Emergency setting. Therefore, there is a need for an accurate and standard way to document the operation notes for a safe immediate and late post-operative care, including follow-up. The LaCON project aims to evaluate and improve the quality of the operation notes.

Method
A retrospective review of operation notes of LCs performed at our institution between August-November 2022. Electronic notes were assessed against the Royal College of Surgeons’ Good Surgical Practice standard, consisting of 18 items.

Results
A total of 80 operation notes were reviewed. There was 100% compliance in surgeon’s name, operation procedure, incision, port sites, and closure technique. Other high-scoring items were indication (98%), operative findings (98%), operation date (91%) and assistant’s name (90%). Among the lowest-scoring items were detailed postoperative instructions (46%), designation as elective or emergency (38%), operative diagnosis (16%) and estimated blood loss (EBL) (8%).

Conclusions
We identified several areas for improvement in LC operation notes, such as a detailed and robust post-operative plan, a precise intraoperative diagnosis and information about EBL. The LaCON project highlighted the need to implement an electronic evidence-based proforma to standardise notes. This proforma will be accessible through a secure online app, in line with the local Hospital policies, and will allow accurate and contemporaneous record keeping and efficient extraction of operative data for analysis.
1144 Audit of Microbiological Sampling in Patients with Diabetic Foot Infections Presenting to a Tertiary Vascular Centre in the North-East of England
Authors: Sillito S , Woodmass M , Nesbitt C , Arkle J 
Published: August 2023

Abstract

Aim
To identify the practice of microbiology sampling in patients presenting to a Tertiary Vascular Centre in the North East of England in accordance with NICE guideline (NG19) ‘Diabetic foot problems: prevention and management’ and the ‘International Working Group on the Diabetic Foot guidance on the diagnosis and management of foot infections in diabetes’.

Method
A two-part retrospective audit was completed before and after the introduction of a podiatrist-led 'Hot Foot Clinic'. Patients were identified from the surgical-take handover and admission database by using keywords ‘diabetic’, ‘cellulitis’, ‘erythema’, ‘pain’, ‘wet necrosis’, ‘collection’, 'osteomyelitis’. Route of admission, timing and type of microbial samples and date of antibiotics prescribed were recorded.

Results
In the first cycle 56.8% (21/37) patients had microbiology samples sent. 47.6% (10/21) of these were sent before antibiotic prescription. 8.1% (3/37) had both a swab and tissue sample taken. 35.1% (13/37) had tissue samples and 21.6% (5/37) had swabs. In the second cycle 74.2% (23/31) had microbiology samples sent. In patients who had tissue samples taken, 23.5% (4/17) were prior to antibiotic initiation. All patients (3/3) admitted from a podiatry-led ‘Hot Foot Clinic’ had microbiology taken prior to antibiotics. 6.3% (1/16) patients admitted through the clinician-led Emergency Admissions Suite had microbiology taken before antibiotics.

Conclusions
Despite introducing a podiatrist-led clinic, reinforcement of correct microbiological sampling in diabetic foot infections is required for accurate diagnosis and optimal treatment. Further specialist input and audio-visual educational material is being developed to improve practice amongst all staff.
1268 An Audit of the Time to Surgery Following Diagnosis of Gallstone Pancreatitis
Authors: Sekyi-Djan M N , Agnihotri A , Goian L 
Published: August 2023

Abstract

Aim
To assess the compliance of our trust with the British Gastroenterology guidelines (BSG) on the management of gallstone pancreatitis which recommends that patients should undergo definitive treatment of laparoscopic cholecystectomy during the index admission or within 2 weeks of discharge to prevent readmission with biliary complications.

Method
This was a retrospective study of patients admitted with gallstone pancreatitis over a 3-month period between January 2021 and March 2021. We collected data from electronic medical records (EPR) and collated them on Microsoft Excel. Data was gathered on patient demographics, diagnosis at presentation, number of days to surgery, rate of readmission and the reasons for this.

Results
A total of 21 patients were admitted with gallstone pancreatitis. The median age was 50 years and 52% of them were male. 14 (67%) patients had laparoscopic cholecystectomy and only 9 (64%) of these had it within the 2-week window. 7 (33%) patients did not have surgery. Of these, 4 of them were not eligible, 1 went private and 2 patients are still awaiting surgery. The median wait for surgery was 3 days. The average time to surgery was 64 days. There were 6 readmissions whilst waiting for surgery with pain being the most common reason.

Conclusions
64% of patients had definitive treatment of laparoscopic cholecystectomy within the 2-week time frame demonstrating poor compliance with the BSG guidelines. We have introduced a semi-emergency theatre list once a week to accommodate definitive management of patients with gallstone pancreatitis and will re-audit the data to evaluate for improvement.
1326 Temporal Artery Biopsy for Giant Cell Arteritis (GCA): A Ten-Year Retrospective Audit in an Irish Hospital
Authors: Westby K 
Published: August 2023

Abstract

Aim
To assess if temporal artery biopsies (TABs) were carried out in accordance with American college of rheumatology (ACR) guidelines. To establish if there is correlation between ESR and histological samples positive for GCA.

Method
Retrospective chart review of all patients who underwent TAB in Sligo University hospital 2010-2020. Patients identified using histopathological department database.

Results
A total of one hundred and fifty-five patients underwent TAB (mean age 70.5yrs, 68% female, 32% male). 27 (17.4%) of samples were positive for GCA. 128 (82.6%) samples were negative for GCA in patients with a clinical diagnosis (P &lt; 0.001). There was no correlation between ESR and biopsy result (r = 0.12). 107 (69%) met the guidelines for GCA.

Conclusions
The low numbers of positive samples may reflect a number of issues e.g., sample length, presence skip lesions, sampling patients already on steroid treatment. There are many new non-invasive modalities e.g., US doppler, which can diagnose GCA.
47 Awareness of Obesity and Morbid Obesity Amongst General Population: A Pilot, Cross-Sectional Survey Study
Authors: Patel A , Iqbal A , Ganguly G , Bandyopadhyay S 
Published: August 2023

Abstract

Aim
The aim of this study is to ascertain level of awareness regarding morbid obesity (MO) in patients visiting a GP surgery.

Method
A seven-question survey was created to assess population awareness of obesity. The questions assessed participant awareness of the BMI definition, causes, management, and co-concomitant diseases related to obesity. The participants were recruited on a voluntary basis at a GP surgery in Manchester.

Results
A total of 226 participants completed the obesity awareness survey. 73.1% of respondents reported that they were aware of obesity being a disease. However, only 59.29% felt that they knew the difference between obesity and MO. The correct BMI range defining obesity was selected by 28.34% of respondents. Majority of the respondents chose “multifactorial” (44.69%) as the cause of obesity, followed by overeating (34.07%), lack of exercise (27.43%), and hormonal imbalance (5.31%). 59.29% felt that MO should be treated aggressively with majority selecting a combined treatment approach (Surgical + Medical + Lifestyle changes) (54.87%). Diabetes (86.73%), depression (73.45%), obstructive sleep apnea (54.52%), and chronic obstructive pulmonary disease (54.54%) were selected most commonly as diseases-related to MO. Only 38.94% and 36.73% thought that reflux disease and hypertension were related to MO, respectively. Interestingly, only 0.88% picked all four MO-related diseases accurately, while 35.40% picked at least three diseases correctly.

Conclusions
Obesity awareness in the general population appears to be suboptimal. There is a need to introduce appropriate interventions to improve the knowledge of public regarding obesity with the view of reducing the prevalence of obesity and subsequently related healthcare costs.
180 Does Preoperative Cognitive Behavioural Therapy Improve Postoperative Weight Loss Outcomes in Patients Undergoing Bariatric Surgery? a Systematic Review and Meta-Analysis
Authors: Hughes J , Hughes R , Musbahi A , Kourounis G 
Published: August 2023

Abstract

Aim
Bariatric surgery is an effective intervention in treating obesity. However, some patients experience weight regain or early weight stabilisation. It is thought that psychological comorbidity may contribute to this. We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) to determine if preoperative cognitive behavioural therapy (CBT) would improve weight loss outcomes in patients scheduled for bariatric surgery.

Method
Medline, PsychINFO, Scopus and EMBASE were searched from their origin to 20th March 2022 for articles comparing preoperative CBT to standard care. Primary outcome was weight loss at least 1 year postoperatively. This review was registered on PROSPERO (CRD42022326336).

Results
Of 144 articles, 2 met inclusion criteria. They included a total of 187 patients randomised between CBT (n = 95) and control (n = 92). One paper included 1 year follow up whilst the other included 1 and 4 year follow up. Our random-effects meta-analysis found no significant difference in weight loss outcomes between the two groups at 1 year, p = 0.43. There was high heterogeneity between the studies, I2 = 90%.

Conclusions
Currently, RCTs do not show a significant difference in postoperative weight loss between CBT and control groups although case specific CBT may still be beneficial. Our study was limited by few eligible studies and high heterogeneity between the studies. One study also demonstrated selection bias by excluding patients who had previously undergone psychotherapy from the analysis.
637 Can Metabolic Surgery Lead to Hypertension Remission? Our Experience
Authors: Mahendran V , Ricart P , Eymech O , Wadley M 
Published: August 2023

Abstract

Aim
To evaluate the rate of remission (RR) from hypertension after Laparoscopic Roux-en-y Gastric Bypass (LRYGB) and Laparoscopic Sleeve Gastrectomy and determine any difference between the groups.
To analyse if the patient’s age, sex, BMI and number of anti-hypertensive medications (AHMs) taken preoperatively affected remission after surgery.

Method
Retrospective cohort analysis of all patients on AHMs who had undergone LRYGB or LSG as their primary procedure at Worcestershire Royal Hospital (WRH) between 1/01/2012 and 31/12/2019 were included in the study. We excluded patients who underwent other types of Bariatric procedures or took AHMs for any other reasons

Hypertension
Defined as usage of AHM(s) at least 18 months before surgery.
Remission from hypertension: defined as no prescribed AHMs for one year after surgery.

Results
475 patients underwent bariatric surgery at WRH between 1/01/2012 and 31/12/2019; 193 patients met the inclusion criteria; LRYGB 52% (n = 101) Vs LSG 48% (n = 92). RR after LRYGB - Year 1: 40% and Year 2: 43%; Vs LSG -Year 1: 40.8% and Year 2: 43.1%. Number of preoperative AHMs, 1 AHM: 53% RR; 2 AHMs: 36% RR and ≥ 3 AHM: 18% RR; (P value = 0.0009). Age ≤45 years: 58% RR Vs &gt;45 years: 37% RR; (P value = 0.024). RR in ≤ 45 years after LRYGB: 77.8% Vs LSG: 39.3% (P value = 0.0085).

Conclusions
There was no significant difference in RR between LRYGB Vs LSG, sex or BMI. Patients ≤ 45 years and those taking fewer AHMs before surgery had a significantly higher RR. Patients ≤45 years who underwent LRYGB had maximum RR from HTN.
1073 Roux-en-Y Gastric Bypass or Sleeve Gastrectomy Versus Medical Therapy in the Management of Obesity in Patients with Type 2 Diabetes Mellitus: Systematic Review and Meta-Analysis
Authors: Shirke M , Sreejith G , Ravikumar N , Roy S , Nizam M Z , Tuli K 
Published: August 2023

Abstract

Aim
Bariatric Surgery has proven to be effective in achieving diabetic control in morbidly obese patients. Advances in Roux-En-Y Gastric Bypass (RYGB) and Sleeve gastrectomy procedures have influenced this majorly. This review aims to analyse the clinical outcomes by comparing the two procedures and medical therapy, in morbidly obese patients with Type 2 Diabetes Mellitus (T2DM).

Method
A systematic literature review was conducted in accordance to the PRISMA guidelines to identify relevant articles that compared RYGB, sleeve gastrectomy and medical therapy for obesity in diabetic patients. Primary outcomes included BMI and HbA1c.

Results
Seven studies were identified enrolling 900 patients. Participants were predominantly female (61.31%) with a mean follow up of 2.71 years. A greater reduction in BMI and HbA1c was noted with both procedures compared to medical therapy. Sleeve gastrectomy was better in reducing BMI than RYGB (SMD = 19.23 [15.61 – 22.84], p&lt;0.01). HbA1c (SMD = -2.37 [-2.72 – -2.02], p&lt;0.01) and Triglycerides (SMD = -0.87 [-1.65 – -0.08], p = 0.03) were statistically significantly in favour of RYGB. No differences were noted between the two procedures in other outcomes including fasting glucose, weight and Blood pressure. Both procedures compared to medical therapy were considered to be superior statistically across all outcomes measured.

Conclusions
Overall, the study shows the superiority of Bariatric surgery to medical therapy in managing T2DM in obese patients. No significant differences were noted between the types of bariatric surgery, however, there exists a need to perform studies with longer follow up and compare the feasibility of these procedures.
763 De-Escalation of Axillary Treatment. Have We Fully Explored the Options for Those Patients Who Undergo Primary Reconstruction with Implants?
Authors: Davies B , Mirghani D , Ooi J 
Published: August 2023

Abstract

Aim
Treatment of the malignant axilla is a contentious area within breast cancer management. The POsitive Sentinel Node (POSNOC) Trial represents one of the largest trials into axillary treatment for the malignant axilla and includes surgical clearance of the axilla (ANC) or axillary radiotherapy (ART).
Patients who undergo primary reconstruction with implants are not excluded from the POSNOC Trial. Yet, data surrounding the risks of axillary radiotherapy to patients with breast implants is scarce. This project aimed to collect and analyse the data of those Trust patients who had undergone immediate reconstruction with an implant and axillary radiotherapy, to review any potential complications, increased risks, and impact on decision-making.

Method
Retrospective study, looking at the five years of data (2017-2022).

Results
21 patients were identified as having breast implants with axillary node metastasis. Of these, eight patients had axillary treatment due to macro-metastasis. Five of these patients had ANC and the remaining three patients had axillary radiotherapy. Out of these patients one patient (33%) had to have their implant removed post radiotherapy, due to capsular contracture. Within the limitations of this small study, we can see that in patients with primary implant reconstruction are more likely to have ANC rather than radiotherapy. Additionally, in three patients with implants 33% had complications that could be related to radiotherapy.

Conclusions
Further research into the impact of axillary radiotherapy in patients with implants is vital, so that patients can be adequately informed to make decisions about their treatment options.
54 Is Nicotine Replacement Therapy (NRT) Offered and Prescribed to Current Smokers Admitted to Thoracic Surgery?
Authors: Nelson A , Crawford A 
Published: August 2023

Abstract

Background
Cigarette smoking is a well-known habitual risk factor for lung cancer. Lung cancer resections make up the majority of BRI Thoracic Surgery admissions. Smoking has a negative impact on long term survival and disease progression of lung cancer patients increasing risk of recurrence and secondary tumours following surgery with curative intent.

Method
Retrospective analysis of all patients discharged from thoracic surgery during December 2021, February 2022 and March 2022. Interventions were implemented following thoracic surgery team meetings in January and February. Data was obtained from pre-operative assessments, inpatient clinical notes, discharge summaries and discharge medications. Interventions included team discussions and education, implementation of NRT prompts in EPR pathway and NRT prescribing stickers in drug charts.

Results
The majority of admissions were for lung cancer resections reaching 49% of admissions in February and March. In December, February and March: 70%, 55% and 50% of patients respectively had no documented discussion of smoking cessation/ NRT during admission and were not discharged with NRT.

Conclusions
78% of patients who were offered NRT as an inpatient accepted and were discharged with appropriate NRT. The number of patients who had no documented discussion about smoking cessation, and subsequently no NRT prescribed on discharge improved over the months (70%, 55% and 50% respectively). 16% of patients had no smoking status documented at pre-op or during admission. There is room for improvement in NRT discussions on the ward, allowing prescription of NRT to promote smoking cessation on discharge.
423 Up Against the Wall - Emergency Double Myocardial Rupture Repair
Authors: Ravi R , Unsworth-White J , Sinha S , Dunlop C 
Published: August 2023

Abstract

Background
Left ventricular free wall rupture (LVFWR) and interventricular septal rupture (VSR) are potentially catastrophic mechanical complications after acute myocardial infarction (AMI). When they occur together ("double myocardial rupture" (DMR)), survival is unlikely. DMR is seen in only 0.3% of all AMIs. With or without surgical intervention, the odds are against the patient.

Case presentation
Our 57-year-old male patient self-referred to the emergency department of a remote hospital 5 days after first experiencing chest pain. Investigations in ED confirmed an inferior ST-segment elevation myocardial infarction (STEMI) complicated by DMR. Coronary angiography revealed a mid-course total occlusion of the right coronary artery (RCA).
He was rapidly transferred to our regional cardiac surgical unit, arriving at the theatre in cardiogenic shock but conscious before arresting and being massaged onto bypass. Not only did he survive the all-night operation, requiring a mitral valve replacement in the process, but he survived multiple ITU complications to be eventually transferred, neurologically intact, on postoperative day 66 to a peripheral unit to complete his rehabilitation. He has been discharged from the rehabilitation centre 88 days after the operation, and He is now able to ambulate with a walking frame.

Conclusions
Our patient, against all odds, has survived DMR and multiple postoperative complications. We present the details of his case and the literature surrounding the condition. We hope patients with meagre probabilities, such as the patient seen in this case, are not given up on; hence, our final message from this report is to persevere and persist against all odds.
589 Medication Prescribing for Patients Undergoing Cardiac Surgery with Heart Failure with Reduced Ejection Fraction (HFrEF) and Review of Left Ventricular (LV) Function Documentation - A Departmental Audit
Authors: Le H B T , Clark L , Campbell C , Lang P 
Published: August 2023

Abstract

Aim
This study aims to audit the prescribing practices for patients with heart failure with reduced ejection fraction (HFrEF) who have undergone cardiac surgery at our department in accordance with European Society for Cardiology (ESC) guidelines for titrating heart failure medication in this cohort of patients.

Method
Data was collected from patients (n = 217) who have undergone cardiac surgery at our department between 20 May 2021 to 20 August 2021. This was collected from Tomcat Systems (Philips) and left ventricular ejection fraction (LVEF) was noted. ESC guidelines define HFrEF as LVEF≤40% and 15 patients met this criterion. These patients had their medications and electronic patient records reviewed to assess whether they are prescribed, considered for titration, or had a contraindication to the following medications (grouped as compliance rate) as per the 2016 ESC guidelines: ACE-inhibitor (or Angiotensin Receptor-Neprilysin Inhibitor - ACEi/ARNI), beta-blocker (BB) and mineralocorticoid receptor antagonist (MRA).

Results
This audit found a compliance rate of 67% (10/15) patients for ACEi/ARNI, 80% (12/15) patients for BB and 67% (10/15) patients for MRA. Following a departmental meeting, significant barriers were identified to optimal prescribing of these medications including lack of LVEF information readily available for ward round, lack of awareness and miscommunication of responsibility.

Conclusions
Having identified the challenges to optimal titrating of these medications, we have implemented interventions to improve communication of LVEF status to the clinical team. We have also encouraged the referral of these patients to heart failure clinic. The next cycle of audit will assess the efficacy of these changes.
1171 Post-Operative Length of Stay Following Anatomical Lung Resection
Authors: Leiberman C , Kostoulas N 
Published: August 2023

Abstract

Aim
This project aimed to identify reasons for a post-operative length of stay (LOS) more than 3 days in patients who have undergone VATS or RATS anatomical lung resections.

Method
Theatre records for VATS and RATS anatomical resections over a one-month period were examined with ones that were converted to open surgery excluded. The patients were then categorised into 3 groups: Group 1 – patients staying 1-2 days post-operatively, Group 2 – patients staying 3-5 days, and Group 3 – patients staying more than 5 days.

Results
A total of 17 patients were identified. Of these, 4 (24%) had a LOS of 1-2 days, 9 (52%) had a LOS of 3-5 days, and 4 (24%) had a LOS of 5 days or more.
In Group, 3 (33%) stayed due to a post-operative air leak, 2 (22%) stayed due to post-operative pain. Case notes were missing for 2 (22%) of these patients.
In Group 5, 3 (75%) stayed longer than 5 days due to a post-operative air leak, and 1 (25%) stayed due to a new arrhythmia.

Conclusions
The most common reason for a prolonged length of stay was due to a post-operative air leak following anatomical lung resection. Further studies could compare other months, compare VATS against RATS, or include data from resections via thoracotomy. A possible way to reduce post-operative LOS, if the cause is an ongoing air leak, could be to discharge more patients with an ambulatory bag.