bluuebunny/crossref_metadata_2025_split huggingface dataset:
1230 A Case of Intratonsillar Abscess Presenting as a Non-Resolving Acute Tonsillitis With Dysphonia, With Learning Points
Authors: Dar T , Tornari C 
Published: August 2023

Abstract
Peritonsillar abscess (quinsy) and tonsillitis are two commonly diagnosed and treated pathologies in ENT departments. However, intratonsillar abscess is rarely reported in medical literature and textbooks, therefore understanding of when to clinically suspect such pathology is likely less known amongst junior ENT doctors. We present a case of a healthy adult treated for a large intratonsillar abscess, at a district general hospital in the United Kingdom.
A 27-year-old man with one previously treated quinsy, presented with 6 days of worsening sore throat, fevers, and dysphonia. Clinical examination showed mild trismus, tonsillitis with an asymmetrically large right tonsil, appearance of right peritonsillar swelling, and a normal neck exam. Clinically this was initially treated as a right peritonsillar abscess, with needle aspiration of the peritonsillar space, however 3 aspiration attempts revealed no pus.
He was admitted and treated as tonsillitis with peritonsillar cellulitis by antibiotics, but over four days little improvement was seen with rising inflammatory markers. Particularly the “hot-potato voice” dysphonia did not improve at all. Given the smoothly enlarged right tonsil and absence of peritonsillar swelling, suspicion for an intratonsillar abscess was raised. Needle aspiration into the tonsil revealed 7 millilitres of thick pus, causing immediate improvement in voice and symptoms.
We suggest that intratonsillar abscess could be suspected in patients appearing as quinsy but with dry aspiration attempts, or in unilateral unresolving tonsillitis. Direct tonsil aspiration can sometimes avoid radiation from CT scanning in patients who are systemically well with no suspicion of deep neck infections.
330 Use of Percutaneous Cholecystostomy - Mission Creep or a Genuine Bridge to Surgery?
Authors: Ninkovic-Hall G , Zardab M , Digne-Malcolm H , Javed S , Magee C 
Published: August 2023

Abstract

Aim
Appropriately used, percutaneous cholecystostomy (PC) can be lifesaving. We have noted an increase their use. This may be due to an increasing population frailty combined with delayed presentations or treatment from the COVID pandemic. We sought to audit the use of PC in our Trust.

Method
Retrospective analysis of prospectively collected data from 2020-2022 at a large DGH with comparison to PC insertion standards (failed antibiotic response & not fit for surgery, septic/too unstable or PC as definitive treatment).

Results
PC performed 67 times in 64 patients (F = 36.5%. mean age 72 (45-92yrs)).
31 (48.4%) were definitive treatment. 36 (53.7%) were not definitive, 19 subsequently underwent surgery (5 as readmissions, 12 elective & 2 same admission).
25 patients did not meet criteria for PC and potentially could have been considered for emergency laparoscopic cholecystectomy.
35.8% (n = 24) had a DNACPR in place at the time of drain insertion. 25.4% (n = 17) had died at the time of analysis.
In the same timeframe n = 168 emergency laparoscopic cholecystectomies were completed.

Conclusions
PC is an effective treatment strategy but our data suggest that some patients may have been suitable for operative intervention, indicative of “mission creep”.
However, the reasons for this are unclear, but may include availability of hot list slots, presentations before a weekend where subspecialty UGI surgeons may not be at hand or a genuine belief that PC is a beneficial bridge to surgery.
The wider role of PC requires further evaluation, especially if subspecialty cover is not available.
632 Return to Pre-Hospital Residence Following Emergency Laparotomy
Authors: Rugendyke A , Holmes M , Ming Y J , Gani J , Pockney P 
Published: August 2023

Abstract

Aim
Poor outcomes following emergency laparotomy include death and the loss of independent living. A widely held apprehension is the ‘salvage’ of a previously independent patient, only to render them reliant on long-term dependent care. We aimed to establish the proportion of patients who returned to their pre-hospital residence following emergency laparotomy, measured at discharge, 90 and 365 days.

Method
Data was collected on all patients over 18 years of age who underwent emergency laparotomy across four Australian hospitals between 1 January 2018 and 31 December 2019. Data recorded included pre-hospital residence, discharge destination, mortality and place of residence at 90 and 365 days.

Results
782 patients underwent an emergency laparotomy during the study period. The mean age was 64 years (range 18-96). Prior to hospital admission, 95.5% of patients lived in their own home, while the remainder resided in supported living facilities. 7% of patients died during their hospital admission. Of those alive on discharge, 77.6% were discharged to their pre-hospital residence. At 90 days, mortality was 10.6% while 97.1% of surviving patients had returned to their pre-hospital residence. By 365 days, mortality was 17.0% while 98.0% of surviving patients had returned to their pre-hospital residence, and 94.0% were living in their own home.

Conclusions
Patients who survive 90 and 365 days following an emergency laparotomy nearly all return to their pre-hospital residence, with only a small proportion of previously independent patients entering dependent care. This should inform shared decision-making regarding emergency laparotomy in the acute setting.
1193 Review of Pre-Operative Antibiotic Prophylaxis (POAP) in National Emergency Laparotomy Audit (NELA) Patients in a Regional Acute Tertiary Hospital
Authors: Pattarukuzhyil Jose J , Davis E , Bateman K , Lewandowski D 
Published: August 2023

Abstract

Aim
The current World Health Organization recommendation for timing before incision (TBI) is that one dose of intravenous pre-operative antibiotic prophylaxis (POAP) should be given on starting anaesthesia, within 120 minutes, to reduce surgical site infections. The Scottish Intercollegiate Guidelines Network suggests TBI of 30-60 minutes for full dosage administration. The aim was to review POAP, including TBI, in NELA patients.

Method
Emergency laparotomy patients were identified on the Trust theatre system over 73 days, and the NELA database reviewed. Data was collected retrospectively through anaesthetic and operation records and if still inpatient, drug charts and clinical notes.

Results
46 patients were identified, and 83% had documented POAP (53% on anaesthetic record, 31% on operation note and 16% before surgery). Of these patients who had a documented POAP, 68% had a recorded TBI; mean time was 99 minutes (range 19 to 386). Of the patients who had a recorded TBI, 77% received POAP within 120 minutes; mean time of these was 59 minutes (range 19 to 112).

Conclusions
The majority of patients received pre-operative antibiotic prophylaxis, although the documentation was variable, and many doses were not given in the optimal time before incision to reduce surgical site infections. Further work includes liaising with the multidisciplinary team to raise awareness of these results and amending the clerking proforma. A further subgroup analysis focusing on septic patients is underway, as well as a long-term review looking into surgical site infection rates.
754 Impact of BRAFV600E Mutation on Clinicopathological Features in Patients with Concomitant Hashimoto Thyroiditis and Papillary Thyroid Carcinoma: A Meta-Analysis
Authors: Janicki L , Patel A , Hellmann A , Kobiela J 
Published: August 2023

Abstract

Aim
The aim of this meta-analysis is to identify the rate of BRAFV600E mutation among Hashimoto thyroiditis (HT) concomitant with papillary thyroid carcinoma (PTC) versus PTC patients alone. The secondary aim is to evaluate the impact of BRAFV600E mutation on clinicopathological features in both cohorts.

Method
Using a predefined search strategy, Medline, Cochrane Library, Scopus, and Web of Science were searched from inception till 16.09.2022. A total of 227 unique articles were found, of which nine studies met the inclusion criteria. Of those, six were retrospective and three prospective cohort studies. Data on patient demographics, BRAFV600E mutation and clinicopathological features was collected. Summary estimates using fixed or random effects models were generated with Review Manager 5.0.

Results
6395 patients were included in this review. The weighted arithmetic mean for BRAF mutation was 71.6% and 82.8% in HT-PTC and PTC patients, respectively. HT-PTC patients had significantly less BRAFV600E mutation than PTC patients (Odds Ratio (OR) = 0.45, 95% Confidence Interval (CI): 0.35 to 0.58). In addition, BRAFV600E positive HT-PTC patients were more likely to have multifocality (OR = 0.71 95% CI: 0.53 to 0.95), lymph node metastasis (OR = 0.59 95% CI: 0.44 to 0.78) or extrathyroidal extension (OR = 0.72 95% CI: 0.56 to 0.92) compared to BRAFV600E negative HT-PTC patients.

Conclusions
Patients with concomitant HT and PTC have less BRAFV600E mutation, which may be one of the factors responsible for less aggressive course of PTC in this cohort.
478 Career Transition Experience of International Medical Graduates (IMGs) Within the NHS Post-COVID19: Evaluation of Challenges and Support
Authors: Lubbad H 
Published: August 2023

Abstract

Aim
The main purpose of this research is to identify the challenges facing international medical graduates (IMGs) during their career transition into the National Health Service (NHS), particularly post-pandemic, and evaluate the organisational support offered to them, its significance, and its effectiveness in easing their transition, based on the practice of inclusion.

Method
A cross-sectional retrospective study was conducted with a mixed-methods design, quantitative data were collected firstly by online questionnaires (n = 72), followed by semi-structured interviews with part of the first-stage participants (n = 4). Quantitative data were analysed in SPSS whereas thematic analysis was used for qualitative data.

Results
The findings show positive insights regarding the support offered to IMGs throughout the pandemic, particularly from seniors and colleagues. It points out the crucial role of the support, organisational support as well as seniors' and colleagues' support, in facilitating the career transition of the IMGs into the NHS in order to fulfil their capabilities and benefit the service as well as move up the career ladder. The equality of support was a point of concern when it comes to the nature of IMGs’ starting position (training/non-training).

Conclusions
The study reveals that it is beneficial to have a higher level of support for the IMGs right from the early stages. Organisational support interventions should be sustained by ongoing seniors’ and peers’ support to get the functional adjustment level of the newcomer IMGs and assist them in their progression.
871 Audit on Compliance and Documentation of GMC Guidelines Regarding the Use of Chaperone During the Intimate Examination
Authors: Singh A , Siby J , Subramanian A , Janakan G 
Published: August 2023

Abstract

Aim
To assess the compliance of GMC guidelines with respect to chaperones during intimate examination and their appropriate documentation.

Method
Analysis of patient notes documented by members of the general surgery department in the surgical assessment unit, or ED, for the month of October 2022.
We checked the patient notes for the following dataset: Chaperone - offered/not offered, name and position of chaperone and signature of chaperone.Area examined – Perineum, Abdomen, Breast or perineum and abdomenGender of patient, doctor and chaperone.Time of the day and place of examination
The data was analyzed (results below). As part of the audit cycle, the results were shared with the department, and education on the seriousness of this issue was discussed. Stickers for chaperones with their name, position, and gender will be attached to the patient notes.

Results
168 patients were reviewed totally. 9/168 (5.3%) – documentation present, 1/9 (11%) had complete documentation. 23 patients had perianal examination – 1 (4.3%) had documentation 141 patients had abdomen examination – 8 (5.6%) had documentation 9/9 (100%) documentation done by male doctors for female patients

Conclusions
We found a lack of adequate documentation for chaperone presence during the examination. It was agreed that chaperone presence was always adhered to, but documentation was lacking. Necessary changes have been initiated, and we are collecting prospective data after the intervention.
406 Review of Consenting Practice at the Tertiary Centre for Emergency Inguinal Hernia Repair
Authors: Karki B B , Nadjarpour A , Akram S , Katuwal S 
Published: August 2023

Abstract

Aim
To compare standardised consenting practice for Emergency Inguinal Hernia Repair amongst various grades in the General Surgery department at the Tertiary Centre. To ensure improvement in the consenting practice and documentation of the risks associated with the procedure.

Method
A proforma was devised which included ten recognized complications following Emergency Inguinal Hernia Repair after a review of literature, BHS Guidelines, and GIRFT which were then cross-referenced with the consent forms of 20 patients: retrospectively & prospectively for the first & second cycles respectively between the period of August 2021 to July 2022.

Results
Out of 11/20 forms completed by junior doctors in the first cycle: FY2(3/11), CT (8/11), documented 6/10 and 6.75/10 risks resp. Speciality Registrar 8/20 (40%) & Consultants (1/20) both documented 6/10 risks which concluded on the wide variation in risk documentation practice. Following to this, consenting workshops were carried out including peer-to-peer teaching & development of the consenting posters. Furthermore, a re-audited result showed a satisfactory increase in risk documentation by 19%, 10%, and 25% among Junior Doctors, Registrars and Consultants along with &gt;10% increase in the documentation of post-op complications like chronic pain, and orchidectomy.

Conclusions
There was a marked improvement in the consenting practice achieved via workshops, posters and peer-to-peer teaching sessions. Further review will be carried out for introducing procedure-specific consent forms in the Emergency setting which will not only act as a source of information for the patient but also a prompt for the doctors to discuss the risks.
597 Incivility in the Operating Theatre
Authors: Tupper L , Miller R 
Published: August 2023

Abstract

Aim
To establish the prevalence of incivility within operating theatres, understand its impact on wellbeing, team performance, training, and direct future studies.

Method
A systematic search was conducted using keywords for incivility in healthcare. Studies reporting incivility from all operating theatre MDT members were included. Data extraction was designed to establish prevalence of incivility, compare experiences in different specialties, assess the potential impact on performance and wellbeing and establish questions for inclusion in a national cross-sectional study.

Results
Incivility can be defined as ‘un-civil behaviour, characteristically rude and discourteous, displaying a lack of regard for others.’ 62 papers discussing incivility, bullying and harassment within healthcare settings were identified. 14 focused specifically on incivility in surgical teams. 48-98% of healthcare staff reported experiencing incivility, with surgeons being the most likely perpetrators. It was more commonly experienced by female, non-heterosexual, and inexperienced members of staff, including trainees. Incivility was associated with reduced performance, higher complication rates, workplace withdrawal, reduced organisational commitment, productivity, and wellbeing. Reduction strategies largely focused on education surround incivility, which appears to have minimal impact.

Conclusions
Incivility has only recently been discussed within a healthcare setting. Its consequences can have a significant impact on teams, and it warrants attention to improve performance, wellbeing and retention. Surgical theatres offer unique challenges from a teamwork perspective and should therefore be studied at an MDT level. These results have informed the design of a national, cross-sectional mixed methods study of incivility in the operating theatre MDT, which will be conducted throughout 2023.
1285 Management of Acute Cholecystitis – Evaluating the Timing of Laparoscopic Cholecystectomy
Authors: Quaunine M , Wilkins A , Chang L , Walshaw J , Lykoudis P 
Published: August 2023

Abstract

Aim
Current National Institute for Health and Care Excellence Quality Standards (NICE QS104) recommend adults with Acute Cholecystitis (AC) have Early Laparoscopic Cholecystectomy (ELC) within 1 week of diagnosis. If this is not achievable, a Delayed Laparoscopic Cholecystectomy (DLC) should be performed more than 4 weeks after the initial episode. This study evaluated current practice in a tertiary hospital General Surgical department.

Method
All patients presenting with their first presentation with AC between November 2021 and March 2022 were identified from prospectively maintained surgical handovers. Patients admitted with acalculous cholecystitis, under different specialities, residing out of the area, and who self-discharged were excluded. Data was collected from electronic patient records retrospectively.

Results
81 patients were included in the study, 29 males and 52 females. The mean age of included patients was 64. 61 patients were fit for surgical intervention. 14.8% (9) of patients had an ELC within 1 week of diagnosis. 85.5% (52) of patients were planned for DLC after discharge. 13.5% (7) of DLCs were performed within 3 months of discharge and a further 50.0% (26) of DLCs were performed within 6 months of discharge. 21.2% (11) of patients were readmitted to hospital with gallstone-related presentations within 6 months of their discharge whilst awaiting DLC.

Conclusions
This study shows that national standards are currently not being achieved. This is likely due to multifactorial causes, including increasing pressures due to the pandemic. We plan to expand our data and utilise these findings to produce a business case for a regular dedicated ELC list.
387 A Multidisciplinary Approach to the Sequelae of Dental Trauma in a Child: A Radicular Cyst
Authors: Chapman S , Kabban M , Woods M 
Published: August 2023

Abstract

Background
A radicular cyst is an inflammatory cyst of odontogenic nature, formed by cells of Malassez in the periodontal ligament, which are stimulated and proliferate, following insults such as dental trauma. First stage treatment is commonly orthograde root canal treatment (RCT), followed by apicectomy or extraction and enucleation of the lesion +/- bone grafting and replacement tooth.

Presenting problem
This case illustrates the sequelae of a repeated dental trauma to a LR1 in a child, which was endodontically treated and obturated with Mineral Trioxide Aggregate (MTA). After a second dental trauma, a painful intra-oral swelling developed with mobility and tenderness of adjacent teeth. The swelling increased after extraction of the LR1, leading to enucleation by the Oral and Maxillofacial Surgery Surgeon (OMFS).

Investigations
Plain radiographic films, cone beam CT (CBCT) imaging revealing a radiolucent area extending from LR3 to LL3, 2 x 1.1 x 1.9cm, with buccal perforation and thinning of the lingual cortex.

Clinical management
Across a 6-year period restoration and orthograde RCT was completed LR1. A second dental trauma 4 years later necessitated extraction of LR1.
Subsequent acute swelling and pain lead to further radiological assessment which was consistent with a giant cell lesion. Following enucleation, histopathology confirmed a radicular cyst, with pulse granuloma and reactive changes. Bony infill was noted and the LR1 was replaced with a resin-retained bridge.

Discussion
This case aims to raise awareness of the sequelae of dental trauma in children and the multidisciplinary approach to their care.
582 Head & Neck Skin Cancer Figures 2020 – in the Midst of the COVID-19 Pandemic
Authors: Sawhney S , Kwaskowski T , Gower R , Mumtaz S , Jefferies C 
Published: August 2023

Abstract

Aim
COVID-19 had a profound effect on the healthcare system in the United Kingdom, in particular the diagnosis of cancer. During the first wave of the COVID-19 pandemic, the diagnosis of early-stage cancer in England fell by 33%.
The aim of our analysis was to assess the impact of the pandemic on the head and neck skin cancer (HNSC) pathway by assessing the number of patients treated by our Oral & Maxillofacial Surgery (OMFS) department.

Method
Treated cases were retrospectively totalled each month and then analysed to produce time-series data that reflects the impact COVID-19 on the treatment of HNSC.

Results
In 2020, a total of 273 cases of HNSC were treated in our OMFS department. Between January and March 2020, the average number of HNSC cases treated monthly was 34. This dropped to 2 cases in April 2020, which corresponds with the first wave of the COVID-19 pandemic. Between May and August, the number of treated cases peaked at 16 in the months of July and August, with an average of 10 cases treated per month. Between September and December, the number of treated cases recovered to an average of 30 per month.

Conclusions
Our data shows the significant impact COVID-19 had on the number of treated cases of HNSC within our OMFS department. Further long-term and multi-site studies may reveal the wider impact that this has had on patient outcomes and the healthcare system.
846 Bone Grafting as an Alternative Approach to Treating Severe Hypodontia in a Child
Authors: Chapman S , Woods M , Harrison M 
Published: August 2023

Abstract

Background
Severe hypodontia (developmental absence of teeth) can have significant functional and cosmetic impact, causing dietary restrictions, speech delay and bullying. Management in childhood is usually with removable dental prostheses, but retention and stability are often compromised by hypoplastic dento-alveolar bone ridges in the edentulous areas.

Presenting problems
A 3-year-old child was referred to Paediatric Dentistry with no erupted primary teeth. Radiographs revealed developmental absence of the entire primary dentition. Genetic investigation was negative for changes in genes known to be associated with hypodontia. In the permanent dentition only first molars were radiographically present. The child was struggling with bullying and self-confidence related to his dental appearance and speech.

Investigations
Plain films and cone beam computed tomography (CBCT) revealed agenesis of all canines and incisors in both jaws, an atrophic edentulous anterior maxilla, and soft tissue communication with the nasal fossa floor.

Clinical management
Despite provision of a retentive upper removable prosthesis was made impossible by a fleshy anterior maxillary ridge with severe atrophy of the dento-alveolar bone and inadequate sulcus depth. Multiple removable prostheses were fabricated, but retention and stability were poor. He was referred to maxillofacial surgery for excision of redundant fleshy tissue in the anterior maxilla and placement of corticocancellous block graft from the hip with Sonic Weld (KLS Martin) to augment and consolidate the ridge. A successfully retentive prosthesis was subsequently fabricated.

Discussion
This case presents an unusually invasive, but effective alternative approach to treating severe hypodontia in childhood, where hypoplastic dental ridge and sulcus depth can restrict treatment options.