bluuebunny/crossref_metadata_2025_split huggingface dataset:
792 Assessing the Frequency of Daily Patient Reviews in a Local Orthopaedic Department
Authors: Dorji T , Al Aaraj M 
Published: August 2023

Abstract

Aim
To investigate the frequency at which patients admitted under a local orthopaedic department are having daily reviews by various teams, and to assess the level of clinical seniority that saw these patients.

Method
Patients primarily under the care of the orthopaedic department were assessed over a 10-day period in two different time frames across November 2022. These included all male and female inpatients presenting with any condition. Data was collected manually by going through the patient notes and the most senior orthopaedic doctor who saw the patient on that day was recorded as the main reviewer.

Results
73 patients with an average age of 76.0 years were included. Overall, patients were seen by orthopaedics on 58.4% of the days they were in hospital. 21.2% of these were done with a consultant present, 10.4% by a registrar, 17.6% by a senior house officer, and a foundation doctor in 9.2% of occasions. Outcomes were worse over the weekends, where 56.8% of inpatients did not get reviewed at all. There were also considerable differences between the various teams, reviewing their patients from 32.9% to 69.1% of the time.

Conclusions
Patients should ideally be reviewed daily as not only does it affect patient flow but also ensures vulnerable individuals are getting the timely care that they need. This pilot study showed a considerable lack in the number of daily reviews, with some patients not being seen for several days. Therefore, better organisation and accountability of the workforce is required to reach higher standards of care.
861 Getting the Surgical Handover Right: A Closed-Loop Audit
Authors: Eva C , Slim N , Ghatge A , Bruno P , Blackaby J , Cutting J , Fowler G E 
Published: August 2023

Abstract

Aim
The European Working Time Directive has led to a reduction in hours worked by junior doctors and subsequently increased the number of handovers between colleagues. Ineffective handovers introduce the opportunity for clinical error and adversely affect patient safety. We sought to improve the quality of patient handovers in a busy surgical department, by assessing compliance with a twelve-point guideline from the Royal College of Surgeons (RCS) as the gold standard.

Method
An audit was performed across a seven-day period. For each patient discussed during the morning or evening handover, compliance was measured according to twelve domains pertaining to a patient’s admission as per RCS recommendations (e.g., diagnosis, location, relevant investigation results). Following intervention with a ‘safe handover’ checklist, we repeated the audit across a subsequent seven-day period. Secondary outcomes, such as environmental and human factors, were also assessed by a junior team member.

Results
A total of 28 handovers, incorporating 337 patients, were included. Following implementation of the checklist, compliance improved across most domains—particularly with highlighting the necessity for an additional review (33.3% vs. 91.0%) and the handover of outstanding tasks (31.5% vs. 84.3%). Compliance with discussion of resuscitation status remained low (7.0% vs 9.2%). Improvements were noted with environmental and human factors, including performance of team introductions and the opportunity to raise concerns.

Conclusions
We have demonstrated an improvement in the quality of patient handovers as per RCS guidance following the implementation of a handover checklist. Further interventions are warranted to improve handover of resuscitation status.
946 A Complete Cycle Audit of the Appropriate Management of Stable Patients Presenting Acutely with a Lower GI Bleed Using the Oakland Score Risk Stratification Tool in Order to Avoid Unnecessary Admissions
Authors: Sharma V , Smith E , Satar I , Birch D 
Published: August 2023

Abstract

Aim
The use of risk stratification tools such as the Oakland Score (OS) to identify patients with low risk of adverse outcomes (scale 0-35, safe discharge threshold ≤8) who present acutely with a Lower Gastrointestinal Bleed (LGIB) in order to avoid unnecessary admissions, in accordance with British Society of Gastroenterology (BSG) guidance.

Method
At a District General Hospital, data was collected retrospectively over six months. Patients who acutely presented with a LGIB were identified using patient handover lists and e-documentation was reviewed for a documented Oakland Score (OS). A departmental survey was conducted to ascertain knowledge of OS and LGIB assessment. Tailored teaching was subsequently delivered, including a summary sheet with a link to an e-calculator. A re-audit was conducted over three months to measure change of practice.

Results
Prior to intervention, 6/63 (10%) had a documented Oakland score (OS). Three patients had an OS &lt;8 and were inappropriately admitted. A survey was completed by 11 members of the General Surgical team. Prior to intervention, 27% (3/11) were aware of OS and only 9% (1/11) reported using it practice. Following intervention, 16/38 (42%) had a documented OS. All patients (8/8) with an OS ≤8 were appropriately discharged.

Conclusions
The use of numerical risk stratification tools such as the Oakland Score, in compliance with BSG guidance, improved patient management and avoidance of inappropriate admissions. Targeted educative measures should be delivered to the department on a regular basis, to account for continual rotating of doctors and ensuring updated knowledge to further improve outcomes.
1181 Surgical Sample Collection and Non-Touch Technique for Tibial Fractures Treated with Fine Wire Frames: First Cycle Audit
Authors: Zhang J , Zhu J , Krkovic M 
Published: August 2023

Abstract

Aim
Tibial osteomyelitis can be an incredibly complex condition to treat, and often causes great pain and reduced quality of life for the patient throughout the treatment and rehabilitation phase. Often, fine wire fixators (FWF) are used for the most severe cases, with infection and concordant bone loss/deformity correction required. A robust diagnostic protocol is required to ensure the correct antibiotics are used for treatment.

Method
The microbiology sampling and diagnostic process for patients with tibial osteomyelitis treated with FWF were audited at a major trauma centre according to British Orthopaedic Association (BOA) guidelines. Fifty-one patients met inclusion criteria.

Results
Poor compliance was defined as &lt;70% guidelines followed. Empirical antibiotics free period prior to diagnostic sampling was achieved in 46/51 cases (90.2%), five separate documented samples for microbiology sampling was achieved in 26/51 cases (51.0%), and documentation of sterile, non-touch, separate instrument technique for microbiology samples was documented in 5/51 cases (9.8%)
We recommend a pre-written template for clinicians on admission of patients with suspected osteomyelitis detailing empirical antibiotic status prior to diagnostic sampling, a template for the surgical team to detail site and technique used for microbiology sampling, and increased communication between surgeons and microbiologists to confirm and document number of samples taken.

Conclusions
Tibial osteomyelitis can be very difficult to manage, with the initial culture-specific antibiotic(s) being employed crucial in the treatment process. Achieving a robust and error-free diagnostic process is vital in combating this debilitating condition, and a key goal for the trauma and orthopaedics department.
1190 Optimising Trauma-Meeting Outcome Documentation
Authors: Akmal K , Murray V 
Published: August 2023

Abstract

Aim
Standardised documentation of consultant-led multidisciplinary team (MDT) discussions for orthopaedic referrals are vital in optimising patient care and safety. There was no formal record of trauma-meeting outcomes within our trust, which could impede the continuity of care and patient safety. We aimed to implement a more robust model for documenting trauma-meeting outcomes.

Method
This closed-loop audit consisted of two 2-week cycles. Cycle 1 audited retrospective data on the proportion of patients with documented outcomes and their referral type. A 2-week intervention was carried out between the cycles. A proforma was developed and teaching was delivered to ensure accurate documentation. Reminders were given prior to each meeting to ensure clear outcomes were voiced. A survey was used to collate feedback for improvements from the team.

Results
Data was collected from 235 patients over cycle one (n = 127) and cycle two (n = 108). Cycle one showed 70% (n = 85) had documented outcomes, in comparison to 91% (n = 98) in cycle two. Analysis by referral type showed patients without documented outcomes were largely referred from the Emergency Department to fracture clinic follow-up. Only 2.13% had documentation in cycle 1 compared to 70% in cycle 2. The survey identified that 100% (n = 11) of participants found the intervention enhanced team communication and particularly improved follow-up care within fracture clinic.

Conclusions
The audit demonstrated positive change and has been implemented as a permanent protocol within the department, which could be incorporated into other surgical MDT meetings to enhance communication and patient care.
1237 Audit Project on Golden Patient Policy Adherence and Its Improvement to Theatre Efficiency
Authors: Chen C , Pandit R , Psaltis E , Khan K 
Published: August 2023

Abstract

Aim
The Golden Patient (GP) is the first patient listed for theatre next day identified and reviewed the day before, with the aim to improve theatre start times and overall efficiency. We aimed to compare the data before implementation of the GP against post-implementation at University Hospital North Durham (UHND) to assess if improvement in efficiency was achieved. We also aimed to analyse the appropriateness of patients listed as GP.

Method
We analysed data of 45 listed GPs between April and August 2022 as well as 50 patients listed first in theatre prior to GP implementation and compared the documented operation start times. We then compared the data of the listed GPs against local trust criteria for identifying the GP which includes ASA grade/ anaesthetic type, case duration, surgical team availability.

Results
When comparing pre- and post-implementation of the Golden Patient guidelines, surgical start times improved on average by 30 minutes. In the GPs, 62.9% met all criteria. Compliance was mostly affected by the number of patients not sent for before 0830 AM (only 68.6% of cases met this criterion.) Otherwise, 97.1% of cases met ASA/anaesthetic criteria, and 94.3% met case duration criteria.

Conclusions
We saw a significant improvement in the average starting times of theatres with implementation of the GP. We also found that we were good at identifying potential GPs however there was much room for improvement with logistics and actually getting patients to theatre quickly.
259 Avoiding Face-to-Face Appointments Following Benign Breast Biopsies: Improving The Patient Experience Without Compromising Safety
Authors: Mistry D , Shaker H , Abbas A , Absar M S , Williams K , Wright C , Nasir N 
Published: August 2023

Abstract

Aim
Minimising face to face (F2F) contact can reduce the costs of outpatient clinics and increase patient satisfaction. Patients undergoing biopsy for suspected benign disease need discussing at an MDT meeting as per national guidelines, however, the majority of these do not need further treatment. We aimed to assess the utility and safety of managing patients without a further F2F appointment following benign MDT discussion.

Method
A retrospective case-note review was performed on 100 patients discussed at the benign biopsy MDT between June and August 2020. Clinicopathological data was collected on presenting symptoms, histopathology, management, and subsequent requirement for F2F appointment.

Results
Median age was 43 years (range 25-88). Eighty-one patients (81%) presented with a lump or nipple discharge. The final diagnosis was normal in 22(22%) patients, a diagnosis of fibroadenoma in 35(35%), a B3 lesion in 8 (8%) patients and another benign diagnosis in the remaining 35(35%) patients. Sixteen (16%) patients required surgery or vacuum-assisted-Biopsy, 18(18%) required further clinical or radiology follow up and 66(66%) were reassured and discharged. Forty-three (43%) patients were informed of the MDT plan by letter and 42(42%) by telephone. There were no malignancies identified in any patients. Fourteen (14%) patients required a F2F appointment most commonly because of further clinical review, patient request or interpreter requirements.

Conclusions
The vast majority of patients undergoing benign biopsy can avoid a further F2F appointment, even if further biopsies or intervention is needed. This can reduce the burden on outpatient clinics whilst improving patient convenience.
99 Computed Tomography Scanning for Sternal Wound Infections: A Systematic Review
Authors: Shirke M M , Dominic C , Debnath P , Sunny J T , Haq M , Nawaz H , Harky A 
Published: August 2023

Abstract

Aim
Sternal wound infection (SWI) has always been a significant risk in patients who undergo sternotomies as part of their cardiac surgical procedures. Computed tomography (CT) imaging is often used to diagnose and assess sternal wound infections. Its purpose includes identifying and locating infection and any sternal dehiscence.

Method
A systematic literature review across PubMed, Embase and Ovid was performed according to PRISMA guidelines to identify relevant articles that discussed the utility of CT scanning for SWI, common features identified, patient outcomes and sensitivity/specificity (Figure 1).

Results
25 papers were included. 100% (n = 25) of the papers were published in peer-reviewed journals. CT scans in SWIs can be seen as a beneficial aid in diagnosing as well as determining the components of infection. Commonalities were identified such as fluid collection in the mediastinum, free gas, pleural effusions, and sternal dehiscence which point towards sternal wound infection.

Conclusions
CT scanning is a novel and emerging methodology for imaging in SWI and post-sternotomy complications; hence, increased research is required to expand the literature on this area and create guidelines and cut-offs or signs for radiology professionals to identify and determine the extent of infection.
198 Clinical and Radiological Features of Cardiac Hydatid Cysts: A Case Series
Authors: Zebirate L , Bouchenafa S , Boukli Hacene A Z , Draou N E , Atbi M 
Published: August 2023

Abstract

Aim
Hydatid cyst disease is a pathology caused by tapeworm Echinococcus. The cardiac involvement is rare, so the aim of this study is to highlight its clinical polymorphism and different radiological features.

Method
This is a retrospective study of 7 patients diagnosed with cardiac hydatid cysts who were admitted to our department in a 5-year duration.

Results
We see that most affected individuals were women (4 out of 7), the revealing symptoms were mostly chest pain and dyspnea, only one case presented AV block with faintness. Concerning the localizations: 2 patients had pericardial cysts, 2 had intramyocardial cysts, 2 others had both pericardial and intramyocardial cysts and the last one presented an interventricular septum cyst. Six patients were diagnosed through transthoracic echocardiography (TTE) and one patient with CT of the chest. In all cases, TTE described a cystic mass except one case that presented multivesicular aspect. The diameter of the cysts ranged between 20 and 88 mm. Two patients had associated liver hydatid cyst and one had pulmonary hydatid cyst. All these patients underwent open-heart surgery for conservative treatment under cardiopulmonary bypass. Only one patient presented recurrence which was treated with albendazole with good results. No patient benefited from pre-operative medication with anthelmintic.

Conclusions
Cardiac hydatic cysts are rare and usually discovered after dyspnea or chest pain. TTE is the most efficient method of diagnosis. Due to life-threatening complications that these cysts can cause, surgery is the main modality of treatment.
95 Case Report: A Rare Case of Juvenile Hyaline Fibromatosis Presenting with Bilateral Acro-Osteolysis
Authors: Wen J , Heras-Palou C 
Published: August 2023

Abstract

Aim
We report a rare case of juvenile hyaline fibromatosis (JHF) leading to acro-osteolysis of bilateral hands in a 54-year-old male patient.

Method
JHF is an autosomal recessive condition resulting from a mutation of the ANTXR2/ CMG2 gene. It results in an accumulation of hyaline amorphous deposits in the skin and other organs. Other cardinal manifestations include gingival hyperplasia, flexion contracture of large joints and lytic lesions of the long bones.
This right-handed window cleaner was referred to a specialist hand unit due to the debilitating accumulation of nodular skin lesions on his bilateral hands. X-ray demonstrated apparent osteolysis to multiple distal phalanges of his bilateral hands.
The patient was experiencing difficulties with gripping, leading to barriers to completing his activities of daily living and performing competently within his occupation.

Results
Currently, there is no cure for this condition. Our patient underwent a total of nine operations over 10 years. Key indications for surgery included ulcerations of the hand lesions or optimising functional and aesthetic outcomes. Radiotherapy and chemotherapy were also attempted with limited beneficial results.

Conclusions
Our case has highlighted that JHF is an important differential to be considered by hand surgeons when presented with acro-osteolysis of the hand. This is a chronic disease that requires a multidisciplinary team approach to addressing both the social and physical manifestations of the disease. The likelihood of multiple operations is high. Therefore, careful stratification of surgical intervention coupled with shared decision-making with the patient throughout this process is fundamental.
278 Ewing's Sarcoma of the Duodenum: A Rare Case Presentation and Review of Literature
Authors: Saiyed S , Mownah O , Bowles M , Kanwar A 
Published: August 2023

Abstract

Introduction
Ewing's sarcoma (ES) is a rare tumour with a tendency to metastasise early and recur. It commonly affects paediatric patients. The most common subdivision comprising 70% of all ES is Ewing's sarcoma of the bone. A review of the literature identified only 5 cases worldwide of primary ES arising from the duodenum.

Case presentation
We present a case of a 42-year-old man with no prior medical history who presented with right-sided abdominal pain. A computed tomography scan of the abdomen demonstrated a 7.7cm heterogeneous mass arising from the second part of the duodenum. Oesophagogastroduodenoscopy confirmed a malignant appearing duodenal lesion with biopsy showing features consistent with small cell carcinoma. The patient underwent three cycles of neoadjuvant chemotherapy followed by elective Kausch-Whipple pancreaticoduodenectomy. A combination of immunohistochemistry and molecular studies confirmed the diagnosis of a rare Ewing sarcoma tumour originating from the duodenum with invasion into the duodenal lumen. The patient recovered well from surgery and remains disease-free 18 months following resection.

Discussion
Literature search revealed this to be an extremely rare case. The optimal treatment strategy for patients with intestinal ES is unclear, with the results of the literature search demonstrating poor outcomes following surgical resection. The long-term prognosis of intestinal ES is unknown due to its rarity. Determinants of poor outcome include tumour size &gt;5cm, tumours involving the pelvic site, old age, non-response to chemotherapy and presence of metastases. In the case we report, the combination of neoadjuvant chemotherapy and surgery led to a good short-term post-operative outcome.
310 Rare Elusive Cause of Significant Haematuria – Case Series and Review of Literature
Authors: Waqar M , Mathias S J , Murali V , Thursby H , Luscombe C , James R , Mak D , Chakravarti A , Day C P , Dyer J 
Published: August 2023

Abstract
Arterioureteral fistula (AUF) is a direct communication between the ureter and an artery and is a rare cause of catastrophic, life-threatening haematuria. Fistulation may occur between the ureter and the abdominal aorta, common iliac, external and internal iliac and inferior mesenteric arteries and is typically observed in patients with a prior history of pelvic radiotherapy, oncological pelvic surgeries, aortoiliac vascular procedures and pelvic exenteration. As AUF is so rarely encountered in clinical practice, the urologist may fail to appreciate its presence until late in the patient’s presentation. We are presenting case series as well as review of literature.
Patient number 1 presented with repeated episodic large volume haematuria in whom the cause of symptoms remained persistently elusive despite repeated imaging. An eventual diagnosis of a secondary right internal iliac - ureteral fistula was ascertained on a subsequent Digital Subtraction Angiography of the renal tract. The fistula was embolised using an endovascular approach. The patient remained stable post emobilisation and was successfully discharged.
Patient number 2 presented with haematuria from her ileal conduit. Initially the cause of symptoms was thought to be due to ureteric stents. During change in her stents, brisk bleeding led to further investigation including iliac angiogram confirming bleeding from left common iliac artery. She had covered common iliac artery stent which successfully controlled her bleeding.
These cases emphasise the diagnostic difficulty of AUF, outlines the management principles of this rare disease and aims to increase awareness of this rare yet potentially lethal phenomenon amongst practitioners of urology and interventional radiology.
365 Subdural Haematoma Associated with a Dandy-Walker Malformation in an Adolescent Karate Athlete - a Case Report
Authors: Wellington J , Estrada L Valéry C 
Published: August 2023

Abstract

Introduction
The Dandy-Walker Malformation (DWM), retrospectively named after Walter Dandy and Arthur Walker as failure to perforate the Luschka and Magendie Foramina, is believed to be the absence of an aperture of the posterior membranous area. Said incidence is reported between 1:25000-1:35000 live births. We describe an unusual case of an adolescent who suffered a moderate traumatic brain injury (TBI) while practising karate presenting with an acute subdural haematoma (ASH) associated with a DWM.

Case Report
A fifteen-year-old Mexican adolescent with depression and anxiety presented to the emergency department 30 minutes post-direct head trauma during a karate competition. At first evaluation, the patient exhibited GCS 14 with bifrontal headache, disorientation, and six episodes of projectile vomiting. CT head revealed a right ASH with 10mm thickness and a 5.7mm midline shift. Posterior fossa malformation characterised by vermis hypoplasia and 4th ventricle cystic dilatation was also observed. An emergency craniotomy was performed, finding an ASH associated with Labbe Vein rupture near its transverse sinus drainage. Post-intervention, the patient was transferred to ICU and made an excellent recovery, discharged 2 weeks post-TBI without neurological sequelae.

Discussion
DWM is the most prevalent cerebellar malformation in humans, linked to psychiatric conditions comprising refractory schizophrenia, poor impulse control, and depression. Approximately 90% develop hydrocephalus with associated anomalies such as corpus callosum agenesis and posterior cerebellar vermis. In karate, the most frequent injuries are haematomas and tooth avulsion/subluxation. To our knowledge, this is the first case of ASH with an associated DWM in a karate athlete.