bluuebunny/crossref_metadata_2025_split huggingface dataset:
943 An Audit of the Management of Necrotizing Otitis Externa Within Royal Devon and Exeter Hospital
Authors: Santana A , Jia W , Ricks R 
Published: August 2023

Abstract

Aim
To improve recognition and management of necrotizing otitis externa (NOE) early to prevent disease progression and reduce hospital admissions/length of stay.

Method
A retrospective audit of patients who were treated for NOE during an inpatient admission to the Royal Devon and Exeter Hospital between 1st December 2020 and 1st June 2022.

Results
A total of 15 cases were identified where symptoms were not attributable to an alternative diagnosis. Lab results, inpatient and clinic attendances were analysed to identify areas of improvement in terms of investigations and management.
The mean number of presentations before admission was 2.3. At admission 66% of patients had a swab taken and 7% of patients had imaging. Systemic antibiotics were prescribed in 20% of patients before admission.
IV antibiotics were started within 24 hours in all patients admitted. Microbiology consults were sent within 6 days in 93% of cases. The mean duration of IV antibiotics was 13 days, and the mean inpatient stay was 19 days.

Conclusions
The incidence of NOE is increasing in the UK, yet there is limited guidance and consensus on diagnosis and management. Some advice is provided by ENT UK, who suggest outpatient recognition might be improved by ensuring swabs and imaging are completed to reduce hospital admissions. In lower risk cases, starting oral ciprofloxacin may then aid with management. On admission investigations and management are being promptly started; however, an area for improvement could be the potential introduction of long lines for outpatient IV antibiotic therapy to reduce the length of hospital stays.
991 A Retrospective Review of Thyroid Surgeries Performed at a Tertiary Referral Hospital Between 2015- 2020 to Determine Incidence of Incidental Parathyroidectomy During Thyroid Resection
Authors: Kruczynska A , Shakeel M 
Published: August 2023

Abstract

Aim
Thyroid resection is commonly used to manage thyroid problems. Incidental parathyroidectomy is a recognised complication associated with thyroidectomy. Findings of parathyroid gland in the pathology specimen varies greatly as reported in literature between 6.4%-31%.
The aim of this project was to determine local incidence of incidental parathyroidectomy during thyroid resection and comparing it to the incidence rates reported in the literature.

Method
Retrospective review of 5-year data set of patients undergoing thyroid resection in tertiary referral hospital between June 2015 -June 2020.
Patient electronic records were searched for pathology report and data collected included: parathyroid tissue detected in the specimen, type of thyroid surgery performed, proportion of parathyroid gland present in specimen, number of parathyroid gland present.

Results
During the period specified 305 thyroid surgeries were identified. Parathyroid tissue was present in the pathology specimen in 50 cases (16%). Out of the 50 pathology reports only 4 reported presence of a whole parathyroid glands (8%) in the specimens, 20 (60%) contained only partial parathyroid gland. Most reports did not specify to what extend the parathyroid tissue was present or whether multiple parathyroid glands were excised.

Conclusions
The local incidence rate if incidental parathyroidectomy in in keeping with the date reported in the literature. More work is needed to determine the risk factors contributing the incidence rate such as whether there was extrathyroidal extension of tumour in those cases. To determine the relationship between proportion of parathyroid gland removed and postoperative hypocalcemia additional data is needed.
68 The Diurnal and Seasonal Relationships of Young Pedestrian Injuries Secondary to Motor Vehicles
Authors: Akhtar A , Brooks A , Kitchen S , O'Connor R 
Published: August 2023

Abstract

Aim
There remains a significant morbidity and mortality in young pedestrians hit by motor vehicles. The of this study was to compare the incidence and injury severity of motor vehicle-related pedestrian trauma according to time of day and season in a young population.

Method
Data was retrieved from the National Trauma Audit and Research Network (TARN) database for patients between 10-25 years old who had been involved as pedestrians in motor vehicle accidents between 2013 -2020. The incidence of injuries, their severity (using the Injury Severity Score [ISS]), and mortality were analysed according to the hours of daylight, darkness, and season.

Results
The study identified a seasonal pattern, highlighting that injuries were most prevalent during autumn (34.9% of injuries). Prevalence decreased throughout the year from winter (25.4%) to summer (18.3%). The greatest incident rate (number of incidents/hour) occurred between 1500-1630hrs, correlating to school pick up times. A significant relationship between ISS and daylight hours was demonstrated (p-value = 0.0124), whereby moderate injuries (ISS score: 9-15) were more likely during the day (72.7%), while severe injuries (ISS Score &gt; 15) were more likely at night (55.8%).

Conclusions
We identified a relationship between the time of day and the frequency and severity of pedestrian trauma in young people. In addition, particular time groupings correspond to the greatest incidents rate, suggesting that reduced visibility coupled with school pick up times play a significant role. We recommend targeted public health measures to improve road safety that focus on these high-risk times of the day.
328 Local Delays in Tubogram Completion for Biliary Patency – Why the Wait?
Authors: Kattam A , Ninkovic-Hall G , Zardab M , Digne-Malcolm H , Magee C 
Published: August 2023

Abstract

Aim
Despite the CHOCOLATE Study (CS Loozen et al 2018) recommending laparoscopic cholecystectomy even in high-risk patients, we are completing more cholecystostomies than ever to manage acute cholecystitis, particularly during the COVID pandemic. Fluoroscopic tubogram can be performed to check biliary patency post intervention, this can potentially definitive treatment or discharge.
We locally assessed the time delay in accessing tubograms.

Method
Audit of all local tubograms completed of the biliary system (September 2020-2022).
All tubogram procedures (not just biliary) within the North West Mersey Region over the same period also quantified.

Results
397 tubograms were conducted in the NW; 51 locally. 26/51 were for post IR drain & 1 for biliary t-tube assessment from 26 patients (av. age 73, range 59-90yrs). 19 were as inpatient, 8 outpatients.
Assessing working days between expected completion and actual completion in both groups:
73.7% of inpatient tubograms were completed within 3 or less days (av. 3.6, range 0-17 days).
37.5% of outpatient tubograms were completed within 5 days of less (av. 7.9, range 0-23 days).
There was 1 true complication (tube slippage & removal), 3 extravasations & 1 abandoned procedure. 4 (15%) patients had died at the time of data assessment.

Conclusions
With the rise of cholecystostomy, there has been an increase in biliary tubograms. These are a specialist procedure; there is a time delay in obtaining them and they do not come without risk. Provision of tubograms needs to be assessed, or a move back to traditional initial surgical management considered.
669 Chronological Distribution and Causes of Mortality Following Emergency Laparotomy – an 8 Year Study
Authors: O'Connell E , Kyriakides R , Rutka O , Misra N 
Published: August 2023

Abstract

Introduction
Emergency laparotomies have variable level of mortality and morbidity worldwide. Studying the causes and times of mortality, could enable better patient care and improve future outcomes. We investigated the mortality data in laparotomy patients, to investigate for trends in mortality and other patient and process characteristics.

Method
Data for all emergency laparotomies undertaken between 2014 to 2022 were collected prospectively and retrospectively analysed. The primary outcome was inpatient mortality. Demographics, clinical management, and outcome data was analysed using SPSS.

Results
1410 laparotomies performed, with an overall crude mortality rate of 11.9%. The P-POSSUM mortality and morbidity scores ranged from 2-99 (mean 42.4) and 40.1-100 (mean 86.6) respectively. The time from operation to death ranged from 24 hours to 123 days (mean = day 11.75), with a uni-modal distribution. In the first 48 hours post-operatively 28.57% (N = 56 patients) died, with a mean age of 70.6 and a mean P-POSSUM of 48.1 (SD 30.6). Bowel perforation (N = 19 patients) and bowel ischaemia (N = 13 patients) where the most common intra-operative finding. The patients that died after 48 hours (N = 116 patients) had a mean age of 73.5 (SD 12.4) and a mean P-POSSUM of 39.6 (SD 29.9, P 0.92), compared to those that survived (N = 1241) with a mean age of 61.4 (SD 16.4) and a mean P-POSSUM of 15.6 (P&gt;0.01).

Conclusions
Emergency laparotomy has a high level of mortality and morbidity, with the first 48 hours carrying the highest risk, particularly in those with bowel perforation or ischaemia.
706 An Audit of Antibiotic Prescribing in Acute Pancreatitis and Introduction of a Patient Safety and Cost Saving Diagnostic Tool
Authors: Allen L , Pearman D , O'Connor O , Bagnall M 
Published: August 2023

Abstract

Background
In managing acute pancreatitis it is challenging to distinguish systemic inflammatory response syndrome (SIRS) from bacterial infection, contributing to inappropriate use of antibiotics, which are only recommended in cases of infected pancreatitis. Over prescribing of broad-spectrum antibiotics is associated with C. difficile, adverse reactions and antibiotic resistance, and has a cost implication. Procalcitonin (PCT) is sensitive (93%) and specific (79%) for diagnosing infected pancreatitis and recommended to guide antibiotic therapy.

Method
We performed a retrospective audit of the care received by 88 acute pancreatitis patients over 12-months.

Results
19/52 (36.5%) with uncomplicated pancreatitis were prescribed antibiotics. 22/36 (61.1%) with infected pancreatitis or a secondary infection source received antibiotics. 36/41 (87.8%) were prescribed broad-spectrum IV antibiotics. Seven days of IV co-amoxiclav costs £15.80, excluding consumables or nursing staff/pharmacy time. A single PCT costs £9.64.

Conclusions
These results suggest inappropriate prescribing of antibiotics in managing acute pancreatitis. Where diagnostic uncertainty lies between acute uncomplicated pancreatitis with SIRS versus infected pancreatitis, PCT is a useful diagnostic tool to help guide antibiotic therapy, therefore improving patient safety and antibiotic stewardship, with cost benefits. Following this audit, our trust has approved PCT for use in acute pancreatitis, and future audits will assess ongoing antibiotic prescribing in this cohort.
1088 Acute Pancreatitis: ‘Treat the Cause’-in Compliance with NCEPOD Recommendations
Authors: Seth S , El Boghdady M , Boven C 
Published: August 2023

Abstract

Aim
The objective of this study was to facilitate in identifying remediable factors in the quality of care provided to patients being treated for acute pancreatitis and assess compliance to the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) guidelines.

Method
All emergency surgical admissions for patients aged 16 or older, diagnosed with acute pancreatitis at the period between August and October 2021 were included. A retrospective analysis in juxtaposition with 8 cardinal NCEPOD recommendations: management of co-morbidity & involvement of relevant specialists, adherence to antibiotic policies, assessment of risk of malnutrition, exclusion of gallstones in all index presentations, early surgical intervention, alcohol liaison support, further investigation - MRCP / ERCP and retrospective morbidity & mortality discussions. Each of the domains were scored based on adherence to the above standards, and subsequently coded as Red–Needing Urgent Attention, Amber–Scope for Improvement and Green–Satisfactory Compliance.

Results
A total of 79 patients were included in this study. Compliance towards the recommendation of routine nutritional assessment of patients was found to be in the RED category, scoring 23.7%. Management of medical co-morbidity & inclusion of specialists, early surgical intervention and alcohol liaison support were all found to be in the AMBER category, scoring 44.8%, 28.0% and 57.1% respectively. The rest of the recommendations showed satisfactory levels of compliance.

Conclusions
Many patients did not receive adequate nutritional assessment. The RED and AMBER areas will need urgent attention. To minimise the risks of severe morbidity and mortality from acute pancreatitis, we envisage a better compliance to NCEPOD recommendations.
1210 Network Meta-Analysis of Associated Mortality with Transfusion Strategies for Major Haemorrhage in Adults
Authors: Crook D , Padfield O 
Published: August 2023

Abstract

Aim
The aetiology of a large proportion of mortality in trauma patients is attributed to acute major haemorrhage. Damage control resuscitation and surgery have been developed as part of management, which often includes large volume blood product transfusion. The aim of this meta-analysis was to investigate differences in mortality between transfusion strategies used in major haemorrhage in adults (18+ years).

Method
A frequentist random effects network meta-analysis (NMA) using the netmeta package in R 4.0.5 of the eligible papers in the systematic review “Optimal dose, Timing and Ratio of Blood Products in Massive Transfusion: Results from a systematic review” compared a 1:1:1 ratio of red blood cells (RBC), fresh frozen plasma (FFP) and platelets (P) to a ratio of 2:1:1, whole blood, and laboratory-guided replacement. Homogeneity and heterogeneity were assessed with Cochran’s Q.

Results
Mortality at one month by group was 21.8% (12/55) for whole blood, 17.0% (58/342) for 2RBC:1FFP:1P, 14.3% (5/35) for laboratory-guided transfusion and 22.3% (96/43) for standard 1RBC:1FFP:1P ratio. The NMA showed no significant differences between groups, with relative risk of death when compared to 1RBC:1FFP:1P by one month of 1.42 (0.631; 3.19, p = 0.398) for whole blood, 0.7643 (0.562; 1.04, p = 0.0871) for 2RBC:1FFP:1P and 0.4396 (0.1741; 1.1099, p = 0.0820) for laboratory-guided transfusion.

Conclusions
The results demonstrated no significant differences in mortality between transfusion strategies in major haemorrhage - however, some arms of the NMA contain few patients and so may be underpowered to detect differences between groups. On this evidence, current use of component therapy is not inferior to another transfusion strategy.
575 Reducing the Risk of Significant Bleeding After Thyroid and Parathyroid Surgery - the Role of a Protocol Driven Approach
Authors: Abbud N , George H , Kirby G , Balasubramanian S 
Published: August 2023

Abstract

Aim
Post-operative haemorrhage following thyroid and parathyroid surgery is a well-recognised life-threatening complication. Following an audit reporting a reoperation for bleeding rate of 1.3% in 1913 patients (World J Surg 2020), a protocol driven approach involving the implementation of several specific measures at the time of wound closure (captured by the ‘ITSRED Fred’ mneumonic - Irrigation of wound, Time, Systolic blood pressure &gt;100 mm Hg, relieving neck extension, Elevating venous pressure, Drain avoidance and Flap evaluation) was implemented and evaluated.

Method
The operative and clinical records of 1525 thyroid and/or parathyroid surgical procedures in a single tertiary unit between 2017 and 2022 were reviewed following the implementation of the ‘ITSRED Fred’ protocol. The rates of re-bleeding requiring surgery were examined.

Results
The median (interquartile range) age of the cohort was 53 (39-66) years with a male: female ratio of 1:4.946 had thyroid surgery, 541 had parathyroid surgery and 38 had both. 0.8% were re-do operations and 20% of procedures included neck dissection.
Twelve (0.79%) patients had re-operation for bleeding (lower than previously reported rate of 1.3% from the same unit). Of these, 5 (0.3%) required re-operation before leaving theatre; 5 (0.3%) had bleeding within 6 hours and two (0.13%) after 6 hours. Bleeding rates were 1.1% (n = 10) in thyroid surgery compared to 0.4% (n = 2) in parathyroid surgery.

Conclusions
A protocol driven implementation of specific measures (such as the ‘ITSRED Fred’ protocol) may reduce the rate of re-operation for bleeding after thyroid and parathyroid surgery.
32 Enhancing Equity in a Widening Participation Scheme for School Students
Authors: Kirkham E , Rozwadowski S , Wijeyaratne M , Ferris L , Bennett J , Coyle M 
Published: August 2023

Abstract

Aim
The Royal College of Surgeons (RCS) Diversity Review 2021 found pre-medical school students from ethnic minority backgrounds were dissuaded from pursuing a career in surgery. Gloucestershire is in the bottom 20% of deprivation; with no widening participation (WP) scheme in the county. We implemented an inclusive WP scheme in Gloucester, with means of accessing virtual and face-to-face work-experience, to enhance the equity of work-experience.

Method
A three-stage project was conducted; 1; virtual Q&A sessions, asking questions about life as a doctor; 2; conversation between the student and patient held virtually, to gain insight into whether medicine is the right career; 3; face-to-face work-experience. Distribution sent to all 58 schools in the county.

Results
129 people attended the Q&A; 70 feedback responses received. 86% female, 56% of ethnic minority background. 26% did not have an immediate family member that attended university, 10% had caring responsibilities. 81% rated the session &gt;8/10 for usefulness. 27 undertook the virtual conversation, feedback from 11; 91% female, 45% of ethnic minority background, 27% did not have an immediate family member that attended university. All rated the session 10/10 for usefulness.

Conclusions
The RCS Report identified barriers with aspiring students from less-privileged backgrounds pursuing a career in surgery. More needs to be done with WP schemes to promote equity. Targeted distribution of WP schemes to all schools, utilisation of a means of offering work-experience, and accessibility to a younger age-group were aspects of our WP, to improve the equity of work-experience in the county.
309 Racial Discrimination in Surgical Practice: A Global Review
Authors: El Boghdady M , Ewalds-Kvist B 
Published: August 2023

Abstract

Introduction
Racial discrimination indicates the unkind conduct towards other persons based on their race or skin color. We aimed to systematically review racial discrimination in surgery and answer the following questions:1) Does racial/ethnic discrimination in surgery exist in the last 5 years. 2) If yes, are ways suggested to reduce racial/ethnic discrimination in surgery?

Method
The systematic review was performed in compliance with the PRISMA guidelines along AMSTAR 2. A 5-year literature search was carried out on PubMed for articles published from 1/1/2017 to 01/11/2022. The retrieved citations were quality assessed by MERSQI and evidence graded by GRADE.

Results
A total of 9116 participants responded with a mean of 1013 (SD = 2408) responses per citations reported in 9 studies from a final list of 10 included citations. Nine studies were from USA and 1 from South Africa. The evidence of racial discrimination was justified on strong scientific evidence constituting the basis for grade I. The second question’s answer was ‘yes’ which was defendable on moderate scientific recommendation and thereby establishing the basis for evidence grade II.

Conclusions
There is sufficient evidence for the presence of racial discrimination in surgical practice in the last 5 years in the US. Ways to decrease racial discrimination in surgery exist. Healthcare and training systems must increase the awareness of these issues to eliminate the harmful effect on the individual and on the surgical team’s performance. The existence of the discussed problems needs to be managed in more countries with diverse healthcare systems.
362 Compliance With GMC Guidelines for the Use of a Chaperone in Urology Outpatient Clinic
Authors: Desouky E , Ibrahim M , Sharma H 
Published: August 2023

Abstract

Aim
To Identify our compliance with GMC guidelines for use of a chaperon in urology outpatient clinic.

Method
1st audit included a total of 12 urologists in our team (6 consultants and 6 SpR) For each urologist, we checked records for 10 patients who attended urology OPD and had a physical examination as evidenced in the notes and/ or clinic letter N = 120 patient records checked Each urologist was given a score ( 0 = if no mention of a chaperone, 1 = if a chaperone was just mentioned or 2 = if the chaperone is identified by name or signature)

Results
We found propre documentation of a chaperone in only 75.25% of clinical notes and 14.6% of clinic letters. At individual level, there were poor scores for most urologists involved. Following the discussion of the 1st audit results in the urology clinical governance meeting, posters were made to raise awareness of the audit outcome as well as direct discussions with the urology team members to encourage them to improve their scores in the re audit cycle. Re audit showed significant improvement was achieved for individual as well as overall documentation in 85% of clinical notes and more than 50% of clinic letters.

Conclusions
As per GMC guidelines: The offer, and use, of a chaperone, including their full name and designation, should be clearly documented in patients’ notes. This can be achieved and emphasized by raising awareness of this good medical practice.
191 Penthrox Is Effective but Is It Patient Approved?
Authors: Dias A , Zeidan Z , Copp M , Eslabra F , Hassan R , Midlleton R 
Published: August 2023

Abstract

Aim
Penthrox is a handheld inhaler that administers methoxyflurane. It’s use is approved for analgesia in moderate-to-severe trauma-related pain in adults in emergency department (ED). The literature currently lacks methodologically robust qualitative data on individual patient experience. Using a structured qualitative study, we set out to address this shortcoming.

Method Focus group
Five patients were selected to identify key themes they felt important to explore and these were included in the questionnaire design.

Study Design
We retrospectively identified all uses of Penthrox in ED from June to August 2021. Qualitative data was gathered using the Trickett short interview method and responses grouped into positive and negative descriptors. In addition, quantitative data concerning their experience using 5-point Lickert scales were also gathered.

Results Questionnaires
101 responded to the questionnaire. Penthrox® was utilised mainly for the manipulation of fractures, most commonly for that of the Ankle and Wrist. 90% reported an overall satisfaction of ‘≥ Good’. 97% reported ease-of-use ‘≥ Good’. Its analgesic effectiveness was rated as ‘Excellent’ by 52%, and ‘≥Good’ by 89%. The most reported side-effects were drowsiness (13%) and nausea (7%). The majority reported no side-effects (74%). 94% would take it again if required. A NVIVO word cloud was created visually confirming an overall positive experience amongst the patients.

Conslusions
This study shows that Penthrox is a well-tolerated and user-friendly means of alleviating trauma-related pain in ED. It highlights the importance of taking into consideration the individual patient journey alongside robust evidence-based data on safety and efficacy for the development of a holistic treatment.